A GREAT Doula

In hospital settings, women who choose unmedicated births are often misunderstood, under supported, and greeted with disbelief, and “hidden” sarcasm.  Hospital nurses are often ill equipped to provide the support needed to help a woman having a normal, unmedicated, non-interventionist birth.  They often don’t understand birth, have a fear of birth and have been indoctrinated into the medical model of care.

Hospitals hinder normal labor and birth with many of its routines like IV fluids, electronic fetal monitoring, and restrictions on movement, eating and drinking.  Aggressive protocols that include Pitocin and artificially breaking a woman’s water bag abound creating a VERY difficult environment for a natural, normal birth.  In spite of all of this, an unmedicated birth in a hospital setting IS possible.  Yes it can be a mountain to climb but you CAN do it with the right preparation and the right support.

As you prepare for your labor and birth experience, there are a number of things you can do to make your chances of an unmedicated birth in a hospital more likely.  Among them are choosing the right birth team.  It is IMPERATIVE, if you are planning an unmedicated birth in the hospital that you bring along with you a friend, family member, or doula. More than anyone else, for a woman who desires an unmedicated birth in a hospital, I believe the presence of a labor doula can have the most profound impact on her birthing experience.   (NOTE:  All women should have loved ones with them during labor and any one can benefit from having a doula on her birth team.  I am just focusing on hospital birth here.)

Although DONA International, the largest association of Doula’s worldwide, has a membership of 6,000 individuals here in the United States alone, many women still have never heard of doulas.  Even when a woman does know what a doula is, somehow the benefits of hiring a doula are not realized.  I am frequently surprised when I ask a pregnant woman, especially first time mothers, if they have hired a doula and they answer:   “No, I don’t think I will need one, my mother, (sister, girlfriend, husband) … will be there.”  Or “No I really didn’t want any strangers in my birth room.”

That one always makes me chuckle…  Believe ME!!!….. There will be PLENTY of strangers in and out of your room during your hospital birth experience:  various nurses, secretaries, lab technicians, OB technicians, students of various specialties, and more.  The one person who can remain constant during this time would be your doula!

While it is GREAT to have your mother,(sister, girlfriend) present for your labor and birth; and while it is fantastic if you have a partner/husband who is interested in playing an active role in your labor and delivery experience,  I cannot begin to express how important and irreplaceable a doula is, ESPECIALLY if you are planning an unmedicated birth in a hospital.  A doula, who has been hired by YOU, who is NOT an employee of the hospital, and who is committed to YOU, YOUR birth, and YOUR experience is invaluable!

I am not just talking about any doula. I am talking about a GREAT doula! One that you have met with, spoken to, and made a decision to hire based on her experience, and the energy you have between the two of you.   While a doula can be effective even if your first encounter is at the hospital in labor, she will be more effective if you have met during your prenatal period. Just as it’s important to do your research when choosing a prenatal provider/birth attendant, it is equally important that you do your research when choosing a doula.  You want to make sure that the philosophy and style of your doula match YOU and your needs.

The great thing about a doula (and this is not always the case with friends and family members) she is specially TRAINED to help you AND your spouse with the work of labor and birth. She can be your advocate and a liaison between you and your care providers.  A great doula knows how to be vocal and strong on your behalf while being gentle and mindful of your needs.

After the birth of your baby you may be amazed at how EVERYONE’s attention (including that well meaning friend and your mother) goes to your newborn.  Your  needs quickly fade into the background.  Even in some of the most “baby-friendly” hospitals, your baby may be quickly brought away to the nursery and often your husband/partner will leave you to go with the baby. Your mother/sister/friend is exhausted and often all they can think about is getting home.

In the midst of all of this, it is your doula who will stay there with you steadfast during your immediate post partum transition.  It is your doula who will visit the next day not just to “see the baby ” or to “say hello” but to help you process your birth experiences helping you have a more peaceful transition to motherhood.  A great doula knows when to stay and what to say.

Now you may still be thinking… “Nicole, I hear what you are saying HOWEVER, I still don’t want to hire a doula.  My sister, girlfriend, mother etc will be there to support me.” That is definitely YOUR choice.  However, before you make THAT your final answer, I want to encourage you to ask yourself a few questions.

Has she had an unmedicated birth? Has she ever witnessed a normal unmedicated birth? Is she supportive of unmedicated birth? Will she be able to support you physically, mentally, and emotionally? Will she be able to help you make sense of the medical jargon thrown at you during labor?  Will she be FULLY supportive of your choices?  Will she do things to undermine you?

I have witnessed it multiple times:  Supportive friends/family members either knowingly or unknowingly talk you into pain meds, or an epidural.  It often happens because THEY are uncomfortable with you being uncomfortable. They don’t understand the work of labor and as a result want to move in to “help you” or “fix you” and all they know is…  “When I (my sister, friend …) had my baby I got an epidural and everything was great after that… are you SURE you don’t want an epidural?”

I have had family members pull me aside to quietly say to me… “I know she doesn’t want an epidural but can’t she get SOMETHING … I remember getting something in my IV for pain.”  Mothers in particular, often struggle watching their daughters experience the pain of birth.  Even a mother who has experienced an unmedicated birth herself feels trepidation and fear when her daughter, cries out in labor pain.  Family members and friends quite honestly don’t usually know HOW to support a woman in labor.  A great doula, knows how.

