What is a doula?
Over the last decade, increasing media attention has people asking, “What does a doula do exactly?” With tv shows White Collar and Season 21 of The Bachelor to celebrities Alanis Morrisette and Alicia Keys, the word “doula” is a buzz!
A doula is often mistaken with a midwife, but more accurately referred to as a birth coach, birth assistant, childbirth educator, or pregnancy concierge. However, these are incomplete definitions. A doula is an assistant, but there are several different types of doulas; Antepartum, Birth, and Postpartum Doulas.
Antepartum doulas specifically care for families during pregnancy. They often provide guidance in navigating emotional and physical changes as they grow a little human or may physically care for the mother or birther while on bed rest. They provide considerations for deciding which new hip products on the baby block are important on your baby shower registry or help organize a nursery.
Birth Doulas are trained professionals able to assist childbearing families with emotional, physical, and educational support. Birth doulas fill a gap in modern obstetric care. Though they provide many of the same services as an antepartum doula, their main focus is meeting with families prenatally to prepare for labor and delivery, and the initial breastfeeding. The cascade of interventions can lead to 1 in 3 women having a surgical cesarean birth. Studies have shown doula support can decrease unnecessary interventions and increase maternal satisfaction. Birth assistants can decrease the need for pain-relieving medications like an epidural. They are skilled in techniques for natural pain relief, such as massage and touch, counterpressure, acupressure, rebozo, aromatherapy and offer suggestions throughout labor to help a birther feel more comfortable. We help facilitate communication by considering questions you may ask and offer alternative methods to discuss with your birth team. Most importantly, birth doulas provide a complimentary care that not only brings confidence as mothers approach their birthing time, but helps new parents feel calm, capable, and a ready to take on parenthood!
Postpartum doulas work within the budding family’s home to help for the new mom, dad, parents, grandparents, siblings and newborn adjust. They may prep food, provide breastfeeding support, bottle feed your baby, attend to older siblings, or care for baby as parents recoup with a shower and much-needed sleep. Sometimes a postpartum doula may be referred to as a night nurse or night nanny when providing overnight baby care so families can feel more rested. They may help with the emotional changes the whole family experiences in the postpartum or postnatal period and guide the strengthening of bonds.
There are dozens of doula training organizations and all doulas are not created equally. Although all doulas are sincerely passionate, all doulas work differently! Some doulas are hobbyists, others balance a full-time work/doula life, while still others have built a full-time professional service. They offer different services, different packages, have different skills and experience ranges. They may have stopped their education after a 2-day online doula training, taken an in-person hands-on training and certified, or have additional hands-on complimentary education such as rebozo, Spinning Babies, or massage.
It’s important to ask questions when determining if the doula you’d like to hire may fit your expectations and is the right fit for you!
New Life Blessings offers Birth and Postpartum Doula services including overnight support for you and baby. Read more.
The doula profession is still rather new despite its rapid growth and popularity over the last decade or so. There are some aspects of this job that are constant throughout the professionals. We all support women in the childbearing year, either in pregnancy, in birth, or in the postpartum period. Also, professional doulas understand that they are not medical professionals, and they do not to act or practice as such. Beyond that, there are many variations in the ways that doulas practice and run their businesses.
The doula scope of practice is outlined very clearly in all of the certifying organizations and there are few variations. Here is an example of the birth doula scope of practice as outlined by CAPPA (Childbirth and Postpartum Professionals Association):
The Certified Labor Doula
CAPPA Labor Doulas fill an important role in providing emotional, physical, and evidence-based, informational support to the birthing woman and her family before, during, and after birth.
How CAPPA Labor Doulas work with families
The Labor Doula works with families during pregnancy, during labor, and in the birth process, and in the immediate postpartum time, offering support, encouragement, information, comfort, and referrals as needed. Labor Doulas can be found working in the community in private practice, in cooperatives, as part of groups or agencies, as well as serving in various community programs
How CAPPA Labor Doulas work within the healthcare system
Labor Doulas are skilled support persons who act as consultants and resources, not clinicians. They therefore work with the healthcare system by encouraging and promoting excellent communication between the birthing woman and the health care team, encouraging informed decision making and self-advocacy, supporting the choices of the birthing woman, providing non-clinical comfort techniques, and offering appropriate referrals when their observance or counseling uncover situations that require healthcare attention or support.
Clinical Limitations of CAPPA Labor Doulas
CAPPA Labor Doulas are nonclinical professionals. CAPPA Labor Doula courses do not qualify a professional to act as a midwife or midwifery assistant, as any alternative medicine provider, or as any medical care provider. Labor Doulas do not diagnose medical conditions, perform clinical procedures, prescribe or administer treatment for medical conditions, make medical decisions for the birthing woman, or direct families to act against medical advice.
