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​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!
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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.
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​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.

​As birth doulas, we see women do amazing things. They struggle, they wonder, they bond, they nourish, they comfort, they love fiercely. The birth with all the power of humanity and in these moments they are vulnerable. They are scared, they are excited, tired, and raw.

Birth reveals much about us to ourselves and to those around us. As a doula, I’ve watched the power of the mind/body connection become more real and tangible than in any other area of the human experience.

The body responds in profound and sensitive ways to stress, thoughts, stimulation, and suggestion. In many cases, whatever a woman thinks about for her birth is exactly what happens. This sounds like it’s in stark contrast to the line that says “things never turn out how we plan”, but there is a difference between a plan and a thought process. So here is what I’ve learned about the mind/body connection in birth work.

Women need to be deliberate in choosing their thoughts for their birth. If they fixate on their fear, that fear will most certainly manifest itself. Fears are real and should be validated, but not given the benefit of too much consideration. For example, if a woman fears that her water will break and contractions will not start on their own, the body interprets this thought process as an instruction. Practicing mindfulness or meditation can go a long way toward honing the ability to be deliberate about thoughts.

The words that a care provider chooses to use during pregnancy and labor have a profound effect on a woman. The phrases “You are only at 4 cm” and “you’ve progressed all the way to 4 cm” convey the same clinical information: cervical dilation to 4 cm. But they communicate profoundly different messages that will be interpreted by women differently. One tells a woman that her body is essentially defective. The other communicates capability. When a woman thinks she is defective, her body may respond to this as stress, which fights with oxytocin. When she is given confidence, her body opens up to its capabilities.

Women should speak what they want for their birth. Affirmations work. Again, the body receives them as instructions and blueprints rather than formless thoughts or whims. Choose your words carefully because both your body and your mind are receiving them.

Women should communicate to those around her that she doesn’t care to hear all the bad stories. Birth stories are like war stories. The worse they are, the more we want to tell them. As soon as someone starts with “well when I had mine….” and you know where the story is going, it’s ok to politely stop the person talking, and ask them to refrain from telling negative stories.


Doulas have seen women dream that their baby has a shoulder dystocia and it happened.

We have seen women say they knew they were going to “need” Pitocin – and they did.

We have seen women say, during their whole pregnancy, “I’m going to show up at the hospital pushing” and they barely make it to the delivery room.

Doulas have stories to tell of women who spoke absolutely everything that ended up happening in their birth, down to the finest detail – both good and bad.
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We know of women who desperately did not want a hospital birth, but felt they had no choice, yet they dreamed of delivering at home. Those births happened so fast that moms barely even had a chance to get out the front door.


You get what you speak. You get what you think. And you get what you fixate on. Print some affirmations and say them to yourself every day. You may be surprised to find just how much your mind influences your body.

​​There is not a single parent that, during a pregnancy, plans on having to deal with preterm labor. While it’s true that pregnant women should not obsess about it to the point of worry, all pregnant women should be aware of the signs to watch for. So for the sake of gathering information, we are going to discuss the basics of preterm labor in this post.

​Clinically, a pregnant woman is considered to be full term at 37 weeks. It’s important to note, however, that clinical definitions do not reflect the actual readiness for life outside the womb for every baby. When allowed to gestate until they are ready, most babies will go to 40 weeks and beyond, and waiting until they are ready is safest for baby. But sometimes babies will come on their own from 37 weeks on, and those who do tend to need very little medical attention. Because the definition of a term pregnancy is considered 37 weeks, a labor that starts anytime before 37 weeks is called “preterm.” Any kind of labor is defined by contractions that cause the cervix to change. Many women experience contractions before they reach 37 weeks, but if they do not cause the cervix to change, it is not considered to technically be preterm labor.

​In short, nobody knows. There are a number of things that can contribute to a woman’s preterm labor, but each situation is different. For the most part, modern medicine does not fully understand all the mechanisms contributing to preterm labor. Because they do not understand it, they do not have all the appropriate the tools to treat it.

