It’s becoming more common for pregnant women and their partners to enlist the labor support services of a doula.  Many women seeking a natural childbirth believe that the emotional and physical support of a doula is crucial in the hospital setting, due to research suggesting that women with continuous support during labor are more likely to refuse unwanted medical interventions, successfully manage pain, and avoid postpartum depression.

Women with first-time pregnancies who are planning a midwife-assisted homebirth often ask whether it is worth having a doula.  Having had two homebirths, my answer to this is yes.  Here’s why:

1)  You may end up in the hospital anyway.

Sorry to start off with such a downer, but a small minority of planned, midwife-attended homebirths do end with hospital transfers.  If you decide that you want a transfer to obtain pain medication, the doula will be able to provide emotional support and assist you in enforcing the outer limits of the interventions you feel are appropriate.  In the emergency transfer scenario, a doula is someone who can think objectively, keep you calm, and explain what’s going on in language you can understand (it’s amazing how a woman in the throes of labor can misinterpret verbal and visual cues).

2)  Your doula is the only person who can devote her time exclusively to YOU during labor.

Some first-time moms make the mistake of believing that her midwife will have the time and resources to provide labor support.  However, the midwife’s role is to monitor your progress and see that your baby is born safely.  While the most competent and compassionate midwives do care greatly about your comfort and well-being, there is simply no substitute for continuous, focused support from a person whose sole function is to “mother the mother.”  For similar reasons, the mother’s partner is also not an ideal source of support, and this is where I disagree with the Bradley method’s principle of “husband-coached” childbirth:  some co-parents are EXCELLENT at providing labor support, but even the best of them do not typically have the equivalent of a certified doula’s professional training and field experience.  Ultimately, the father or other co-parent will be excited, emotional, and a bit nervous (ok, a LOT nervous) at the prospect of becoming a parent, whether for the first time or fifth time.  A doula can more objectively focus on the woman in labor.  Make no mistake: your partner’s supportive presence can make a world of difference in how you experience pain and in your feelings on the birth in general, as with a doula.  However, support from a partner alone simply may not be enough for the both of you, which leads me to the next point …

3)  Your doula can support your partner too.

Guess who else is having a baby?  Ok, I’ll admit it, if my husband had exclaimed something like “we’re having a baby!!!” during the worst of my contractions, I would have somehow mustered up the strength to lunge at him while screaming “NO YOU IDIOT, I AM HAVING THIS BABY, NOT YOU!!!!!”  Fortunately he’s smarter than that — but the sentiment is there nonetheless.  During my first birth, a posterior positioning with a prolonged period of excruciating back labor, my husband began to silently freak out and question his own ability to support me.  Our doula was able to pull him aside and just say, “how are you holding up?”  This allowed him to vent, process what he was feeling (guess what would have happened if he had approached me to “process” anything at that time?), and feel renewed in his resolve to support me until the baby came.  I will always be thankful for the emotional support she gave him, which ultimately helped me as well.

4)  Homebirth allows you to enjoy the comfort and familiarity of home during labor — but not completely.

A woman in labor, especially when she hits transition, is in a very vulnerable state and may require assistance with even the most mundane of tasks — like going pee.  I kept forgetting to urinate during my last labor.  When the contractions were some of their worst, I was stuck lying on my stomach on the bed, and every time I tried to get up to go to the bathroom, another contraction would start and I would flop back helplessly on the bed.  At one point I said that I would just not pee, or go on the bed if I needed to.  My doula convinced me to get to the toilet, and then had to assist me during a contraction on the bathroom floor, and then with finding a position to sit comfortably on the toilet.  Yes, there is more than one way you can do it — straddling it backwards, standing up, etc. — whatever it takes to feel comfortable and confident in case a contraction hits, um, mid-stream.  Finally, I needed our doula to help me rip off the toilet paper so I could wipe myself.  It’s amazing how something like an unstarted toilet paper roll — you know, where the first piece is kind of stuck to the roll itself so that it doesn’t unravel in the package — can become a huge obstacle during labor.

So don’t think that just because you’re in a comfortable, familiar environment for your birth, it means you will have an easy labor experience without any outside support.

5)  Your doula may need to catch the baby when the midwife doesn’t show up in time.

This happened to me about 3 weeks ago, when our new cutie Aurelia was born.  My first labor was torturously long, so I had no frame of reference for having a relatively textbook 14-hour labor.  We should have called our midwife earlier, but we didn’t.  So when I got in the tub for what I thought would be another hour or so of the first stage of labor, I was shocked when I felt the urge to push and realized this kid was coming NOW.

Our midwife was only about a half hour away, and she would have made it in time for Aurelia’s birth if she hadn’t been pulled over just down the street from our house.  She was only speeding down a major road, running red lights, and talking to us on her cell phone, all at 1:40 in the morning … gee, I wonder why she was pulled over?  I had a few choice words for the police officer, who could hear me cursing over the speakerphone while my kid’s head was crowning.  Well, anyway, my point is, our doula suddenly became the most qualified person in the room to deliver the baby, and my husband and I would have been thoroughly freaked if she hadn’t been there.

Keep in mind that under normal circumstances, doulas are NOT a substitute for a properly trained midwife.  However, having witnessed numerous births in a variety of settings, our doula was confident enough to calmly observe what was going on and follow the instructions of our midwife over the phone.  Two minutes after our baby was placed on my chest, our midwife walked in the door.  We’re forever grateful to our doula for helping us bring Aurelia into the world!

A final note:  I’m not saying that you need to shell out a few hundred dollars for a professional doula, if you can secure competent labor support from a friend or family member.  However, this person should not assume that her sole function is to say “great job!” and bring you a sip of water once in a while (although those are very nice things to do for the laboring woman).  The person charged with the duty of labor assistant should know that his or her job is to understand the woman’s wishes, repeat and reinforce them when appropriate, serve as a coach during contractions and in between them (“Hey, it’s time to go pee now while you can!”), and ANTICIPATE the woman’s stated as well as unstated needs, rather than simply react to whatever needs she happens to articulate from time to time.  This kind of support is ideal for both the hospital and home settings, and expecting parents should take the time to seek out this support well before the birth.

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