A doula is a "woman who serves" and a popular role in the birth industry these days.  What does a doula do?  This topic is covered in a variety of ways all over the web, but I want to cover a very important topic that seems to get lost in the mix of attended births, especially hospital births.   Although there are a few male doulas here and there, a doula typically is a woman and "serves" other women during the perinatal stages, commonly, birth. 

There are a variety of areas a doula can specialize in including antenatal doulas (who serve during pregnancy), labor doulas (rather self-explanatory), and postpartum doulas (who support during postpartum and many also provide placenta encapsulation services).  Their role, first and foremost, is SUPPORT for the mother.  We're going to discuss that specifically in this post.

Because a mother may often require emotional and physical encouragement and/or assistance, the labor doula's top priority is providing this type of support. 

Doulas (as adapted from DONA.org):

• Reduce fear and anxiety
• Reduce requests for pain relief
• Increase chance of spontaneous vaginal delivery
• Shorten labors
• Reduce complications
• Reduce pitocin usage
• Reduce need for interventions and cesarean delivery
• Increase use of a birth plan
• Increase positive feelings about childbirth experience
• Enable couples to feel more secure & cared for
• Increase success in adapting to new family dynamics
• Increase breastfeeding success
• Decrease risk of postpartum depression
• Increase bonding and sensitivity
• Create more self-confidence in parenting

Contrary to what many believe, advocacy is not her primary role.  And, although she may provide this type of support in some sense, she cannot change policy.  This is why parents need to understand why hiring a doula for the right reasons is so essential to a positive experience.  Let's get a few things straight, first:

1. Get Educated
2. Make choices that SUPPORT YOUR birth philosophy and understand how those choices affect your ability to birth biologically.
3. AFTER you've made those choices THEN hire a doula for support and maybe advocacy if you don't have the option of a birth philosophy-supported experience.

You really should not make birth choices that require you to use a birth guide or doula to have your wishes met.  In most locations, finding a provider to support your birth philosophy is very possible.  In many cases, yes, you likely need to be open to a home birth, but, I haven't quite understood how parents feel safe fighting for a birth guide in a hospital rather than being thoroughly supported by a home birth anyway.  In a hospital, chances are, your L&D nurse is the one caring for you and conveying details to your provider.  A home birth midwife is typically far more experienced than an L&D nurse (especially in regards to natural birth).  Not to mention, they are right there with you and can do things to help you or transfer if needed, whereas most births in the hospital require waiting for the care provider to show up to determine risks and emergencies....hmm... something to think about.

The birth team works best when everyone supports each other and negativity is thrown out of the mix.  Negativity increases stress, which increases pain, which decreases oxygen, which triggers maternal and/or fetal distress...  See where I'm going here?  You should not choose a birth environment or care provider believing you (or dad, or your doula) can change the way they practice.  Do you have rights?  Of course.  But, so do they (and you also have to consider all those consent forms you may have signed).  And, they also have a bit more power than you might like to believe.  Better to reduce the tension and just have a great birth, don't ya think?

Along those same lines, don't hire your doula and forego the perinatal education because you believe your doula can educate you along the way.  Many doulas do offer childbirth education, often even private classes, BUT this is PRIOR to the birth.  A doula can absolutely provide you with on the spot pros/cons/education...etc., when necessary (which shouldn't be needed in the average birth situation that was created through choices supporting your birth philosophy) but this should NOT be relied upon!  When you're in the moment of birth, you don't want to switch on that logical part of your brain to get some last-minute education.  You need to stay in that primal-brain birth mode to work with your contractions, listen to your instincts, and progress your labor.  Additionally, if you haven't been educated, you have likely not developed a birth philosophy and therefore don't really know what all your options are or what you want (and may not be selecting choices catering to what you would have wanted had you been educated...etc...etc.)  All of this tends to end up in a "had I known..." scenario or "wish I would have..." situation.  Doesn't cater to the positive birth experience that could occur.

A doula is best used when physically and emotionally supporting the mother.  This can come in the form of physical touch, pressure, supporting positions, suggesting bathroom breaks, creating privacy, calming breathing, making noises, and what have you.  Telling mom "you're doing great," "one contraction at a time," and remembering specifics like relaxation triggers, positive words (wave, sensation...etc. vs. contraction, pain...etc.).  She is with the woman throughout her labor rather than doing paperwork and tending to another birth.  She is also suggesting supportive techniques to the birth partner, giving the birth partner breaks, and allowing the birth partner to participate as much as they can (and prefer) to be involved.  If she has to spend her time fighting over policies and routines, telling someone she doesn't want to labor on her back, and preventing a provider from doing things like episiotomy and early cord clamping, then her skills are not being efficiently utilized, and the mother is not being fully supported...nor using her instincts.

This is no different in a home birth.  You should not select a provider in any location where a doula needs to be your advocate.  And, because this perspective of a doula is so prominent, many midwives get offened that doulas are hired for home births.  Likewise, many mothers are not hiring doulas because they really don't "get" how valuable they can be at home.  For the most part, a midwife offers continuous support.  However, they are often doing more clinical things that a doula doesn't provide.... and if they're doing clinical things, then the mother may be lacking some support that she needs.  If the mother feels like she doesn't want to birth alone (i.e. unassisted) then she needs to select the team that best supports her.  If the midwife needs to document part of the birth, check heart tones, check blood pressure (or one of those crazy vaginal exams)...etc., the mother may want that doula-support that she isn't getting during those times.  Not to mention the births that may require a little more clinical care than others, difficult labors, or births that need transferred.  If there is an emergency, the midwife will be focusing on health of the mother and baby.  Even when there isn't an emergency, the midwife is watching over the mother and focusing on the health - a perspective that isn't the same as just supporting.

Bottom line, select a birth environment that SUPPORTS you.