When I tell people that I'm a doula, I tend to get 3 responses: "Huh?", or "I love doulas!", or "That's like a midwife, right?" The latter might be my favorite response because it provides a chance to talk about the differences in the training and approach of maternity care providers. Midwives are medically-trained professionals, just as are OBs. The difference that midwives are trained in birth as a normal event; doctors are trained in the abnormalities (the level of complications doctors are trained to manage increases from a family physician, to an obstetrician, to a perinatologist). Doulas differ from both midwives and doctors in that they are non-medical caregivers. Below is an FAQ-style overview of a doula's role. Though the focus here is on delineating what a doula does from that of a midwife, this also applies to births with doctors and doulas. You can also check out my corresponding post on Doulas and Homebirth.
REMIND ME, WHAT IS A DOULA AND IS IT LIKE A MIDWIFE? IS HAVING BOTH REDUNDANT?
A doula is an expert in labor support. Support is a broad term, and a doula’s skillset is equally broad in order to meet the differing needs of each family. These are the general areas in which doulas focus their support. Together they facilitate an easier birth:
Emotional and psychological preparation, guidance, and ease.
Physical comfort, positioning, and nurturing touch.
Supporting you in your confidence, decision-making, learning, and information-gathering.
Doulas and midwives are often similar in that they both value these components as part of a satisfying birth. Doulas, however, focus only and primarily on these things. For midwives, clinical care and safety take the front seat. One of the unpredictabilities of birth is whether the circumstances will allow your midwife to provide all these components of care. Midwives also vary in the degree to which they enjoy and are skilled at this type of care. Having a doula ensures this is part of your experience.
MY PARTNER AND I WANT TO DO THIS TOGETHER. WILL A DOULA MAKE MY PARTNER OBSOLETE?
Doulas and partners make for a support dynamo. Doulas know birth; partners know the laboring person. Combined, doulas and partners provide deeply robust care. And doulas facilitate a closer bond between a laboring person and her partner. A partner can have a pretty big role put on their plate: being the emotional rock, the physical rock, remembering what was learned prenatally, applying all the techniques at the right time, determining what the laboring person is experiencing, knowing if it is all normal...and having their own emotional experience as well. A doula can guide the partner, suggest or model what to do and say, be a reference point and encyclopedia. A doula allows a partner to find ease in whatever their role is. The doula can take care of the details so that the partner can focus solely on the laboring person. The doula can be more hands-on, facilitating the partner being the photographer, or taking a break to eat. It is a collaborative team that best serves everyone involved. Bottom line: Doulas enhance, not replace, the partner. They can also help with older siblings who will be present or nearby during birth.
WHO-DOES-WHAT ONCE LABOR STARTS?
Your doula can come to your home before you head to the hospital. A doula helps you establish your labor rhythm, supporting you to discover and utilize what works best for you. A doula is also a cheat-sheet for your partner, so that they know what to do. Also, a doula takes away the layer of stress about needing to identify when to go to the hospital. Once you transition to the hospital, a doula helps translate what was working at home so that you keep your labor rhythm. Labors often slow at this transition point: doulas mitigate that effect.
Your midwife will be present depending on the circumstances of your labor and the other people in their care that day. The midwife will check in periodically and also be present if any major choices need to be made about your care. There may be times she is able to provide hands-on care for an extended amount of time. There may also be times where their care needs to be balanced between you and others. Additionally, there are points where it’s wise for your midwife to rest, helping her stay mentally alert to assess safety and medical aspects. Your doula is in a different brain-space: their cognitive brain is not activated by providing medical care. Therefore, your doula is able to stay with you, helping to guide you and your partner from beginning to end.
When labor hits its peak of intensity, two needs are present: sustained, present support and preparations for baby’s arrival. The midwife cannot always do both at once. Your doula stays focused on your emotional experience throughout all labor’s ebbs and flows.
Doulas help you clarify your vision and preferences for birth. Your doula visits create the space for you to talk about your questions, desires, and fears and, from there, develop strategies unique to you. By bringing your developed vision to your midwife, she can then help facilitate that vision for you.
AND WE MEET THE DOULA BEFORE BIRTH, RIGHT?
Oh yes! A personal relationship is the cornerstone of doula support. Working together prenatally helps you to have personally-tailored preparation. It builds your toolkit for birthing. A doula who gets to know you prenatally knows the ins and outs of what you want, what strengths you bring, and how to utilize those things in labor. The one-on-one preparation and education gives you gems of knowledge that aren’t able to grow out of a group dynamic. A doula who knows you personally is equipped to sync up with you in labor and birth and help you have the kind of experience you are aiming for. Having a doula on your birth team creates a cohesive and authentic experience--one rooted in the uniqueness of each family.
THEN...WHAT ABOUT AFTER THE BIRTH?
Doulas visit the family again after birth--often twice. They reflect on and process the birth experience with you, having witnessed your amazing powers in birth. Doulas also focus on helping the family adjust and care for each other, recognizing both the joys and challenges of the early parenting experience. A doula fills in the gaps of what you know, helps you understand what to expect and what is normal, and assists you in building connection and confidence. Having a doula that is skilled in breastfeeding support is a huge asset, as the learning curve to that relationship can often come with challenges and questions. A doula is an expert in what she knows and doesn’t know--she assesses and refers for challenges outside her body of expertise.
PRENATALLY, IN LABOR, AND POSTPARTUM, YOUR DOULA TUNES INTO YOUR INDIVIDUAL CIRCUMSTANCE AND SUPPORTS YOU IN FINDING YOUR OWN WAY WITH CONFIDENCE AND JOY. HAVING THIS ATTENTION AND SUPPORT IS A RICH COMPLEMENT TO YOUR MIDWIFERY CARE.