7 things about birth and postpartum doulas that always surprise people
If you're considering hiring a birth doula or postpartum doula in Sydney, the Hawkesbury, Hills District or Western Sydney, you probably have questions. And if you've been doing your research, you might also have a few misconceptions - which is completely understandable, because there is a lot of noise out there about what doulas actually do.
In almost every meet and greet and antenatal visit I have with families, there are certain things that come up that genuinely surprise people. So I decided to write them all down in one place. Hopefully this helps you feel a little more informed about what birth and postpartum doula support actually looks like in real life.
Full disclosure: every doula has different ways of approaching the support they provide, different philosophies, different methodologies and skills and experience, so this is all valid for me as a doula, but will not necessarily apply to any other doulas.
1. Doulas don't replace your partner. Birth doula support is here for both of you
This is something I ALWAYS discuss with couples, usually in our initial meet and greets before they have officially hired me. Doulas DO NOT automatically replace your partner as your primary birth support. In fact, I assure people that I am actually here to support the partner as well - it can be incredibly reassuring and helpful for a doula to be present so that the partner can focus wholeheartedly on being the support the birthing woman needs.
Often, women will have a clear idea of the roles they want their partner/support person and their doula to play in the birth space. I have attended births where these roles play out the way the woman envisioned, and others where it has been a lot more fluid. As your doula, I will often slot in and fill whatever void there may be; for example, if I notice the water bottle isn't being filled frequently and offered to the woman, or if her partner needs a break from hip squeezes and counter pressure, I'll sub in and they can grab a bite to eat or cup of coffee.
I have attended births where sometimes all the partner needs is to be able to look over and see that I am calm and at ease, know that everything is going positively and they can feel reassured and continue to support the woman the way she needs. Some women will hire a doula because they don't have birth support, or because they would prefer their partner focused on other things during the labour and birth (older children for example). In these circumstances, a doula can be all you need for birth support.
2. Doulas don't speak for you or give consent on your behalf. Here's what doula advocacy in hospital actually looks like…
One of the most important aspects of antenatal prep with a birth doula is gaining a deep understanding of your informed decisions for your labour and birth, as well as the motivation behind them. This is so that by the time you are in labour, your doula and support team are completely across what you want from your birth, how you want it to look and what you are deciding to accept, decline and why.
When in labour, once you've arrived at the hospital (if that is your chosen place of birth), there will be times when your care providers will make certain recommendations and you will be expected to accept or decline. A doula cannot speak for you or advise you one way or the other, even if you have created a birth map or plan together that details what you will decide in this exact scenario.
What I can do is remind you of what you had discussed previously and your motivations behind your decisions. Doulas can request the hospital staff leave the room and help provide a safe, private space to discuss without any pressure. Doulas can quietly remind your partner that we're deviating from the woman's original decision and encourage them to ask questions. Doulas can directly ask doctors and midwives for further information and ask for clarification.
Providing these small acts can be hugely impactful in advocating for the woman in labour without overstepping or pushing past the boundaries of a doula’s scope of practice. I've found all of them to be incredibly useful in a hospital setting, and at 3am in hospital, they are always met with immense gratitude from the couples I am supporting.
3. Doula support doesn't have an expiry date. I'm on call from 37 weeks until your baby arrives, whenever that is.
I get asked this question here and there and it always surprises me that there is an assumption that at some point I'd just... stop being available and would refuse to support you. If you're comfortable going to 44 weeks pregnant, then I am happy to support you! That's why my on-call period is "from 37 weeks" and doesn't have an end date. Most women I've supported have their baby by 42 weeks (although I've supported a few women who have been almost 43 weeks!) but I will wait for as long as your baby needs.
4. Birth doulas don't give advice or recommendations, and here's why that actually matters
Doulas provide evidence-based information and direct you where to go for quality research; they don't give advice or recommendations. Which is actually exactly what a doctor or midwife should be doing too.
