Sex

Read Part 1 here and Part 2 here.

Part 3: So how do I find a doula?

But how do you choose your doula? Where do you find one?

If you have a midwife, most offices keep a list of doulas that work in the area. Even OB/GYN’s are beginning to come around to the idea of doulas as partners in the birthing process and asking at your doctor’s office could be a good place to start.

Ottawa is home to the Ottawa Birth and Wellness Center, located on Walkley Road. It can be a huge resource for parents looking for birth options and for links to local doulas. On the third Wednesday of every month, if you have a midwife, you can attend their Choice of Birthplace seminar and it can be very informative if you are on the fence about where you want to birth and the type of birth you are looking for. Especially for a first-time parent.

There is also word of mouth. Ask around among other pregnant friends, see if anyone recommends someone, and doing a google search for doulas in your area can also give you a place to start.

Finding a doula and choosing a doula are two different things. It’s a good idea to interview your doula options, ask about their previous experiences, their training (if they have any), maybe some references if they are really new. But when it comes down to choosing your doula it’s about connection. You might connect with the one who has 14 years experience or you might connect with the one who has just finished training and is looking for some experience. Pay close attention to how your gut feels about the doula.

“I think connection is one of the most important things,” says Anderson, “because it’s very intimate giving birth. You need to be careful with who you have there and the people who are there should be on your side and you should feel good about that.”

The process of birth can be an incredibly empowering experience for women, and a doula can help avoid traumatizing pitfalls that can stay with women long after the labour is over, affecting their mental health by increasing the chances of postpartum depression and making it more difficult for a mother to connect with their newborn in the days and weeks that follow.

Whether you enlist a doula to support you in your labour or not, please do your homework on what your rights are and be aware of the cascade of interventions that can lead to a less than optimal outcome for both mother and child. Medical advancements have saved a lot of children, but when people rely too heavily on machines and stop listening to their bodies, the scales tip back towards there being a potential for more trauma due to unnecessary interference. The US has some of the most medicalized births, relying very heavily on machines and interventions, but they also have worse birth outcomes than some third world countries, so those machines do not necessarily know better than a woman’s body what it needs to do.

Trust yourself.

References

Wise Woman Way of Birth

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Read Part 1 here.

Part 2: A doula’s toolbox

Doulas have many tools in their repertoire that can help a woman in labour.

“When I first go to a birth, I observe what my client is doing and ask her some questions,” says Anderson. “For instance, if the mother says the pain is all in the back, I would start straight away with counter-pressure and ask her, ‘does that feel better?’”

Communication with your doula is key. Anderson will check in with her clients repeatedly about what is working, what’s not, and will change up her techniques accordingly. She can offer the use of a TENS machine, which can help some woman cope with the pain better. Anderson will also remind the labouring woman to stay hydrated, to rest, to breathe.

It’s not uncommon in birth for emotions to come up.

“If somebody gets really emotional, if they need to cry, I tell them, ‘Just cry’,” says Anderson. “I can ask them questions as to what’s coming up, what are you worried about and sometimes they’re very valid worries.”

And if something comes up on the medical side, Anderson can help remind the woman or the couple that it’s okay to ask questions. Rarely is there ever anything in birth that requires such an immediate response that there isn’t time to ask questions and find out what’s happening before making a decision.

“Sometimes in a hospital setting people can find it overwhelming where [information] is often presented as ‘this is how it is’ and some people have a hard time going against it,” says Anderson. “Sometimes it’s really hard to collect your thoughts when people are looking at you waiting for an answer, so I might say to them, ‘Ask for five minutes’.”

The discussions a couple has with their doula at their pre-meetings, as well as work they did on the birth plan, will make all of this easier to navigate, as there will be a bond and the couple will already be privy to a foundational understanding of the choices they may face during labour.

“Many times, at the hospital,” says Anderson, “the nurses would say to me, ‘You’re really lucky because you got to know these people. I just met them and they’re in labour’.”

The support a doula can provide for the non-birthing partner is amazing as well.

“[Partners] have a hard time because they feel like ‘oh, my love is in this much discomfort and I can’t do anything’. They feel helpless and that’s a difficult place to be.”

Doulas can help partners learn massage and counter-pressure techniques to help reduce pain, which gives the partner something to do and can help them feel more connected to their labouring partner and the birthing experience as a whole. Doulas can remind partners to breathe and to take time to rest, eat, or drink, especially if it’s a long labour as was the case for Chris Brown’s wife Debbie. Her labour went on for several days and they were sent home from the hospital a number of times, plus there were other complications such as meconium, a complication where the baby poops inside the amniotic sac and runs the risk of aspirating it into their lungs before they are born.

“I actually hyperventilated and left,” said Brown. “I think it was because I was afraid for Debbie and the obvious pain she was undergoing.”

But he credits their doula with providing them with a lot of information ahead of time, that allowed he and his wife to navigate the overwhelming elements of their daughter’s birth.

