What is a Doula? And Why Should I Hire One for My Hospital Birth?

Hello! In this post I wanted to address that common question these days-- What is a doula? And why do I need one? I want to answer this for those birthing in one type of birth setting: The hospital. Pam England, author of Birthing from Within, explains what she believes women ought to know before going into labor in a hospital and this description, to me, outlines exactly why a woman should consider working with a doula. She writes, "Contemporary women who are birthing in a hospital need two kinds of knowing. The first, and most basic, is primordial knowing, that innate capability which modern women have but must rediscover (and trust). The second kind is modern knowing: being savvy about the medical and hospital culture and how to give birth within it. Birthing from within requires both these kinds of knowing."Studies have shown that 45% of new mothers have reported experiencing birth trauma. I think a big reason women have unsatisfied births is both that they have not connected with their pregnancy and that 'primordial knowing' that their bodies understand how to birth and also their lack of 'modern knowing' of how hospital births often times go. For the many couples who do end up taking a Lamaze, Hypnobirthing, or Birthing from Within class and even a childbirth education class provided by their hospital, still, I feel, may lack the knowledge and innate understanding of what their birth experience may entail if they go into it with the support of their partner only. I love the metaphor that says, "Would you willingly hike the top of Mount Kilimanjaro with just your partner and not a guide?" This really is, in so many ways, the same thing. I always tell my clients, "The hospital has their birth team. You should have one too." And while I think a tribe of women present at your birth (mom, sister, aunt, grandma, best friend) can be wonderful, that team may lack the skills of modern knowing on top of primordial knowing. "Well, aren't the nurses and my midwife (or OB) my birth team?" You may ask. Yes and no. They're busy! They typically have multiple patients at the same time and while they care a great deal about your health and safety, more often than not, the decisions that they make in regards to your care come from what is in the hospital's best interest. This is a topic I could elaborate on but I want to keep this post specific to doula support.

The term doula is a historic Greek word meaning "a woman who serves." While some mothers will chose to traverse ahead with solely their partner, the many that choose to also include a doula have with them a piece of wisdom, knowledge, and history. If you hire a doula early on in your pregnancy, the primordial knowing that England refers to is the starting point. This wisdom that both you and your doula possess should be discussed at length during your prenatal visits so that you feel emotionally and mentally prepared to trust your body and your instincts. It is so important to go into labor with the understanding that birth is normal and that all of your fears and anxieties have been discussed. These visits also help prepare the partner to also trust you and trust in the process. While labor classes and breath work will prepare you for the rigorous workout of birth, they may not prepare you for the time to let go and let your body take over. This is the only way birth not only happens naturally but is the gateway to a satisfying experience. During labor you will try to overthink the experience, doubt your capabilities, and try to escape from it entirely. Losing yourself in 'labor land,' however, is what gets you to the end and is most successfully achieved when you have the right support team.

The 'modern knowing' that Simkin refers to in hospital birth is the tool box. If you participate in a childbirth education class offered by your hospital, many of the routines and potential interventions used will be discussed. Induction, vacuum extraction, and hep-lock are a few of the many clinical terms used to prepare a patient for the protocols and potential outcomes of their birth. But there is a multitude of things to consider when birthing in a hospital such as pain management, medication side effects, Covid-19 protocols, newborn routines, cesarean rate, how to have an unmedicated birth, etc. Because birth is so unpredictable and different for everyone, the list is so extensive, it would be impossible for a first time mother to educate herself on them all. And why should she?! Pregnancy should be a time of connection, postpartum preparation and meditation on having a satisfying birth. But so often, when a new mom has her baby in a hospital, with the sole support of her partner, there are things that happen that she may not understand or may resent later. When a doula is not present, the other unfortunate outcome may be violation of the birthing person's human rights. There is a common term used by hospitals called implied consent. This means that the hospital may assume a specific procedure or decision for care has your consent since you signed a piece of paper upon admittance stating that you give the hospital your consent to care for you the way they see fit. While this may not sound terribly wrong or threatening, it has problems for two main reasons. One-- you are not a sick person. You are a mother doing something incredibly natural and (more often than not) safe. Unless under general anesthesia, you are capable of understanding and consenting verbally to any procedure involved in giving birth. The other problem is this-- Giving birth is the absolute most intimate thing you will ever do. While it's unfortunate that most of us will not birth in a dark and quiet den of our choice (as most animals and mammals do), it is even more unfortunate that the act of giving birth often lacks respect, privacy and at the very least, proper bedside manner. This is where the value of a doula continues. Your interests are incredibly important to your doula. She is the one person who not only likely knows every possible hospital intervention and protocol, but cares deeply about how those things affect your birth experience. If there is a term, tool, touch, or technique that you don't understand, your doula will hold your hand, explain it to you, and ensure that you feel safe, respected, and in control of your birth. Advocacy and the discussion of informed consent are terms discussed and explored prenatally and an incredibly important aspect of doula support.

And now, to finish this post off, I'll address the fun little details of doula support and how these tips and tricks can turn a hospital room into a cozy, home-like den. My personal approach to labor support stems from my own experiences giving birth-- both what I lacked the first time and what I cherished the next. I've found that to attempt a natural, unmedicated childbirth relies on a safe and calm environment. Renown midwife, Ina May Gaskin, calls this the "Sphincter Law," which essentially states that the sphincter will not relax and open unless it feels safe. Imagine someone walking in on you in the bathroom during that, ahem...very private time. You'd close up immediately and wait until you had your privacy back. Well, it is my theory that this is why so many hospital births are prolonged, induced, and full of interventions to get things moving. So, the hope is that if we can transform the environment, birth will continue naturally. As your doula, and with your permission of course, I will alter the room in the following ways: Lower the blinds, turn off the lights, put a sheet over the monitor, set up the LED candles, turn on the twinkly lights and essential oil diffuser, and either offer you ear plugs, a sound machine or music. You will also take comfort in the small but necessary details of doula support such as water, chapstick, hair ties, a cold washcloth, a comforting touch, and giving your partner a break. I find it important to "find your den" before labor becomes difficult. As labor progresses and you feel the need for physical support, I will revert to either water therapy like a tub or shower, use the Rebozo to relieve weight from your belly and hips, offer you a birth ball, or exercise a few of your preferred labor positions. I, along with your partner, will use massage, pressure and verbal affirmations to help you through transition (the final stage of laboring before the pushing stage). I will make every effort to limit interruptions, lower voices, and maintain a comfortable environment. During the pushing stage, your partner and I will ensure you are in an optimal position to bear down and welcome your baby into your arms.

Support, of course, does not end there. A doula's contribution continues well into newborn care, lactation, mental health, physical healing, home visits, nutrition, gifts, doting, the list goes on and on ;) I hope this has given you a little insight into the importance of doula support for a hospital birth! Stay tuned for my next post, "Why hire a Doula for Home Birth?"

Have a great week!