Questions People Ask Me about Being a Doula
The moment of birth is one of the most spiritually exquisite experiences on this planet earth. As close as I feel to G-d in other aspects of my life, I feel His Presence most profoundly at each birth as I witness the soul entering this world. Being part of the team that facilitates a relaxed environment so that we can access this precious moment always brings me joy.
However birthing parents experience their child’s entering this world, with or without drugs, or with other comfort measures, or through a birth that necessitates other medical interventions, they can make choices that can empower them and establish a solid foundation for their emerging family. The doula can help guide them to find their way to choose what is right for them. I don’t make their decisions. I may present options, but support them and help them find their own conscious choices.
Just as G-d begins the Torah with the story of Creation, so too we establish and create our relationship by sharing stories of birth. This may include talking about the parents’ previous births, and/or share their ideal birth. Preparation includes prenatal interviews, talking about the anxieties and fears and the myths they may have heard, education and planning. We may also do relaxation exercises and visualizations that we might choose to use in labor. We talk about how to advocate for ourselves with caregivers and nurses. During prenatal meetings, we also create a birth preference list. We are not in control of outcomes; that is in the Hands of G-d . However, the birthing couple can take responsibility to know what they would prefer given different common circumstances. This helps pave the way to a potentially wonderful birth experience.
Questions people ask me about being a doula:
1. Is a doula a labor coach?
If a coach is someone who facilitates being all you can be, finding your inner strengths that you didn’t know that you had, that is a good place to start describing the doula’s role.
A doula can help the birthing couple create a sacred space so that mom and dad feel safe and protected. She can provide information because she is familiar with birth and hospital procedures, she offers comfort measures such as massage, relaxation techniques, and other methods of natural pain relief, and she can help the parents communicate with their caregivers so that this team forms a “village” to birth this child.
A mother will always remember her birth experiences. I have spoken to women in their nineties, whose children are in their seventies, and they remember the events as if it was yesterday. Having a doula present can help make those memories ones that make her smile. We do our best to prevent birth traumas that linger for years afterwards in the psyche of the new mom. Doulas have no magic to prevent surprise outcomes, but they can support the family through it.
Most doulas want to help their clients build the inner strengths in the childbearing year that will lay the foundation that will make them wonderful parents for the rest of their lives. The coping skills and emotional strengths that they develop as they birth their children will follow them into the next phase of their experience into this awesome labyrinth called parenthood.
I once met a lactation consultant who called doulas “fairy godmothers.”
2. Are you like a midwife?
Midwives deliver babies. They take responsibility for the physical health and welfare of the mother and her baby. In contrast, doulas do not provide medical services. There is a paradox in the fact that study after study has shown that when laboring couples are attended by a doula, the need for all kinds of medical interventions in a normal birth diminish. And yet, doulas do not provide medical advice or care. We don’t check for dilation, we don’t do any exams and we don’t make decisions for the parents.
3. What education and training does it take to become a doula?
There are several agencies that certify doulas. The most prominent ones are DONA (Doulas of North America) and ALACE. DONA requires attendance at a birth workshop, a lactation workshop, a childbirth series, readings and reporting on the reading, attending a number of births, with evaluations by the medical personnel, i.e. doctors and nurses, evaluations by the parents, as well as a few other essays. This process can take as short as six months, and up to two years.
4. What are the realistic financial opportunities for doulas?
Because a doula needs to be “on call” for two weeks before the new mom’s EDD (estimated date of delivery), and two weeks afterwards, most doulas take one client at a time. For this reason, most doulas also have other sources of income. Many enter complementary professions such as massage therapists, psychotherapists, and childbirth educators.
5. I would love to have a doula at my birth but I can’t afford one. Having a doula is a luxury for rich people.
Most doulas believe in their heart and soul that every family that wants to have a doula at their birth should have one. Rather than being a luxury, it is an investment in building a sound foundation for the emerging family. It is not the type of profession that women go into for the money; they do it because they are passionate about births, and want to help make this journey to parenthood a pleasant one. Many will offer a sliding scale, they may accept a payment plan, or if they are unable to accommodate you, they may refer you to someone who is able to fit into your budget.
6. What do you do to speed up birth?
On the whole, labors are shorter and less interventions are necessary with the presence of a doula at the birth, according to most studies. This may be due in part to the fact that mom is relaxed, and therefore the muscles don’t tense and close. We cannot guarantee outcomes, outcomes are in the hands of G-d. Doulas are all about focusing on the process. The doula will encourage the mom to adapt different positions, she may walk with the laboring woman and this also tends to speed up labor. If augmenting or inducing labor becomes necessary, doulas may also refer their clients to those who practice other modalities that may help speed up labor such as acupuncture. As with everything else that a woman does during labor, this is only with the guidance of her primary caregiver, and there are no medical contraindications.
Best of all, when mom gets into her right brain state of being, she may not be watching the clock wishing that this ordeal would be over.
7. How does it affect you to lose so much sleep, getting up in the middle of the night to go to births?
There is an incredible adrenaline rush that comes with every birth that I attend. Every birth that I have ever attended has been so special; I feel honored to feel the Presence of G-d in this incredible miracle. I usually feel this joy for at least a week after a birth. I often do need to sleep after a birth, when that initial adrenaline diminishes.
