The role of a Doula is a fairly recent one. It hasn’t always existed, at least not by that name. Throughout history, reaching as far back as the first people giving birth on the earth, other women have attended a woman in labor, giving physical, emotional, and informational support. This role was, and still is in many cultures, filled by close friends, family or fellow villagers. The woman in labor would be familiar with and often closely related to these birth attendants.
In America today, we have largely separated from the midwifery and wise-woman model of care. Birth care has been outsourced from the village to doctor’s offices and hospitals. Advances in technology and hygiene mean more babies are born alive and grow to adulthood. But the significant trade-off is that more women are isolated from places and people that are comfortable to them, and birth is something to be afraid of and managed by strangers in a strange place. Studies are beginning to pop up, telling the story of the rise of birth trauma and postpartum depression in the United States, which is not without causalities of its own. This can be seen especially in the current cesarean section rate in the U.S., an average of 33%. The World Health Organization admits that a cesarean rate of 10 - 15% is all that is needed to save the babies truly in need of emergency action. And yet, the rate has climbed 500% since 1970, and continues to rise.
So what changed, exactly? What has made this difference? There are many theories, but the biggest in my view is the outsourcing of care – the movement of birth from home to hospital, and the lack of knowledge and support women have in regards to giving birth. Enter the doula. But so many women either don’t know what doulas do, or they have massive misconceptions about having a doula and the role a doula has or the benefits one would provide. So here are the seven most common reasons women (and their birth partners) choose not to have a Doula, and why those reasons aren’t always valid.
#1: I don’t need a Doula, my Husband/Boyfried/Nurse/Mother/Best Friend will support me.
Husbands, or fathers of the baby, have only recently been asked into the birthing space. For thousands of years, and in most cultures, fathers of babies have been found pacing hallways, smoking or drinking and waiting with their buddies, sitting just outside the door trying to distract themselves while they wait for the child they helped create to arrive. Women did all of the work of birth. Midwives attended women, her sisters, friends, and mother held cold cloths, gave instructions and advice, and soothed her emotionally. Today, in America as well as other countries, it has become commonplace for the father of the baby to be in the room, watching his child be born and in many cases, acting as the main or sole support of the mother in labor. Men, in large part, are unprepared for this role. That’s not to say they don’t belong there – in fact, when they feel supported, confident and prepared, husbands and boyfriends can provide some of the best support for women, even some that a doula couldn’t provide because of how intimately they know the birthing mother.
But, despite birthing classes and months of preparation, articles pushed on them and books read, husbands are most often just as overwhelmed and caught up in the birth process as the woman giving birth is. They haven't spent years studying birth. They most likely have never even SEEN a woman giving birth outside of a television show or movie. Additionally, they tend to feel insecure in a hospital setting, and most of their confidence may leave as soon as he enters the doors. This happens for a lot of men when faced with a strange place or the authority of doctors and nurses, so having a doula to support your husband so he can support you is smart and often needed in the hospital (and even at home!), not to mention that when you hire a doula, you hire a professional who is trained to support women, and their husbands, in labor.
So what about my mother-in-law or other female support? They’ve given birth before, right, so they know how to support me?
In theory. But it’s not as simple as just having another woman in the room, although several studies have shown the benefit of this. Many women do choose to invite mothers, mothers-in-law, grandmothers, sisters, and friends into the birthing room. What about them? Aren’t they enough support to negate the need for doulas?
In most cases, no. Realize that they will bring all of their knowledge of THEIR birth experiences, as well as any fear, trauma, or belief, into the room with them. A mother-in-law might make you feel uncomfortable, or try to control your birth experience (mothers can do this too!). Sisters and best friends, while incredibly supportive, often don’t know what to do to support you, even if they’ve given birth before. If you want a natural birth, but your sister has only had epidurals, she won’t know what to do when your contractions start to hurt. The opposite is true too – if your best friend is an advocate for unmedicated birth, and that’s all she has experienced, she might get confused when you get an epidural, and she will have very little idea how to support you.
And most family members (and others that love us), including husbands, don’t do well when someone they love is in pain. They just want to make the pain stop and for you to feel better, and if they don’t know how to do that without medication, they’ll be asking you to “just get the epidural.” They aren’t trained in pain relief techniques that don’t involve medicine. Doulas are.
