Doula FAQ's

The word doula --pronounced DOO-Luh-- comes from the Greek word meaning "woman who serves". Doulas are described as "mothering the mother" and serve the laboring person by offering comfort and support. 

A doula is like a personal trainer for birth. Their role is to provide labor support via physical, emotional, informational, and advocacy support to a birthing person before, during and shortly after childbirth to help them achieve the healthiest, most satisfying experience possible.

Physical Support helps a birthing person to maintain control, comfort, and confidence. This support may include: 

• Soothing with touch through the use of massage, counter pressure, or a rebozo
• Helping to create a calm environment, like dimming lights and arranging curtains
• Assisting with water therapy (shower, tub)
• Applying warmth or cold
• Assisting the birthing person in walking to and from the bathroom
• Giving ice chips, food, and drinks

Emotional support helps the birthing person feel cared for and feel a sense of pride and empowerment after birth. One of the goals of a doula is to care for the birthing person's emotional health and increase their potential to have positive birth experiences. This support may include:

• Continuous presence
• Reassurance
• Encouragement and praise
• Helping the birthing person see themselves or their situation more positively
• Showing a caring attitude
• Calmly describing what the birthing person is experiencing and echoing back the same feelings and intensity
• Accepting and acknowledging what the birthing person wants
• Helping the birthing person and partner work through fears and self-doubt
• Debriefing after the birth—listening to the birthing person with empathy

Informational support helps keep the birthing person and their partner informed about what is going on with the course of labor. A doula can provide them with access to evidence-based information about birth options. Aspects of informational support include:

• Guiding the birthing person and their partner through labor
• Suggesting techniques in labor, such as breathing, relaxation techniques, movement, and positioning (positioning is important both with and without epidurals)
• Helping them find information about different options in pregnancy and childbirth
• Helping explain medical procedures before or as they occur
• Helping the partner understand what’s going on with their loved one’s labor (for example, interpreting the different sounds the birthing person makes)

Advocacy can take many forms—most of which do not include speaking on behalf of the client. Advocacy is defined as supporting the birthing person in their right to make decisions about their own body and baby. Some examples of advocacy that doulas may provide include:

• Encouraging the birthing person or their partner to ask questions and verbalize their preferences
• Asking the birthing person what they want
• Supporting the birthing person’s decision
• Amplifying the birthing person’s voice if they are being dismissed, ignored, or not heard, “Excuse me, they are trying to tell you something. I wasn’t sure if you heard them or not.”
• Creating space and time for the birthing family so that they can ask questions, gather information, and make decisions without feeling pressured
• Facilitating communication between the parents and care providers
• Teaching the birthing person and partner positive communication techniques
• If a birthing person is not aware that a provider is about to perform an intervention, the doula could point out what it appears the nurse or physician is about to do, and ask the birthing person if they have any questions about what is about to happen. For example, if it looks like the provider is about to perform an episiotomy without the person’s consent: “Dr. Smith has scissors in their hand. Do you have any questions about what they are wanting to do with the scissors?”

(Adapted from evidencebasedbirth.com)

A doula is not a medical professional. Therefore, there are tasks that a doula does not do because it is out of their scope of practice. These tasks include:

• do not perform clinical tasks, such as taking blood pressure, fetal heart check, or vaginal exams 
• do not deliver the baby
• do not make decisions for you
• do not speak to the staff on your behalf
• do not take the place of or take over for a partner or family member

According to extensive research performed on more than 15,000 patients (source: Evidence Based Birth), researchers found that overall, people who receive continuous support during childbirth experience:

• 25% decrease in the risk of Cesarean; the largest effect was seen with a doula (39% decrease)*
• 8% increase in the likelihood of a spontaneous vaginal birth; the largest effect was seen with a doula (15% increase)*
• 10% decrease in the use of any medications for pain relief; the type of person providing continuous support did not make a difference
• Shorter labors by 41 minutes on average; there is no data on if the type of person providing continuous support makes a difference
• 38% decrease in the baby’s risk of a low five minute Apgar score; there is no data on if the type of person providing continuous support makes a difference
• 31% decrease in the risk of being dissatisfied with the birth experience; mothers’ risk of being dissatisfied with the birth experience was reduced with continuous support provided by a doula or someone in their social network (family or friend), but not hospital staff

Other studies showed that while nurses try to support women in labor when they can, they are actually only in the room for approximately 30% of the time. The advantage of a doula is that they provide continuous support. They do not change shifts like a doctor or nurse nor do they support more than one person at a time. They are able to focus on the one birthing person in labor and provide consistent support.