​The signs to watch for in preterm labor are the exact signs of regular labor. The only difference is that they take place before 37 weeks gestation. Do not hesitate to go to the hospital if you think you suspect preterm labor. The earlier it is caught and diagnosed, the easier it is to manage and stop. There are many signs of labor, but the primary sign to watch for is contractions that are getting stronger, longer, and closer together. In any kind of labor, you may feel a bit nauseated, lose the mucous plug, and your bowels may empty. If your water breaks, you are definitely in preterm labor and you should go to the hospital right away.

​When you arrive at the hospital in preterm labor, you will first be sent to triage for assessment and monitoring. This is the same as if you were having a full term labor. The triage nurse will notify your care provider (doctor or midwife) of the situation. Your care provider will then give care orders to the nursing staff and they usually manage the majority of your care.
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Depending on the intensity of your contractions, the staff may choose to simply monitor you and your baby to see if labor progresses. They will be watching for the cervical change. If labor does not progress and it appears that you are only experiencing minor contractions, you will likely be sent home with instructions to rest and hydrate. However, if your cervix is changing with your contractions, you will probably be given a medication to manage the situation, depending on the severity.

​If you are diagnosed with preterm labor, the hospital will want to act quickly to attempt to stop your labor and there are a variety of medications they may want to use.

If they need to slow your contractions, they may choose to give you a classification of medication called a tocolytic. This is a medication that causes muscles to relax. Since the uterus is a muscle, it often times responds to this medication. This classification of medicine usually lasts several hours, so your nurse will monitor you until the effects wear off. They will want to see if labor starts up again on its own without medicine. For many women, a single tocolytic shot is all that is needed to stop a preterm labor.

However, if labor picks up again after the shot has been given, labor is indeed starting and there is not much they can do to stop it. Depending on how far along you are in your pregnancy, they may decide to give you another dose of tocolytic. If they opt to do this, they are trying to buy you as much time as possible. (The long term use of tocolytics is generally not recommended, except in very early pregnancies where the birth would be extremely dangerous.) If your pregnancy is further along and the first tocolytic dose does not work, your provider will likely allow labor to continue to progress on its own, and they will manage it like a regular labor.

In some cases, a mother can be given a steroid shot which will encourage the baby’s lungs to develop faster. After giving the shot, they will wait as long as possible to get the baby out; sometimes they will wait days, sometimes weeks, depending on the situation.

If your waters are broken and your provider wants to give the baby as much time as possible to develop in utero, sometimes they will give you antibiotics to prevent infections from developing. As long as there is no infection, chances are baby can still stay in utero and develop a while longer.
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Modern medical advances have been lifesaving for many babies and mothers experiencing preterm labor. Many preterm labors can be safely managed, and fortunately many very early babies can be saved. It is never optimal to have a baby before they indicate that they reach full development, but most of the time it is manageable. The most beneficial thing that moms can do during pregnancy is to take good care of themselves and their health to the best of their abilities. Then, love on those babies whenever they arrive.

​We are on to part 3 of our Hypnosis for Birth series! In case you missed it, check out part 1, where we detail what hypnosis really is. In part 2, we talked about the benefits associated with using hypnosis for birth. And today in part 3, we are going to talk about the crux of using hypnosis for birth: How to use hypnosis for labor and birthing.


In short, the message is that the words that you use when you speak about pregnancy and birth have a tremendous impact on your birth outcome.


We often take for granted the power of words in our modern world. Particularly with the invention of texting, communication has been reduced to rudimentary acronyms for blurbs that we wish to communicate on a whim. It’s a shame because language matters a great deal!


And in birth, language is how we communicate with our subconscious and with our bodies to accomplish the greatest and most heroic feat of all mankind: bringing forth life.


So, what kind of language is used in our culture today to discuss birth? Grab any book off the bookstore shelf for expectant mothers today, and what kinds of terms will you find?

• Cervix
• Uterus
• Dilation
• Effacement
• Contraction
• Fetus
• Pain

What do these all have in common? These are medical terms. Yes, they are anatomically correct. But they are all somewhat detached from the human element and they are medical and physical in nature. For the purposes of medical study and physiological understanding, these are fine.


