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Sunday
May192013

How to Choose a Birth Doula

There are as many kinds of doulas as there are women who want one, so deciding how to choose one can really come down to personality. But, might there be other aspects of doula-dom that aren’t so individualistic? 

Education

It should be a given that your doula has taken a training course of some kind. I am not of the school that believes a certification makes a great doula (I am not a certified doula, either), but definitely a weekend workshop should have been had. Whether it’s DONA, CAPPA, toLabor or any of the other groups one might find (Radical Doula has a great list here), attending a training will have been infinitely helpful to your doula.

Experience

This doesn’t necessarily have to be hands-on experience since some of the best doulas I’ve met have been newbies, but there is a great deal of information out there that women can learn via books and videos. They can also learn at meetings where doulas gather to talk about cases. Watching videos of doulas, she can see what makes a good doula, how the woman touches the laboring mom, what kinds of suggestions she makes to her as the labor progresses and how to move about the room unobtrusively. I talk more about experience below in Referrals. Ask your doula-to-be how she’s come by her experience and these might be some of her answers.

Knowledge

This doesn’t have to be just book knowledge, but books cannot be overlooked when a doula is educating herself. What the doula reads and assimilates can help her practice immensely. Much of what I think a doula could do to up her knowledge is to read midwifery texts. Reading Heart & Hands and Ina May’s Guide to Childbirth are two really good books to read to get a feel for the rhythm of labor and delivery. The Birth Partner and The Ultimate “How to” Guide for Doulas are great doula books to read. I haven’t read Experienced Doula: Advanced Skills for Hospital Doulas, but the Amazon comments seem to recommend it. If it lives up to the title, it should be a good one.

Referrals

How do you know how the doula’s going to be interacting with the hospital staff? How will you know until you are in the throes of labor? The best way is through recommendations. This, of course, would mean your doula is experienced. This won’t work if your doula is brand new. But, not to knock new doulas (who might be awesome out of the gate), but I would really encourage at least a little bit of experience before venturing into a doula-client relationship. The question becomes, how can a doula get experience if women only hired experienced doulas? Most doulas start out helping friends and family, not being hired outright by strangers, so developing clientele, even if it is friends and family, is a great way to garner the recommendations she will need. This is sure to be my most controversial advice, but I do stick by getting referrals as a way to learn how a doula acts in labor and birth. You still might come up against a doula that isn’t a good fit in labor, but the likelihood would be less. How a doula interacts with the hospital staff can mean the difference between an awesome birth and a train wreck, so recommendations can’t be taken casually.

Asking the Right Questions

Knowing what kind of doula you want will help you here. Are you looking for a motherly-type doula? Or a take-charge doula? Do you want a doula to tell you what to do throughout your labor? Or do you want to lead the way? I know this can be a challenging question, but imagining yourself in labor can help you decide what type of woman you are and what you’re looking for in labor.

A good doula is able to mold herself into what you need, so if you change your mind in the middle of things, she should be able to move along with you.

So, what to ask?

- How many times will we meet? That answer should be at least twice during the pregnancy and once or twice afterwards; most meet with you twice afterwards.

-When do I call you? The answer should be “Whenever you want to.” Doulas should be available via phone, text, email throughout the pregnancy and then physically available from 37-38 weeks along. I say 37 or 38 because doulas have different beliefs about call-time. If you suspect you will go early (and not just because you hope you go early!) you might make sure you hire a doula who will come earlier.

- What If I have pre-term labor? Will you come? Most would if at all possible, but if you’re having pre-term issues, it would be good to ask the doula this question.

- When do I call you in labor? Again, the answer should be “Whenever you want to.” (I tell women, “If you think, ‘Should I call Barb?’ the answer is ‘YES!’”) Women need to be able to touch base with their doulas in early labor even if the doula is hours away from going to them. Through repeated phone calls, the doula and client can decide when the right time to get together will be. Depending on whether the doula is meeting you at your house or at the hospital depends on how far along in labor you will see each other. If you want a doula sooner than later (you think), mention that to the doula. Make sure she goes to the mother’s home before you find out in labor she’ll only meet you in the hospital.

