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What is a Doula?
DONA (Doulas of North America) defines doulas as “a trained professional who provides continuous physical, emotional and informational support to a mother before, during and shortly after childbirth to help her achieve the healthiest, most satisfying experience possible.”
DONA makes the following analogy on its website: “Like travel guides in a foreign country, birth and postpartum doulas help support new families through the life changing experience of having a baby!”
If you’re curious, the word doula comes from Greek essentially meaning woman’s servant.
Some Data and Thoughts on Doulas
According to Childbirth Connection’s 2013 Listening to Mother’s III report, only 6% of women received care from a doula during labor. With such a small percentage of women using a doula, one might assume most have not heard of a doula. However, according to the same report, “three out of four women (75%) who did not receive care from a doula had heard about this type of caregiver”. I was honestly surprised to read that finding, but an important note is that the report surveyed women who gave birth. I think the percentage would certainly be lower if women in general were surveyed. For example, I wonder what percentage of women ages 25-40 in general have heard of doulas? (Go poll your friends!)
I also think it’s important to consider two questions. When are most women first hearing about doulas and and how accurately do women understand what doulas do? I believe it’s likely that many women are not aware or have limited knowledge of doulas prior to pregnancy and only become aware and more knowledgable of these caregivers during pregnancy. While it’s speculative, I believe this matters as greater awareness and knowledge of doulas before pregnancy would lead to more women wanting and making it a part of their birth plan.
My wife, Jillian, was one who had limited knowledge about doulas prior to pregnancy. While she “kind of knew” about doulas, she did not really understand what they do, so it was not something she considered using. As for me, I had never heard of doulas. How many male partners and husbands do you think have heard of doulas prior to their partner’s pregnancy? I’m sure it’s a very, very low percentage. Having a plan for a doula early on is important for a few reasons.
1) This is something women need to discuss with their partner and husband as the doula will be intimately involved with the pregnancy including the actual labor and delivery. 2) You may need to financially budget for it as doulas can be expensive and insurance does not generally cover it. A simple web search returns results that doulas can cost from around $800-$2,500 dollars. Our doula, who was wonderful, was $900. If the cost is immediately a concern to you, please know that you may be able to find a doula in training. These doulas often charge a minimal amount or may even offer their services for free. 3) You want to get the full benefits from the doula. Since a doula also provides prenatal service and even visits, the earlier you go with one, the more you can make use of her service and expertise.
I want to mention an additional resource here. Kopa Birth has fantastic online birthing classes focused on natural births. The courses are comprehensive and thorough (over 12 hours!). While I certainly don’t believe the online classes replace having a doula, a doula is expensive, so this is a far less expensive resource definitely worth your consideration. You can take a detailed look here. Ideally, if you are able, doing the class and having a doula would be the most prepared way to go.
Benefits of a Doula
There are numerous articles that highlight statistics on the benefits of a doula. I will not go into great statistical detail in this post as you can easily search online for these statistics, but I will summarize some general benefits here. Studies have found that having a doula during the labor process reduces the risk of cesarean section, reduces the use of epidurals, reduces labor induction through use of drugs such as Pitocin, and reduces labor time. Let me briefly mention a side note on labor induction here. While there are completely medically valid reasons to induce labor, there are also many cases where labor is induced when unnecessary. I strongly encourage folks to do their research on when induction is necessary and the potential risks. Studies also show that all the above mentioned benefits then results in a higher rate of a natural vaginal birth and satisfaction with the labor experience.
For me, the benefits of a doula can be summarized much more simply. Without our doula, Jillian would not have been successful in achieving her birth plan of having a natural birth with our first son, period. I share the detailed personal story below.
