At least once a day new friends and strangers ask me,
“So what does a doula do anyway?”
I do my best to answer with the most concise elevator speech I can manage.
“A doula provides continuous physical and emotional support to a laboring person and their partner. They facilitate communication between the care provider and client, promote evidence-based resources and choices, and create a safe and loving pregnancy and birth environment for their clients. I like to think of it as your best friend who also happens to know a whole lot about childbirth and will always respect and support your choices.”
While the above statement is completely true, I think of my work as so much more than that. Sometimes when I give my elevator speech to people I actually want to shout,
“BUT IT’S SO MUCH MORE THAN THAT!!!!”
This is also a big reason why I offer free consultations. Everyone is different and a doula molds and shifts to your needs and wishes to help you have the most positive birth outcome. I am here to help you figure out what that might mean for you and your partner.
I thought that a great way to describe what a doula does is to go through a typical ‘Labor Day’ as a doula. This, of course, is a fictional description of someone’s labor day. It is comprised of my extensive birth support experience of what is common of a typical full-term, unmedicated, vaginal delivery at a hospital. This is not the support case for everyone and definitely not how every birth I attend goes but it is a great insight into what doula support might look like in this case.
Doula Diaries: Nadia and Jim
So we will call this Birthing Person Nadia and her Partner’s name is Jim. They have expressed wishes for an unmedicated vaginal birth in the hospital. This is their second baby. Their first was born vaginally 3 years ago and is named Poppy. During our prenatal appointments we have discussed their birth wishes and preferences, practiced comfort measures, and done evidence based research to support choices or answer any questions they might have as pregnancy goes on.
Nadia has reached her 41st week and is beginning to feel some contractions every 15 minutes or so. She calls me and tells me of the sensation. I talk to her on the phone and listen through a contraction, using guided imagery to slow her breath and help her to relax. I encourage her to go about her day-to-day activities as much as she can. She loves walking around the mall with her mom so she makes that a plan and promises to keep me updated, drink water, and eat fulfilling meals. I begin to prepare my doula bag, eat something healthy, and update my childcare and back-up doulas so that they are prepared for the upcoming birth.
Nadia calls me with an update that her contractions are getting closer together – every 7-8 minutes – and they are feeling more intense but definitely manageable and that she does not need me there yet. Labor feels REAL. Now that Jim is home, I encourage him to work on the comfort measures we talked about. I remind them both that this is a great time to bond with one another, to be intimate (in whatever form that takes) and foster that love connection while it is just the two of them. Nadia’s mother takes Poppy to her house for a play date so that Nadia and Jim can be alone.
Jim calls and says that Nadia’s contractions are 5-6 minutes apart and she is starting to work hard through each of them. Nadia and Jim are ready for me to come over. I encourage Nadia to try to go potty while Jim refills her water and then get into the bathtub and get comfortable while I head over.
Once I arrive, I find Nadia in the tub relaxing in the warmth. I find her playlist she created on Spotify and turn it on so she can relax to the music. I set up some LED Candles and turn off the lights. I put a big towel over her exposed skin and begin pouring water over her to keep her warm and relaxed. I know that she wants Poppy to come see her during labor so I suggest to Jim that he call the Midwife to update her on the contraction patterns while I call Nadia’s mom to ask them if they can come over now that she relaxed into labor. Nadia’s Midwife suggests, since they are close to the hospital, that she labor until 2-3 minutes apart before heading in. After every contraction I offer her some water.
Contractions are now 3-4 minutes apart and I have been squeezing Nadia’s hips in the tub while Jim strokes her hair and repeats the words of encouragement they have written together. Nadia is focused and calm through each contraction. Poppy has come in to give her kisses and has left to go get ready for bed with Nadia’s mom. I encourage her to relax her jaw and make whatever sounds are comfortable for her, I even chime in to help her feel more comfortable. I gently help her to sway her hips to the music from her playlist. She expresses that she is ready to go to the hospital and I help her to get out of the tub and change into her laboring nightgown, slippers and a sweater while Jim gets the car ready to go. Nadia’s mom comes to kiss her and says she will come to the hospital as soon as she can with Poppy. On the way to the hospital, I call ahead to labor and delivery and inform them that we are on our way in active labor and to alert Nadia’s midwife. They know to expect us and have a room ready so that Nadia can skip over being stuck in triage for another hour without a room.
While Nadia is answering questions in Labor and Delivery, I am putting away her things, spraying her room with a Lavender Spray she likes, covering the clocks, putting the LED Candles up, dimming the lights and screens, turning down the monitor volume, upping her music, giving the nurse her birth plan and introducing myself, and getting her water and comfy pillows close to her. Her contractions during this time are met with hip squeezes from me and loving caresses from Jim. Her Midwife arrives and she gets a cervical check – 7cm, 0 station.
During the excitement of the hospital trip, Nadia’s contractions have spaced out to 5 minutes apart and is having a hard time getting back into the labor zone. I suggest moving to the shower, but she does not want to move because she is in pain (her words). We get her onto her birthing ball so she can be upright and I wrap a Rebozo around her head, covering her eyes and ears. Jim places his hands on her hips and assists her in rocking side to side. I guide her through imagery of facing the ocean with the waves rushing over her feet and rocking her side to side. We stay like this through a couple of contractions. Everything gets very quiet in the room.
Nadia begins grunting and quietly says, “I have to poop. The baby is coming.” I call the nurse and let her know that she is feeling the urge to push. The nurse comes in and we both get Nadia up so that she can do a cervical exam. Nadia is fully dilated and ready to push the baby out. I remind the nurse that Nadia’s preference is to push unassisted in a quiet space so that we can all be respectful of that. The nurse is excited for Nadia and goes to get the Midwife and delivery team ready for the birth.
There is excitement all around as the L&D Team fills the room. Lights come on, there is a lot of movement, and the energy has shifted away from the peaceful anticipation. My focus is on Nadia and I help her get into her most comfortable position for pushing. I cannot control the room, but I can be there for her. I remind Jim to focus on her and be her support, and I lean in to Nadia and whisper in her ear, “Just stay focused on your baby and Jim’s voice. Nothing else here matters. You are incredible, let’s breathe slowly together.” We start breathing through the pushes all together. Within a few minutes, the baby is born and is immediately placed on Nadia’s chest.
As per my client’s request, I take as many photos on my phone as I can to capture the moment. I also ask Jim and Nadia if Delayed Cord Clamping was something that they still wanted to do and, if so, to remind their midwife. I congratulate my client and help to facilitate their post-birth wishes.
Once everything has calmed down in the room, I dim the lights again and make sure they are comfortable. I encourage them to rest and bond in this first hour. I plan to leave for a bit to give them space and ask if there is anything they would like to eat. I take their food orders and begin moving all of their things to their new postpartum room, setting it up so it is ready for them when they transfer. I pick up food and upon my arrival back in the room, I help Nadia to facilitate a good breastfeeding latch.
Once everyone is comfortable and in their new postpartum room, I congratulate my clients, pack my bag, and thank the nurses on my way out. We will have a phone call in the next day, a gift drop off of herbal baths and lactation cookies when they arrive home, and a postnatal visit to walk through their birth and provide any resources they might need.
But it never has to end there. My clients and I usually remain friends. We connect through social media and text with check-ins and questions. I stay a support for this postpartum period, making sure they don’t feel that they are alone.