Our reasons for choosing a doula

So, we met the doula we were checking out on Friday (23 weeks!) and got such a good feeling that we decided to go ahead with her. Just waiting to hear back from her now. I’m incredibly indecisive with these things, especially anything that involves money, so it was just as well we had all that time on the Megabus to and from London yesterday for the second half of our hypnobirthing course with Katherine Graves. All in all, it feels like a few pieces of a puzzle are coming together for this birth. Not that that’s a puzzle that can be complete. There is always room for mystery in the human experience, especially in something as important as birth.

For any not familiar, a doula (say doo-lah) is a birth companion trained and experienced in assisting women in childbirth and the postnatal period. They’re knowledgeable about a lot of the issues that surround birth and provide the mother and father with emotional and practical support.

This being our second time around, I wasn’t totally sure we needed a doula and wondered whether the skills we’re learning through KG hypnobirthing, coupled with our own experience and various other preparations I’m making would be enough. Laurence was keen though and, talking about it I realised that none of those things had to be mutually exclusive. They could all be part of the story.

Our initial meeting with our doula served to refresh our memory as why we wanted a birth companion.

1. It’s useful having another pair of hands you know and trust
It means that Laurence doesn’t have to feel that he needs to be with me all the time. He can go off to do other things or to get some rest. I found I didn’t respond well to too much contact with midwives during my last labour. Lovely as the ones I remember were, I didn’t know them and my body was very responsive to any change in situation. I’ve met our potential doula once, feel very comfortable with her and will hopefully have a couple more antenatal visits with her before the birth. It may well turn out that this time we’ll stay at home and I won’t want anyone with me but it’s reassuring to have the option there. We’re also open to Talitha staying at home so it’s just nice to know that another grown up will be around, should the need arise.

2. It’s brilliant to have a birth companion who isn’t too emotionally involved
Labour may be quick and simple this time but in the event that any surprises come up, we both think it’s useful for someone to be there who won’t find the situation emotionally exhausting, simply because she’s not that close to us. Having that distance also means that she can help us talk through our options if there are any decisions we have to make without becoming unduly overwhelmed.

3. Her experience and training will be valuable
Ultimately, I’m the one who has to make decisions about what happens in labour. However, I don’t expect to be in a position where I can have an extended discussion of options and if I am, I’m probably not in established labour! Last time, I was so out of it that Laurence had to make decisions on my behalf which he found quite stressful, googling various things on his phone and asking numerous times for more time as one often can in labour. While a doula cannot give medical advice, she has good training in the physiological aspects of birth and many things seen in birth won’t come as a surprise to her, so she can help us sort through the information in a calm, encouraging and respectful way. She can also offer suggestions (eg positions) we might not have considered.

4. She can act as an advocate
While the doula cannot make decisions for us she will be well-versed in our birth preferences and, as someone outside of the situation, can remind of what they are. Laurence did a lot of this last time but it was wearing. It would be nice knowing that someone else can make sure that low-lighting and a quiet atmosphere are respected as far as possible.

I’m particularly concerned about the third stage being respected. I understand that the midwives felt it necessary to cut the cord immediately and inject me with syntometrine as part of the protocol because there had been meconium in the waters. I get that. However, I don’t feel those options were presented as just that, options. Being exhausted by that point, I agreed to whatever but it was something I’d felt strongly about and, knowing what I do now, it’s even more important to me that I attempt to have a natural third stage and delayed clamping, unless there is a clear medical reason as to why not. And even then, the decision needs to be ours. I feel more confident about this stage knowing that we’ll have an advocate on our side, if needed.

5. A doula can help you de-brief
After the last birth, I had a powerful need to talk about the experience – about the things I remembered, about the things others there remembered. I needed to process it. It had been too huge an experience not to. My community midwife was amazing at helping me with this but she hadn’t been at the birth and I found myself wishing I could talk to someone who had been there who wasn’t Laurence or my mother. The doula we’re hoping to go with also writes birth stories so that should be pretty cool too.

There are a few other reasons but I think I’ll call it there as this post is getting pretty long now. I think it’s such a personal decision and this time round it feels like the right one for us. Would you have a doula? If you did, what was your experience?

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    • Well, they are medical practitioners (just as, as a breastfeeding peer supporter I’m not) but they are informed women who’ve been train in many aspects of birth, physiological and otherwise. But yes, just great to have someone there who’s on your side and going to keep calm about it all.

