I occasionally hear about families who are told by someone that they don’t need a doula because someone else can fill the role. Sometimes it’s a sister or mother-in-law, sometimes a labor & delivery nurse, and occasionally it’s even a midwife. Here are ten questions to ask so that you know what to expect
1.) How will you get to know me, the rest of my emotional support team (my partner and other people who will be attending my birth), and my birth preferences before my birth?
Your sister may know you really well, but how well does she know and work with your husband? Your mother-in-law may know you both really well but how much does she know about your birth preferences? Is she willing to listen and support your decisions?
2.) Are you able to come to my home to help with early labor if I need it? What about if I need help but the hospital won’t admit me yet?
Your Labor & Delivery Nurse simply can’t come to your home to help you. Hospital midwives are usually in the same boat. If you’re planning a home birth, you may assume that your midwife will be there but midwives often don’t come until you’re in active labor.
3.) What will happen if I have a really long labor?
The absolute most powerful part of doula care is having CONTINUOUS care, meaning that one person is with you the entire time. You may take for granted that your sister will be there but what happens if your labor lasts several days? Can she get a week off of work? Is her babysitter willing to keep her kids for that long? Who is going to let her dog out and get the kids off the bus? Most importantly, is she physically and emotionally able and willing to support you for that long? Nurses work in shifts, so there’s almost always at least one shift change. If there’s a particular nurse who wants to support you, is she willing to stay late or come in early? What about if it’s her day off? Are you guaranteed continuous one-on-one support if many women are in labor at the same time? Who will take over her other patients while she stays with you? Is that person always available?
4.) What does your availability look like for three weeks before and after my estimated due date? What does your childcare situation look like?
What happens if I go into labor during little Johnny’s choir concert? What about Suzie’s graduation? Your husband’s birthday? What about when you promised to take your kids shopping or they need help with a big school project that’s due tomorrow? What happens if your childcare provider is unavailable? Do you have a back-up? Do you have a back-up for your back-up? You’d be surprised how many people just don’t answer their phone at 3 in the morning. What will happen if your child care provider has an emergency while caring for your children?
5.) Who is your back-up in case you’re sick or have a family emergency? When can I meet her?
Even if there’s nothing planned and 87 childcare providers, no one is immune from getting sick, experiencing a death in the family, or missing a phone call. Who should you call if she can’t be there? When can you ask her these same questions?
6.) How will you handle an emergency?
Although emergencies are rare, they do exist. If you’re talking to a friend or family member, will they be capable of controlling their emotions enough to focus on yours? Will she panic if there’s an emergency? What about if your nurse or caregiver start to panic a bit? What skills and experience do they have to help you keep calm during an emergency and then process everything that happened afterward? If you’re talking to a nurse or midwife, who will take over their medical role while you fill the role of my doula? During an emergency you want hem to be focused on managing the emergency, not keeping you calm and explaining what’s going on.
7.) How will you respond if I make a decision that you don’t agree with or is against my the advice, recommendations, or policies of my caregiver, hospital, or birth center?
If your doctor recommends an induction of labor and you decide not to take her advice, will your mother-in-law lecture you? If you plan for evidence-based fetal auscultation (checking your baby’s heart rate with a stethoscope or Doppler every 10-30 minutes) will your nurse remind you every twenty minutes that the hospital’s policy is continuous electronic fetal heart rate monitors on? If you’re feeling great pushing on your hands and knees but your caregiver wants you to push in a sitting or laying position will your sister remind your that it’s your choice?
8.) How will you help me determine what’s right for my birth, my baby, and myself? How much do you know about the risks, benefits, and alternatives to common birth interventions? Do you know when they’re recommended, how they’re performed, and how each impacts other choices?
If you’re at a decision-making point, how will this person respond? Will she be able to help you decide what’s right for you while keeping the opinions and advice of others out of it? Can she remind you about the risks, benefits, and alternatives of a cesarean birth? Does she know when artificially breaking your water is recommended? Can she tell you how an induction of labor is performed, what your options are, and what options are no longer available if you elect an induction? This is important information that is vital to making an informed choice.
9.) How much experience does she have with measures for comfort and labor progress that don’t involve drugs?
This is arguably the most common reason why women want to hire a doula. Even if you’re planning to use narcotics or an epidural, you’ll still need to manage the intensity of labor before it’s administered and then work to decrease the risk of other interventions being needed afterward. How many unmedicated births has she attended? How much experience does she have with positions, movement, birth balls, peanut balls, squat bars, rebozos, massage, ignoring, distraction, bath, shower, heat/cold application, focal points, breathing techniques, progressive relaxation, hypnotherapy, aromatherapy, accupressure, TENS, affirmations, visualization, meditation, and music? How would she help if your labor isn’t progressing as expected (either too fast or too slow)? What about if your baby is malpositioned or you have back labor? How would she help you if you get an epidural? How will she help you prepare for an assisted vaginal birth (using forceps or a vacuum) or a cesarean birth? These are things that birth doulas excel at that others are typically not familiar with.
A doula isn’t the best fit for every birthing family. As a doula I 100% support mothers who decide that they will be more comfortable without a doula. If a woman wants a doula though, I suggest hiring a professional birth doula who can fulfill all of the duties that the role entails.