What is a Doula?
Doulas provide emotional and physical support in the run-up to, during, and after your baby’s birth. Professionally trained, a doula is your support companion on the exciting ride that is pregnancy and parenthood.
But what does a Doula really do? Darby Morris, Birth Doula, goes in-depth into the role of the doula and the support they provide.
Daniela: Good afternoon, Darby, and a warm welcome to Dreaming of Baby! It’s a pleasure to have you with us today. As a Doula, you have assisted many in their journey to parenthood, and we’re looking forward to what you have to share with us today, in particular on the role of the Doula in the run-up to, during and after birth. Before we start with our discussion, it would be great if you could introduce yourself further as well as let us know a little bit more about your experience.
Darby Morris: Good morning, Daniela. Thank you for having me! My name is Darby Morris and I am a birth doula. I just started as a birth doula in May of 2017 but have been taking workshops for several years through DONA (Doulas of North America) and Spinning Babies. I am also currently in the process of getting my PhD focusing on anthropology, so I am particularly dedicated to providing families with accurate, reliable information. This requires me to do as much continuing education as possible.
What does a Doula do?
Daniela: That’s impressive Darby, thank you. We’ve been hearing quite a lot about Doulas but what a Doula actually does might not be clear to all. So, with the aim of providing a more complete picture to our readers, what is the role of a Doula?
Darby Morris: There are many different kinds of doulas: birth, bereavement, abortion, death, postpartum and full spectrum doulas who do all of the above. I work primarily as a birth doula, which means I provide physical, emotional and informational support to the birthing family before, during and just after their birth in order to help them achieve the most positive experience possible. Personally, I believe that birth doulas should be able to support everyone no matter if they desire a medicated or non-medicated birth and no matter what kind of family they are: LGBT, adopting, or otherwise. I also do some occasional volunteer work as a postpartum doula at a local hospital. Postpartum doulas generally help families in the first few months once they leave the hospital but with this volunteer work, I am able to assist just before they leave the hospital. It is my desire to become a full spectrum doula by 2018 including working as an abortion and bereavement doula. These doulas typically assist with stillbirth situations. Death doulas are the only type of doulas who don’t deal with any aspect of birth, they just do end of life care.
Daniela: Thank you for this informative overview Darby. Connected to this – and focusing on the role of the birth doula – What can a Doula do, and what cannot she do?
Darby Morris: Though I am a cisgender female (in other words I still identify with the sex that I was at birth), not all doulas are women. In general, birth doulas do not assist with anything medical. This means that we do not perform vaginal exams, check fetal heart rates, deliver babies, cut umbilical cords, or even check the birthing individual’s temperature. We also do not speak for the birthing families, rather we encourage and remind them to speak for themselves. During the birthing process, families are becoming parents to a specific child for the first time. It is important for us to encourage them to have a voice as that child’s parents. From the time a contract is signed, we are there supporting families via email, phone call, and text. We conduct a few prenatal visits in order to ensure we understand the type of birth the family wants and the family learns about labor, delivery, and postpartum.
Darby Morris: Once the time for birth comes, we assist families in determining when to go to the hospital. We are then the only person outside of the birth family to stay with them and encourage them throughout the entire birth. We provide comfort techniques throughout the labor process and do our best to ensure that the family is on the right path for the birth that they envision. Once the baby is born, we stay for at least two hours after the birth in order to ensure that the family is situated. If the family is interested in breastfeeding we help them get that started. We also visit the family in postpartum to review the birth with them, ensure that everything is going smoothly and answer any questions they may have.
Darby Morris: “Once the time for birth comes, we assist families in determining when to go to the hospital. We are then the only person outside of the birth family to stay with them and encourage them throughout the entire birth.”
Daniela: Thanks for this comprehensive overview, Darby. What would a typical prenatal visit look like? Would this differ if the mom-to-be is looking into a home birth?
Darby Morris: From my experience, birth doulas mostly work with hospital births since there is a greater need for us through this process. As I mentioned, in hospital births, we are the only people that stay with the family throughout the birth. Nurses, midwives, and OBGYNs have many other patients to see so they are not available to stay with one family throughout the birth. In a home birth, and occasionally at a birth center birth, both the midwife and the doula are there throughout the birth with the family. One other important difference between home and hospital births is that doulas do not need to assist birthing families in determining when to go to the hospital for a home birth.