Hospital policies for the acceptable amount of people in the surgical room for a cesarean section vary from hospital to hospital. In some cases, hospitals allow only one additional support person in the room. I have been invited into the operating room as a second support person about 50% of the time. This is usually decided by the anesthesiologist assigned to the birth. (This often times has to be a topic of conversation that the birth family needs to advocate for in advance.) If I am not invited into the operating room, doulas can still provide emotional support before and after the procedure including during a postpartum visit at home to review the overall birth experience. Some hospitals will allow the doula to come in if the dad/partner goes to stay with the baby to the nursery. Having a doula allows the birthing person to have constant companionship and support. Doulas can still provide physical support before and after the surgery such as foot massages, music, aromatherapy, and assistance with feeding. 

What is TENS? 

TENS stands for Transcutaneous Electrical Nerve Stimulation. Using a handheld, battery-operated device, mild electrical impulses are transmitted through the skin to stimulate nerve fibers. TENS is a safe, non-drug method of pain control for backache in labor.
 

What is the purpose of TENS in labor? 

TENS is used in labor to reduce back pain while allowing the laboring person freedom to move and walk.
 

Why does TENS work? 

TENS was developed as an application of the Gate Control Theory of Pain, formulated by Melzack and Wall. This theory states that the awareness of pain can be reduced by increasing pleasant or innocuous stimuli - such as the electrical impulses of the TENS device. Pleasant or innocuous stimuli travel to the brain faster than pain stimuli do, and therefore close the “gate” to the pain.
 

Does TENS work? 

Research findings on TENS (Carroll et al, 1997) have shown that laboring person using the device use less pain medication than persons using a “sham” TENS device. The majority of people surveyed in the National Birthday Trust Survey (Chamberlain et al, 1993) rated it as moderately or very helpful in relieving pain, and would use it again in a future labor. A study that investigated the use of TENS for back pain in labor found that “TENS has a specific beneficial effect on pain localized in the back.” (Bundsen et al, 1981). Thomas et al (1988) also found relief of back pain with TENS.
 

How long and where has TENS been in use for labor? 

TENS has been used since the mid 1960’s. It is widely used in Great Britain, Australia, and Canada, where people can rent or borrow a TENS unit to use from early labor at home for as long as they want.
 

What are the advantages of TENS?

The laboring person controls the TENS unit themself. They remain clear-headed and can walk and move freely. TENS can be used with other comfort measures and may help to postpone or avoid the use of an epidural. There is no reported harm to the birthing person or baby as a result of TENS use.
 

What are the disadvantages of TENS? 

TENS is less effective than an epidural. Some birthing people do not find it at all helpful. It must be initiated early in labor to be effective. It cannot be used in the bath or shower.
 

Who should NOT use TENS in labor? 

TENS should not be used in the absence of labor before full term (37 weeks). It should not be used on inflamed or injured skin or over a rash (psoriasis or eczema). People with a seizure disorder or a demand-type cardiac pacemaker should not use TENS.
 

What precautions should be observed when using TENS?

The TENS unit should not be placed in water or near high heat. It should not be dropped on hard surfaces or used near flammable gas. It should only be used with specified stimulating pads placed on the body as directed.
 

Placenta encapsulation is the act of taking a fresh, raw placenta, washing the placenta, steaming (or slicing the placenta raw), dehydrating, grinding and putting the placenta powder into consumable capsules. Please note that the capsules are not designed to reverse medical conditions or ailments from pregnancy, to treat postpartum depression, to ensure normal milk supply or to replace medical attention. Always consult your medical provider before consuming your placenta. 

How consuming the placenta can help: 

- Preventing and lessening the risk of postpartum depression or ‘baby blues’
- Replenishing your iron from blood loss during birth and to prevent postpartum anemia 

- Lending you a consistent flow of oxytocin long after your birth euphoria ends
- Providing the HPL hormone to help establish early and healthy milk supply
- To stabilize your ever changing hormones post birth
- To replenish your B vitamins and energy that were used during the labor and birthing process 

- Protection from infection and bleeding due to retained placenta tissue or membranes
- Offer natural pain relief from the labor and birth of the baby 

Hormones Known to be in the Placenta: 

- Oxytocin­, the feel good or love hormone, creates feelings of bonding, pain relief, happiness and elation. 

- Cortisone­ unlocks energy stored in the body and combats stress. (cortisol)
- Interferon­ stimulates the immune system to fight off infections while the mother is healing from birth. 

- Prostaglandins­ acts as an anti­-inflammatory
- Hemoglobin­ replenishes iron, stimulates iron production in blood
- Urokinase inhibiting factor and factor XIII­ lessens bleeding and promotes faster healing
- Prolactin/HPL­ stimulates healthy mammary function and milk production