And what about your husband/partner:  Will he be equipped to support you, or will he need support of his own?  I have seen men be both remarkably supportive as well as irritatingly disruptive during a labor and birth.  What is the relationship like between you and your husband during a normal day?  Where do the two of you struggle? How will this affect your labor?  What does he think about normal birth?  Will he truly be able to “let go and let birth?”  While being present is one thing, being your primary support is another.  A great doula knows how to be supportive to you, your partner, and the two of you as a dyad.

How COMMITTED are you to having an unmedicated birth? If the answer is VERY committed; if you can’t envision your birth any other way; then quite frankly in my opinion you HAVE to have a doula.

Now there is an exception to every rule… If you are a part of a community of friends and women who support, understand, and have experienced normal birth…. Be happy and know that one of them can likely be the support you need.  If this is NOT your normal sister circle, you should SERIOUSLY consider hiring a doula.

In the moment when you are working well with your contractions, in a good rhythm, and your provider wants to “speed things up with a little Pitocin” you need someone there who can help you understand your options, your choices and what is normal.  A great doula can.

In your moment of wavering faith, when your body is working hard and your mind questions if you can go forward;  You want to cry out that you can’t go on and your nurse is repeatedly asking  “Are you sure you don’t want an epidural?”

You don’t need someone whispering in the corner… “why doesn’t she just get an epidural?”  You need someone to tell you it is going to be fine, you are strong, and you can go on.  You need someone who will encourage you and help you refocus while simultaneously communicating your wishes to the staff.  A great doula will.

A great doula can do all these things and more.  If you desire an unmedicated hospital birth, hire a doula!!  Make the investment.  Wondering about the actual cost/investment to hire a doula… here are a few words from Lisa… a reader:

“I often seen women say that doulas are “too expensive.” A couple of points about that:

1) I see it as a one-time cost for a once-in-a-lifetime event. To put it in perspective, my doula cost about as much as my wedding dress — in both cases, the memories I got in return were MORE than worth the cost.


2) There is a huge range of prices for doulas. For my current pregnancy, we interviewed doulas ranging from $200 to $750, and you can even find doulas-in-training who will work for free! And more expensive does NOT necessarily mean better; the one we ended up picking was right in the middle of the price range.


3) If the cost of a doula really is a hardship for you, most doulas I’ve seen are willing to work with you on price. So ask about it! Don’t let money be the ONLY reason you choose not to use a doula”

Thanks Lisa for that great insight… I definitely say Hire a Doula… You will be glad you did.

In Birth and Love
Nicole ~ Follow me on Twitter @SistaMidwife

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21 responses to “A GREAT Doula

  1. Thanks for this. As a Doula myself sometimes I loose sight of the good I am doing.

  2. Thank you for this awesome post!

  3. I am in TOTAL agreement. I am VERY broke and the doula I hired worked with me and we came up with pay arrangements. The advice/resources/support/information I got from her inspired me to try and help women of color and poor women to empower themselves with information on birth. My doula IS a GREAT doula! I haven’t given birth yet, but I know she’s in my corner 100%. She’s easy to talk to and not just about the pregnancy but about EVERYTHING as she knows that EVERYTHING can have an effect on your pregnancy and labor.

  4. Jessica Klanderud

    I was also able to have a natural birth in a hospital attended by a midwife. I did not have a Doula for my first but I will strongly consider it for my second. I will say that my husband was awesome for the birth of our son. We took Bradley classes and I swear he was more exhausted than I was after my son was born. We were a great team through the birth and we are still a great team in raising our child. Although I had a decent experience in the hospital I think we are considering a home birth for any future child. We are committed to unmedicated birth and it seems like it is getting harder and harder to get in a hospital setting. Having a doula seems like an invaluable resource for the team, not just the mother.

  5. Awesome post! (I came over from Science and Sensibility.) As a new doula, I enjoyed this article. Not only because I firmly believe in a doula’s work, but also because you emphasized qualities that a doula should have – strength, compassion, and the ability to empower. I look forward to reading more.

  6. Pingback: Science & Sensibility » Healthy Birth Blog Carnival #3: Bring a loved one, friend, or doula for continuous support

  7. I had doulas for both my natural births at the hospital and it was invaluable. With my first, there was a bit of chaos since my doula was going out of town, and her backup was sick, so we had an emergency backup meet us at the hospital and just knowing she was there I relaxed so much more and felt much calmer even though things were going very fast and I wasn’t sure everything was okay. With my second, she came to the house and labored with us before going to the hospital and was wonderful! She helped me get through the contractions, kept encouraging me & my husband and amused the toddler. After the baby was born, she stayed with me while my husband took the baby to the nursery, and it was so nice to have someone there to keep me company and help with the transition from room to room. I whole-heartedly tell any pregnant mommy to consider a doula to help with the labor process. Having someone with more knowledge there to help us and provide that calming influence really helped me be able to just focus on what I needed to do rather than worrying.