But from within, as a birthing woman, birth is about so much more than simply the sum of interrelated anatomical parts and their respective roles.


What effect does it have on our psyches to refer to a perfectly normal and healthy process that involves the mind, body, and spirit, using only its anatomical and functional terms?


We come to see ourselves as only a function of medicine, and we therefore think we are dependent upon it in order to birth.


And our subconscious mind comes to see medicine as necessary for healthy birthing.


While it’s absolutely true that medicine has a place in rare complications, it is not a requirement for birthing to be healthy or safe in most situations. In fact, evidence supports physiological birth as the safest option for both moms and babies.


Consider this. Every other branch of medicine has common, everyday terms for organs as well as their processes. For instance, you wouldn’t tell your friends that you had a myocardial infarction. You would say you had a heart attack. Similarly, you wouldn’t say that you had pyrosis. You would say you had heartburn.


Why is it that we do the opposite in birth? A woman is not a vagina who births a fetus. She is a whole human being whose mind, experiences and spirit are all in this birthing experience together! And the words that we use to communicate everything about the experience impact all of those parts of her.


So, how can we change our language in birth to better reflect and communicate with our minds and bodies?


Take a step back – and examine the language we’re using to communicate with our subconscious mind.


Rather than saying “I am dilating,” use the phrase “I am opening.”
Rather than saying “I am effacing,” use the phrase “I am softening.”
Rather than saying “My baby is at a zero station,” use the phrase “My baby is moving down.”


It’s a pretty big difference!


The word “contraction” is one in particular that is neither accurate nor useful. Because you see, the uterus is not actually contracting! The uterus and cervix are not, in fact, two separate organs – they are one organ doing several separate and distinct jobs!  The word contraction means to tense up and to make hard. During a “contraction,” the uterus and cervix are actually doing the opposite! They are pushing, softening, opening, and moving the baby!


Furthermore, a “contraction” involves more than just the work of the uterus and cervix. A “contraction” demands the entirety of a woman including her mind, the movement of her body, and the willingness to surrender to a process that feels bigger than herself.


In hypnobirthing, the term “contraction” has been replaced by the term “surge.” So rather than saying “I’m having a contraction,” use the phrase “I feel a surge building.” The term “surge” more accurately captures what is happening within a woman – both mentally and physically.


In addition to the types of words that we use, the way they are communicated has a huge impact. For instance, imagine the way a woman would experience these two phrases from her provider:


“You’re only 6 cm.”


Versus:


“You’re doing great and you’re at 6 cm!”


One plants a seed of defeat, the other of encouragement. The facts remain the same. But the language used to communicate those facts portray opposing mindsets.


Which one do you feel would be more productive for a laboring woman?


I can speak from experience as a doula, as can thousands of other doulas and midwives, that what a woman thinks about in her pregnancy is nearly almost always exactly what she gets for her birth. For instance, say a woman decides she wants to have a natural birth, but she keeps thinking she’s going to need an epidural. What ends up happening? She has an epidural.


What was she thinking about while she was preparing for her birth? The epidural.


Now hear me: This is NOT to say that epidurals are bad. It’s only to illustrate that what your mind fixates on is ultimately what leads to your experience. What you think about is what you are unintentionally telling your body to do.


So, what are you thinking about as you prepare for birth? Are you thinking about what you DON’T want? Or are you thinking about what you DO want? Are you visualizing your cervix opening, your baby moving down easily, your being in control of your surges, and holding your baby in your arms after it’s all done?


Or are you staring down your impending labor with a terrified longing?


Because what you fixate your mind on and the messages you give it will ultimately determine the way your birth plays out. The subconscious mind does not judge what we give it. It only receives and acts accordingly.


So how do you train your subconscious mind to be ready for birthing?


Practice visualization. This gives your mind the exact messages you WANT it to have as you prepare. Visualize your cervix softening and opening easily, your surrendering to the process of birth, and your surges peaking and subsiding. Visualize and practice deep belly breathing every day during the entirety of your pregnancy so that your mind and body are already practiced in the art of relaxation.


