Did you know that I used to be a music teacher before I became a doula? I used to have a sweet private piano student who is now in college studying to be nurse! (WOW I AM SO OLD)

She is in her OB rotation and she and her classmates are working on a project specifically about continuous labor/doula support. She asked (because we follow each other on instagram!) if they could come up with some interview questions for me to help them with their project. As I was answering these questions, I realized that I’d love to share them! So here goes nothin’…

What reasons have you come across for why women choose not to have a Doula? (or maybe are not able to have a Doula?)

The main reason that I've found that women choose not to hire a doula is simply a lack of knowledge about what a doula is, what service we provide, and the value of that service. In larger cities, doulas are more widely recognized as a profession and service (although still only 1-5% of women hire one), but in rural Delmarva, we're a bit behind the tide, unfortunately. I'm working on that! The second most common reason is finances. Like any service provider, we have fees to support our business and ourselves, and if a family is either unable to afford a doula fee or doesn't prioritize that fee as a necessary expense, they will pass on the support. Occasionally, a woman will not be interested in doula support because she already has a knowledgeable support person by her side (mother, sister, friend, etc), or just prefer that the birth remains as intimate as possible between her and her partner.

Why are Doulas helpful/needed in the labor process?

There is a lot of evidence to support the use of doulas, or one-on-one labor support! I don't actually believe we're "needed" at all, though. Babies will come out with or without doula support. In the hospital setting particularly, most women are being treated by a care provider who has maybe never met them before, or who has only met them a few times throughout their pregnancy, and perhaps didn't have time during appointments to form much of a relationship. Their nurses are mostly strangers, and have (too) many responsibilities, patients, charting, etc. The doula is oftentimes the only person in the room who is an expert in childbirth, and also has a formed, trusting relationship with the women and her partner/family. Because the relationship is formed throughout her pregnancy, she can feel safe and comfortable with their presence and support.

What do you do in every labor with your clients? (techniques?)

Every labor looks vastly different. Primarily, I'm there to protect her mental state so that she can feel valued, heard, supported, and leave her birth experience without regrets and with a lasting positive memory of the day that her baby was born. Her care providers treat everything from the abdomen down. And I support everything from the abdomen up (the heart and mind!). Evidence shows that women (like every other mammal) birth most safely when they feel safe, unobserved, comfortable, and protected. Stress, fear, and tension all result in the release of cortisol, catecholamines, and other stress hormones. Those hormones have an impact on the release of the necessary, productive, and protective labor hormones (most notably oxytocin), and so my job is to reduce her level of fear, and impart strength and trust. I do that in a variety of ways, dependent on the woman's personality, her needs that she's discussed with me beforehand, and by being a keen observer and fostering intimate connections during childbirth so that I can predict her needs based on how her labor is progressing. That can include:

Staying close by, 24/7, so that she benefits from continuous support (unless, of course, she needs some alone time or time with her partner! or if I have to pee or eat!)
Non-judgement-based communication, with absolutely no agenda other than supporting her needs and desires (I don't have an opinion about her medical care or decisions that she makes, regardless of what they are)
Educational/informational support: sharing risks/benefits/what to expect of certain procedures, interventions and processes of labor; reassuring mother and family when things are "normal" (since they can feel *very* intense to a loved one); sharing about what to expect in their particular birthing setting; and facilitating communication between them and their care provider(s)
Providing physical support: hand holding (surprisingly important for many women), special techniques to relieve back pain (massage, counter pressure, etc), rebozo techniques, position changes, use of material tools (birth ball, peanut ball, squat bar, bath, shower, etc), activities/positions for various labor "issues" (stalled or prolonged labor, discomfort in particular places, baby's position, long pushing periods, etc)
Words of encouragement when the mother is open to them and needs some additional support, vocalizations with the mother, and breathing with the mother through contractions
An overwhelming belief and trust in *HER*, which unfortunately most women don't receive from anyone (in my opinion, this is the most valuable and priceless "perk" of a good doula)

What are some ways to demonstrate what exactly a doula does?

Attend a doula training or labor support workshop! Attend a birth with a doula present! Watch a birth video on Youtube with a doula present! Ask a mother who has had a doula exactly what support she received that was most important to her. Ask a doula to show you some common physical techniques/positions/support she utilizes in labors.

What are some barriers to receiving a doula’s help?

Barriers can include:

finances
inability to find a doula that they feel comfortable and safe with (every person is different and will feel a connection with some doulas and not others)
not receiving support from the partner or family to hire a doula
birthing with care providers who do not support the use of a doula (and the mother doesn't want to cause strain in the birthing room) OR hospitals/care providers who have banned the use of a doula altogether (I haven't personally experienced this too much, but I know it happens. Honestly, I believe it happens primarily because of doulas who are exhibiting behaviors that interfere with the care provider's or hospital's ability to care for the mother's medical needs, which is something that I'm aware of and recognize is *not* my role.)

Was there anything you were surprised by? Do you have anything to add?