A Doula's Role in Homebirth - North Carolina Homebirth

A Doula's Role in a Homebirth

Midwives, once the exclusive birth attendants in America, are coming back in vogue, gaining in both popularity and numbers. A midwife has years of experience attending birth in its natural habitat. She nurtures, cares for, and encourages while preserving the safety of her clients.

Along with the resurgence of midwifery, a birth attendant comparable to midwives is regaining popularity. She does not perform clinical activities; she is purely a labor educator during pregnancy and emotional support during childbirth. She stays with the family during labor and birth and her sole purpose is to provide support and encouragement, and to make sure all the laboring woman's physical and emotional needs are met. She is a doula.

Photograph courtesy Megan Daniels

Doulas work at hospital and home births. In hospitals, since there is normally no one on the payroll who stays with a woman throughout her entire labor and birth, doulas provide this service. Doulas are also known for their ability to advocate for a laboring woman's wishes at a hospital. At a homebirth doulas take on more of a labor-support role and less of an advocate role. With her expertise in labor support, the doula is a great source of knowledge and comfort. In addition to supporting and comforting the laboring woman, a doula makes sure the needs of the laboring woman's partner are met, allowing the partner to focus energy into becoming an effective, positive part of the birth process. A doula can create an atmosphere between partners that facilitates wonderful labor memories, adding to the superb care midwives provide by remaining close by while your midwife performs clinical tasks.

Together they make an excellent birth-attendant team. Your doula will spend quality time with you and your partner throughout your pregnancy, during which you will get to know one another. She will educate you about what happens during labor and provide you with proven methods of non-medical pain relief. She can guide you in preparing a birth plan in case you decide, or have to go to the hospital. In the event that you do go to the hospital she can accompany you. This may be an added comfort if you have a CPM or traditional midwife, or a Certified Nurse Midwife (CNM) that does not have privileges at your hospital. In addition, the doula may have more experience in a hospital setting and in the role of advocating your choices during birth.

If you have made arrangements with your midwife to come to your home after your labor has advanced, you can be comforted in knowing that you can call your doula at any point during your labor.

She can give you and your partner pep talks over the telephone or show up at your house whenever you request it.

Your doula will be available after your baby is born to help you with breastfeeding, postpartum care, and basic infant care. Although your midwife will be available to help you in these areas as well, it is comforting to have more than one woman to turn to for support.

Most doulas are certified by a doula organization, like Doulas of North America (DONA) or Association of Labor Assistance & Childbirth Educators (ALACE). They have gone through extensive training to learn everything there is to know about labor support and they have to be recertified every so many years.

Your midwife may be able to recommend a doula that she works with. If she cannot recommend one, look for a doula that has worked at homebirths. All the doulas listed on this site attend homebirths. Because most doulas work at hospital births, they are used to not only giving labor support, but also spending time reminding the laboring woman of the plans and goals she set worth originally so that the mother-to-be can tell the hospital staff. It would not be wise to hire a doula that had only worked in that setting. Many doulas are aspiring midwives who are familiar with homebirth.

Some questions to consider asking a prospective doula are:

What training have you had? (If she is certified, you may want to check with the certifying organization for performance references).
What is your philosophy about childbirth and supporting women and their partners during labor?
When do you try to join women in labor?
May we meet with you to discuss our birth plans and the role you will play in supporting me (us) through childbirth?
May we call you with questions or concerns before and after the birth?
Will you meet with me (us) after the birth to review the labor and answer questions?
Do you work with one or more backup doulas for times when you are not available? May we meet her/them?
What is your fee, what does it include, when is it due and what are you refund policies?
Can you provide references? (Be sure to check the references)

When you meet the doula (and it is a good idea for both you, and your partner to meet her), pay particular attention to your personal perceptions of the doula. Is she kind, warm, enthusiastic? Is she knowledgeable? Does she communicate well? Is she a good listener? Is she comfortable with your choices or does she seem to have her own agenda? Do you feel comfortable with her? The way you feel with her may be more important than the number of births she has attended. You may want to interview more than one doula and make a comparison to help you find the doula that is right for you.¹

Notes
¹DONA (Doulas of North America) “Birth Doulas Make a Difference.”
http://www.dona.org/PDF/BirthDoulasMakeaDifference.pdf and http://www.dona.org