Choosing the Right Doula
What Questions to Ask
The word doula comes from the Greek and it means “Female Servant “. However, a doula is much more than that. A certified birth doula is a woman experienced in childbirth who provides advice, information, as well as emotional and physical support before, during, and just after childbirth.
Doulas are becoming more and more common in today’s birthing society, and they are recognized as a woman who is passionate about childbirth and views it as a key experience that a mother will remember all of her life. She values the impact that this has on a woman and understands the physical and emotional needs of a woman in labor. A Doula will stay by her side and make sure that she is comfortable, and that her needs and wishes are being met.
In childbirth, women recognize the deep desire and need to have an attendant present who is entirely on their side of things. More often than not, women feel that their care provider or nurse may be swayed by medical model or hospital policies, rather than what the client, and ultimately the birthing mother, has in mind for her care.
Even if your care provider knows exactly what you want in your birth, and is behind you 100% she or he often has other patients, cases and obligations to tend to, which often leaves the birthing mother alone in the hospital room. She often feels lonely, and separated from her care providers, and scared in this environment away from home, and neither she nor her partner always feels that they know what is going on. These feelings have been shown to slow, and even hinder the progress of labor, which is why recent studies have shown that having a birth doula present can:
Decrease the request for epidurals by 60%
Decrease the overall cesarean section rate by 50%
Decrease the need for forceps by 40%
Decrease the mother’s need for pain medication by 30%
Decrease the length of labor by 25%
These are significant numbers, and many health care providers, such as certified nurses, midwives and OB-GYN’s, not only welcome, but embrace the presence of birth doulas in the delivery room.
That leads us to one question, and a very important one at that: How do you choose a doula that is right for you?
First of all, it is important to realize that doulas have individual personalities just like every other care provider and person in the world! When interviewing potential doulas, do not ever feel like you are being too picky or unreasonable. It’s so important to feel confident not only in your doulas experience, but how comfortable you are with her personality and how they get along with you and your family. If a doula is constantly talking or cutting you off, informing you of her knowledge of birth and life, when you want a quieter personality in your birth room, don’t be afraid to keep looking. If you just have an “ uneasy “ feeling that your personalities just “ don’t gel “, then find someone with whom they will.
A lot of people know what questions to ask doulas: How long have you been practicing, how man births have you attended, do you have back up support, or do you try your best to make it to each birth yourself, how close are you to the hospital, how will you provide labor support starting at home, or do you meet me at the hospital, etc. However, those questions just tell you the basics about a doula. Do not be afraid to scratch below the surface and see how her personality meshes with yours.
Medicated All the Way or “All Natural”? If you want a medicated birth with an epidural, ask the doula how she feels about medicated births. She may personally feel that natural is better, but still feels confident in accompanying you in your labor. Has this doula ever experienced a medicated birth? What made her choose this option? Would she do this again?
If you want to go all natural, ask the doula if they have experienced this as well. What made them choose this form of birth? What type of natural birth did they choose? Homebirth? Waterbirth? Did they use a midwife, or did an OB/GYN assist them during their pregnancy(s)? As a doula, what support does she give for natural birth? What methods of relaxation, breathing, or positioning does she suggest for pain relief?
If you are considering waterbirth, which is considered a natural epidural, which doulas support this? Have they experienced waterbirth themselves? Why and how do they support waterbirth? Do they feel that it is safe? Do they recommend care providers who will offer this service?
Dad and Doula: How does your doula include your partner in the scheme of things? Does she feel that the baby’s father is a vital part of the birth? For the most part, fathers are now welcome in the labor and delivery rooms; however, some doulas may choose to include your partner more than others. Does the doula work to include dad, or does she feel that she is the sole person who can care for your needs?
I like to observe a couple and get a feel for how they work together. During the birth, dad and mom have the unique opportunity of either being closer than ever or separated by unknowns and fears, in the intimate setting of the birth of their child. Dad does not always know how to react to beeping monitors and seeing his loved one in pain. He wants to help, but does not always know what to do. The partner can be a tremendous support in labor and delivery. A good doula can help incorporate him into this special event and also be a relief for him. Dad can move out into the hallway for a bite to eat or to update relatives, without worrying that mom is in the delivery room coping with labor alone.