Does having a doula mean you shouldn’t invite your family members or friends to the birth? Definitely not! The relationship you have with them is really valuable. But a doula has knowledge they don’t, and you’ll benefit a lot from that whether you have an epidural or not (see reason #6).
Additionally, if your family member or friend stops being helpful, or if they are causing problems (as they sometimes do), your doula can be the one to ask them to leave, or give them a job to do outside of your hospital room or home so they still feel helpful, but they stop prohibiting your ability to give birth easily and safely. No matter who you have at your birth, a doula will always benefit you.
So what about Nurses? It’s their job to support me in labor, isn’t it?
Nurses are amazing people, incredibly dedicated to their jobs. They work constantly with pregnant women, supporting them in hospital settings as they labor to bring babies into this world. It takes a very special person to be a nurse, and the work they do is incredible. But the large majority of nurses are simply unavailable to provide the continuous emotional and physical support a woman needs while in labor. Consider this:
“Labor support does not always occur because nurses tend to have coexisting responsibilities for more than one laboring woman, spend large amounts of time managing technology or keeping records, and begin or end shifts in the middle of women's labors” (Hodnett, Gates, Hofmeyr, & Sakala, 2007).
Does the nurse have time to spend hours with one woman, giving counterpressure or using a rebozo to offer physical relief? Is she able to stay in the room, offering positive words of encouragement while the woman labors, or making suggestions to her birth partner to support him as he supports the woman birthing their child? The answer is no. In fact, one study notes that while providing labor support is an important component of nursing care, only 6.1% of nurses' time was spent in providing supportive care (Gagnon & Waghorn, 1996).
“Factors that hindered nurses' intrapartum care fell into six themes; (1) hastening, controlling, and mechanizing birth; (2) facility culture and resources; (3) mothers' knowledge and medical status; (4) outdated practices; (5) conflict; and (6) ethical/professional decline. Of these six themes, hastening, controlling, and mechanizing birth was most frequently mentioned” (Sleutel et al., 2007).
#2: A Doula would replace my husband/boyfriend/etc. supporting me
This is a common concern, but when you have a great doula, it’s an unnecessary one. A doula will be as hands-on or hands-off as you like. She will encourage and support your husband in supporting you by teaching him techniques she would use, or, if your husband is the type who would like to be more on the sidelines, she’ll be right in the thick of it, giving you what you need!
In the birth of our second baby, I had a water birth. My husband climbed in the tub with me, to hold me and support me as I changed positions to bring our baby out. Our doula was outside the tub, and when I became discouraged and started saying the baby would never come, and that I couldn’t do this, she was right there with a positive, affirming word, telling me I was bringing my baby and that she was definitely coming. She was ready with a cool cloth for my head or a drink with a straw to keep me cool and hydrated. She was the rock I leaned on all through transition. After the birth she got us settled, making sure breastfeeding was going well and making me a smoothie. Doulas do so much more than just attend your birth.
#3: A Doula is too Expensive / We can’t afford a Doula
Probably the most common reason of all, the cost of a doula is definitely a concern for a lot of couples. Doulas prices vary from location to location, and range anywhere from $300 - $3,000. In Utah, where I serve as a doula, most fees are in the $600-900 range. The reasons for the wide variation are found in different experience levels, cost of living in different areas, and how much a doula values herself or relies on her income as a doula for providing for her family. (For more on why doula costs are what they are, read this article.)
My belief is that there is a doula for every woman that wants one. If you think you can’t afford it, my challenge for you is to interview a doula (or several) and ask her (and yourself) this question:
“How can we afford your fee?” or “What can we do to make this a realistic possibility?”
The truth is that most doulas will do one of several things. They will:
· Offer a payment plan or accept a credit card
· Offer a sliding scale fee based on your income
· Take trades for part or all of the fee (commonly traded services are childcare, haircut/color, massages, website design, etc. I’ve even had clients sew or crochet things for me in exchange for my doula services!)
· Give you recommendations for another doula in the area who offers a lower fee than they do, or one who is in a position to offer a lower price or even a free birth as needed
In other words, keep interviewing doulas until you find one that will work with you! Cost should never be the only reason you don’t have a doula if you feel like you need one because, as I said before, there is a doula for every woman who wants one.
#4: We want birth to be an intimate experience, just my husband/boyfriend/etc. and me. A Doula is basically a stranger, and we don’t want strangers at our birth.
