Midwives and Doulas

Have you hired your doula yet?

Research has shown numerous benefits of having a doula, and as midwives we see these positive effects again and again. Because of this, at Pomegranate we are strong advocates for doula care.

What’s a doula?

Doulas (also called Childbirth Assistants, Labor Support Professionals, Birth Assistants, or Birth Companions) provide emotional, physical and informational support during pregnancy, labor, birth and immediate postpartum.

  • A Doula provides continuous, uninterrupted support throughout labor and birth. She offers information, massage, suggestions for position changes, relaxation techniques, reminders to stay hydrated and keep your bladder empty, etc.
  • A Doula does not replace a partner. Instead she also helps support the partner in ways that help enhance the bond between the couple.

Why do I need a doula?

Even if you have a wonderful, caring partner, best friend, midwife/doctor, will he or she:

  • Provide prenatal visits in your home?
  • Bring a birth ball and other tools to make your labor easier?
  • Provide massage appropriate to whatever stage of labor?
  • Provide relaxation and focusing techniques?
  • Suggest positions to help labor progress?
  • Do the double-hip-squeeze or provide counter pressure in just the right place? Or even know what these are?
  • Know how to appropriately use the Take Charge Routine?
  • Suggest positions to ease back labor, aid relaxation, help with pushing, etc?
  • Offer you cold/hot packs?
  • Bring you drinks, snacks, ice chips?
  • Stay by your side so that your partner can take a break when needed?
  • Instinctually know when you would like someone to mop your brow with a cool cloth?
  • Know when your request for drugs is a way of asking for more physical/emotional support?
  • Stay by your head providing encouragement while you are in transition and when the baby is being born?
  • Take notes during labor and provide you with a written record of the birth?
  • Take photographs of you, your partner, your baby, and other members of the birth team before, during and after birth?
  • Visit you at home afterwards to review the birth and see your beautiful new baby?
  • Help you with breastfeeding?

What do doula services include?

  • Pre-natal visits (usually two) in your home or other comfortable space
  • On call guarantee 24/7 for two weeks prior to due date to two weeks after, or until baby is born (or similar variation) , with a back-up doula if needed
  • Telephone support during early labor, before you need physical support
  • Continuous presence once labor is established, until one or two hours postpartum
  • If early labor is long, telephone support and/or home visits where appropriate to help create a coping plan
  • Labor and birth positioning suggestions for comfort and labor progress
  • Massage and other alternative pain relief measures
  • Information on all aspects of labor for you and your partner
  • Support of whatever choices you make during labor
  • Photographs or videotape of birth, if desired
  • Help with initiation of breastfeeding
  • One or more postpartum visits, at your convenience

Additional Services may include:

  • Telephone support throughout pregnancy and immediate postpartum
  • Assistance with preparation of a Birth Plan that works
  • Accompany mother to meet with midwife
  • Private childbirth education classes in your home
  • Personalized relaxation tapes for birth
  • Pregnancy photography
  • Belly cast
  • A written record of the birth (“Birth Story”)
  • Intensive postpartum breastfeeding support
  • Postpartum Doula support, including overnights if desired

How do I find a doula?

Whether you just got pregnant or are already in labor, it’s never too early or too late to hire a doula

  • Ask your friends and acquaintances – you’d be surprised how many people have now heard of or used a doula.
  • Ask your midwives for referrals

Don’t be shy about interviewing as many doulas as you want. You want someone you are comfortable with, and who you feel will work well with you and your partner. You won’t necessarily “click:” with the first one you meet. Don’t worry, nobody will take it personally!

What about fees?

Fees range anywhere from $0 to $1000, usually depending on the experience of the doula. The average is around $600. Additional services, such as private prenatal classes, would be an added fee.

If cost is an issue, some doulas are able to offer a sliding scale to a small number of clients. Also, there are a number of doulas who are available for low or no cost. Call the Doula Services Association, who keeps a list of these doulas.

Myths about Doulas

We notice that when clients are first introduced to the idea of having a doula, there are a number of comments that come up frequently. Of course they are meant sincerely, but often come from a place of not understanding birth and/or the doula’s role. The following are grouped by theme.