CAPPA Labor Doulas:
The CAPPA Labor Doula is not a clinician and therefore does not:
That about sums up the job of a doula. There are a few things, however, that all doulas do not agree on, and the discussions go on.
There are no right or wrong answers to many of these questions. In some cases, it’s a matter of personal preference on the part of the professional. Yet the discussions continue.
Why does this matter? Doesn’t every profession have areas of disagreement? Of course, they do – and that is part of what drives improvement in any industry. The doula profession is no different. They all work a little differently, with varying perspectives and philosophies.
It matters to the mothers that we work with because it’s important to know that no two doulas are the same. Make sure you hire the right one for you.
Interview a few doulas, ask them about their approach, their fee structure, their insurance, their stance on advocacy, or things that matter to you. If you want a doula that will be more available to talk with the hospital staff, make sure you ask if she will do that. If it’s important to you that your doula is insured, ask her about that. If you want a doula that will labor with you at home before you go to the hospital, make sure she does that – because they don’t all practice that way.
Doulas have the privilege of being welcomed into a sacred space. Your birth is a once in a lifetime experience – having the right one can make a huge difference in your experience.
To learn more about the work New Life Blessings does with their clients, please email us NLBlessings@gmail.com
5 REASONS HAVING A DOULA ROCKS!
You may have been hearing more about doulas in media or from friends & family, but you aren’t quite sure what the benefits of doula support are. So here are 5 clear cut reasons having a doula ROCKS!
1. Help you make Informed decisions
Doulas are not medical professionals, but they have a vast knowledge about birth and can help you navigate the confusing medical world. They will listen to your needs and help you create a tailored birth plan which reflects the birth you desire. During labor, they can help you understand suggestions given to you by staff and also think outside the box so that you can make the most informed decisions about your unique situation.
2. Continuous emotional and physical support during labor
Birth is hard work! You may not remember everything you learned in childbirth education, nor should you have to. Guiding you and your partner by offering physical techniques and emotional support can decrease discomfort and progress labor more quickly. It’s like having an open book and professor available on exam day.
3. Increased Medical Benefits
According to a study conducted by the Cochrane Collaboration which assessed birth experiences of over 15,000 women — women who have continuous support during labor are:
That brings us to #4.
4. Greater birth satisfaction
Being cared for, listened to, emotionally and physically supported – it’s everything you ever wanted from your spouse, am I right? What about for you and your baby?
5. Postpartum support
Let’s face it: the end result of pregnancy and labor is having a baby. This is about the rest of your life – you will be parents forever. After the birth of your baby, there may be new challenges during the first weeks of parenthood. Doulas provide a wide spectrum of support which may include, but is not limited to breastfeeding assistance, newborn care, help around the home cooking healthy meals, laundry, and emotional and physical support.
Curious how a doula can help you? Let’s explore!
Have an experience with a doula? TELL US about it in the comments section below.
If only I had a doula when…
That baby there is me, in my mother’s arms on Tuesday, April 16, 1985. Her name is Kathleen, and she died in my arms on Tuesday, August 18, 2014, at 10:33 pm in room 2410 of a local hospital.
I’ve always been “Mommy’s little girl.” On the weekends when I was still young and my older siblings had all left the nest, I would stay up late nights watching “I Love Lucy” and chatting with my mom as my dad worked the night shift. After the lights turned off, we’d become delirious with laughter, sing songs and pray. Pray in thankfulness. Pray for our loved ones. Pray for our health. And pray for the world.
We charted hurricanes and watched storm chasers. We’d sit outside on the covered porch and watch the thunderstorms as they rolled by. She encouraged me to jump in puddles, to rearrange and sow the materials of my clothing so I could represent ME, to pull apart electronics and write songs on my guitar. When I struggled with my history homework, she’d stop everything to help. When I had school projects she’d stay awake helping me assemble them. When I was falling asleep placing all our hand cut glow in the dark stars inside my mini planetarium, she sent me off to bed… and when I awoke, not only was the Planetarium complete, but there was a special message in hand cut glow in the dark letters, “Jesus loves you!”
She told me I could be anything I want. When it was a gymnast, she signed me up for gymnastics and brought me every week. When it was a figure skater, she made me a skating dress and surprised me with a set of skates. She took me to the rink weekly just to watch me fall on my tush over and over again. She’d take me home and bandage the blisters on my feet, massage my sore muscles and hold ice on my bruises. When I won first place, she’d smile and tell me, “I knew you could,” and when I fell short she’d always lift me up, “You did your best and I’m proud! Next time, kid. Keep practicing.”
When I was 9 years old I wanted to participate in the competitive Junior Bible Quiz team. My mom quizzed me and when I had difficulty remembering, she’d make Biblical quotes easier to memorize by putting them to familiar music. And when our church participated in an in house Bible Quiz, my mom and I both took home matching FIRST PLACE BLUE RIBBONS – even beating out the pastor who desperately wanted to trade out his “pretty yellow ribbon for a boy’s blue ribbon.”