  8. Don’t forget that a doula can be a help for those not planning a natural birth. Even someone who goes in for a scheduled c section can benefit from a doula!

  9. I want to make another comment around the husband aspect. My husband was FABULOUS during my labor with my daughter, I couldn’t have asked for anything more… but that does NOT mean we didn’t need a doula! Not at all! It was a long labor (gotta love inductions), and having a doula meant that my husband could go get something to eat or go to the bathroom without worrying about leaving me alone. He even took a ~30 minute power nap in the middle of the day! My doula asked me, “Don’t you just hate him for it?” and I said, “No! He needs the rest, and you’re here, so I’m doing fine.”

    My husband and my doula also had different strengths. My doula came armed with the experience of being present at many births (including three of her own); my husband came armed with his love for me and our baby. I needed both.

    I had an amazing natural birth experience, in spite of being in the hospital and being induced, and I give a lot of credit to my doula for helping make it possible.

    Also, don’t underestimate the importance of doulas during that prenatal period. I had some pubic symphysis pain starting at around 32 weeks. My OB said, “Normal pregnancy pain, nothing you can do about it, sorry.” My doula made a recommendation for a wonderful acupuncturist, and within a day of my first appointment, I was nearly pain-free. Being able to enjoy the last months of my pregnancy rather than being in pain: PRICELESS! Thanks to my doula.

    Finally, speaking of price, I often seen women say that doulas are “too expensive.” A couple of points about that:
    1) I see it as a one-time cost for a once-in-a-lifetime event. To put it in perspective, my doula cost about as much as my wedding dress — in both cases, the memories I got in return were MORE than worth the cost.
    2) There is a huge range of prices for doulas. For my current pregnancy, we interviewed doulas ranging from $200 to $750, and you can even find doulas-in-training who will work for free! And more expensive does NOT necessarily mean better; the one we ended up picking was right in the middle of the price range.
    3) If the cost of a doula really is a hardship for you, most doulas I’ve seen are willing to work with you on price. So ask about it! Don’t let money be the ONLY reason you choose not to use a doula.

    • WOW!! Lisa… THANKS soooo much for your wonderful comments and insight! Thanks for the specifics of how a doula can help the “dyad” of a husband and wife. Husband and doula both with different strenghts make such a GREAT team! Also I love LOve LOVE your wedding dress analogy!!! Do I have permission to use that?! ;-)… I would definitely give you the credit. Thanks always for reading and sharing!

      Nicole

      • You can absolutely use the wedding dress analogy! :) Anything that helps more women consider doulas, because they ROCK.

    • Great story and great analogy about the wedding dress! I’m going to my doula training in a week and a half (!), and that is something I will remember to mention to people who are considering a doula!

  10. My third child was an unplanned natural labor and it was by far the best experience of my three. My first started as natural with a midwife however at shift change she was replaced with a doctor. Due to a long labor and FEAR, I happily accepted the epidural when it was offered. After being stuck in the birth canal for so long, my daughter came out with a severe cone head (it’s normal now). So when my second came along I just got the epidural because I didn’t want to go through the experience I had with the first.

    With number three however I was laboring and didn’t realize it, probably because I was involved in so much physical activity – getting my other two ready for school which entailed going up and down the stairs in my house. When I finally got the pain that stopped me in my tracks I realized it was time and headed for the hospital. When I got to the hospital I pushed for maybe 10 minutes and she was out. No medication and not really any pain. And of my three deliveries, this was the easiest to recover from. In addition my third child was, and continues to be, the most alert.

    If I had it to do all over again, I would definitely hire a doula. The horror stories about everybody else’s labor pain was what triggered the fear in me to get medication, when the laboring started to get rough. However, the ease of my unmedicated third showed me how pleasurable a natural birth really is. Now that I have three daughters, I will definitely share with them the joy and empowerment of my third birth rather than the fear during my first two, when it is time for them to make their own decision.

    • Sharlene THANK YOU soooo much for sharing your story!! Keep sharing it not only with your daughters but with sister friends too. It is so important for us to share stories to help women release some of the fear surrounding labor. Your story beautifully illustrates how MOVEMENT in labor really makes it much easier. HA! At the cone head… VERY common!! They always go back to “normal” ;-)

      Thanks again for sharing!
      Nicole

  11. Thank you SO much for this post. I hope the world reads it. :)

  12. Wonderful post! I totally agree. I had my MIL there for my last birth and while she isn’t a doula she definitely could be one! That is the reason I didn’t hire a doula, though I did think about it.

    We ended up having a natural birth, in a hospital. It helps that I had a midwife and when I started demanding an epidural they all gently told me to try something else first. I’m glad they did! Because I DID IT! I gave birth to my baby without an epidural and I am so proud of myself. The best part was seeing how proud my husband was of me because I knew he had doubts.

    • Hi Joy!! I am so happy to hear from you! I am also PROUD and happy that your birth turned out the way you planned! Congratulations on your new addition! :-)
      I knew that you and your husband did not see eye to eye on a natural birth so I am soooooo very HAPPY for you!! You are awesome!!! Thanks as always for reading and posting!

      Blessings,
      Nicole

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