  • I really want a doula next time round. When I heard of doulas before I had gone through labour I thought it was a waist of money but now I feel it would have been invaluable. I really feel that someone to advocate for us would have been wonderful. Not that my labour was particularly stressful but there are still things I do differently. So doula and home birth are ny future plans.

    • I wanted to last time but felt we couldn’t afford it. This time, we still can’t really afford it but decided we better find the money from somewhere!

  • Would you mind telling us how far away the closest emergency medical facility is? 10 minutes? 5 minutes? Then would you mind holding your breath for that long? That is exactly what will happen if your baby is born and is not breathing.

    But please don’t worry! You will have a doula there to offer psychological support while Laurence uses his smartphone to flip through a bunch of blogs that tell you just how beautiful the experience is. After all, it’s not like childbirth poses any substantial risks to the life of the mother and the baby…

    • Differing points of view are welcome here, though this one has been phrased somewhat aggressively. Thank you for your touching concern for my family over our informed choices. You seem to have jumped to the conclusion that because we’ve chosen a home birth and a doula, we’ve decided on having an unassisted birth, which is a valid choice for those who choose it but isn’t what we’re doing. There will be midwives present and the same tools for resuscitation are available at home as at a midwife led unit or consultant led unit at a hospital. Home births are for many reasons the safest option when it comes to low risk pregnancy and our reasons for choosing to birth at home are not purely psychological and experiential, though both of those things are very important.

        • To be fair, it was probably a response to me mentioning that Laurence had to google things when we were in hospital last time around. And this was because though the benefits are certain medical procedures were presented to us, risks were not being mentioned and it’s impossible to be able to make an informed choice without both sides of the coin. It was an unfair position for him to have been in.

          But yes, home birth is as old as time and research does not show it to be the more risky option. An experienced midwife would always advise a transfer to hospital long before a concern became an actual emergency.

      • I owe you an apology. I found your blog while researching unassisted home births. From this particular post, it wasn’t clear that you were planning on having other trained professionals assist you during your delivery, although I’m sure you’ve mentioned it elsewhere on your blog.

        While I don’t necessarily agree with your decision to have your baby at home, I don’t consider it to be at all the sort of irresponsible idiocy that I see among advocates of unassisted home birth.

        Again, I apologize for the misunderstanding.

        • Thank you for the apology. It is very clear from this post, however, as one of the main points is the doula’s role in helping us communicate with medical staff. I also state very clearly that doulas cannot give medical advice. I know that it can be easy to skim read when trawling through information online though and I appreciate that you were probably looking through a lot of sites. I have to admit that if I were having a free birth (unassisted birth) I would not have found the way you communicated your view particularly effective in changing my mind but thank you for coming back to clarify your position.

          • “I have to admit that if I were having a free birth (unassisted birth) I would not have found the way you communicated your view particularly effective in changing my mind…”

            This point is well stated and well taken.

  • I had a doula (and two other birth partners) at my first birth. She was incredible. She was calm. She reinforced my decisions to the midwives, when the midwives didn’t want to listen (like when I told them I was pushing and they said “don’t be silly, we’ve not even examined you yet”. She made them check, and I was right. She helped me into different positions, she helped with natural pain relief and showing my birth partners how to do massage, without making me sick. She was brilliant. She was our clarity, our support, our encouragement and our calm. She made labour so much easier and I gained a friend in her. I wish I’d had a doula for the twins birth too.

    • Your story about the pushing made me smile. To think you knew what your body was doing without an expert examining you? 🙂 She sounds wonderful. Thank you for sharing your story.

  • Oh dear poor what a terrifying world Tolstoved must live in, hopefully he/she is now a little more informed to not have such a knee jerk aggressive response to your decision. I’m sure it was written purely out of concern for your family 😉
    Like you say home births are the safest option when it comes to a low risk pregnancy. It’s such a shame that pregnancy and birth is often conspired a medical problem with ‘worst case scenarios’ being the outcomes people think of when birth is a normal natural process.
    As you know me and my four siblings were all born at home, as was Wilf. I think I too would have chosen a doula if it wasn’t for my mum being there too. We found it took a lot of pressure off Tom and she and the midwife were such reassuring presences. At points Tom would go off and make cups of tea or tidy the house and it was fine as my mum was there (and the midwife eventually, who all through my pregnancy did not blink an eye over my home birth choice). Xx
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    • Your mum sounds lovely and as you know, I love reading your birth story! By the way, my mother had me and my brother at home too. And even if we end up going to the hospital (or especially!) as we did last time, I really see the value of having a doula there. That’s possibly when partners need even more of the pressure taken off them.

