Doulas, Who Needs 'Em?

If you are like me when I was pregnant with my first son, you might be thinking that a doula would only be an intrusion on an otherwise very private and special time for you and your spouse.  This is a very common concern (to see other common misconceptions, click here).  But unless you are birthing completely alone, sans midwife, at home, it is impossible for you to have a completely private birth.  The majority of women in the US birth in a hospital and will have all manner of nurses and caregivers assisting them with their labor and delivery.  Having a doula can actually help a woman and her partner have a more intimate experience amidst all the hustle and bustle of a hospital.  And having a doula, with training and experience, at their side enables the partner to just be in the moment with the laboring woman, supporting her, rather than fielding questions like:

• Why am I shaking?  
• Why is this taking so long?  
• Why do I feel dizzy?  
• What do we do now?  
• What is that smell? 
• Do we have other options?

And the list just goes on and on and on.  If you look back at my first blog post, you can see more specific details about the role of each person on the birthing team but a doula is the only person who can provide ALL of the following.  The physician provides some of these things.  The nurses provide some of these things.  But the doula provides all of them.

• A continuous, uninterrupted presence
• Knowledge and understanding of the emotions and physiology of labor & delivery
• Experience with other laboring women
• Ability to remain calm and objective
• Perspective on problems and options 
• Knowledge and advocacy of mother's wishes, goals, & hopes
• Freedom from other obligations, other patients, tasks, clinical management, charting & policies
• Knowledge of comfort measures.

To further illustrate I thought I would share some of the details of my birth story with my first son, back in September of 2008.  Here is how it went down. It was, by the way, a very good birth experience.  I really lucked out.   I do, however, think that a doula would have been HUGELY helpful.  Read on for details.

This is how I thought things would shake out.

• After laboring at home for as long as possible, Jason and I (along with my mom) would head to the hospital.  Check.
• My mom would be in the room with us but only as an observer and (silent) supporter.  Check.  
• Our nurse would help with coaching me and helping us figure out what to do, what comfort measures to try.  Um, not really.   While we had 2 incredible nurses with us during my labor who were both very kind, they weren't really part of the show, so to speak.  They took my blood pressure, checked my stats, answered questions if we asked, but otherwise left us to our own devices.  
• Our doctor, who was fantastic, would be an integral part of the day.  She would be there to tell us what to do.  Definitely not.  While I think our OB is absolutely one of the best in the business and she played a significant role in our overall experience, we only interacted with her 2 times during our 10 hours of laboring in the hospital.  

Here are some ways we think a doula would have helped us.

• I got into the bathtub at the wrong time.  I had no idea that if you get into the tub at a certain stage of your labor, you will slow things down.  It was one of the first things I learned in my training as a doula.  If you need to slow things down during labor, have the woman lie down in the bathtub.  But I didn't need to slow things down.  It wasn't a good choice for me at that stage of the game.  A doula would have known that and would have given us that information.  But we didn't know.  So I spent 3 hours of intense labor in the tub but made virtually no progress, which was terribly discouraging to us at the time.  
• I had a really difficult time changing positions.  I would get into one position or place (bathtub, toilet, side of the bed) and then feel stuck.  I couldn't figure out how to change positions without completely disrupting my rhythm and breathing.  Jason obviously had no experience with this kind of thing and didn't know how to help me.  This led to a high level of anxiety and stress for both of us.  We felt helpless.  A doula is trained to help a woman change positions and maintain her rhythm with little stress.
• After I finally made it out of the bathtub, my doctor suggested that we break my water.  I was not in a place to think through the options and needed someone with a clear head, like a doula, to help us.  Instead, I just sort of sighed out an "ok, whatever."   Without going into all the details, I will just say that at the top of my list with my second birth was to let my water break on its own.  And as a doula, I would make sure my client understood what they were getting into before they agreed to AROM (artificial rupture of membranes).  
• After the doctor broke my water, things moved VERY quickly.  In a matter of minutes my contractions were only 20 seconds apart and I lost all control.  I had no rhythm or way of making it through my contractions and Jason was at a total and complete loss as to how to help me.  I was frantic.  This is when a doula steps in with what is called "the take charge routine."  To help a woman find her rhythm again.  At that moment, we needed a doula to take charge.  And to explain to both of us that I was in transition and very close to the final stage of labor.  Instead, in our desperation, we asked for an epidural.   Now, if you read my blog or have even just skimmed my front page, you know that I am not at all opposed to epidurals.  That said, I am opposed to a woman being uninformed.  And in hindsight, I would have very much appreciated some more information.  Knowing that I was in transition might have changed the course I chose.  

All told, I was very fortunate.  I had an incredible birth.  Twenty minutes after the epidural was in place, with the lights down low, my mom up by left shoulder and Jason holding my left leg, I started pushing and about 25 minutes later, Gryffin was on my chest.  It was unbelieveable.  Our doctor was so calm and soothing and I couldn't have asked for a more intimate experience with Jason.  But do I still wish we'd had a doula?  You bet.