“She was genuinely there for us when we needed her and she did provide a lot of comfort and knowledge,” says Brown.

There have been some studies conducted on birth outcomes for woman with labour support and while some of the results are harder to quantify, in general most woman did better with continuous labour support. According to the Journal of Perinatal Education, “Doula-assisted mothers were four times less likely to have a low birth weight (LBW) baby, two times less likely to experience a birth complication involving themselves or their baby, and significantly more likely to initiate breastfeeding.”

(At the end of the article there will be an additional of list of resources and recommended reading that you might want to explore if you are contemplating a doula for your next birth.)

References

Oakville Family Birth
NCBI
Science Direct
Dona

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Part 1: What’s a doula? Why do I want one?

Pregnant women often say that what matters most is the health of their baby or babies. Our society focuses heavily on the arrival of baby often to the detriment of the mother. One of my favourite quotes is, “the moment a child is born, the mother is also born,” and according to the internet it is attributed to Osho, a controversial figure. But the quote captures a truth about childbirth.

The woman is as integral to the process of birthing as the baby is, and her importance and her need for support is just as important as the health of the child. The act of labour is a symbiotic relationship between the woman’s body, mind, and soul working along with the movements of the newborn descending through her birth canal. The more we can allow that process to happen unhindered and for women to be free to listen to the intuition of their bodies, often the better the outcomes are for both the mother and child.

Unfortunately, our highly medicalized birthing system in North America has forgotten the power of the female body – but this is starting to change.

Women are remembering, they are learning to trust themselves, and they are demanding more support. One of the forms that support might take is a doula.

“[A doula] is somebody who helps you see your strengths, helps plan, helps craft questions for your healthcare provider,” says Courtney Holmes, the family outreach and birth companion support worker at Mothercraft Ottawa. “They really help instill a sense of confidence and empowerment moving through the experience.”

Mothercraft Ottawa provides doula services to at-risk women in Ottawa. At-risk includes new immigrants and low-income mothers. The support the doulas provide those women is invaluable.

“How women feel about their labour and delivery is a huge marker for postpartum mental health issues afterwards,” says Holmes.

Pia Anderson, a local doula and Hypnobirthing teacher, has been a doula for over 14 years and has supported hundreds of women physically, emotionally, and informationally through their journeys of birthing their children.

Anderson tries to meet with each family at least three times prior to the birth. This helps build her relationship with the woman and her partner.

She is a big supporter of a birth plan, not because she expects everything will go according to the plan, but it gives a chance for the woman and her partner to explore their options and be aware of the different scenarios that might come up, as well as to explore questions they might want to bring up with their healthcare provider. It also gives them a chance to voice any fears or worries. Anything that can be addressed ahead of time or can be anticipated to come up during the birth, can help increase the chances of a positive birthing experience.

Anderson worries about the mothers who make a birth plan that they are too attached to.

Birth is not a predictable process and getting too entrenched into an idea of how it should go, ie. having your heart set on a “natural” birth (meaning no epidural, vaginal delivery, etc…) can set a woman up for disappointment if anything deviates from her vision. The birth plan is a great tool for educating yourself on what could happen and to help you be prepared for various outcomes, but it’s important that it’s viewed as a tool to help create an optimal birth in spite of anything that happens, and not a carved in stone agenda. Very few births go completely according to plan.

Melaina Landriault is a mother of three in Ottawa. Her first birth was a c-section as her daughter was full breach and stuck, but her two subsequent pregnancies were homebirths with doulas. Her second birth didn’t quite go as planned. It was supposed to be a hospital birth, but the hospital sent her home thinking she was still hours away from delivery. Her daughter had other ideas.

“I delivered her myself,” says Landriault. “[My doula] caught the baby!”

“We really believed what the doctor and midwife had told us and I’d never birthed before,” continued Landriault. “Then I remember pushing and [my doula] was like ‘Don’t push!’ and I was like, ‘I can’t stop this!’”

Landriault’s daughter was born in her living room with only her doula to support her. Her midwife arrived after the birth and an ambulance arrived to check everyone out as well.

This is not a typical scenario for a doula and most doulas will actively avoid a birth without any medical practitioners in attendance, but this one thankfully had a happy ending.

Unfortunately, if a doula attended a birth with no medical support and it didn’t have such a happy outcome, the doula could be open to a lawsuit with devastating results and charges could even be laid if the outcome is deemed the fault of the doula in any way.

Doulas are not medical practitioners and should never provide medical advice on your pregnancy or how you choose to birth. They can provide information to help you make a decision and will direct you back to your OB/GYN or midwife for answers, but they should never tell you how or how not to do something. The main goal of a doula is to support you in whatever choices you make and to help you achieve the best outcome for your birth so that everyone, including the mother, is healthy.

Stay tuned for Part 2 and Part 3 in two and four weeks respectively.

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