Use intentional language that creates a positive expectation for your birth. “I’m terrified to give birth” is the general feeling in our world today. “I’m confident in my body’s ability to birth” is much more productive.


In conclusion, simply being aware of the language and messages that you are taking in during your pregnancy can go a long way toward creating a healthier and more satisfying birthing experience for both you and your baby.


Happy birthing!

How Can Hypnosis Help You In Labor?Of the most popular birthing approaches today, hypnosis is gaining ground as an effective tool to use during labor. While anyone can use general hypnosis, the method that teaches how to use it in labor is called Hypnobirthing. I am not a hypnobirthing instructor, but as a doula I have worked with women who have used it in labor and found it helpful.

In my last post on hypnosis for birth, I described the foundational psychology behind hypnosis. Before reading on, I encourage you to take a look at it! You can read it here.

So, how can we utilize this tool in labor?Well, to start with, consider this: a woman is already experiencing a type of hypnosis in active labor anyways – without even trying to be!

You see, when a woman starts active labor, her thinking brain shuts off and the primal brain takes over. It’s one of the ways that birth professionals can identify that a woman is in labor: can she answer a basic question? If the answer is no, or if it takes considerable effort for her to do so, she’s likely in active labor.

Her mind is already in a sort of hypnosis – it’s deeply relaxed and the subconscious is at the forefront.

How do I mean?

Hypnosis is essentially just a mental state of being. In hypnosis, your mind is deeply relaxed, and your subconscious mind is especially vulnerable to suggestion. This is exactly what is happening in labor as many women can attest!

Women who have experienced natural labor report that labor feels very mentally hazy – like a fog of sorts. They have no concept of time, they cannot hold a conversation, and they don’t know what they want. As soon as they start pushing, the fog lifts a little bit and they can converse and engage a little better. Then, as soon as the baby is born, it’s all over and instantly they are back to being themselves.

A woman’s subconscious mind is highly receptive during labor. In a very real way, intentional language and messages can go a long way toward sustaining a labor. The body responds to the mind – and the messages that we give it truly matter. The impact that these messages have is heightened when in hypnosis and deep focus.

A woman can give her mind specific messages about labor that help her with the entire process. We call these affirmations.For example:

• I am strong

• I am powerful

• My body was made for this

• I can do this

• I AM doing this

• I can’t wait to meet my baby

• I can do anything for a time

• My labor will be fast and easy

• I trust in the birthing process

And these messages can carry a mother through her labor.

The big question most mothers have is: Will it help with the pain of labor?

Well, it certainly can. I’ve seen it be a great tool for this use. However, it’s important to note that a mother should never feel that she has somehow “failed” if she prepares to have a pain free birth through hypnosis and ends up feeling the intensity of her contractions.

That said, does hypnosis help a great number of women with pain management? 

Absolutely.

Hypnosis for labor is most effective if a mother has been practicing its use as long as possible during her pregnancy. She can intentionally give her mind the message that birth is safe, normal, and attainable. As she practices saying affirmations,listening to relaxation scripts, learning to intentionally read her body for areas of tension, and visualizing her birth, she prepares her mind and body to relax in the same way during labor.

Furthermore, it’s entirely risk-free. Hypnosis in birth is simply strengthening, taking advantage of, and honing in on a natural process that is already in place during labor: deep focused relaxation. There are no risks associated with that!
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In order for hypnosis to be truly effective in labor, the choice of one’s words matters quite a bit. We will cover that in our next installment on hypnosis for birth. ​

​Home Birth vs Hospital Birth

Please note: This post is not meant to sway clients one way or the other in terms of their childbirth choices. As a doula, I support women no matter what they choose. I simply wish to shine some light on some observations I’ve noted about the various options that women have for their births.

Each woman is different, and each birth is different. Most of the births I have attended have been in hospitals. I’ve worked with some incredible hospital births. Most go swimmingly, and I’ve seen women have wonderfully empowering experiences there.

On the other hand, I’ve been a firsthand witness to the effects of interventions. Most of the time, medical birth interventions, despite their legitimate risks, are overall safe and usually well managed.  