Darby Morris: To return to your particular question, a typical prenatal visit would involve getting together in person so that we can get to know each other as much as possible. Once we are together I try to understand and discuss all of the family’s concerns and desires. If this is the family’s first child, it is often important for doulas to walk the family through the birth process, explaining the different stages of labor and what the family can expect. Even if the family is well versed in the stages of labor, aspects of the birth process change depending on the chosen birth location (hospital or home) and chosen care provider (one OBGYN or midwife to the next). This discussion of the birth process is the biggest difference between a prenatal visit with an individual giving birth at home and one giving birth at a hospital. It is our job as doulas to go through all of the differences they could encounter with a given provider to make sure they are not surprised if something comes up during the birth.
Darby Morris: “If this is the family’s first child, it is often important for doulas to walk the family through the birth process, explaining the different stages of labor and what the family can expect.”
Darby Morris: I also try to prepare the family for the postpartum. This includes helping the family to find the best pediatrician for them, and if the family is interested in breastfeeding, I do my best to set them up with as much breastfeeding information as I can. I recommend that families try to attend a La Leche League meeting prior to the birth in order to learn as much as possible about breastfeeding before they start. It is easy for a new parent to forget that they won’t have time to do everything they used to in the beginning. They need to slow down and take care of their body and baby first.
Darby Morris: If it is not the family’s first birth, we typically spend the prenatal visit walking through the first birth (or most recent birth) that individual had and what we can do to ensure they have a positive experience this time. If the family has been told by a midwife or OBGYN that their baby is breech, then I set up a prenatal visit with the family in order to teach them some techniques that may help the baby to turn around. I also use this time to walk them through some procedures that the doctors may conduct to help turn the baby. If this does not work, then I can help discuss with the family further options of vaginal breech or cesarean birth.
How does a doula assist the partner?
Daniela:: It’s great to know what to expect at such meetings, and also important to know that support changes in accordance with the family’s needs. You mention partners and how they usually have different concerns – how would a doula assist the partner, prior to the birth, during the birth, and after?
Darby Morris: Partners are extremely important to the birthing process. The first thing I try to do, especially as an anthropologist, is ensure that I am working with the birthing family in the most culturally specific way I can. In some cultures, the birthing individual does not want the partner to attend the birth, or there may be customs about who can physically assist who throughout the labor. I want to ensure that I am doing everything I can that is suitable for that particular family. In general, the types of things that I enjoy doing with the partner prior to the birth is making sure that I address their fears, concerns, and questions just as much as I do with the birthing individual. Often there is so much medical focus on the birthing individual that I may be the first person to ask the partner how they are doing. At the end of the day, the whole family is having a baby, not just the birthing individual so it is really important to include and address everyone involved. In addition to going over concerns, I use this time prior to the birth to teach the partner as much as I can about birth and postpartum so they can be amazing for the birthing individual during the process. If the partner has never had children before they can often feel removed from the birth process so I also try to get them involved as much as possible, making sure some of the tasks are assigned to them instead of the birthing individual doing everything to prepare.
Darby Morris: “Partners are extremely important to the birthing process. The first thing I try to do, especially as an anthropologist, is ensure that I am working with the birthing family in the most culturally specific way I can.”
Darby Morris: During the birth, I try to stand out of the way as much as I possibly can. The birthing individual and their partner helped bring this baby into the world and so the birth should be about them, not about me. The partner’s love for the birthing individual is a key part of the process. The more I can do to help the partner express that love during the birth, the better. Sometimes that just means encouraging the partner to hold the birthing individual’s hand, or allow the birthing individual to lean on the partner. If the birthing individual is experiencing back labor then I help the partner to do double hip squeezes to help relieve the pressure. Baths and showers can also help so I remind partners to bring their bathing suit so they can get in the shower with the birthing individual. The oxytocin that is expressed when we feel love for someone else is the same oxytocin that flows during contractions so the more love and relaxation the birthing individual can feel throughout the birth process the more progress they can make in labor. If the birth is very long, I can be there while the partner takes a break or gets a much needed bite to eat. Once the baby comes, they won’t have much time to sleep so it’s important that the partner has as much energy as they can for the postpartum. I can also help translate things from the medical staff to the birth family and reassure the partner what types of things are normal in birth. Partners often wish they could take the pain away from their loved ones. The more involved they are in the birth process the more they feel like they are contributing to the process as well and the greater their chance is for an overall positive experience.
Darby Morris: After the birth, I encourage the partner to help the birthing individual feed their baby, and walk them through any lingering concerns they may have. The postpartum visit is important to check for any potential danger signs with the birth family. Sometimes, after the birth process, the family ends up focusing on the baby more than on the couple’s relationship so I try to encourage them to spend some time (even just a few minutes each day) together as a couple. I also think that it’s very important for the partner to understand as much as they can about breastfeeding so the birthing individual has someone to turn to if any concerns may arise.
