What the f*** is a doula?
When you're pregnant it seems as though no topic is off-limits. Whether it's something relatively benign like the baby's gender or potential name choices, or a more personal subject such as morning sickness, stretch marks or weird cravings, your bump seems to serve as a massive neon sign flashing 'ASK ME ANYTHING! I'M AN OPEN BOOK!' On our final trip back to the UK before D-Day, I was seven months pregnant and everyone wanted to know what having a baby in the States was going to be like – what was the hospital like, did we have a birth plan, you know the drill. When I talked through our arrangements and the fifth British friend in as many days queried, 'what the f*** is a doula?', I got pretty adept at trotting out a response.
So, what the f*** IS a doula? Well, it's basically a paid birth partner. Someone who is in the delivery room with you to provide physical comfort measures (that's the w*nky phrase the experts use – basically massage, breathing techniques and use of pressure points to relieve pain), encouragement, relief and moral support for you and your partner (I know, I know – theirs isn't the tough job, but if labour kicks on for many hours it's not exactly a breeze for them either), and to help facilitate decision-making between you and the hospital staff. Usually a doula will also come and see you at home once the baby's arrived, to provide support and answer questions in those first terrifying days of new parenthood. Although using a doula is by no means commonplace in the US, they're gaining popularity, particularly in large cities like Philly where there are multiple hospitals with progressive views on labour and birth, and they're certainly more common than in the UK where hardly anyone has ever heard of them.
I'll admit that when I first read about the concept of the doula, I dismissed it as some new-age notion for wannabe earth mothers. The last thing I needed in the delivery room was my cynical British husband rolling his eyes as a gentle-hearted hippy encouraged me to 'embrace the wave' of each contraction. But, whilst discussing my hopes for a low-intervention birth with an experienced and very normal midwife, she suggested that we consider using a doula. She said there was no telling how many patients the midwife and nurses on-call might be dealing with when I went in to labour, and that having another experienced pair of hands who was dedicated to looking after us might help in achieving the medication-free birth I hoped for. (N.B. I am NO drug-free Nazi. My desire to try to get through labour without intervention was based purely on the fact that it had worked for my mum three times, and a gut feeling that I wanted to let my body try to do its thing. I would absolutely have been right on the gas and air from the word go if they'd offered it in America - but sadly they don't. And I wasn't vehemently opposed to drugs at all costs; indeed at the peak of what my husband would term my 'crazed wolf' state, I was literally crying out for the epidural - only to be told it was time to push and therefore too late. No choice is a bad choice when it comes to getting those little (or not so little) peanuts out.) There's also a growing body of evidence about the benefits of using a doula – including reduced rate of C-sections and increased satisfaction about the birth experience among women who use one.
The more I researched the role of the doula, the more I felt having one would work for us in our particular circumstances. If I'd given birth at home, I wouldn't have had my mum in the delivery room, but I would have taken comfort from knowing that she was at the end of the phone and, crucially, in the same time zone if necessary during the early stages of labour when you're trying to work out if now is the time to make the mad dash to the hospital. My husband, who turned out to be a total legend on D-Day as I probably always knew he would be, was nevertheless not a particularly 'hands-on' partner during my pregnancy (steady - I'm talking about back rubs and foot massages here, nothing blue) and not exactly in his comfort zone talking about optimal positions to open up the pelvis and counteract labour pain. I felt some gentle encouragement and guidance for both of us might be beneficial on the day – particularly given his reluctance to engage with the small library of pregnancy books I'd amassed. And what particularly appealed to me was the fact that our doula would come and see us at home once the baby was born. She could help with getting going with breastfeeding, answer the gazillion questions we had about keeping this baby alive, and provide some reassurance that we were doing ok. These were the things I definitely would have wanted from my mum, but given we didn't know exactly when the little one was going to make an appearance, and we'd decided we wanted to get through my husband's paternity leave just us before the wider family started to descend, she was never going to be there in the very early days.
I'll admit I was a bit anxious about broaching the subject with my husband: he's a typical British bloke who is pretty stoical in public and doesn't love small talk with strangers at the best of times, let alone in the midst of such a significant life event. But of course you don't say no to a pregnant woman, and although he liked to claim I'd put him through enough preparation classes to qualify him as an actual midwife and therefore didn't need any extra assistance, ultimately he was ok with whatever I wanted.
We found our wonderful doula, Cathy, through the Philly Doula Co-op - although there were tons of places to look once you scratched the surface. I deliberately went for someone who was more like my mum than a hippy earth mother - she had her own kids and grandchildren, and had already attended over 100 births so was seriously experienced. She came to meet us at home three times in the last couple of months of my pregnancy - discussing our hopes and concerns about birth, agreeing what her role would be, and giving us advice to increase my comfort in the last weeks of pregnancy and early labour. Cathy was on the end of the phone whenever we needed her (brilliantly reassuring when I had a spiked blood pressure reading in the 38th week and was sent for emergency monitoring), and when labour started she was in regular contact to advise when to head to the hospital and agree at what stage we wanted her to come down.
During labour Cathy helped me try a range of positions to ease the pain and keep things moving, coached my husband exactly where to apply pressure (shock horror - in the heat of the hour all that bravado about managing this single-handedly went out of the window), and had all sorts of great props to help target the pain exactly where I was experiencing it - providing much quicker relief than us novices would have managed alone. Crucially, as well as being completely au fait with the American system (which we, obviously, were not) Cathy also knew our nurse and midwife well from attending many previous births at our hospital, so when it came to making decisions about how and when to move things along, we were really comforted by their collaborative approach. And because they knew and trusted her, she was allowed to use things like heated rice socks (sounds weird – worked a complete treat) to target the pain I was experiencing, which we wouldn't otherwise have had access to.
I was really lucky: my birth was relatively straightforward and once labour really got going it only lasted about nine hours – not bad for a first time at all. I don't know for sure if having Cathy there made a difference to how it all panned out, but in the moment it certainly helped me cope with the pain and stay calm (apart from the 'crazed wolf' stage, but I don't remember that so it doesn't really count). And having her come and visit a few days after our return from hospital was wonderfully reassuring. I know, if we'd had any major freak-outs in those early weeks, she'd have been there day or night to help us too - that piece of mind was priceless.
Tellingly, my cynical British boy was also a complete convert. I think he genuinely appreciated having someone else who was of sound state of mind to help support me and with whom to discuss our options when it came to making decisions about how to move things on. Having since been on the end of the phone in the small hours to a good friend whose wife was stalling in an agonisingly long first labour, I think he practically considers himself a doula now (there's the bravado again!), and I've overheard him singing their praises to other boy mates. I'd chalk that up as a win for the doula movement!
When I tell people now what the f*** a doula is, their follow-up question is normally, would you recommend using one? And my answer is always the same: absolutely. I like to think of Cathy as the driving instructor of my daughter's birth. I would never have driven a car for the first time without a qualified personal teacher in the seat next to me, so why would I eschew some expert instruction for this most monumental of moments?!