My Story and Our Journey
I’m a very logical person so I generally love data and statistics. As I mentioned above, there are lots of statistics you can find on the benefits of a doula. With the birth of a child being such a emotional experience though, referencing a bunch of statistics does not feel like the most appropriate or effective way to tell people about doulas. Instead, what feels right and much more powerful is to share my story and our journey. It’s “my story” and “our journey” because it is my wife and I’s journey to becoming a family, but it is my story about the doula experience from a dad’s point of view. I wanted to share my doula story because it doesn’t seem like dads do this. I searched online and found nothing. Even the articles I did find related to dads and doulas were written by women and usually about what dad’s should know about doulas or how doulas don’t replace dads (seriously?).
How We Came to Hire a Doula
Living in northern Delaware, we had the fortune of having The Birth Center within 20 minutes of us. The Birth Center is a wonderful, holistic women’s healthcare organization. While The Birth Center provides on site birthing services, my wife’s birth plan from the very start was to have a natural birth in a hospital. (My use of natural birth in this writing refers to a non-induced vaginal birth with no medication, specifically an epidural). The Birth Center provides all types of classes including one titled, “Childbirth Education for the Planned Hospital Birth.” Jillian and I registered for the class, and it was in this evening class that the doula journey began for us.
One of the topics covered in the class was doulas, and there were some doulas there to meet the attendees and answer questions. By the time we were driving home from the class a few hours later, we were pretty sold on a doula. I suppose it may be more accurate for me to revise the last sentence to say, “I was pretty sold on a doula.” This is because I was the one who suggested that we should seriously consider one. I can’t imagine it’s common that the male partner is the one who suggests a doula. Jillian and I still sometimes laugh about the way it played out.
I honestly can’t tell you what specifically sold me on wanting to hire a doula. Perhaps it was simply hearing about the comprehensive support a doula provides before, during, and after pregnancy. Or, maybe it was interacting with them during that class and sensing their expertise and supportive nature. I also remember thinking how the $900 cost was lower than what I would have expected. While $900 is definitely nothing to sneeze at, I felt like it would be a small monetary investment for arguably the most significant moment of your life. People spend that kind of money all the time for a TV, computer, and other material things. If people think about that for a moment, I believe many would feel a doula is money well spent. Little did I know at the time just how pivotal a role our doula would play in our first son’s birth, and how this would arguably be the best money we’ve ever spent.
I stated earlier that without our doula, Jillian would never have achieved a natural birth with our first son. This is because her labor was long and difficult. This combined with not having a previous birth experience to draw upon, I am convinced we would have proceeded down the path of an epidural at some point had it not been for the support and guidance of our doula, Rachel. There is nothing wrong with having an epidural. It just wasn’t the birth plan Jillian wanted.
I truly feel very fortunate that we had access to a class like the one described above. If you unfortunately do not have access to a class like this near where you live, or feel you need greater preparation, take a look at the Kopa Birth online classes mentioned earlier.
It was around 4:30 pm the afternoon of April 11 when Jillian woke from a nap and began to have pretty consistent, strong contractions. For the next handful of hours until around 9:00 pm, Jillian labored at home and I helped as I could during a contraction by providing massage and counter pressure techniques I learned from The Birth Center class and from Rachel in one of the prenatal visits. At this point, Jillian was in pretty great discomfort and wanted to call Rachel. Rachel got to our house around 10:00 pm, and I immediately felt more relieved having a professional to help us. Rachel jumped right in and took over doing some of the counter pressure. This process continued for probably about two hours, but Rachel’s expertise told her that it was not yet time for us to head to the hospital. She was able to get Jillian more comfortable to the point where Jillian was able to get back in bed to try and sleep around midnight. Rachel then left to try and get some rest herself knowing it would likely be a long night.
