Doula: “Breathe, deep and slow. You’re safe. Your body knows what to do”…
Doctor: “When I tell you to push, I need you to really bear down and let’s get your baby here to meet you”…
Complementary voices, guiding and coaching a new mom as she performs what is arguably one of the hardest tasks she will face in her lifetime. A birth doula can provide much needed emotional support as someone the woman has come to know over the course of several weeks or months, as well as guidance to help her get through the challenging parts of labor and birth. The doctor, typically the woman’s obstetrician, plays more of a clinical role, but can also be very encouraging and supportive emotionally. These two separate caregivers have very different roles, but can coexist in order to ensure the woman’s care is complete and seamless.
Birth is a time of wellness and new beginnings. It is important to feel safe during the transition of bringing life into the world, and for some families that means birthing in a hospital setting. While others prefer the non-hospital setting, it is important to note the beauty of birth in whatever environment is chosen. Doctors are the primary caregivers in hospitals, and as such, influence many of the rules and processes. When doctors welcome the presence of doulas, they are accepting natural birth as a very safe and viable option. Doulas hold space, while doctors keep the space safe in a sense. For example, the doctor will require monitoring of the woman’s and baby’s vital signs. This can warn of a potentially dangerous situation in which intervention might be necessary. Although occurrences such as these are rare in a healthy mom and baby birthing naturally, the doula can hold space by presenting herself as a sounding board for the woman’s fears, assuring her that she is doing well, and creating a parameter of space for her to move around, change positions, and be as silent or as vocal as she feels she needs to be.
Some doctors encourage the mom to stay home when labor begins and arrive at the hospital when her labor reaches the active phase. The doula will assist by accompanying the woman during this laboring phase at home, giving her the utmost confidence to remain in her sacred, quiet space at home as labor ebbs and flows, while approaching the active phase of labor. Once at the hospital, and as things progress, the doula will pay close attention to signs that indicate progress. She will watch the woman’s countenance for signs of turning inward and mentally retreating; similarly the way animals literally retreat to a quiet place before birthing their young. The doula will look for and make note of other physical signs of labor, as well as emotional changes as the woman becomes irritated, or more in need of comfort and reassurance. While some doctors rely more on the nurse’s assessment and data from monitoring equipment, the information a doula provides can be instrumental in helping the doctor know how the woman has been managing her labor.
In the hospital setting, the doula respectfully takes her place, finding the balance between distancing herself so the medical team can begin necessary assessments and keeping the woman feeling safe and cared for. This is an opportunity for the doula to observe and learn more about the medical side of birth. Every birth is different and offers the doula an opportunity for growth and expanding her knowledge. Many doctors are willing to answer questions regarding processes and the next steps that might be taken. The doula can sit closely and help reassure the woman of the benefit of a particular action that the doctor might want to take. It often happens that a particular step or intervention can be very beneficial, or possibly a hindrance to progress, depending on when it is performed, what stage of labor the woman is in, her frame of mind, and other factors that are present at the time. If the doula disagrees with the doctor, she would typically respectfully suggest to the laboring woman, or couple, that they take five minutes to consider what is being suggested and make a conscious decision. Unless there is a life-threatening emergency, there is generally always time for brief contemplation before agreeing to a procedure. The doula’s role is not one to speak up or challenge unless it is a matter of safety.
In the event of an unplanned outcome, such as a cesarean birth, the doctor and doula can provide solid reassurance to the woman and her family that only the best steps were taken to ensure the best outcome under the circumstances. Partnering at a time like this can go a long way in helping the woman have a positive recovery and postpartum experience, both physically and emotionally. For example, the doctor can explain from a medical perspective what he or she noted during the physical exams performed during labor that might have contributed to the decision for a cesarean. Supporting the doctor’s explanation, the doula can remind the woman of how hard she worked and how hard her baby was working right along with her, and that there are wonderful positives to take from the experience. The doula can lend credibility to the doctor’s decision by sharing information, reminding the woman and her family that often safe outcomes result from skilled surgeons making the right call at just the right time.
It would be an ideal goal if doulas and doctors first look at the big picture of birth and the beautiful life changing miracle that is occurring. Second, recognizing that the birthing woman deserves the right to choose from an educated perspective how she wants to birth her baby is of the utmost importance. Working as a team, neither the doula nor doctor should unduly influence the birthing process based on personal preference or experience, but solely based on the evidence and the woman’s wishes. Personal experience will of course help guide a course of education, but the ultimate decisions regarding birth are extremely personal and sacred. When both the doctor and doula approach attending birth with that premise, it is easy to find common ground and work better together as a team and ultimately improve maternal outcomes while coexisting in the labor room.