Every doula is going to have her own biases and opinions about what she would do in any given situation - that's only human. However, a doula worth her salt will never let those biases affect how she supports you, nor will she give advice or make suggestions on what you should do.
If I feel like a woman I'm supporting doesn't have all the information about something, whether she is 3 months pregnant considering who her care provider should be, or in the thick of labour deciding whether to accept or decline something, the only advice I'll give is: investigate further and ask questions.
5. Having a birth doula at your hospital birth often means you'll get more supportive midwives
This is purely based on my experience and the experience of other doulas I talk to regularly - I doubt there is any hard evidence to support this. BUT, yes, I have found this to be the case enough times to be a pattern.
Quite often, the women hiring doulas to support them are going to be asking questions, be more confident and decisive about what they want and will be more likely to decline interventions including pain relief. When you inform the hospital you will have a doula in your birth team, I've found it's more common to be assigned a midwife who wants to work with doulas, and more importantly, women who want a low-intervention birth and to be supported through the hard work of labour, rather than be offered pain meds at every crisis of confidence.
Doulas help to ensure the woman and her partner are informed, set up the birth space to be conducive to the production of birth hormones, provide emotional support and pain management strategies and do practical tasks like fetching extra pillows, warming up a heat pack and grabbing maternity pads. Many midwives see that as a huge plus, and love the fact that if a doula attends a birth, they're able to focus on their main job of providing clinical care and support.
6. Sometimes the most powerful doula support looks like doing nothing at all
The most skilled, experienced and confident doulas will often look like they're not doing much at a birth. I'll often tell women and their support people that I will arrive at the birth space, either at home or in hospital, and will get down on the floor and quietly observe for a time. I won't rush in, start offering suggestions and pulling out tools and strategies at the get-go. Most women are handling labour beautifully when I first come to them, and my biggest priority at that time is ensuring I don't disturb the space and interrupt their flow.
A doula's role is very often sitting and observing, holding space for the woman and her partner, listening to the woman (whether it is her talking, crying, vocalising or breathing), and doing things outside the labour space to allow those within to remain in the zone. If a woman is in active labour or very nearly there, a doula's role is about facilitating that flow to ensure the woman can lean into her liminal space and continue on her journey to "labourland."
Funnily enough, sometimes that is literally all I do at a birth, because it progresses smoothly and the woman and her birth support are working wonderfully in synergy, and it is often those experiences where the woman and her partner express how grateful they are for my presence, and make claims like "we couldn't have done this without you" - even though my response is almost always "yes you could have, because you did!" One of the most wonderful things about doula work is knowing that the relationship that I have built with the people I am supporting, and the prepping and mapping we have worked through together, has meant that when the day comes, I am there to hold space and that is truly enough.
7. Birth doulas support every kind of birth, not just physiological or "natural" birth
As a birth doula, my number one philosophy is informed birth. It isn't my business if a woman chooses to birth her baby in a way that deviates from physiology or isn't the most "natural" pathway. What is my business is that the woman and her support have access to the most up-to-date, evidence-based and high quality information available. This isn't necessarily the policy the hospital abides by or the philosophy of their care provider - and surprising to some, those two things are quite often not backed by research at all.
Whether you're planning a caesarean, having a VBAC, approaching your first birth or your fifth, you deserve informed birth support. What the woman does with that information is up to her. My role is to work my hardest to help birthing women and their partners experience the most positive birth and postpartum possible, and that is far more likely to be the result of a labour and birth where she felt completely informed and in control of her decisions. It's not my job to guarantee a certain outcome, and I can't - but often a difficult experience and birth trauma is the result of disrespectful care and care provider coercion that takes advantage of people who don't have all the information.
That's why you have a doula.
Looking for birth and postpartum doula support in the Hawkesbury, Hills District, Penrith or the Lower Blue Mountains?
If any of this resonated with you and you'd like to find out more, I'd love to hear from you. Feel free to get in touch for a completely obligation-free chat. Click here to get in touch.