Now, I have no qualms about a doula meeting you at the hospital instead of in your home. It’s what I do if I doula. I am uncomfortable laboring with a mom at home when she isn’t monitored, so only do monitrice work when a woman wants me to come to her home in early/ier labor. But, many doulas don’t have any issues with going to women’s homes and that’s fine, too. Just be sure you know what your doula will do before you get there.

Some answers you might hear include: When you can’t walk or talk through a contraction; When you feel you need me or When your contractions are less than 5 minutes apart. All of these are valid answers, none better than another.

- Who is your back-up? No matter how wonderful your doula, things happen and sometimes she won’t be able to make it to your birth. She or her kids might be sick. Someone in her family died. There might be another client in labor and she’s already committed to her (because the other woman went into labor first) or because her car broke down… all of these but the car have happened to me with clients over the last 30 years. It’s rare, but can happen. I have a couple of great (female) back-up doulas that are glad to meet with clients beforehand, but don’t have a monitrice back-up (yet). I am clear with monitrice clients that this might happen and I will refund them the difference if I have to send a doula instead of my going when she’s in labor. It’s best if your doula is able to connect you with her back-ups, even at least with a phone call so you know how to reach her/them if necessary.

- How do you see your role? This answer can be endless and this is when your own expectations come into play. Typical answers would be: As someone to soothe you when you’re in labor; To help you before, during and after the birth and As an educator to help you know your options in birth. It is important for a doula to be a teacher of some sort… not necessarily a childbirth educator, but have a teaching gene. She’s going to let you know your options in birth, help you learn how to communicate your wishes to the hospital staff and will probably help you get started breastfeeding (if that’s your choice). Will she help you with your birth plan? Most will help you with that, even if they start with a standard birth plan off the Internet. If she’s a good and experienced doula, she will help mold the template into your unique birth plan. (There’s nothing worse than presenting an Internet birth plan to the labor and delivery staff.)

During the interview, take note of the type of person she is. Is she direct and clear? Will that come across as bossy to the hospital staff? Or is that a trait you appreciate in a person? Is she meek and mild? Will she have the strength to guide you in labor when you need someone strong? Is she full of ideas for your comfort measures even now or is she only focused on labor? A doula who has information for you at the point you are in your pregnancy is a great doula! She will have loads of ideas in labor, too… and she isn’t afraid of sharing them with you. It also gives you a glimpse into her experiences.

- What kind of births have you seen? Has she been to VBACs? Twins? Cesareans? Moms with preeclampsia? Inductions? Natural/Unmedicated births? Moms who’ve hemorrhaged? Births with certified nurse midwives? Home births? Birth center births? Shoulder dystocias? The more complications she’s seen, the more births she’s been to –because they are generally rare and you have to go to a lot of births to see some of the more unusual ones. What does it matter if she’s seen complications? She’s not the one managing them, right? What it can tell you is that she will have acted/reacted in an emergency, helping her client through a crisis. This can be crucial to a woman’s postpartum adjustment period, how the complication went down at the time. Especially with cesareans since those are so common; it helps if the doula has gone through this with a client so she can guide you if you’re going to have one, too. Knowing the cesarean ritual helps the woman to prepare for what’s coming and can help her assimilate what happened postpartum. If she’s been to natural births, that lets you know she can work with a woman through the whole birth experience without medication… this is a totally different experience than when she has an epidural. Helping women through pain for hours and hours takes stamina and creativity. Then, working with women with epidurals, as different as it is from natural birth, takes a different type of creativity… does she work with peanut balls? Does she know the routine side effects of epidurals? Will she be comfortable sitting on her hands while the mom and dad sleep, sometimes for hours?

As you can see, there are many more ways to tell if you’re going to have a positive/good doula than just a personality mesh, although that can’t be overlooked either. After everything, do you and the doula get along? Does she look you in the eye? Does she include your partner in the discussion? Does she have ideas for him/her to help in labor, too? Is this someone you wouldn’t mind spending 20 hours with in a small room? If she irks you in any way, I’d say PASS on her and find another one. If she annoys you in the interview, how is she going to affect you when you’re tired, hungry and in pain? Find someone who will comfort you. You deserve to have the best doula for your pregnancy, birth and postpartum. I know she’s out there!

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