Active Labor Part 1
Around 3:00 am, Jillian woke me up and said that we needed to go to the hospital. We gathered our items and I called Rachel, who said that she would head out as well. The hospital was only 15 minutes from us, but was about an hour from Rachel, so we obviously arrived before her. We checked in at the maternity triage upon arriving. Jillian was really in pain now, and she later said that she thought she was around 7 cm dilated. The cruel reality however, was that she was barely 4 cm. (This experience proved useful for Jillian when we had our second son as she had a far better sense of where she was at and how to manage the pain, which led to a much smoother labor.) When the nurse checked and told Jillian that she was 4 cm, Jillian would tell me later that she couldn’t handle it. Having already labored for 12 hours, to hear she was barely 4 cm was very defeating for Jillian. Here was one of the pivotal moments where I believe things may have gone differently had we not had Rachel.
Rachel was at the hospital but was not allowed to come into triage. Rachel was only able to join us later once we were formally admitted. At this point in triage, Jillian was in a lot of pain and was strongly voicing statements that she couldn’t do this and very much considering an epidural. Rachel was texting me to get updates and I was texting her back details including what Jillian was saying. Rachel would text back, often in caps and with exclamation points, messages along the lines of “TELL HER SHE CAN DO IT!” Some messages were blunt, almost like an order, saying to not let her get an epidural or that I needed to remind her of her birth plan. Most people who know me would say that I’m very calm and rarely emotional or frazzled, but at that moment, I was completely overwhelmed. I remember specifically texting Rachel back at one point with, “I don’t know what to do.” Part of me wanted to just go along with my wife because I didn’t want to see her in so much pain, but part of me also wanted to go along with Rachel because I knew she knew what she was doing.
Finally, 1.5 hours later, which felt like forever, Jillian was formally cleared to be admitted. Rachel was now able to join us. THANK GOODNESS! To have her right there with us brought me so much relief. She could now be the strong one to push Jillian to stay the course cause I certainly was not strong enough.
(A point of clarification here: I want to be completely clear that at no point did Rachel ever speak for Jillian and take over the power from her. For example, had Jillian fully committed to getting an epidural, while Rachel would surely have reminded Jillian of her birth plan and pushed her to stay true to it, Rachel would have respected and supported Jillian’s decision. When hiring a doula, I believe it’s imperative that this dynamic is clear. Jessica English has a great post about this.)
Active Labor Part 2
It was about 4:30 am when we were admitted – almost exactly 12 hours from when Jillian’s contractions first began. We had no idea at the time that it would be another 15 hours until we would finally get to meet our little boy! Much of this time followed the same pattern – a contraction that Jillian would push through with Rachel and I assisting as best we could. It’s nearly impossible for me to imagine how I would have managed by myself without Rachel. For me, the emotional support was the most vital. Rachel was continuously calm, reassuring, yet direct when needed. She would tell Jillian over and over that she could do it and that she was doing great. Rachel herself had very long labors with both of her children, so it helped to know that she understood firsthand what Jillian was feeling and going through.
Jillian was understandably exhausted and with the labor progressing slowly, she made a decision to accept Stadol, a type of opiate, around 10:00 am. While it was ultimately Jillian’s decision to make, the three of us did all discuss it. Jillian’s birth plan was ideally to not use any medication, but we felt the use of Stadol would not go against the overall birth plan. Even though we didn’t have extensive information at that time, it was explained to us that the main purpose of the Stadol was to to relieve some pain, which would help Jillian get some much needed rest. Eventually, after our son was born, I looked up more information on Stadol which further made us feel that it did not go against the overall birth plan.
According to an article from the American Pregnancy Association, opiates are “usually administered during the early stages of labor in an attempt to avoid potential side effects for both the mother and baby.” Additionally, “Opiates offer pain relief and do not interfere with a woman’s ability to push during labor. Unlike an epidural, an opiate does not numb the pain.” When the Stadol wore off a couple hours later, Jillian was still in active labor so the effects of the Stadol definitely did not affect the transition stage and delivery. The Stadol did in fact do what we were told it would do in allowing Jillian to rest and sleep for a couple hours. She’s said that it was one of the most amazing sleeps she’s ever had.
