Doulas 101: What they do, how to choose one and why I love mine

I’ll never forget when an out-of-town wedding guest told my husband she had become a Doula, and my husband reacted with accolades and encouragement. I later confirmed what I had suspected: he didn’t have even the vaguest idea of what a Doula actually was.  He’s not alone.

In French, we call a Doula an accompagnante à la naissance, which roughly translates to “birth guide.” I can’t think of a better definition for this increasingly popular, but ancient, profession. While an obstetrician or midwife, whomever you may choose to follow you throughout your pregnancy and birth, will be more focused on the medical and mechanical aspects of gestation and delivery, a Doula is there to guide you and your partner emotionally, physically and psychologically through the process, not just during labour but also during the pregnancy and postpartum.

I am privileged to count three amazing women, all Doulas-in-training, in the group of friends that formed after the birth of my son. While I did consider a Doula for my first pregnancy, I had too many doubts about what a Doula’s role would be in my experience, I worried that I would find the Doula to be in the way during delivery and that this would stress me, and I was just too shy to find out more about what a Doula’s role truly was. Having uninhibited access to my three dear Doula friends, able to ask my questions without any sense of obligation or commitment convinced me that I did indeed want a Doula for my second pregnancy, and that I undoubtedly wanted my dear friend Adrienne to be my birth guide. (And no, choosing one of my three friends to be my Doula was not like picking a Maid of Honour: being a Doula is all about wanting what is best for the mother-to-be, even if that “best thing” is another Doula.)

Because Adrienne is both my friend and my Doula, we don’t have a formal Doula/client relationship. I don’t always know if the questions she asks me or the topics of conversation she broaches are coming from my best friend or my Doula. I’ve come to understand that it is both, because your Doula will put you at ease like a dear friend, she will see you at your most vulnerable without judgment, she will be a sounding board for your deepest fears and a voice of reason and calm in times of panic.

In case you are apprehensive about hiring a Doula for your own pregnancy, I made a list of the questions I wish I’d asked about the role of a Doula before deciding to go without one the first time around. A huge thank you is extended to my best friend and Doula for carving the time out of her busy schedule to answer them for me.

Can I interview prospective Doulas to find the right one?

I had a couple of friends initially recommend their Doulas to me when I was pregnant with my first child. I was worried that if I phoned one, we wouldn’t “click,” but I would feel embarrassed to not hire her.

Adrienne tells me: “You should absolutely be interviewing prospective Doulas, and a good Doula will insist on this step before agreeing to work with you. The chemistry between Doula and client is extremely important for both parties. Make sure to have a list of questions prepared, and it is always a good idea to sign a service contract (most Doulas work with these) that states fees, on-call dates, and services provided. You should also have a clear understanding of what to expect from your Doula in the event of an emergency delivery, or if she uses a backup Doula during her on-call period.”

What makes a Doula a Doula?

Another concern I had was whether or not I would stumble upon women calling themselves Doulas, but without any formal training. I wondered to what extent the profession was regulated.  I now know that there are reputable Doula-training programs, and from talking with my three Doula pals, the training is in-depth and intimate. However, there is no regulatory body that authorizes a woman to use the title of Doula.

Adrienne tells me: “Because there is no regulatory body governing Doulas and their work, there isn’t really a standardized program for Doulas to follow. However, several widely respected Doula organizations (DONA, MotherWit) have set up training programs whereby Doulas can learn standard practices and become certified. Choosing a certified Doula means that the care you receive has been taught by experienced professionals, and also that your Doula has a community supporting her practice. That being said, some of the best, most practiced Doulas have not been certified, since formal training and certification are relatively new concepts in the Doula world.”

What does a Doula learn in training?

My friends actually went to camp to start their Doula training! All three of them brought their sons (as did many of the other participants), and it was an unintentionally very camp-like experience due to a power outage where they were staying.

My friends are all training with an organization called MotherWit: “I am in the process of completing the MotherWit Birth Doula Training. In addition to 60 hours of classroom learning, MotherWit-certified Doulas need to attend five births for which they are reviewed by nurses, doctors, midwives, clients and other Doulas. They need to attend four hours of La Leche League breastfeeding workshops, and a series of hospital-sponsored birth classes. There are also fifteen books to read, and seven book reports to write. Finally, there is a thousand-word paper on a subject of your choosing, as well as an exam to write. This training is the most extensive that I know of, and covers a lot of holistic aspects of care that other programs don’t. Once certified, a MotherWit Doula is able to provide naturopathic care receipts to her clients, which many can claim with their health insurance.”

How do I find a Doula in Canada?

Adrienne recommends using “Google, Facebook and word of mouth.” Your healthcare provider may have recommendations based on their past experience, but rest assured that your midwife or OB does not need to approve of your choice of Doula: “she is there for you regardless of the medical care you have in place.” Lactation consultants, midwifery and child birthing organisations may also be places to seek out recommendations.

DONA International: Find a Doula

CAPPA Canada: Find a Doula

Once I’ve chosen a Doula, how many times do I see her before the birth?

There’s no standard amount of times that a client will see her Doula before her birth. It’s not like with your ObGyn or midwife, where checkups are at regularly-scheduled intervals. With my first pregnancy, my ObGyn visits with their endless wait-times were already taking up so much of my time! Adrienne says that it is often up to the client and Doula to decide: an “experienced Mom who just wants a Doula for the birth might benefit from a reduce rate if she only wants one prenatal meeting. I usually like to meet with a client three times before the birth.”

