Have any of you noticed that it’s difficult to describe what a doula does in practical terms? The role seems pretty abstract and often parents don’t really get a feel for how a doula makes a difference in birth until they’re actually in labour with their doula! Very generally, a doula offers non-medical emotional support and advocacy to parents during labour and birth. A doula is the only person on your support team that stays with you from early labour to hours after the baby is born, and is the only person on your team whose sole role is your (and your partner’s) emotional support. To better clarify the role of a doula, sometimes the best place to start is in the description of what we’re not. Here are five myths commonly associated with doulas and the truth behind them!

Myth #5: Doulas aren’t well received in hospitals

Doulas have been practicing within Toronto hospitals for decades and have significantly developed their relationship with hospital personelle. Although there is more to be done in terms of creating awareness about doulas amongst individual hospital staff, we are generally welcome support people at hospital births. Hospitals now recognized doulas as health care workers. This means that the “only two support people per room” rule includes two support people in addtion to your doula not including your doula.

Despite these developments, there can be times when tension exists within the labour room as a result of mis-matched personalities. Whether you have a doula or not, with the number of people and shift changes you experience at a hospital, it is realistic to assume that you’ll meet at least one person that you really get along with and one…..not so much.

Myth #4: I don’t need a doula if I’m having an epidural

It is a common misconception that there is no support left to be done when I woman uses an epidural for pain relief. Whether you are planning to have an epidural or discover that you would feel supported by one during labour, parents often go through a period of labour without the epidural in their early stages. In fact, most Toronto hospitals are actively encouraging you to dilate to 4-5 cm before they’ll support your choice for an epidural. Your doula can be a great support during this time and can help you maintain a coping mindset until you’re ready to receive your epidural.

The administration of an epidural can be stressful and parents sometimes need support to cope with anxieties around the procedure or to hold still during contractions while the epidural is being administered. After the anesthesia is is place, the body continues to labour just as hard as it was, and more as labour progresses. This means that although a labouring parent is no longer feeling the sensations of labour, they can be VERY exhausted because their body is still working so hard. Your doula can help you to relax enough to sleep, use acupressure to help labour continue to progress and encourage baby to stay in an ideal position. She may also help you get into positions that make use of gravity but are appropriate for the limited mobility a labouring parent experiences during an epidural.

Pushing can also feel different with the numbed sensation of an epidural and your doula works with your hospital team to help you to learn to push effectively.

And finally, whenever medical support is more consistently involved in a birth, parents have more consults and conversations with their doctors. Your doula can help you to ask questions and gather information when you need to make decisions about your birth progress.

Myth #3: I don’t need a doula if I’m having a cesarean birth

Cesarean birth is a pretty big unknown and many parents don’t receive information about what to expect from their health care team, what the health care team will be expecting of them or what options they have within a cesarean birth to make it more their own experience even though it looks different than what they planned.

A doula can go over this with parents prenatally or in the moment during birth so this big unknown is a little more familiar to parents should it unfold for their birth experience. Doulas are sometimes permitted to come into the operating room during a cesarean birth and can continue to provide emotional support to both parents during the procedure. She can help the health care team remember or learn the parents’ preferences and help the mother feel connection with this birth experience.

If she’s not able to come in the room and/or after the birth she can set up the recovery room, continue to provide physical (massage, acupressure) and emotional support to parents while their bodies adjust to the work of this birth. Although no pain is felt during a cesarean birth there can be a lot of sensations of pressure and/or shaking that can be a challenge to cope with.

If the birthing parent is having trouble sitting up, the doula can help them to find other positions to feed in, should that be the preferred method of feeding. A doula may also offer extended postpartum support to ease the adjustment home given the addition limitation of mobility parents sometimes feel following a cesarean birth.

Myth #2: Doulas interfere with the partner’s and/or family’s involvement

A good doula will help your partner and family to be involved to the degree they are comfortable and fill in where they are not. In your prenatal visits your doula may go over some labour support practices to help partners build confidence in their ability to offer support during the birth.

Once you’re in labour, your doula provides support for your partner as well. Since partners often haven’t seen birth before (let alone their lover birthing!) they may not have an idea of what is normal, what is not normal, when the best time to go to the hospital or call the midwife is or how to advocate and gather information with your health care team. Your doula offers the perspective of someone experienced in labour and can take some of the pressure regarding these tasks off of partners.

If partners are comfortable in the main support role (offering verbal guidance, massaging her, etc) he/she may not be able to leave her side to get food or make phone calls. This is where your doula can leave to get food for everyone, get things from the car or update the family in the waiting room. Of course, should partners need a break, the labouring parent is never left alone because their doula is available to remain by their side until partner’s return; and partner’s you’ll want to take a break! I can go home and sleep it off but you’ll be staying up with your baby that night too!!

During the more difficult stages of labour, it can be very difficult to know what the ‘right’ way of supporting is. Partners sometimes feel caught of guard or scared of what they see their loved one doing to cope and have moments of panic or ‘freeze up.’ A doula is essential in these moments because she can continue to help the birthing parent cope while reassuring the partner that what they are witnessing is normal and if they need to take a moment to themselves, they can.

And finally….

Myth #1: I don’t need a doula if I have a midwife

Doulas and midwives have very different roles and offer different kinds of care during birth. Your midwife is a clinical health care professional who is there primarily to take care of your physical needs within the holistic approach of the midwifery model. As your primary healthcare provider, your midwife has many clinical responsibilities in addition to offering you labour support which that means that, at times, she may not be always be able to be at your side. Other tasks your midwife may need to attend to include monitoring mom and baby, charting, setting up equipment and communicating with other health care providers on your team. Your doula’s only role is your emotional care. Her responsibilities in birth primarily include helping you to maintain a coping mindset, giving your physical support and helping your partner to feel supported and involved.

Doulas often come to you in early labour before your midwife arrives. Early labour can take some time and many first time parents don’t realize how much time they spend by themselves before it’s time to see their midwife. Your doula is available for you in this time so you aren’t labouring alone and can help you to interpret when it’s time to call the midwife or go to the hospital, what your midwife might want to know when you speak with her and offer breaks and support to partners.

Midwives and doulas often draw on one another’s experience during birth and in this sense, work very much in collaboration with each other. Because doulas’ and midwives’ trainings differ from one another, they often exchange ‘tricks of the trade’ that expand awareness of how to effectively support parents in varying birth scenarios.

As a nice side note, if you’re birthing at home, your doula will often clean up any mess made during the birth and will sometimes start dinner if you’re ready to eat.

Hopefully this dispels some of the myths floating around out there about doulas. At the end of the day, you’ll know if a doula is right for you; but PLEASE know that you that a doula always an option no matter what your birth plans may be