As I stated earlier, Jillian’s labor was a long one. Reflecting on it now, some of these hours are definitely a blur, but there are certainly moments that I will always remember. One such moment was around 3:00 pm when Jillian was closing in on 24 hours of labor. The Stadol had worn off a few hours earlier, so Jillian had been admirably pushing through the pain and grind of each contraction during this time. Our midwife came in to check on Jillian who had progressed to about 7cm dilated. Our midwife then said that she would come back around 7:00 pm to check on her again. Both Jillian and I looked at the clock and thought, “THAT’S STILL 4 HOURS FROM NOW!” Neither of us could believe our ears as we thought that Jillian had to be imminently close. Our midwife must have know what she was doing though as it was just about 4 hours later that Jillian got to about 10 cm. Fortunately, Rachel was right there once again to support and encourage us to stay the course, but there was much more we would still need from her before this journey was over.
Transitional Labor and Delivery
As Jillian progressed into the transition stage, the contractions grew very intense and more frequent. It honestly is one of the toughest things to see someone you love in pain and basically not being able to do anything to take that pain away. Then the excitement, and by excitement, I mean absolute awfulness, really began. It was probably about 6:30 pm that Jillian was basically at 10 cm. Though I didn’t know about cervix effacement / cervical lip prior to this moment, I would grow to despise everything about it. I learned that when the baby is so close, the pressure is so great that it creates a natural urge to push. I vividly remember Jillian saying, “I have to push, I have to push!” The problem was that our midwife was saying to Jillian that she CAN’T push. She said that if she pushed with the cervical lip, it could create problems including cervical swelling, which could then make deliver difficult.
A side note here: In my research writing this post, I came across a lot of information on when to push during labor. There is quite some debate on whether early pushing is actually harmful. You can search and find a lot of articles related to this, but here is one I found quite interesting: The Anterior Cervical Lip: how to ruin a perfectly good birth.
This urge to push is essentially involuntary, so how do you get someone not to do something that the body is naturally doing? I imagine it would be like trying not to blink except with a whole lot of pain mixed in, but I’m not going to pretend for a second that I can relate to that experience. In my opinion, the support Rachel provided in this moment alone justified the money we spent. Rachel directed Jillian exactly what to do to try and combat the urge to push. She told Jillian to do quick blows over and over like she’s trying to keep a feather in the air. Every time a contraction and that urge to push came, Rachel and I would join Jillian in blowing and keeping that feather in the air. I can’t tell you exactly how long this awfulness lasted, but we must have blown that damn feather a thousand damn times. Our midwife would periodically recheck Jillian only to share the bad news that the cervical lip was still there. Each time she shared this news, I was so defeated and I wasn’t even the one going through it! I know it was absolute hell for Jillian. We’d go back to blowing that damn feather until the next check. This cycle probably repeated 5-6 times. I remember a couple times when Jillian simply could not resist the urge and would push, yelling out, “I have to push! I’m pushing! I’m pushing” This was the worst because I knew how hard she was trying not to push and how worried she was that she did push. We were both scared that the pushing was creating an issue that would complicate delivery. I don’t think I’d ever wished for good news in my life more than wishing for that cervical lip to be cleared.
If I had to guess, I would say that this ordeal lasted about 30 minutes. Maybe that doesn’t seem long, but it felt like the longest 30 minutes of our lives and it was absolutely brutal. When our midwife checked Jillian and the cervical lip was finally clear and she gave the green light to push, it was like the biggest weight lifted off our shoulders. I can only imagine the relief Jillian must have felt to be able to allow herself to push and not have to fight against her body anymore. So, Jillian pushed and 19 minutes later at 7:27 pm, our little one came out to the world.