She had a music ministry with my father, traveling the East Coast sharing the Good News and love of Christ. Her voice was truly anointed a powerful and beautiful gift.
I suppose, with any gift, comes a curse.
You see, my mom had always lived in pain. When she was 11 years old, a boy beat her so badly that it broke her hip and she needed surgery to repair it. As the years progressed, arthritis set in and the pins, which had never been removed, tore apart her muscle with each and every step she took. When she finally decided to do something about it on February 27, 1998, when I was just 12 years old, a big mistake was made during a “simple surgery” and it rendered her unable to walk.
Wheelchair and bed rode, pain plagued her, but she only smiled in its face. She soldiered on creating an online antiquity business with my father and uncle.
I grew up, moved out, got married, gave birth to a son… but I religiously called my mom several times a day, every day and visited her weekly.
The years took their toll on her body.
Looking back, I realize I was lucky to have another 15 years with my mom and blessed to have the last 2 years with her by my side in my home where she challenged me to games of Boggle, enjoyed our morning brew of coffee as we sat on the deck bird watching, where she cuddled my son watching Frosty the Snow Man for the umpteenth time, and where she held my minutes old daughter, Everleigh.
January 20, 2014, my mother was admitted to the hospital with what our family recognized as a bout of reoccurring cellulitis – a deep subcutaneous infection which was now brewing in her leg and hip. For THREE DAYS they refused to treat her for cellulitis and for three days she suffered a high fever, body aches, and skin lesions began to appear. If only I had a doula who would have advocated for our desires – a second opinion.
On the morning of the fourth day, doctors agreed and diagnosed my mother with cellulitis, but by this time, the infection was RAGING and not responding to several rounds of IV antibiotics. Finally, they found a compound of antibiotics which she began to respond to just in time!
“You had us frightened there for a moment, Mrs. Brindle. We thought we were going to lose you!”
Within 18 hours the hospital decided to send her home with a mid-line IV and orders for a visiting nurse who would show ME how to administer the antibiotic twice daily for the next week or so. I argued she hadn’t been on the antibiotic for even 24 hrs and should stay and be monitored to be sure she had no adverse side effects and the infection would continue to respond to the medicine. After talking with several doctors and several nurses including the department head, against our wishes, she was released from the hospital. If only I had a doula who would have reminded me to call for a patient advocate when our wishes weren’t considered.
Regardless, her smile beamed ear to ear as she came up the ramp and into our home. There is no place like home!!
For two days I administered the medication. By the morning of the third day, she complained of severe neck pain. Luckily, she had a great primary who offered to make a house call after office hours. He said she was suffering a form of whiplash, probably from laying in a hospital bed for over a week.
In the wee hours of the next morning, my mother called me from my bedroom to help her get to the bathroom. Tears streamed down her face as I carried her head for her. She couldn’t even lift it. A few hours later, her entire body was in severe pain and she barely had control. We called EMS services and she returned to the hospital via ambulance. After a few days, it was confirmed that my mother had a reaction to the drug interactions of Daptomycin and Pravastatin causing severe myopathy and renal failure. For a long time, I lived with that fact… that for days I dosed her body with a poison.
If only I had a doula who would have reassured me this wasn’t my fault.
She never came back home.
For months, it was a slew of battles. While she battled the delicate line of care between renal failure and congestive heart failure with dialysis, surgeries, medications, etc., we were fighting insurance to pay for care and hospitals and rehabs to make room for her. Shuttled here, there and everywhere.
While in the hospital, she caught a contagious disease… and we had to gown up just to visit. She wasn’t allowed to see her grandchildren and she hated having to hug yellow gowns and gloves when we said hello and goodbye. On one of these visits, I was stopped along my journey to her room, implored by a surgeon to sign a consent for surgery which she was already in; a CNA had dislodged the catheter access for dialysis and a large hematoma developed… she was essentially bleeding out underneath her skin.
Often our family would struggle for information. Some of the staff supported us, others battled us; they refused to acknowledge evidence or take the time to answer questions. They snickered when we offered alternative diagnosis – especially when they turned out to be the reason for an issue at hand.
A rehab center absolutely missed that my mother had become delirious, hadn’t consumed food or drink and had been awake for less than 2 hours in a whole day. She was transferred back to the ER where the medical staff seemed stumped. I sat beside my mother for hours thinking, contemplating why. Her oxygen levels were low from the congestive heart failure and I wondered if carbon dioxide was building inside her blood. For 24 hours, I pleaded for them to hear me.
If only I had a doula to remind me I could fire the doctor and ask for another.
