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Serving the Greater Los Angeles area
Serving the Greater Los Angeles area

REFLECTIONS ON 27 YEARS OF DOULA-ING

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labor-doula

Two clarifications: First, I have always been at an advantage in that my labor doula clients were my Supported Birth or Lamaze students. They had taken my class, I had provided their knowledge and preparation, and I knew them as a couple. Most doulas meet a wide range of people, get interviewed, and are hired by a much broader clientele – with differing levels of preparation, differing hopes and expectations.

Second, my doula style was likely formed from my own birth experience, where in a dark secluded labor room in a Jerusalem “women’s” hospital, my midwife and doula basically left me alone, to go into that altered state, that I realized in retrospect, was Laborland. They were a bit stoic, believing in my process, and simply being present in that darkened, undisturbed environment, even casually chatting in the main room while I spent time alone in the bathroom, swirling in pain and another dimension. I was not afraid, which is an important piece of the puzzle; otherwise, I might have wanted or needed more close contact.

I used to call myself a “tough love” doula. Another term, that I used in my Doula Trainings, was “Less is More.” I think what that meant was that I was never inclined to “coddle” a woman in labor, to make her dependent on me as her pain management coping skill, and at the same time, that’s what I am. It’s really a contradiction. I believe that the doula IS the “intervention,” in the sense that a couple should call the doula when they feel unable to cope on their own any longer or when they feel they need the next level of help. In that sense, the doula is the drug or the substitute for the drug. Instead of going to the hospital, they call the doula. I go to them, she is ideally in an active or advanced state of labor, we hold out even longer, we get to the hospital at 8 cm, and she gives birth soon afterward, delighted in her accomplishment. I observed over the years that the doulas with the most “tools” in their doula bag, the ones who offered the most “techniques,” who offered the most “help,” were the ones whose clients ended up with epidurals. Because another person cannot carry that for her.

There are always several calls leading up to this call for “help,” during which I “downplay” (quite consciously) what is going on. I can hear some anxiety and the unspoken question “are you coming? do we need you?”  This is the hardest part, but I have found it so important over the years, to hold out, to act like “this is nothing, this is fine.” There is always a bit of internal tension (are they mad at me? do they feel abandoned? will they give up & go to the hospital?)  but typically what happens is that there is eventually a call from the DAD (or partner). That’s the call I’m waiting for. She no longer wants to talk to me on the phone. I ask him if she can come to the phone. I hope he says no. I ask him to let me “secretly” listen to her while she’s having a contraction, and I can tell a LOT from how she sounds. THIS is the point when I tell them I am coming. They may not understand yet, but when the birth is over, and we have arrived at the hospital in late labor and had the baby soon after, instead of being mad that they didn’t have more of my time, they understand that my job was to keep them away from the hospital, believe in themselves, and believe that the intensity of labor was normal. I think many doulas are taught (or expect) that they should immediately cater to their “mama goddess” and be all over her, massaging her, following her, and doing as much as possible. That’s another style, it’s just not mine.

I am not talking about a woman in a third-world country, who is lying on a cot by herself, perhaps surrounded by others moaning in labor, who would probably greatly benefit from a nurturing, hands-on, comforting presence directly by her side. Weird as it may sound, I’m talking about women in Beverly Hills, going to Cedars Sinai, where she thinks she is receiving state-of-the-art prenatal and labor care. This woman needs to find her own strength if that was her desire. 

Doula and client laboring in the chapel at UCLA hospital, when rooms were full. 

Over the years I have laid my hands in a firm and gentle way and said “you’re doing it” or “let it go.” I remember feeling that I had not done much (this is the “less is more” style that is so hard to convey to new doulas) and yet the women showered me with gratitude afterward for how my calm presence gave them confidence when they had doubts. Almost all women say to their doulas: “I couldn’t have done it without you.” I can accept that, but I want her to forget about me soon after, and for her to remember her birth with a sense that I gave her the space to do it, rather than I did it.

Dr. Michel Odent, one of the luminaries in the childbirth field, after half a century and perhaps 15,000 births (both hospital and at home), came to the conclusion that a laboring woman needs not much more than to be left alone, simply to be attended to by a quiet, non-invasive and low profile midwife. He went through a period of calling out doulas as yet another “interference” at births. Their role should be protector of the process and the space. More

I recently heard of doulas charging $5,000 for a birth. I don’t understand this at all and it may be controversial to say this. What are they openly or implicitly offering as their service? To me, it seems to imply some kind of a guarantee. This in turn implies a huge dependence on this doula. I have a problem with this. This couple could choose to have a home birth, including prenatal, labor, and postpartum care, for $6,000-7,000. They can birth OUTSIDE the system that they are hoping for this $5,000 doula to “protect” them from. And the need for protection from those forces immediately vanishes.

I believe that doulas deserve to be paid hugely and that the right match will be made and no judgment. I understand and agree with the argument that a doula’s work must be valued and compensated. They don’t know if the birth will be 10 hours or 70 hours. They may need a week of recovery. Being on call is stressful. Doulas are the missing link in maternity care, offering continuous support with no other role or distraction, doing their best to ensure that laboring and birthing women are protected, respected, and a part of all decisions. Our system has no doctor present for the labor and has no time or expectation for nurses to attend to the women’s physical and emotional needs. Doulas are now expanding their role into extensive skills in positioning, taking extra levels of training from workshops like Spinning Babies, etc. The role of a doula seems to be changing. I would never begrudge a doula to charge or receive whatever she can. My concerns are about expectations, over-dependence, control issues, and choices. 

That said, everyone should have a doula!

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