We had waited to find out the gender, but I was so overcome with emotion in that moment of birth that I honestly didn’t think about whether we had a boy or girl. In all the years Jillian had known me up to that point, that may have been the only time she’d seen me cry. Of course I was ecstatic that I was a dad, but the emotion was really from the relief that Jillian was no longer in pain. It had been 27 hours from when her contractions first began. When the nurse said that we had a baby boy, it snapped me out of my emotional state and I recall laughing to myself how I didn’t even pay attention to whether our first child was a boy or girl!
Rachel was with us for about an hour after delivery. She took a bunch of pictures for us and assisted Jillian with getting the baby latched for the initial breastfeeding. The three of us reflected on the last 24 hours and Rachel told Jillian what an amazing job she did. She told Jillian how she was so strong especially since it was a harder and longer labor. I definitely told Jillian how great she did too, but I do believe it added something special for Jillian to hear it genuinely from another person and professional. Our nurses also said similar things and how rare it was for them to deliver a natural birth. One thing that was wonderful to see was our midwife and the nurses praising Rachel and saying that it was great to work with her. We’d heard that sometimes doulas can clash with doctors and nurses, but in our case there was clear mutual respect. Rachel was even asked to leave some business cards with them. This made Jillian and I feel fortunate to have had such a strong and cohesive team.
Unfortunately, there were a couple post labor issues that developed. Our son had pneumothorax, which is a collapsed lung. He had air inside his chest, which pushed on one of his lungs not allowing it to inflate properly. As a result, he had to be in NICU for a few days for observation. The doctors said that the air pocket often goes away on its own as its absorbed into the body. The other issue that developed was that Jillian had a piece of retained placenta, which led to heavy bleeding. She ended up having to get a blood transfusion. Fortunately, both issues ended up resolving without much further intervention. The air inside our son’s chest did end up going away on its own. While Jillian’s issue was slightly more complex, and there was some initial concern surgery may be needed, she ended up only needing to take a pill.
In Rachel’s postpartum visit later that week, Jillian was able to talk with Rachel about the post labor issues, specifically the issue of the retained placenta. I know it helped Jillian to be able to talk about it with Rachel. When we hired Rachel for our second pregnancy (are you surprised?), this was something Jillian was able to discuss with Rachel and make a plan for to try and prevent.
I truly feel like the relationship with a doula goes far beyond a professional/business relationship. You’re making a choice to bring in a person to be involved in one of your most intimate life events. This makes it very different than other professional relationships. With Rachel, we always felt like we could reach out to her as needed, and she reiterated the same thing to us. Even today, we would feel comfortable contacting Rachel if we had a question or just to catch up.
Jillian and I have both said that we don’t know what we would have done without Rachel. I whole-heartedly believe that without her, Jillian’s desire for a natural birth would not have happened. This doesn’t mean that not having a natural birth is any less valid. I’ve read articles about the judgement that can sometimes occur with natural versus medicated births. But I honestly couldn’t care about that, and I know for Jillian, her desire for a natural birth wasn’t so she could earn some special accolade. A natural birth was simply the birth experience she wanted. The average family has about two kids, so many women only go through a birth experience twice. If that’s all you get for such a significant life event, wouldn’t you want to give yourself the best opportunity to have it happen the way you want? I think for Jillian, if she did not end up having a natural birth (whether it was within her control or not), it would be something she would have always wished had gone differently. So, I am forever grateful to Rachel for helping Jillian achieve the birth she wanted.
I hope my post and story provided some useful and interesting information about doulas. Maybe it will even get you to consider a doula if you weren’t considering one. It’s important to point out that doulas are not only for natural births. The benefits of a doula can be tremendous regardless of the birth plan you have. I think many people may picture a doula supporting a mother giving a water birth at home, but obviously, we hired a doula for a hospital birth. As I quoted in the first paragraph, a doula’s role is to help a woman “achieve the healthiest, most satisfying experience possible.” And that’s really what it’s all about.
Share Your Story and Experience
What is your experience with a doula? Did you have a similar experience with a doula or a different experience? What questions do you have? Please feel free to share your thoughts via the comments below.