Finally, at shift change, when I had become dehydrated from crying and my voice hoarse from lack of sleep the newly assigned doctor agreed to check blood gas. Sadly, it was true. She had a large amount of carbon dioxide in her body. She was transferred to ICU where they began a c-pap machine and increased the oxygen level and after another 18-24 hours, she began to wake.
Eventually, this delicate balancing of her kidney, heart and lung function became more and more unstable and on August 13, 2014, Kathleen was told she was dying. She had a fever, elevated white blood cells, tachycardia, high potassium and creatine levels, low oxygen levels…
My sister was sitting on my bed as I prepared to head to the hospital. When my father called me, I didn’t believe it. It didn’t seem real.
In her last days, I didn’t have a moment alone with my mother while she was awake. Those little moments we were all together. We loved on her, sang to her, prayed over her and tried to find ways to let her know we’d be okay. I spent my time analyzing her vitals… an escape from the reality of losing my best friend.
Suddenly, she stopped waking.
If only I had a doula to shake some sense into me – to tell me to forget about the puzzle and just be present in her last moments.
At that moment, I knew, I’d be her doula as she crossed to a new life. Somehow, I felt her soul tell me I’d be the one with her. I wouldn’t leave her side. I talked to her, hoping she could hear me. I held her hand, sang to her, moistened her lips and mouth, I suctioned the mucus which built up in the back of her throat. If only I had a doula to tell me about the death rattle I’d hear her breathing… what the normalcy of passing would bring.
Beside her, I fell asleep. Suddenly, I snapped awake. Something was different. Her breathing was different. My sister stood up and said she was going to grab something to drink. My eyes stared her down – inside I felt I was supposed to say “Don’t go”, but I couldn’t say the words even when she asked, “What?”
My father was finally sleeping in the recliner just behind the head of her bed. It was quiet. Except for her staggered breath. I reached my left arm around her shoulders and took her right hand in mine. I learned cheek to cheek and whispered in her ear, “It’s okay, mom. I’m here with you. I’ll breathe with you.” I took slow deliberate breaths. I could barely match hers. I knew. I just knew. I kissed her cheek and said, “It’s okay. We’ll be okay.” And I began singing, “Come, Lord Jesus. Come.”
Her last breath was after the second bar of the song. I looked at the clock. 10:33pm. I opened the door and called for a nurse. My father awoke. Not realizing she had passed, he attempted to lovingly remove the rings from her swollen fingers. “It is finished. She’s not here anymore.” My heart broke twice. Once for me and again for him.
If only I had a doula to help with everything else that came; telling family, making arrangements, preparing to pick up her ashes, and each day since.
I’ve come to realize that a mother is a doula; unbiased, compassionate emotional and physical support, always there for you. And in my mother’s last moment, I was hers.
My dearest mother,
You gave me life, but let me mold it. You’ve shown light on the path, but let me walk it. Though I stumble and fall, you have not thought me weak. Instead, you’ve lent me a hand and dusted me off so I might stand tall. And though you are no longer by my side, I know you are ahead, paving the path for every stride.
I love you with every beat of my heart.
The Most Important Tool of a Doula
When doulas meet with the expecting families they will potentially support, one of the main questions often posed is, “what tools do you bring with you to the hospital and which are most important?”
Over the years, my answer has changed. From tennis ball to Rebozo, to my hands, to my unquenchable desire for knowledge and skills…
But today I undoubtedly recognize a doula’s most important tool is her time.
The most invaluable asset any professional can provide you is the ability and desire to afford you the time to be listened to, care, and share! Every crevice of a maternity professional’s brain is archived with valuable data files to educate on every well-kept secret alternative throughout your prenatal to postnatal care. Most U.S. Maternity care practices do not afford the medical team time to share with you! Afterall, time is money! This isn’t Care-A-Lot — this is a business, Baby Hugs.
The United States’ annual maternity-newborn cumulative cost for its 4 million births is well over a staggering 50 billion dollars and is more expensive than any other developed country.
So when you see your obstetrician or midwife for your 15 minute visit once per month, consider their average of 35-40 patients per day and you begin to see how easily costs tally and how easy it may be to blur your birth wishes with the other Carebear in 30 minutes after you, and how difficult it may be to offer explanations or alternatives or perhaps notice which of their patients may have been morose.
Doulas will meet prenatally, spending an average of 1 – 2 hours per a visit and offer unlimited phone and email support, extending that to 24/7 on-call support as you near your estimated due date and until you have your baby. Some may continue the 24/7 phone support in the first days or weeks after having your baby. They get to know you and you get to know them.
When approaching your birth, you should feel secure and be in a place of empowerment, not solely at the mercy of the momentary lapsed mind of busy care staff. A doula will enhance your maternity care and birth team, giving the time and support you may need for you and your partner to find that empowerment.
Time is precious; It is a resource which is perishable. Use it wisely!
Interested in doula support? I'd love to help! Contact me here.
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