An Awesome Thought and Several Things to Consider

What is your relationship to my other caregivers? How will you help me make your presence as my doula work for everyone in the room?

Prospective clients ask this question for a few reasons. Some come to a doula interview unsure of exactly what a doula does. Families are usually looking for concrete information about the different roles that are played in a birth setting. Some are unsure if obstetricians allow doulas. Some are wondering if there is a need for a birth doula when there is also a midwife. Others wonder if their partner will feel like an extra in the room.

One of the simplest ways to answer this question is to say that a doula is the only person at your birth who is there just for you, the laboring woman. Every other person in the room has layering responsibilities and experiences during your labor.

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Your partner and fellow-parent:

Your partner is there to give you love and support but while also remaining present to the experience of witnessing the birth of their own child. I am happy to share to work and model the tasks of massaging your back, brushing your hair and offering you physical support. There are also ways I am able to help you because of my training and experience that include finding the best positions tow work with your body and techniques for counter pressure to help with back pain and much, much more. Through all this I can provide quite reassurance to you and your partner that the noises, sensations and discomforts of your labor are normal. For loving partners, concern for their family can easily take over their ability to offer support. With reassurance from a doula, your partner can continue to enter in to your experience and help meet your needs.

Your nurse

Studies have shown that continuous support -the way a doula provides it from hospital staff personnel can have benefits for laboring moms. There are a few potential problems about counting on a nurse to help you all the way through labor. The first is that your nurse's primary obligation is to monitor the condition of the laboring mom and her fetus. At times and in some hospital settings, nurses will have the time and opportunity to provide high quality labor support. Many that I have worked with over the years have the experience, skills and passion for this work. However, labors do not follow the shift schedule of a hospital. Change of shift will happen at regular intervals no matter where you are in your labor.

At times your nurse will have to step out because of other patients, will have to update an incoming nurse about your condition, or will have to communicate with an OB or midwife. Your nurse's job is a very important one because should you or the baby have a change in your condition having access to your history throughout the entire labor is a extremely valuable tool for how you and your medical care provider will decide if any medical intervention needs to be considered.

If you want to read a bit more about the evidence of doula support having an edge of support from a hospital staff or a family member you can find that at the always helpful Childbirth Connection.

Your midwife

Your midwife is highly invested in giving you quality support throughout your labor. If you are birthing in a hospital with a Certfied Nurse Midwife, you midwife will most likely meet you there for your entire labor. She may or may not have other laboring patients at that time but her goal is to help you progress through your birth to delivery feeling safe and supported. Women report a wide range of experiences with their midwives it is important to know that some quality that may irk one person about a particular provider might be the exact quality someone else appreciates the most in that provider. Some midwives may appear to be more hands on than others with regards to labor support. Some of that is dependent on the standards of care and expectations in your care setting, as well as factors outside our control such as how many women are delivery babies the same day as you, and your CNMs on training and preferences.

One important fact that is often not immediately clear to expectant families is that a Certified Nurse Midwife must record and document your condition, your fetus' condition and you care because all CNMs in the United States work under a supervising Obstetrician, who is available for surgeries and consults. Of course, you are hoping this will not be necessary for you, as is your midwife but it is her responsibility to make sure that all the information is available to the OB should any situation warrant consulting them. It has been my experience working at many births with CNMs that there is plenty of labor support to be done. The room simply does not feel crowded or chaotic when people are working together in harmony to support a laboring woman.

Your obstetrician

Even with both home birth on the rise and increased awareness about hospital based midwifery, the vast majority of babies born in the Unites States are born under the supervision of an obstetrician. Some obstetricians may have heard of doulas. Others may not have. Some may have reservations about doulas and wondering if adding an extra person in the room is beneficial to the birthing process, Or perhaps they have had little experience with natural childbirth and view it (and doulas) with some suspicion. Others have more varied and positive experiences and may welcome you taking some ownership of your care and hiring a doula. No matter the situation, if you hire a doula, she works for you. Whether you obstetrician is thrilled with her presence or wary, she is still there to meet your needs. Ideally you have a chance early enough in your pregnancy to talk about labor and birth. If you feel your current provider does not have the ability to support you through a safe, healthy,low-intervention birth, you have the right to look around for a new provider. One thing is for sure, obstetricians do not specialize in hands on labor support. Depending on the length of your labor you may see an obstetrician from your practice once or twice during your labor before you are pushing and in some settings, not at all. For families seeking a low intervention birth a doula becomes a necessity to provide continuous labor support.

All this makes it sounds like I am anti-obstetrician, when I am not. I have worked with many wonderful OBs in the last decade. I have seen some completely changed their minds about the presences and value of a doula, about low intervention birth and even some some wonderful champions for woman-centered birth. I have even had a chance to congratulate new residents on attending their first non-epidural birth, or first birth with a woman not leaning back in the bed. Having meaningful, honest communication with your care provider is the most important thing.

Weaving it all together

As an experienced doula, I weave all these factors together when I come to you in labor. If you could be a fly on the wall at your own birth, you'd see me:

squeezing over to make a little extra room near you if your partner is holding back

stepping in close when your midwife has to stepped away fora moment

listening along with you to something the nurse is suggesting and looking into your face so you know you can voice any concerns or questions you have about that

showing your partner the exact spot on your hips to squeeze to provide the most benefit to you

stepping out to refill my water bottle, and yours, and your partners.

You would also hear me:

- Asking you out loud, "Are you comfortable with that? Do you have any questions about what your nurse/midwife/OB just said?" Or "Do you need more time to decide?"

- Thanking your labor nurse by name each time she shuts down the lights, brings us a fresh cold cloth or warm blanket.

- At your request, updating any family you may have waiting for you -or by phone so you don't have to be distracted by this task and they can be well assured that you are doing fine.

- Checking in with you to see if your silence means you are feeling safe and calm or alone and needing more support.

- Encouraging your deep vocalizations sounds, letting you know that you have our support and are free to work with your own body to birth your baby.

As your doula, I hold the birthing space for you in tangible ways. I will make sure those lights are dim, that your door is closed, that your music in on if that is you desire. But you also need an emotionally safe space in which to birth. Many women are trained from an early age to be concerned and take responsibility for the emotions of others, the responses others are having to them and the ways that others are getting along. On the day you are birthing your baby, you do not need to take care of everyone in the room. I am there to take care of you and to work harmoniously with your team so that you have the safe space you deserve to have.

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Posted in Home Improvement Post Date 04/20/2021


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