Doula and the Family: How will your doula handle other observers and participants in the birth? Will she use this as an opportunity to allow other family members to take over and support you? Will she involve them in the birth? Many people want to include several, if not more family members, including siblings and young children. How will your doula handle that? Will she still feel the need to stay at your side, and support your family as well as yourself throughout the process? Will your doula instruct the family on when you would like to be left alone, or when the care provider needs more room or privacy in the delivery room?
Medical Experience: Some doulas work well with nurses. Some of them do their best to work hand in hand with the nurses, speaking to them about your progress, negotiating when your internal examinations will take place, reviewing hospital and care provider policies and your personal preferences. But some doulas prefer to stay in the background and simply be your emotional and physical labor support. Which of these will help you better? Some doulas may also be a montrice which means that she has had medical training, usually in nursing or midwifery, and will monitor you and your progress during labor and at home. Unless a doula has medical training, though, using her as a montrice is not recommended. Ask doulas what their policies are regarding their involvement in the medical aspect of birth. A doula should never try to be the midwife. Theirs are two entirely separate roles that work well together, though not necessarily as one.
Hospital Policy Vs. Doula Policy: Does your doula see the need for you to stay hydrated and well fed during labor? Will she remind you to eat and drink to keep up your strength? Most hospital employees prefer and will suggest that you refrain from eating during labor. However, many hospitals and midwives are realizing that labor is long and nutrients are vital to a healthy mother and baby during delivery.
Does Age Matter? Here is another example of where personality comes in. Some women envision a motherly person, an older woman who is a grandmother age and who provides a mothering effect at the birth. Others want someone who is closer to their own age, who is raising a family and has given birth not that long ago herself. Many women want someone who is like a sister or a best friend, but with more experience related to childbirth. Some people suggest that a good doula can be all of these in one; a best friend, sister, coach, mother to the mother or her own personal nurse.
Breast Vs. Bottle: If you wish to breastfeed or are even considering this option, is your doula passionate about this as well? Chances are that she will be the one helping establish bonding and breastfeeding after birth. Does she feel confident helping you establish this for the first time? Will she be available for phone support, and possibly come back to the hospital if you need help nursing your baby? Most hospitals employ lactation consultants as part of their staff, but she may not come in until much later after your birth. If you are planning to breastfeed, it is important to introduce the breast early on, and since you will be most comfortable with your doula, she should feel confident helping you in this area.
If you are planning to bottle feed, be sure to let your doula and care providers know this ahead of time. Ask your doula how she feels about bottle feeding. If she is a “solid“ breast is best “ advocate, is she willing to put her feelings aside and realize that bottle feeding may be better for her client? Do you feel confident that she will help you introduce bottle feeding?
Birth Plan: A birth plan is key in any birth. A birth plan is a helpful communication tool that helps expectant mothers create a list of ideals and preferences of what she wants to have, avoid, or who she wants to include in her labor and delivery, and even postpartum. How does your doula feel about a birth plan? Will she help you create a birth plan and do her best to see that your plans are carried out in labor and delivery? I personally feel that it is best for expectant parents to have a birth plan created and multiple copies given out a month or more before their due date. Do not forget to carry extras for your nursing staff as you are admitted to the hospital!
What if There Are Complications? What if you end up with a C-section instead of the natural vaginal birth that you were hoping for? Your doula should feel confident in staying by your side during labor, no matter what the circumstances. In the case of cesarean section, many doctors allow two people to remain with you. Your partner will probably want to sit with you as the baby is delivered, then follow the baby to the nursery, in which case you will want your doula nearby to remain with you.
If you are planning a natural birth, and decide to go medicated at the last minute, or even during labor (which happens many times), your doula should again stay close, at least reachable on her cell phone or pager, while you are resting, and come back to your side to provide support during delivery. It is very important that you ask your doula what her policies on how long she will stay with you, and if she will continue to do so should an unexpected situation arise.
Special Interest: What are each doulas areas of special interest? Does she enjoy being a mother? Does she support, and have an interest in special needs situation? Does she proactively support waterbirth? How does she feel about large families? What about adoption? How does she feel about home birth? Let her know what your special interests are, and how hers match yours.
And Last, but not, Least: Ask the doula her personal birth stories. What made her decide to become a doula? Which agency is she certified through? How long did her certification take, and what was included in her educational course?
The birth of your child will mark one of the most special days of your life. It is something that you will always remember. Choosing how you desire this experience to be and who will be included are both important decisions. These are just a few areas that will help you determine how your birth experience and memories will be. Blessings on choosing a great doula and heads up for a special birth experience!