    • “Oh dear poor what a terrifying world Tolstoved must live in… It’s such a shame that pregnancy and birth is often conspired a medical problem with ‘worst case scenarios’ being the outcomes people think of when birth is a normal natural process.”

      No, I don’t live in a “terrifying world.” I live in a world where my father happens to be a neonatologist who runs a medium-sized NICU. When we were children we would often visit him at work and look through the window at tiny, tiny babies in incubators with tubes and monitors attached all over their bodies. This wasn’t a huge hospital in a huge city, but there were always, without exception, a number of babies who had very serious issues in the hospital. So while extremely serious complications are hardly the norm, they are far from being incredibly rare. While many problems can be predicted months before the baby is born, a substantial number of them cannot. They are unanticipated true emergencies.

      We would also hear stories about the issues that he had to deal with at the local birth center, which was located literally across the street from the hospital. Time and again, he had to deal with the complications that arose because the staff there lacked the knowledge, equipment, and experience necessary to deal with problems that could have been nipped in the bud had the baby been born in the hospital.

      We would also go to an annual Christmas party where parents with children who had spent a significant amount of time in the NICU came back to thank the staff for saving their babies’ lives. The contrast between those tiny helpless children and the completely normal, completely healthy teenagers who came back years later was truly incredible.

      None of this convinced me that childbirth is always a traumatic or extremely hazardous event. What it did convince me of is the rather obvious fact that childbirth presents very real dangers to both mothers and infants and that modern medical care has turned complications that would have been fatal not so long ago into routine issues that are handled every day in NICUs across the country.

      You are absolutely correct to say that birth is a “normal natural process.” However, I find it rather galling that you don’t also concede that a frighteningly high incidence of maternal and infant mortality in the absence of modern medical interventions is also “normal and natural.”

      • It is entirely understandable that if your father is a neonatologist, the vision of birth you would have grown up with would be quite shaped by quite unusual births. The work people do in NICU is brilliant and much needed. You mention tiny, tiny babies and I’m sure you realise that women who are having premature births generally do not give birth at home or unassisted. Unfortunately, true emergencies and tragedies do happen, both at home and in the hospital. The advantage of being home is that you have one-to-one care, whereas in a hospital an overstretched midwife may have to look after several women at once. Midwives are also trained to advise transfer long before a potential problem becomes a true emergency so, on the whole, the risk is quite low for a woman having a normal pregnancy. If you look at the figures for the UK, in fact, they favour home birth. It’s worth remembering that hospital births carry risks too (eg infections and a spiral of interventions which carries its own risks). Each woman has the right to review the information and make up her own mind about where she feels safest about giving birth and, for many of us, provided all is going well, it is at home. For others, it is hospital. Thank you for sharing your unique perspective.

        • I disagree with your characterization of these cases as “quite unusual.” Somewhere between 10 and 15 percent of all newborns require treatment in an NICU. Approximately 75 percent of those cases involve preemies, but 25 percent are full-term babies. Of those, a number involve complications that can be detected through proper prenatal care (which should not be confused with the “prenatal care” that certain radical advocates of “free birth” claim to be performing on themselves). However, there is absolutely no indication that dramatic interventions will be required for a substantial number of babies who have very, very serious problems. In these cases, time is often of the essence.

          I suppose what annoys me here is that many advocates of home birth (and especially of unassisted home birth, which you are not advocating) seem to confuse “a relatively small percentage” with “so rare that it’s ridiculous to even worry about.” There are over 82 million trips taken by people with a blood alcohol content over .08 in this country, and yet “only” about 10,000 people are killed in alcohol related traffic accidents. The percentage is small. That doesn’t make drunk driving safe.

          In any case, my original post was clearly not aimed at you but at a straw man image of what I mistakenly thought you were advocating. As far as I can tell, your decisions have been responsible. I hope you will accept my sincere apology for my initial tone and my sincerest best wishes for the delivery of a healthy and happy child.

          • Arrrg… my reflexive Yankee imperialism led me to reflexively use “in this country” when I should have said “in my country” or “in the USA.” My bad.