8. What do you have to offer women who have been traumatized by their previous births?
There are so many women in our culture who have been traumatized by their births. Many think that this is the way it is supposed to be. Much of the prenatal planning is to create an environment that is calm and comfortable instead of traumatizing. In the postpartum period and subsequent births, we can use several modalities to clear the fears, heal the past, and “be present” at this birth.
Please see my services as Birth Story Listener to help mothers and fathers heal from previous birth experiences that leave them with wishing that it would have been a different way.
9. My husband has been very supportive throughout this pregnancy. He loves and understands me as no one else does. He reassures me with every discomfort, and I expect that his role in labor will be a continuation of this. Why do I need a doula in addition to him?
Doulas are there to support the birthing couple, not just the mom. It is only in recent times, i.e. the last 35 years that fathers have been expected to assume the role of sole labor support person, and patient advocate for their wives. Since the time of creation, women have been supporting other women in birth. For many new fathers, these are hard shoes to fill, as they are going through their own transition into fatherhood, and may need support instead of giving support in an environment in which they no familiarity or training. He may not know how to deal with his own feeling s of seeing his wife in pain. A doula can support the new father, as well as help him find his own level of involvement that makes him feel fulfilled as a husband and as a father.
In addition, for Jewish orthodox couples, once the wife is a niddah, the husband will not be allowed to touch her. That eliminates many of the comfort measures that he could otherwise provide. It helps to have a doula to hug and to offer massage and cool washcloths.
10. Won’t the father be threatened by the presence of a doula? Doesn’t a doula come between the intimate relationship of mom and dad at the birth?
Instead of standing in the way of intimacy, doulas can help create an atmosphere in a clinical setting that allows for intimacy instead of the impersonal environment that can often be created in a hospital setting where the staff is most concerned (rightly so!!!) with efficiency and physical safety. They may not have time to give the husband some ideas as to how he can help his wife, or to address his fears.
11. My mother is coming with me to my birth. Do I still need a doula? What can a doula do that she can’t do?
In recent years, it has become fashionable for mothers to accompany their daughters in labor. When a new mom feels close to her mother and wants her presence that is awesome. There are so many ways that the new grandma can be helpful; she can be part of the community that creates a loving environment to welcome the new baby into the cherished arms of his or her new family. Some grandmothers have even taken doula courses specifically to support their daughters and daughters in law. However, for those who have not, the doula can support the grandmother in a similar fashion that she supports the father. It is often helpful if the grandmother and/or father join the mom in meetings with their doula so that everyone is on the same page.
12. My doctor said that I don’t need a doula. I get the sense that (s)he is threatened by the presence of a doula.
This may due to the fact that he or she does not know what a doula does. We do not offer medical advice, and we do not make decisions for the birthing family. The presence of a doula often makes the doctor’s work easier, as happy and relaxed birthing families make for happier patients, and statistically often contribute to better outcomes. In addition, medical staff may be taking care of other laboring women, and cannot physically provide their patients’ need for continued presence throughout the labor. They can’t be in two or three places at one time, even if they want to. Their primary focus is the actual physical birth, and not the birth process. They may also be busy with paper work, their responsibilities include documenting each birth that they attend. In addition, the doctor or midwife with whom the birthing parents bonded during the pregnancy may not be on call when birth occurs, and therefore is not present.
13. (Question from an older man) When my children were born, we didn’t have anything like doulas. My wife was able to bear the pain without complaining. She just put her mind to it and bore it. This generation is too pampered.
There are many cultures that glorify suffering. Many modern conveniences have made our lives easier and most of us would not want to go back to the “way things were”. There is enough suffering in the world without going through suffering that doesn’t have to be experienced, as this is a modality to help that don’t even carry any side effects that we know of.
14. I don’t think that I would be comfortable having a stranger supporting me at my birth.
This is one reason that we recommend several prenatal meetings with your doula. Part of our goal is just to feel comfortable with her. If all goes well, most women tend to bond with their doulas by the time they give birth.
15. I am planning to have an epidural. How can you help me?
Many people think that doulas are all into natural childbirth. Whatever their personal opinions are is not important, as their role is to be totally present at your birth. They are there to carefully listen to your conscious choices, i.e. to support you in whatever is right for you. For a woman who is planning her birth with an epidural, usually she will not need the same kind of comfort measures that the woman who is planning a natural birth would want. (By the way, this is not always true. Sometimes the anesthesiologist is not available right away, or the epidural occasionally doesn’t work) However, the epidural may take away the pain, but does no t remove the anxiety or fear. Having an epidural does not necessarily prevent birth trauma. A woman who is having an epidural will probably still want her birth to be a happy memory, would still want to create a sacred space to birth her baby.
16. I am planning to have an epidural. Will you try to talk me out of it?
Doulas are there to support you in the decisions that are right for you, not make the decisions for you. If a couple have made a well thought out decision that they would like to give birth with the help of an epidural, the doula will not only honor that decision, but will do everything in her power to be totally present in their reality. They deserve our support!
A wonderful resource for a Jewish perspective on positive birth experiences are books by my good friend and colleague, Sarah Goldstein, Special Deliveries and Special Deliveries II.