If you want to limit the number of strangers at your birth, first off, I recommend you consider giving birth at home or in the birth center. Most of the time you only see one or a few midwives during your pregnancy, and you’ll most likely meet her assistants before the birth. This is the most sure way you’ll have that intimate experience you desire.
However, if you are planning to give birth in the hospital, you might want to consider this: nurse shifts change, and sometimes doctors don’t make it. Your birth could be only a few hours, perhaps 6-8, or, especially as a first time mom, it could extend upwards of 24 hours or more. It can happen any time, day or night. You cannot predict or control who shows up to your birth.
Here are some other things to take into account when planning an “intimate” hospital birth experience:
If you have an obstetrician you’ve seen your entire pregnancy, he or she may, for any number of reasons might not make it to the delivery of your baby. Another doctor will come to catch your baby, and you may not have met him or her.
If you have a rotation of midwives, you might get one you’ve never met before. She may or may not support all of your birth decisions.
If your hospital trains other doctors, you may end up with a room FULL of people you’ve never met before, as they crowd in to watch the doctor cut an episiotomy, use forceps, or stitch you up as needed. They will be there to watch a live birth happen in the hospital, as part of their training, and unless you specifically request otherwise, a resident in training might even be the one delivering your baby.
If you think nurses will fill the role of a doula in the hospital, that’s another misconception. Skip back up to reason #1 for more on that.
A doula is, in fact, the only “stranger” at your birth who you can guarantee will be there! And you get to meet her in advance.
So how can a doula make your intimate hospital birth more of a reality?
If the nurse shift changes, and it’s a nurse you don’t like, she can help you request that another nurse be assigned to you so that you find one that is kind and respectful of your desires.
If the room gets noisy with others talking or monitors beeping, the doula can quiet them while you focus on laboring.
If the room is too bright, the doula will turn your lights down for you.
If your doctor or midwife doesn’t show up and it’s someone you don’t know, your doula will be right by your side, comforting you and your husband through each contraction and helping you focus on your baby, not on a stranger being there.
Your doula will also encourage your husband and support him so he knows what to do and how to do it, and that will bring you closer than ever in your birth experience. For more about husbands/birth partners in labor, see reasons #1 and #2.
Your doula can always leave the room and give you some space if you absolutely want to be alone, but she'll wait outside and be there the moment you need her!
A doula will also see you at least three times before you give birth. Once for the interview and two more times for prenatal visits where she will learn about your desires for and concerns about giving birth, as well as get to know you better. Some doulas offer more than two prenatals. If getting to know her is a concern, ask if you can meet an extra time or two so you feel more comfortable with her in the room.
#5: We took a childbirth class, so we don’t need a doula
This reason was one of those my husband and I had with the birth of our first baby. We took a Hypnobabies class and it was very informative and gave us a lot of confidence in birthing our baby. We had our birth plan, we had our birth ball, and our Hypnobabies meditation tracks and scripts. We had a supportive rotation of midwives, and we felt ready. And then we spent 8 hours in the hospital, trying to get labor going, self-hypnosis not really working, and everything we had learned went right out the window. The nurses left us pretty well alone, and the midwife on rotation had two other women in labor in another hospital – leaving us completely alone. The “intimate” birthers dream, right? But I wasn’t progressing the way the hospital likes to see, and they started asking us to consider using Pitocin to get labor going. I wanted to avoid that completely, but my husband and I were at a loss for what to try. A doula could have recommended specific position changes, nipple stimulation, walking or dancing, even rebozo techniques to get labor to progress, but we were left to our own devices. We found ourselves wishing we had someone with us providing knowledgeable and continuous support, and although our birth turned out all right (natural birth after 18 hours of labor), I was traumatized by not having the support I wanted and having to push for my own desires in labor. When I got pregnant with our second baby, my husband was the one who insisted we find a doula for our waterbirth at home, and we are so glad we did!
Doulas who are serious about making this a career spent incredible amounts of time and money attending additional trainings to help them support women in labor more efficiently and effectively. They learn about positioning, pushing, pregnancy concerns, postpartum concerns, breastfeeding, rebozo techniques, ways to encourage posterior or breech babies to turn, counterpressure and (some) massage, birth balls and peanut balls, and more. They read books, study their craft, and learn so much more than even Google can reliably tell you. So don’t go into labor expecting you can just turn to Google when something goes wrong – a doula is trained to help you navigate everything that happens in labor, and if she’s unsure on something you can be sure she knows exactly where to find the answer and won’t have to spend precious time searching. In short, doulas know everything about pregnancy, labor, birth, and postpartum, so you and your birth partner don’t have to! (But you should still take a childbirth class!)