Darby Morris: “Partners often wish they could take the pain away from their loved ones. The more involved they are in the birth process the more they feel like they are contributing to the process as well and the greater their chance is for an overall positive experience.”
The birthing individual
Daniela:: You refer to ‘birthing individual’, and ‘partner’; can you please elaborate on this choice of terms?
Darby Morris: As I mentioned earlier, I strongly believe that all families should be able to have a doula that works for them. Not all birthing individuals are women and not all of them like the typical term “mother”. Similarly, not all partners are male. If I were to use gender-specific nouns then I would be excluding these individuals from the birthing process. It’s also important to note that birth mothers are not the only ones that can breastfeed. All birthing individuals can feed their babies no matter whether they call it breastfeeding, chestfeeding or whatever other term. I have chosen to use the term breastfeeding in this interview since there are so many other terms for this type of feeding that it would be difficult to use all of them, it is also the most commonly agreed upon and used term. Adopting families and partners can also breastfeed the baby if the family so desires.
Darby Morris: “I strongly believe that all families should be able to have a doula that works for them. Not all birthing individuals are women and not all of them like the typical term “mother”. Similarly, not all partners are male. If I were to use gender-specific nouns then I would be excluding these individuals from the birthing process.”
Daniela:: Thank you for going deeper into this. The journey to parenthood can be a challenge in its own right, so it’s great to see that families have this support. Moving on to the postpartum, what would a typical doula visit look like?
Darby Morris: Postpartum visits depend a lot on how the birth went. If the birth went very well, I use the postpartum visit to check in with the family, ensure there are no danger signs present that suggest that the family needs to see or talk to a doctor or other expert. Baby blues is common but some postpartum depression can be dangerous. Both the birthing individual and their partner can get postpartum depression so I try to check in to make sure how everyone is feeling and leave them with resources should they need help. I also make sure the family understands how to calm, swaddle, change diapers, feed, and sleep with and around the baby. It is not uncommon for families to be so worried about sleeping in bed with their baby that they end up sleeping in areas that are much more unsafe for their babies. I try to explain to them that beds are much safer than these other pieces of furniture and can be just as safe as a crib if you set it up to be. I also go over some postpartum exercises with the family and make sure they are eating and sleeping properly (or to the best they can, given the circumstances).
Darby Morris: One other thing I make sure to do during a postpartum visit is to walk through the birth with the family. Everyone tends to have a different perspective of how the birth went and it’s rare that people get a chance to talk about their birth so I walk through how each person felt about and what is remembered about the birth. No matter how much we prepare for a certain type of birth, there is never a guarantee that that type of birth will happen. If, for example, the family wanted a vaginal birth and they ended up, for whatever reason, getting a cesarean section, then there may be some grief felt postpartum. Unfortunately, not all births end with healthy babies. Sometimes, the family does not know until after the birth that the baby is disabled. The birth may also be a stillbirth or the baby may pass away after just a few days. These families need a lot of support postpartum. I strongly believe that doulas should be able to support families in any situation. Sometimes the family needs more help than I can give as a birth doula (or even a bereavement doula). In these situations, I have many resources that I can give to the family: contacts for lactation consultants, postpartum doulas, grief support groups, new family support groups, pelvic floor therapists and other specialists.
Daniela: I would like to backtrack a little, and focus a bit more on the birthing individual and their partner. You note that not all birthing individuals are women and it’s not only the birth mothers who can breastfeed. In a hospital setting, would the Doula be the point of contact between the healthcare professionals and the birthing individual and her partner on such important matters?
Darby Morris: In a hospital setting there is a birth plan that lays out all of the preferences of the family. Sometimes the hospital has a template for the birth plan that each family fills out (and can add to as they like) and sometimes the doula works with the family to create the birth plan from scratch. Doulas have typically worked with each hospital several times or have connections to other doulas who have worked in that hospital, so we know the process with any given hospital. Gender, feeding, vaccination and medication preferences are all typically found in this birth plan. As I mentioned earlier, the doula’s job is not to speak for the family but to encourage the family to speak for themselves. In certain situations, if the family is being made to feel very uncomfortable, whether this is just because of the personality of an individual or repetitive misgendering, the doula can help encourage the family to ask for a change in healthcare professional at any point throughout the birth.
Darby Morris: “The doula’s job is not to speak for the family but to encourage the family to speak for themselves.”
Daniela: Great, thank you for delving deeper into this subject. I wish to thank you for your time today Darby; the information you have shared with us will be helpful to many! It’s been a truly enlightening discussion!
Darby Morris: Thank you very much for your time. I have enjoyed it!
