What Does a Doula Do?
By Andrea Crossman, RN & Doula
I just returned from the home of new parents Nikki and Sam, where we had our postpartum visit joined by Nikki’s mom (grandmothers are the original postpartum doulas) and two and a half week old Leo. We ate salads, reminisced about the birth, discussed breastfeeding, and enjoyed the afterglow of the experience. Nikki shared that her birth was different than what she had imagined—and absolutely wonderful; a statement she followed with “and that’s not something I hear a lot of women say.” New papa Sam chimed in that by having a doula they always had a map for what was ahead, even as the road took unexpected turns.
My work as a labor support doula in New York City is the result of a few unexpected turns. A Midwest girl, I moved to New York to attend Columbia University with the end goal of providing integrative primary health care. After receiving my bachelor’s in nursing, I began a master’s program at NYU and worked as a labor and delivery nurse at one of the busiest labor and delivery units in NYC. Witnessing the positive transformative experience that birth can be inspired me to launch Holistic Doula NYC , through which I offer holistic RN and doula services as well as childbirth education classes.
As a doula and a nurse, I am concerned with the birth of the baby and the birth of the mother. A quote by Osho illustrates this beautifully: “The moment a child is born, the mother is also born. She never existed before. The woman existed, but the mother, never. A mother is something absolutely new.”
So how do I support the birth of the mother? What exactly does a doula do? Well, a whole bunch of things! Here is an A-to-Z description of how I typically work with a client.
Meet and Greet: Meet and understand how you would work together.
How it works
Most important about this meeting is to simply check out the “vibe.” Second is to make sure you feel good about the experience and energy your potential doula can bring to your birth.
Unlimited Support: Continue building a relationship, have a go-to for your questions, keep your doula up-to-date on your pregnancy.
How it works
I offer unlimited e-mail and phone support to help my clients better navigate their pregnancy and birth. I also ask my clients to update me within 24 hours of each midwife or OB/GYN appointment. I can help translate medical-speak and am able to also see potential issues before they arise and offer suggestions for how to stay on track with your birth goals.
Prenatal Appointments: Help the mother clarify her desires and goals; explore how the mother, birth partner, and doula will work together; create an early labor plan; and clarify what happens when labor begins.
How it works
Over one or two appointments, we discuss the mother’s priorities, fears, concerns, and questions, as well as coping and comfort techniques.
We also talk about how I work with the birth partner. Although many people mistakenly think the doula will displace the birth partner, the doula should actually help increase the birth partner’s confidence and ability to support the laboring mama. In the postpartum I just attended, new father Sam said that having a doula freed him up from worrying about all the infinite details that take place before and during labor and allowed him to focus on being present.
We also do a number of practical things, like help with the labor bag and make sure the fridge is stocked with labor-friendly food and beverages. Knowing that someone else is doing these simple little things helps foster a feeling of emotional readiness.
Labor Time: Provide continuous informational, emotional, and physical support for a happy, healthy birth; guide the birth partner in supporting the laboring mama.
How it works
Once early labor really kicks in, I remind my client or her birth partner of the early labor plan. Although most early contact is over the phone, as soon as active labor begins, I pack my bag, spray on an essential oil blend that supports labor, and join my client. My labor doula support typically begins at the woman’s home where—for women who choose a hospital birth—she labors until deciding it’s time to transfer to the hospital.
During active labor, I remind my clients that their bodies instinctively know how to give birth; reassure them; and suggest options to help them—new positions, massage, breathing techniques, Reiki, or aromatherapy depending on the situation and preferences. My familiarity with the hospital culture helps me anticipate what’s coming and make suggestions that can help prevent unwanted interventions. After Nikki’s birth she said to me, “one of the greatest benefits to working with you was that you managed to stay one step ahead of the hospital staff.” Having a trained birth professional who can predict and adapt to the provider’s care plan is definitely one of the benefits of working with a doula.
Immediate Postpartum: Take first family photos, help with initial breastfeeding, get mama some refreshments, and reinforce how amazing the birth was.
How it works
Right after the baby is born, I honor the amazing work my client has done. At a recent birth, when I asked my client post-birth, “Are you proud of yourself?” She got a mischievous grin on her face and she let out an, “Oh yeeaaaah.” (Her husband’s mantra was “That was so awesome! That was so awesome!”)
It has become my custom to get my client her first real food and drink, and after such hard work, this is always a much-enjoyed reward. After that, I help with breastfeeding, say my goodbyes, and leave the family to enjoy their first hours together.
Postpartum Visit: Admire the baby, answer questions, and process the birth.
How it works
This visit, in the client’s home, is focused on talking about the birth, filling in any blanks, answering questions, admiring the new baby, and bringing closure to the amazing experience.
Overall Benefits
So what difference does all of this support make to a woman’s pregnancy and birth experience? A pretty big one, according to research conducted by Kennell and Klaus. Here are some of the most significant benefits of continuous labor support:
· Cesarean rate decreased by 50%
· Length of labor decreased by 25%
· Requests for epidurals decreased by 60%
· Use of Pitocin decreased by 40%
All of these factors influence postpartum recovery, initial bonding time between mother and baby, and health care costs. Studies have also shown that women who had continuous labor support rated their birth experiences higher and had a decreased incidence of postpartum depression. To contribute to these positive outcomes, while supporting a family at a sacred time, is an honor and a privilege. In summary, a doula supports women as they become mothers, couples as they become families, and babies as they start their lives.
*Even Taye Diggs and Jimmy Kimmel have pondered “what does a doula do?”
Andrea Crossman is a holistic RN, childbirth educator, and a labor and delivery nurse turned doula. She is the founder of Holistic Doula NYC and writes the HDNYC blog where she shares information and resources related to holistic pregnancy and empowered birth. Andrea works with women to support three important milestones: preparation for pregnancy, pregnancy, and birth. You can follow all of Andrea’s labors of love on twitter: @AndreaCrossman .