However, I’ve seen the effects of invisible passive interventions as well. The clock is a perfect example of a passive intervention, and its effects are very real.

“Textbook birth” happens in one place, and one place only: the textbook. The range of “normal” in everything related to birth is vast, yet most hospitals tend to confine “normal” down to a rather narrow window. Women tend to be “allowed” to labor for “X” number of hours, they can push for another “X” number of hours, and the placenta must come within another “X” amount of time.

I see something very different in home births.

Homebirth midwives respect the birth process too much to restrict it down to a fixed series of allowable proceedings. They understand that the body can start and stop labor, that some phases can go unusually quickly and others can take longer. Midwives do not define labor by a set “allowable” time since their practice is not governed by a hospital’s rigid status. As long as the mom and baby are both doing well, labor is respected and permitted to take its course. When a stage of labor takes longer than normal, midwives carefully watch, listen, monitor medical safety, and let the birth proceed as usual.
Which begs the question: how does the hospital differ? What do they do when labor doesn’t always go according to the allowable textbook timeframe?  In my experience, most normal, healthy women are given a myriad of interventions to force the process along, and many ends up in the OR with a cesarean. They often refer to the Friedman’s Curve as a guideline to call an “arrest in labor” and a need for a cesarean. I do see differences between hospital to the hospital due to policy and provider to provider due to their experiences, but for the most part, cesarean for Failure to Progress according to the textbook definition of the Friedman’s curve is really happening and many times unnecessary.

Birth interventions are known to increase the risk of cesarean so this is not surprising. However, it can be devastating to women who truly wanted to experience birth, or who were frightened of having a cesarean.

I talk to a lot of women that want to hire a doula so that they can avoid the operating room – they want to avoid having a cesarean. Doulas absolutely do reduce the incidence of cesarean for many reasons. However, my encouragement for women that truly desire to impede the risk of cesarean is to carefully consider your provider. Hospitals are wonderful places for the most part. But one cannot accurately predict exactly what their birth is going to look like beforehand. If your desire is to avoid the OR, perhaps it’s time to consider other options.

The hospital is not your only option. It can certainly be a good option, but it is not your only one. A new study on home birth safety concluded childbirth at home with midwives in the US to be a safe option for low-risk pregnancies. I encourage you to consider exploring all of the available options during your pregnancy. You can always switch your provider – up until the moment you go into labor! Read Care Providers in Pregnancy to learn more about the difference in providers. If you are considering home birth, contact me for some great referrals and care in Massachusetts!
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I support you no matter what you choose – just make sure that the choice you make is for sure the right one for you.

​The discussion about Pitocin use after the birth of your baby is based around Expectant vs Active Management.

Active management means actively participating in the process of birthing your placenta. Many providers routinely administer Pitocin immediately after birth via IV drip or an intramuscular shot.

After the birth of your baby, your uterus will take a brief rest and then continue to contract to help deliver your placenta. On average, this process can take up to an hour after birth. I have found some providers will not, or perhaps do not have the time to patiently wait for a woman’s body to naturally release and deliver the placenta. They will use Pitocin and sometimes additionally use cord traction (light tugging on umbilical cord) to facilitate the birth of the placenta.

Active management means actively participating in the process of birthing your placenta. Many providers routinely administer Pitocin immediately after birth via IV drip or an intramuscular shot.

After the birth of your baby, your uterus will take a brief rest and then continue to contract to help deliver your placenta. On average, this process can take up to an hour after birth. I have found some providers will not, or perhaps do not have the time to patiently wait for a woman’s body to naturally release and deliver the placenta. They will use Pitocin and sometimes additionally use cord traction (light tugging on umbilical cord) to facilitate the birth of the placenta.

However, there are times the placenta will indeed need assistance to be birthed and Pitocin is medically necessary including when bleeding is excessive or when the placenta is being retained by the uterus.

Expectant management would mean belief in your body’s ability to expel your placenta, and so, the provider anticipates you to feel cramping contractions which will release the placenta. Your provider would look for signs such as the umbilical cord becoming limp or a small amount of separation blood and would then instruct you to attempt to push your placenta out of the birth canal.