          • Ah, I see from your post below that you’re from the USA, which I wondered because I take it that freebirthing is much more of a movement there. I could get into analysing those figures more but I think we’ve both said enough for anyone reading this thread to get a clear enough view to do some more digging and make up their own minds. Thank you for your apology and best wishes. They are most certainly accepted.

  • I think having a doula is a great idea, had I been able to afford it I would have had one without a doubt this time round although in the end I did manage okay with one. I think if we all got to know the midwife that was going to deliver our baby when we were pregnant then it wouldn’t be so necessary but I hated not knowing who was going to turn up or if they were going to be on the same page when it came to my decisions. I think the main reason it worked out okay for me is that the midwife who delivered J was fab, the first one who turned up wasn’t though and I’m glad my contractions stopped when she arrived! x
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    • Isn’t it amazing that your body was so responsive? I never cease to be amazed by way our bodies and minds are connected!

  • I felt very much pushed into having the emcs with Harry (I think we’ve spoken about it before) and often wonder if I’d had a doula whether that would have made a difference. The reason for the emcs was failure to progress, as far as my hazy memory goes I don’t think that either myself or Harry were in danger and I had only been in active labour for six hours and was coping just fine on G&A alone. That said, there was some meconium when my waters were broken, so maybe it was that. All I know for sure is that I was disappointed at being told in no uncertain terms that I needed a EMCS without really being made clear why. If my health allows us to have another child in the future I will definitely be looking into having a doula a lot more!
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    • Thank you for sharing your experience. It sounds like a difficult one. It’s a shame that it wasn’t clearly explained so you could make an informed decision, a decision you could really own. That happens all too often. A doula would listen to your birth story too, which you might find would help with releasing any baggage that comes with it. It’s been coming home to me again and again what a powerful thing listening is.

  • Wow what a discussion statisticly intervention rates are lower with a doula. Births at home and in birth centres statisticaly speaking also have a lower intervention rate. Birth is beautiful and power ful and woman have been doing it for millions of years. Women deserve the space and clesn slate to do it the way they want to with out medical professionals brining the fear of previous bad experiences into it. Yes mother and babies die but the is no evidence that continous monitoring in a medical setting is safer than birth at home or in a birth centre. 🙂 adele you will be amazing you will have an amazing support from Lawrence and your doula and gods grace provideing strengh x

    • Thanks for your input and encouragement, hon. So true about what you say about previous bad experiences. I imagine that, as a consultant, if you see a lot of births which aren’t running their normal course, you could become conditioned to see birth as an innately dangerous occurrence. On the other hand, I’ve been hearing a lot of positive stories about consultants who believe in natural birth too, which is thrilling. The best we can do as women is inform ourselves and surround ourselves with positive caregivers. I have heard about the statistics in relation to doulas and I just think it shows how effective womanly support can be. Of course, we know this about breastfeeding support so why wouldn’t it be for birth?

  • I had my husband and mother along with two midwives for my first child’s homebirth, and it was an incredible experience. Second time round I had a friend who needed one more ‘case study’ to finish her doula training and I said she could attend my second birth. I was REALLY glad I did! Because I had had a 48 hour labour first time round, when labour was established the second time round, no one really paid much attention. I decided to stay busy and active in labour so my then 2 year old and I decided to bake a cake after her nap – during which I was dancing around the living room on my own! – we started baking the cake at 3.30 and by 5.21 I had a new baby in my arms!

    Because I was calm and relaxed and baking, no one was paying my contractions much attention, so they didn’t think I was too far along. When the doula arrived as the cake went in the oven, I started baring down and she was the only one listening to me. She filled the bath with water in case the pool wasn’t going to be filled in time, got my two year old busy with something else as at that stage she was riding on my back pretending I was a horse! and looked after ME.

    The midwives arrived and I had a baby shortly after.

    The doula did a placenta smoothie for me while everyone was doing their paperwork and clean up and all that, and I was really grateful for her on the day. There are always student doulas around who often work for costs only,

    Also, a doula doesn’t have to be trained – I ‘doula’d’ for a friend three weeks after my baby was born. Doula means servant girl or hand maiden. If you have a friend who has given birth – preferably the kind of birth you want yourself – there’s no reason why you can’t have them as your labour support.

    Very best of luck Adele. You can do it!
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    • Amazing, Luschka! Thanks for sharing your experience. I’ve been thinking we’l bake a cake and we plan at the moment to have Talitha here and just continue life as normal, seeing how it goes. True about the training. It can be helpful but of course there’s no reason a friend who’s given birth can’t.

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