11 Comments
That is exactly what I am looking for. I’m due in December and I was just explaining to my husband what a doula does. I live in Los Angeles. How do you suggest I begin my search for a doula?
Fantastic post! I am also a birth and postpartum doula and the benefits are incredible. There is an organization called DONA (Doulas of North America) and you can search their website for doulas in the area. Also, many doulas who are working toward their certification are willing to offer low cost/free services to clients in exchange for the experience. I highly recommend working with a doula–I think you will be very happy that you did! :)
Hey Samantha, I’m so glad I answered some of your questions, that is just what I was hoping for! Corrin, congratulations! I may actually know someone in LA, email me at andrea@holisticdoulanyc.com and I’ll help if I can. Otherwise Elizabeth is right on, you can go to dona.org and search for a doula. I also think google searches like “best doula LA” can be helpful as you often find testimonials and new-mama blogs. Finally, word of mouth is always useful. Elizabeth, thanks for chiming in doula sister!
Thanks for this post, Andrea. Such useful info here! :) XOXO
I went into pregnancy feeling militant about wanting an unmedicated, unplugged childbirth, but also feeling insecure about going all out and having a homebirth (like I should have done). I opted for a halfway solution: a Birthing Center within a hospital and midwives who worked under the aegis of an obstetrician. I armed myself and my husband with everything that is wrong with the state of obstetrics in America today—chiefly that the medical profession, for one reason or another, neglects the fact that women’s bodies are built for childbirth, and concurrently, that women are ignorant of their bodies’ capabilities, and so they are guided along by doctors who manage their labors right into unnecessary surgery and then feel grateful to the medical profession for “saving their lives.”
My husband and I prepared for the big event with partners yoga and classes on how to deal with hospital staff, the stages of labor, and alternative coping methods. We were A+ students. So when it came time to choose a doula, my feeling was that I wanted one to be on hand if we needed her, to be a back up in case we had trouble getting what we wanted at the hospital, and secondarily, to give my husband ideas for how to comfort me in labor. It was my husband who felt we needed a doula. What I neglected to see was that just because my husband didn’t have to deal with the pain of contractions, he was not therefore prepared to juggle the overwhelming everything else.
When labor began in earnest, everything that we learned was eclipsed by the intensity of the sensations of labor, not just for me, but for my husband as well. Partners yoga, whirlpool baths, swaying, walking, dancing—all of that flew out the window because I couldn’t bear to do anything but huddle in child’s pose. My contractions did not progress in the textbook fashion we had learned about, but started out all over the map and stayed that way right up through transition and into pushing. These major deviations from the plan sort of unmoored my husband, and he was happy to have a doula (who, incidentally, was Andrea, the author of this blog entry) to coach not just me, but him as well. It turned out that we needed a doula to keep us on track, to make sure I stayed hydrated, to try out different coping techniques so that none wore out its welcome.
Everything that I suspected about the hospital situation was true, and it takes a lot more than just informing them of your wish to labor naturally to get what you want. It is hard to fight hospital policy and a front line of residents who have been trained that it’s best to put a laboring woman on her back, hooked up to monitors, medicated to the point of dim, dull submission, letting synthetic, less effective versions of hormones that already exist in a woman’s body commandeer the labor. These are people who don’t believe in the usefulness of gravity and have been taught no other way to catch a baby than by making a laboring woman push with her legs held back toward her head, which takes potentially stretchy tissue and makes it tight and subject to tearing and which takes a potentially wide open passage and makes it much narrower and harder for a baby’s head to get through. These are people who dress up in haz mat suits in preparation for catching a baby. Not even a doula can necessarily get such people to back off and trust a laboring woman’s body to do what it needs to do to birth a baby, but what she can do is keep you away from the hospital for as long as possible. Without a doula, I am certain that my husband and I would have arrived at the hospital hours before the baby was born, and, given the state of hysteria that stirred up when we did arrive with me fully dilated and pushing, I am fairly convinced that I would have been told I needed a c-section (for high blood pressure and other complications). Having a doula meant not giving the hospital staff the opportunity to guide us down that path. And now we have a robustly healthy 11 week old and I am healthy and scar free. My only regret is not having realized early enough in my pregnancy that home birth was the better option for me. At least the actual hospital birth experience was only a tiny blip in a great laboring experience in which I was free to do what I wanted to do, surrounded by loved ones and purring cats, not beeping machines.
Aubrey! I’m so happy to see you here and think your perspective is invaluable. Thank you so much for sharing your experience, there is a lot here that is so important for other mamas to be. You were a birth rockstar and I was honored to be a part of your story!
LOVE this piece, Andrea, and love hearing about your experience, Aubrey. Thank you so much for providing such a miraculous service, Andrea, and for explaining what you do so articulately and eloquently.
Hey Rory,
I’m a big fan so I love that you’ve weighed in! Aubrey’s story is indeed an amazing one and I’m so happy to be able to provide the real scoop about how all of this doula business “works.” Making (overly) complicated health and wellness things easy-to-understand is my favorite thing, so it was an honor to be able to do it on behalf of Crazy Sexy Life!
Thanks again Rory!
xo Andrea
I LOVE THIS BLOG!!! I am a passionate Mama and new Doula!! This is so unique and inspiring. different from anything Ive seen and yet so familiar. Great Job!!!!!
Jennifae,
Thank you so much for your love and positivity, not to mention your contribution to the world as a mama and doula. You made my night and I wish for you dozens and dozens of peaceful births!
xo Andrea
I was wondering what exactly a doula does after the blog post about home birthing. Thanks for the info! It sounds like you provide a lot of needed support to moms-to-be!
April 14, 2010