After the placenta is birthed, it is your uterus’ job to contract and involute – retracting itself to a more pre-baby size. After long labors, it is possible for the uterus to become tired and go on strike! A shot of Pitocin would help your placenta find the motivation to contract, slowing bleeding more quickly.
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Pitocin for labor isn’t always great, but Pitocin after isn’t quite the same. Not every woman will need Pitocin after birth and even if it is the policy of a hospital or provider, it is your right to choose to decline now and still accept at delivery if medically necessary.

All of the literature available to pregnant women today encourages them to “talk to your doctor or midwife.” This is sound advice. A good relationship with a well-matched, compatible care provider is of utmost importance in your pregnancy and birth. Yet the fluidity of those terms being used together can give the impression that the two are one and the same. It seems to suggest that your care will be only slightly different with a midwife than it would be with a doctor.

The reality is much different. Doctors and midwives approach pregnancy, labor, and birth from two profoundly different foundations of training. When it comes to the actual labor and birth, their training drives their decision making, and the approaches they take could not be more different.

Doctors tend to practice what is known as “active management” of labor and midwives mostly practice “expectant management” of labor. Of course there are exceptions, but by and large, this is what you will find in your doctor or midwife. Your choice of care provider matters more than you may think – and it’s worth it to understand the difference between the two approaches before hiring a doctor or midwife.

“Active Management of Labor” was invented in Dublin during the 70’s. It was the first method used to define labor, determine what is “normal” for clinical purposes, and establish protocols to keep women’s labors within its defined set of “normal.” Active management of labor protocols was not based on evidence, yet they were fully embraced as such without question. Active management of labor made its way to the United States soon after it was invented in Dublin.

According to Midwifery Today: The basic [abbreviated] principles are: diagnosis of labor based either on painful contractions and complete cervical effacement or broken water; one hour after admission, progress is assessed and amniotomy (water broken) performed; cervical dilation must advance by at least 1 cm per hour or oxytocin is started and increased until mother has 5-7 contractions every 15 mins; maximum labor length is 12 hours; a midwife stays with each woman throughout labor; the midwives manage labor, senior staff consults; induction is rare; pain medication is available but discouraged.

Unfortunately, the only pieces of the program that survived the Atlantic crossing (from Dublin) were routine amniotomy (breaking the water), the liberal use of oxytocin, and the time limit on labor. Other parts–the continuous support of an experienced woman, that residents did not make decisions, the minimal use of epidurals (5%), the minimal use of induction (<10%), not using painful contractions as the sole diagnosis of labor–did not make it…. Moreover, the Dublin doctors expected women to give birth vaginally….

In short, active management of labor is committed to the defined process, and to keep a woman’s labor on track with the arbitrary definition of “normal”. It does not allow for the many variations of normal in labor, and the goal is for a woman to have her baby within a certain time frame, whatever the cost.

Expectant management of labor, by contrast, is the approach that midwives tend to take. In this approach, the attendant sees birth as a normal and uncomplicated process that only requires intervention in a small number of cases. In contrast to the active management approach, a midwife sees normal birth with a wide range of variation. Birth does not need to be confined to a set standard, especially so long as the mom and baby are both doing ok.

An expectant management approach can also be called the “wait and see” approach. Rather than jumping on the use of interventions right away, a care provider who practices expectant management may take a step back and allow the birth process to unfold the way it needs to, provided that safety is of utmost importance.

To demonstrate the difference between active management and expectant management, imagine a woman is in labor and the labor slows down. By definition of the active management approach, the woman’s labor is now “stalled” and requires synthetic oxytocin in order to stay on track per the definition of labor. She is given intravenous Pitocin, her cervix is checked every hour to ensure “proper” progress, and she has now become a high-risk case due to the use of medication. Furthermore, she has now started what can quickly become the snowball of interventions.

An expectant management provider, however, would see a slowed labor through a different lens. She may see it as the laboring body giving mom a rest. She may see that the labor has, up until this point, been working on positioning the baby properly, and she may just leave well alone. She approaches it from a respect for the birthing process rather than seeing or feeling the need to make the labor conform to a pre-set idea.

