Why you need a doctor or midwife, a nurse AND a doula

A doula’s primary job is to focus their attention on the birthing person or new parent and their state of being. There are a lot of different ways we go about doing that, so to answer why you need a doctor or midwife, a nurse and a doula, I’m sharing a short list of the most common and effective functions we perform.

  1. Doulas get to know you pretty intimately during pregnancy. Pretty soon we’re chatting about vaginas, epidurals, baby carriers, etc. with you as if we were old friends, so there’s a comfort level there prior to your birthing day. Hopefully you feel a similar connection with your providers, but in many cases your doctor or midwife works in a group practice and the provider on call may not be a person with whom you’ve spent a significant amount of quality time. It’s pretty unlikely that your nurse will be someone you’ve met before, so part of the doula’s job on your birthing day is to set the tone for positive communication between you and your care team, tailored to your unique personality and communication style.
  2. Nurses are often unable to focus completely on providing you with emotional support. It’s not because they are uncaring or because they don’t want to. It’s because they are often taking care of more than one patient at a time and they have many other tasks which take precedence in a hospital setting. The order and procedure of a hospital helps to keep patient care running relatively smoothly. Documenting information is a big part of a nurse’s job, whereas a doula has the privilege of just being present in the moment with you.
  3. Doctors and midwives are rarely able to stay with you continuously. Doulas are the only people who are able to provide you with continuous care. That doesn’t mean we are magically transported to your house the moment you have your first contraction, however it means that we’re in touch with you when those early labor signs begin to happen to provide ideas and tips. We may come to your home during early labor if you are in need of hands-on support, help you make an informed decision about when to go to your birth place, will be with you as you are getting settled at your hospital or birth center, and will stay with you until your baby is safely in your arms, usually until they are nursing! The only exception to this would be an especially long labor without any intermittent rest periods, or during a previously discussed interruption of service. If these scenarios occur, we provide seamless transfer to a trusted back-up doula; this is discussed and agreed upon far in advance of the need.
  4. We help your partner feel like a rock star. A lot of folks who are unsure about hiring a doula are worried that their partner/spouse will be replaced. This couldn’t be farther from the truth! In fact, our goal is to help your partner feel more included than he/she would have if we hadn’t been there. We do this by teaching and reassuring during our prenatal visits, through gentle reminders about the birthing process and comforting techniques during labor, and by paying attention to the experience the partner may be having and the feelings associated with it, which can include anxiety and fear as well as joy and pride. We are there to support those experiences and to normalize them so that the two of you can work even more effectively as a team. And if your teamwork as a couple is working naturally and smoothly as it often does, we protect the space around you for that to happen. We do this by interacting with the staff and with the environment in a sensitive manner relevant to our job role.
  5. We are with you in the days after you give birth. Your provider will make their rounds and visit you in the hospital, but we will visit you at home just a day or so after you are discharged. If we are your postpartum doula, we are with you for longer periods, including overnights if you desire, in those days as you are getting to know your new baby. Postpartum doulas (a separate service) help you gain confidence in your parenting instincts and provide much-needed practical newborn support. This can be such an important aspect of your physical and emotional healing process. As birth doulas, we are there to normalize the physical changes occurring which can feel so abnormal to new parents, and we know when medical referrals are immediately necessary. And when all is well, we are simply there to listen. New parents have an intense desire to share their birth stories; this is something pretty universal and it’s just inexplicable until you’ve experienced it. Doulas are there as a witness to hear things from your perspective.

OK but do I really need a doula (I mean, really)?

These are a few of the major ways doulas enhance your birthing day and postpartum period. So when we say that doulas are needed it isn’t that we are essential to the mechanics of giving birth or to newborn care, as that obviously isn’t true. It’s that we have developed an incredibly valuable, professional service which addresses the needs of modern birthing people. As a doula educator I am so very proud of this. This function was so naturally performed in villages in the past, and still happens as a function of culture in other places in the world today.

In the modern, developed world with all its bells and whistles, it’s easy to lose sight of why a doula’s comforting touch is needed. But I would argue that’s actually what makes doulas even more necessary. Compassion is necessary during pregnancy and birth, so why wouldn’t doulas be? We certainly expect that your medical care team also approaches everything they do with compassion and sensitivity (and doulas help you identify and find the qualities you are looking for in a provider), but we know in reality that emotional support is not always ideal in medical systems and settings. Birth can be unpredictable and doulas are a steady rock in those challenging and joyful moments. So I hope you will keep these points in mind regarding why you need a doctor or midwife, a nurse and a doula as you decide whether to hire one, as well as by sharing these points with friends and family in the future!

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