What happens at a prenatal meeting with your Doula?

I was worried that prenatal meetings with my Doula would be too esoteric for my taste, too “touchy feely,” if you will. Turns out this is not the case, meetings are practical! Says Adrienne: “Prenatal appointments usually begin in the second trimester, with getting to know the client’s health history, as well as any previous pregnancy and birth experience. A good Doula will include the partner in these discussions, to get a sense of how he will participate in the birth, and the appointments usually last about an hour and a half each. The second prenatal covers the process of birth, expectations and pain management. The third is usually about adjusting to life with the new baby, as well as breastfeeding and sibling involvement.”

For my first birth I definitely wanted to deliver in a hospital. I wondered: Can you bring a Doula to the hospital?

Many people will associate a Doula with homebirths or births attended by a midwife. Having been the caregiver for Adrienne’s son while she’s been attending births, it seems like, in fact, the majority of her births are in hospitals! With my new understanding of a Doula’s role, I can reimagine my own hospital experience and see how much a Doula would’ve helped me:

For example, in the short amount of time that my husband was parking the car, I had a severe drop in blood pressure and so did the baby. I almost passed out, and a bunch of doctors were rushing about in the room. Eventually one decided to break my water, and it was a huge frenzy of frightening panic that would’ve been greatly eased with the presence of a Doula!

Adds Adrienne: “Doulas are a great commodity in a hospital birth, since your nurses and ObGyn will be busy with other patients, and might not have the time to focus on your wellbeing like a midwife would. Because of the sometimes hectic environment in a hospital, birth can stall, and a Doula will help you with positioning, movement and massage to help get contractions going before medical intervention becomes necessary. A Doula can also help you advocate for yourself, and will encourage you to speak up and make sure you are aware of the medical decisions being made for you and your baby.”

I have to agree with the points she raises: I barely saw the medical staff at the hospital until it was time to push! My husband took care of 99% of my needs, from emptying my little pee pan (there’s no shame when you’re in labour) to heating up my magic rice bag for my back and fetching my fruit sauce and water. He was so exhausted once baby arrived that he passed out in our room and was completely dead to the world for the night. (Keep in mind that he was also working while I was in labour! He had his laptop and cellphone with him the whole time because circumstances obliged.)

How much does it cost?

Another barrier between me and choosing a Doula the first time around was the financial aspect. I didn’t realize, at the time, that our extended health plan could have covered most of the cost, as some Doulas (including those trained by MotherWit) can provide receipts as naturopaths.

Says Adrienne: “A Doula’s fees vary from city to city, and depend a lot on experience, training, and services offered. Doulas can charge anywhere between $300-$1,200, and sometimes more. This may seem like a lot, but when you consider the prenatal appointments, the time spent at the birth, and the postpartum follow-up, as well as travel costs and parking, it adds up quickly. Some Doulas are able to offer receipts as naturopaths, which many extended medical programs cover in some part.”


So… what exactly will she do at my birth?

When I told Adrienne that my biggest fear about having a Doula was that I would feel self-conscious about having someone else in the room and that maybe I wanted only my husband present, she said something that has stuck with me: if she’s doing her job right, I won’t even notice she’s there. She elaborates: “A Doula’s main role in a birth is to ‘hold the energy’ in the room. I like to think of it as forming a protective bubble around the birthing woman and her partner. Regardless of who might come in or out of that bubble over the course of her birth experience, it’s a Doulas job to keep things mellow, positive, and full of love. If that means getting a glass of water, massaging an aching back, or just sitting in silence while the hours tick by, a Doula is there to provide physical and emotional support for the birth. Oftentimes, a partner wants to offer comfort measures to the labouring woman and is unsure of what to do. A Doula will subtly suggest certain things, and can take over back rubbing or leg holding when the partner tires. Doulas do not replace birthing partners, but empower them in their role.”

What happens after the birth?

I know I saw my ObGyn at about 6 weeks postpartum. Doulas usually schedule a postpartum appointment with their clients: “The goal of this meeting is to check in on the new family, as well as offer support and resources if there are breastfeeding and adjustment issues. It’s also important for the new mom to get a chance to talk about her birth experience. Oftentimes, the details of the birth are blurry to the new parents, and it helps to process this momentous event with someone who was there.”

I can assure you that my ObGyn did not have time to sit down over a cup of tea and debrief my birthing experience. Looking back, I have questions about the minor interventions that took place during my birth, and there wasn’t anyone I could ask. Also, I had to trek downtown on the subway with my new baby: a Doula can come to your home!

Yes, I want you, Doula!

Armed with all of this information, I am very confident in my choice to have a Doula present for the birth of my second child. It definitely helps, in my case, that I know my Doula well and am particularly comfortable with her. That said, knowing what I now know about a Doula’s role, I would feel much more at ease setting out to hire a Doula if Adrienne and my other friends weren’t the right fit for me.

Did you have doubts holding you back from hiring a Doula?

 


 

Lindsay Gallimore is a former high school teacher now working from home as a translator and a blogger at Maman Loup’s Den. Expecting her second child this summer, she strives to help her readers find the ECOparenting balance – making choices for their families that are both eco-friendly and economical.