#6: I’m having a homebirth (OR) I’m having an epidural or a planned C-section, so I don’t need a Doula.
Some women think doulas are only for “crunchy” moms planning a natural birth, or a birth at home. Other women are convinced doulas are only for women who are having epidurals or hospital birth and need someone to “fight” for them. Both are wrong. Studies have shown that having a continuous labor support present at the birth, no matter the location , can shorten labor time and pushing time, reduce the need for use of anesthesia (epidural), forceps or vacuum assistance, and cesarean delivery.
So how, exactly, can a doula help if you have an epidural? First of all, she will be there at your bed constantly as labor support. So if you need company, someone to play a game with, talk to, or otherwise support you, she’s right there! Your husband is too, and so are other family members, but many births I have seen where an epidural has been placed, other family and friends (including husbands) tend to gravitate towards their phones. I’ve been at a birth where, until she started to push, most of the time her six family members and two friends were talking to each other and playing on their phones. As her doula I rubbed her back and shoulders, helped her fix her hair, talked with her, helped her change positions, brought her into her family’s conversations and experienced it with her. Birth with an epidural is often many hours of sitting and waiting for things to progress, and it can be a bit like watching paint dry for the support people there when there isn’t much to do. But a doula knows better – a doula knows that there is still plenty to do, and lots of support that can be given, when a woman chooses or needs to have an epidural during labor.
Additionally, many women labor at home or in the hospital for a good long time before they get the epidural. You need to be progressed in labor a certain degree before they will place it so that labor doesn’t stop or slow down. Have you planned and prepared for the potential of having hours of contractions, possibly painful and difficult to cope with, alone at home? Maybe through the night or during the day while your husband is at work? Would it be nice to have someone knowledgeable about labor and birth come to your home and provide physical support to you (or your other children!) while your husband drives home from work, and while you wait to go into the hospital for your epidural? Absolutely! A doula will attend you anywhere you’re in labor. I even had a client give birth in a restaurant, and while I didn’t make it to her baby being born, I was able to come after, help her clean up, and get her settled in at home (planned home birth). Doulas are great for the times when birth brings something unexpected. And where birth is concerned, that’s nearly every time!
If you’re having a cesarean section, some people would debate that you really don’t need a doula. Any maybe they’re right. There are doulas are experienced and specifically support planned cesarean sections. Ask around and see if there are doulas in your community like this and ask how they would support you. Personally, I think that if you are having a cesarean birth, you might find it more valuable to invest in a Postpartum Doula, which is a topic for another post entirely, but you can head over to DONA’s Postpartum Doula FAQ page for more information.
What about home birth, then? A midwife (and most likely an assistant or two) will be there constantly. That’s one of the benefits of home birth! There’s no shift change and no in and out of the room. What does a doula bring when that’s the case? In the first birth I attended as a doula, the mom got to the point of pushing her baby out. She was leaning over the couch, grunting and pushing in a dark room. The midwife was behind her with the woman’s husband, helping him catch their baby (as fathers often like to do), and the assistant was holding a flashlight and handing the midwife things she needed. The woman needed more gravity assistance and needed to sit up, but in the throes of labor she couldn’t support herself. I slid onto the couch and let her wrap her arms around my neck so she could raise herself up and push her baby out.
Most of the time in home birth a doula is the extra set of hands that can do everything no one else has time to do. Giving you a drink of water, rubbing your back, shoulders, or head, applying a cold cloth, giving hip squeezes while you slow dance with your husband. Everyone else has a job to do that may or may not allow them to focus on you. But a doula? That’s exactly what you’ve paid her to do! Midwives are amazing, and so are their assistants, but largely their role is medical. They are going to help your baby come into this world. They are listening to heart tones and feeling baby’s position. They are checking your cervical dilation and recommending positions. But less often do they have the ability to give counterpressure and massages at the same time as doing these things. Your husband can, but only if he knows how and when. And that’s where the doula comes in.
#7: I have a birth plan (OR) This is my 2nd (third, fourth, etc.) baby, I already know what I’m doing!