Not all care providers are the same, and certainly, there are going to be doctors with a more expectant approach and midwives with a more active approach. Active management of labor has been the standard used and taught to doctors and hospitals for so long that creating change toward a more expectant approach is slow, but change is fortunately happening.
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Until then, make sure you know you are hiring the right provider for you. Interview them thoroughly. Understand the differences between the two approaches, and carefully decide which is right for you. Your choice of care provider is a crucial one, and as a doula, I’m always willing to help match you up with a provider whose values align with yours, whether that be expectant or active.

​“I’m planning to get an epidural so I don’t need a doula.”

This is unfortunately the primary thought among birthing women today, particularly those who plan to choose medication for their births. Obviously, doulas have historically done a very poor job of educating the public about the role of a professional doula. To further muddy the waters, many “doulas” that have made poor impressions on society at large about doula support. They have cheapened the meaning of the words “I’ll support you” by following it with the word “if.”


I’ll support you IF you choose not to circumcise.
I’ll support you IF you want (my definition of) a natural birth.
I’ll support you IF you labor at home as long as possible.
I’ll support you IF you decide to have a home birth.
I’ll support you IF you don’t get induced.
I’ll support you IF you don’t get an epidural.
I’ll support you IF…. You do things my way.
Not yours.


And most of the time, these “doulas” want to see only one kind of birth: an unmedicated one. They leave once their client asks for an epidural. Beware these “doulas.” That is not a doula.

That is a birth activist posing as a doula to use a woman’s birth for her own agenda. It’s no surprise that women choosing to have medication feel like they don’t need a doula. It’s as if to say that an epidural can replace everything that a doula does. But friends, an epidural is no substitute for a professional doula.

An epidural cannot meet with you during your pregnancy, spend personal time listening to your thoughts, fears, expectations, and apprehensions about your upcoming birth.

An epidural does not personally know the care providers in your area. Therefore, it cannot get to know your personal situation and make appropriate recommendations for who may be a good match for you.

An epidural cannot help you process and discuss your previous births as you prepare for another one.

An epidural is not connected with a network of birth related support professionals to provide you with extra support prenatally and postpartum.

An epidural does not have lending libraries of priceless information for you to look through as you prepare for labor, birth, and life with a new baby; it cannot know your personal situation or preferences and make recommendations accordingly.

An epidural cannot talk you through all of your birth and baby care options, help you from your birth plan, or answer questions as you put it all together.

An epidural cannot provide reassurance that your experiences and emotions in pregnancy and are normal and it cannot sympathetically encourage you to hang in there as you wait during the last few weeks.

An epidural does not go on call for you 24/7 in the last weeks of your pregnancy to answer questions, offer physical or emotional support, or help you understand what may be a confusing and inconsistent early labor phase.

An epidural can not support your labor at home before you get to the hospital, and it cannot help you decide when is a good time to go.

An epidural cannot watch you as you labor to help you understand what stage of labor you may be in, which is sometimes a general guide for when to leave for the hospital.

An epidural cannot support you as you labor until the pain medication takes effect.

An epidural can provide you with one option for effective pain control.

An epidural is not an expert in positioning during labor in such a way that the baby has the best chance of moving through the pelvis.

An epidural cannot support your partner.

An epidural cannot communicate about your labor to other family members.

An epidural cannot help you understand the medical language that may be used around you and about you as you labor.

An epidural cannot reassure you that any medication side effects you may be experiencing are completely normal. It cannot offer you options for managing those either.

An epidural cannot massage your feet, brush your hair, or gets something to drink for you and your partner.

An epidural cannot help coach you through the pushing phase.

An epidural cannot take pictures of you, your new baby, and your partner during or after the birth.

An epidural cannot help you get into a comfortable position after the birth.

An epidural cannot help your baby achieve their first latch.

An epidural cannot follow up with you days or weeks after the birth to see how you and baby are doing.

An epidural cannot provide you with ongoing postpartum support or resources.