I’m very private … OR … I want as few people as possible … OR … There are already going to be a lot of people (friends, family or staff) … OR … A doula will decrease the intimacy between my partner and myself

A good doula will actually make it feel like FEWER people in the room, thus enhancing the intimacy of the experience. She can do this in various subtle ways:

  • Taking over the practical jobs that would otherwise take your partner away from you, fetching food, refilling your water, calling the midwife, heating hot packs, etc.
  • Giving pointers as to how best provide support: back massage, cold clothes, double hip squeeze.
  • Addressing the questions or fears of family/friends (whether present or on the phone) so that the laboring mom doesn’t have to

We frequently hear and see how having a doula takes the pressure off the partner to remember everything about every stage and variation of labor and birth, and then choose the appropriate types of physical, verbal and emotional support. This way your partner can relax and enjoy the beauty of the experience, as well as discover his/her own strengths. As a client once said, “It’s like having cheat notes!”

My friend who loved her birth experience didn’t have a doula … OR … I’ve already had a baby, I know what to expect

Yes, it is possible to have a birth without a doula, but even an “easy” birth can be enhanced by a doula. For this reason, even pregnant midwives and doulas hire doulas!

If I have a midwife, I won’t need a doula … OR … My midwife will bring her student

Midwives and doulas do have much overlap in styles and skills. There are also a number of key differences:

  • Increased labor support: Because a midwife’s primary responsibilities are clinical – to make sure that you and baby are safe – certain situations will take her away from focusing on just labor support
  • Early labour: Midwives do not attend you until you are in active labor – 4 cms dilated and having regular contractions. If you are like many other women, chances are you will have hours of early labour – ranging from 2-24 – when having a doula to reassure and support you could be very helpful for you and your partner. Rather than navigating this time alone, you and your partner could have the additional support offered by your doula. A doula will be there when your partner needs to eat or sleep, if you run out of coping strategies, or even just need a reminder this is still normal.
  • Precipitous labour: If you have a very fast labour, your midwife will be occupied with getting ready for the birth. When things need to be done quickly, a doula can be an extra set of hands that frees your partner to stay with you during this intense experience. A doula can also be the person whose voice is constantly in both your ears reminding you this is normal, just fast, and will be over soon.
  • Moment of birth: As mentioned, at the moment of birth the midwife is focusing on her many clinical duties, most which are below your belly button (including reducing your chance of tearing). A doula will still be available to do all other forms of physical and/or emotional support that you and your partner may need.
  • Scary outcomes: When things are not going ideally, there may be a flurry of clinical activity. A doula can stay with you and your partner/family to “translate” what is happening and help facilitate information flow. Your doula will be a grounding presence for you and your partner while your health care providers work to ensure that you and your baby are safe.
My partner will be my doula … OR … My mother/sister/best friend will be my doula

Each labor is unique in its own way. Unless your partner/mother/sister/best friend has extensive birth experience, they may not have the creative resources necessary for the twists and turns of your labor. In addition, the added element of being emotionally involved can have moments of such depth that they need to step out of the doula role. This is especially true for grandmothers (your mother)! Doulas have much more of an ability to maintain neutrality when confronted with the intensity of a laboring woman; for example, if your birth plan is to avoid drugs but your sister had three epidurals, she may not know how to support you if you have moments of doubt about your ability to continue without drugs.

My friend who had a doula still had a long, difficult labour

Having a doula does not guarantee a fast, easy labour or a vaginal delivery. It can, however, enhance your experience no matter what that is.

I can’t afford a doula

Some doulas work for low or no cost in order to get more experience. Many of these women have a natural instinct or other skills that make them excellent despite their minimal experience. The only time a newer doula would not be recommended would be if you have special or complicated birth needs, such as planning a VBAC, breech, etc.

I’m too shy … OR … I don’t have time to interview doulas

Ask your midwife for a referral – we will try to choose someone we think you will connect with. We also have a list of doulas on our website. Or you can check out Pomegranate’s Doula Speed Dating night.

I’m planning on having an epidural, so I won’t need a doula

Usually you will not be able to have an epidural until you are five centimetres dilated, so a doula can help you cope until then. Once you have your epidural, you still have much work to do to have a baby. There will be a role for a doula no matter what type of birth you have.

Midwives and doulas have been working together for centuries. Historically, doulas were women from the neighborhood who attended births and helped out a friend in need. In the last century when birth became more medicalized, the labouring woman was expected to be alone. Partners have been invited into the labouring rooms only for the past several decades. For centuries, birth was an event where families, and experienced women, supported the natural birthing process. At Pomegranate, we are invested in you having a birth where you feel safe, informed and supported. Our intention is to offer you resources so that you can make decisions that suit you and your family best.

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