Did you know that it’s basically a law of the universe that for every plan made something is going to happen to thwart that plan? Did you know that every birth is a unique experience? Did you also know that babies don’t often listen to plans? In my first birth, I was not expecting my water to break and to only be dilated to 1 cm for twelve hours. I wasn’t even expecting it to hurt as much as it did to push a baby head out of my vagina. I was convinced I would give birth on all fours, feeling little to no pain with the self-hypnosis I would surely be using. That, of course, all changed when my water broke at midnight that September. And my second birth was dramatically different – a six hour water birth at home to a 9 lb 2 oz baby girl that left me with a large tear that had to be stitched up, something I never really considered. And this lead to the third, an even bigger baby girl born at home without a midwife in attendance, and not a tear to be found. Case and point, EVERY BIRTH IS DIFFERENT.
Hospital staff and doctors might read your birth plan, but it’s not a contract. They don’t have to follow it and often won’t if their practices, culture, and policies don’t mesh with your desires. Occasionally hospital staff even become agitated and deliberately unhelpful when you present a birth plan, and act according to their own agendas to hinder your plans for a peaceful, positive birth. They won’t often do something directly harmful, but they may be condescending, rude, neglectful, or blatantly disrespectful in going against what your birth plan outlines. They still get paid no matter how your baby is born. If this happens, do you want to be alone to navigate it?
Or would you rather have someone compassionate, trained and ready to help you advocate for the care you deserve? Someone you’ve paid to be on your team, to help you when the plan changes, as it most likely will. A doula will read your birth plan( she’ll even help you write it if you want!) and encourage you and your husband to ask the questions that need to be asked so that others coming into your birth space will respect you and be helpful to you as you birth your baby in a positive and safe way.
You might know what the pain of childbirth feels like, only this time baby is posterior, and all the contraction are in your back. Are you prepared for that? Doulas know special techniques and positions to specifically assist you when you have back labor, or if you need to turn a posterior baby. You might be so prepared for everything the anesthesiologist does to place your epidural, but are you ready for the epidural to only take on one side this time? A doula would be there, pressing on the areas that hurt, relieving the pain as much as possible, or distracting you with music, positive affirmations, changing positions (even with an epidural!), maybe even aromatherapy. Do you have all the knowledge you need if your labor goes on for two days? Or three? Or if your home birth becomes a hospital transfer, and your plan goes completely out the window?
Birth plans, and even personal birth experiences, can’t replace the weeks, months, even years of preparation and the dozens of births a doula has often experienced serving other women.
#8: My husband said I can’t, or that he doesn’t want to have a Doula.
I know I said there were seven reasons, but as I wrote this, there was another reason that popped into my mind. I have heard many women give this reason. Their husband, or boyfriend, doesn’t support having a doula. Hopefully after reading through the other seven explanations, you’ve already convinced him that having a doula is financially possible and definitely worthwhile. For those who still have birth partners against the idea, here is my advice: set up interviews with doulas and have your husband there to meet them. Ask them all of the questions or bring up the concerns and reasons your husband has expressed about having a doula. Ask the doula how she would help you overcome them. Most likely, your husband just doesn’t understand why you would need a doula if you have him or the nurses at the hospital. He doesn’t believe doulas are actually beneficial and wants statistical evidence to prove it. He is afraid of being replaced. He doesn’t think you can afford the cost of a doula. He thinks they only belong at home births, (or births in the hospital). If your husband has a reason besides the seven above, I have yet to hear it. So, if your husband doubts, do these two things:
You, pregnant mama, deserve whatever support you need or want. You are worth it. You are worth paying someone several hundred dollars to be at your side no matter what. You are worth waking someone up in the middle of the night so they can leave their family and help you grow yours. You are worth having a positive birth experience surrounded with support and love.
How do I find a Doula?
Local to Northern Utah? Check my availability!
· Google search for Birth Doulas in your area
· Attend a pregnancy and birth expo or conference in your area
· Join a pregnancy or birth forum on Facebook
· Ask your friends or family members who they recommend
· Ask your midwife or obstetrician if there are any she has worked with that she would recommend
*As a final note, there are women who really, truly, don’t need a doula. If you feel like this is you, I support you in that too! But don’t get caught up in one of these excuses and pretend you don’t need one. If you have an excuse, find a solution and make it happen! If you really don’t feel a doula is right for you, prepare in other ways to be sure you have all the support you need. Consider receiving digital support from a Doula on Demand.