Aztec elders taught that women who died in childbirth go to the same level of paradise as men who died in battle. After attending over forty births, I fully understood why. Men die in battle from intense wounds. They bleed as they sacrifice for a greater cause. The same holds true for women who die in childbirth. They bleed as they open to life. The juxtaposition of beauty and pain in each birth astounds me. Each story lives in me.
Amy Wright Glenn in “Birth, Breath, and Death—Meditations on Motherhood, Chaplaincy, and Life as a Doula”
At 9:35pm, my first doula client called me in active labor.
“I’ll see you soon,” I told her. “You can do this Amanda. Just one breath at a time.”
Thirty minutes later, I had everything I needed to begin my doula career. I kissed my husband good-bye. “I’m not sure how long I’ll be gone,” I said holding him close. “Wish me luck.”
It was December and the New Jersey winter air filled my lungs. I drove to Amanda’s address. After parking the car, I looked up at the stars and prayed. I vividly remember walking to her apartment door.
I had successfully completed my doula-training workshop, read many birth books, and seen a multitude of videos and images of birth. Yet, nothing compared to the honor of being asked to support a woman through labor and delivery.
Over the course of the next 17 hours, I held Amanda’s hands, massaged her back, shared encouraging words, kept silent vigil, and even at points laughed with her as she rested between the waves of contractions transforming her being. Then, the time came. Amanda stood up, fiercely held onto her loving husband, and pushed her daughter into this world. The midwife joyfully caught the infant from below. I marveled at the wonder of birth.
My first birth as a doula transformed me as did the dozens more that followed – each unique and beautiful, each a testament to a mother’s courage.
I’m deeply drawn to the doula path. I love offering my time to women as they open their hearts, souls, and bodies in childbirth. As a doula, I stay up for hours on end holding, nurturing, and making space for a laboring woman to find her strength. As a doula, I hold the hands of women as the next generation enters our world.
The word “doula” comes from a Greek term meaning “woman servant.” Historically, doulas were servants skilled at attending women in labor. Today, doulas continue to serve birthing women.
Doulas are not midwives, OBs, or nurses. But together with these professionals, doulas work to support a woman through birth. While the focus of the medical team involves analyzing data and safeguarding the physical health of both mother and child, a doula focuses on the holistic wellbeing of the mother. Doulas teach comfort measures, offer loving touch, speak encouraging words, and serve as a spiritual support at a most transformative time in life. In today’s hospitals, doulas work from a place of softness in an obstetrical world of hard edges.
Most modern women have never personally witnessed a birth. So often, the first birth they experience is their own. When contractions begin, the majority of pregnant women embark upon one of the most transformative experiences of their lives without first hand knowledge of what awaits them. This fact stands in stark contrast to the birthing practices of our ancestors. For the vast majority of human history, women have always surrounded each other in labor and delivery. This aids birthing women and emboldens future mothers with the first-hand knowledge of female strength. Today, doulas reconnect birthing women to the powerful legacy of female support in birth. A doula’s presence also impacts the quality of the birth itself.
According to Christine Morton, a Stanford-based research sociologist and co-author of “Birth Ambassadors: Doulas and the Re-Emergence of Women-Supported Birth in America,” more and more American couples are hiring doulas. Morton argues that this is because midwifery care isn’t widely available and a doula’s presence at birth can lead to many of the same benefits found in a midwifery-based model. Morton writes, “Doulas are the birth ambassadors for the midwifery model of care in the US.” Such a model empowers women to be fully involved in the birth experience. Many studies confirm that the presence of trained labor support shortens the length of labor, minimizes the use of interventions, and reduces the use of pain relieving medicine. As Dr. John H. Kennell famously stated, "If a doula were a drug it would be unethical not to use it."
But, what about the husband or partner? Does a doula replace the birthing mother’s most intimate labor companion? No. While a doula “mothers the mother” through the birth process, the husband or partner also deeply benefits from her presence. Often husbands or partners become more involved in supporting a birthing woman as they learn and adopt many of the doula’s comforting techniques. A doula’s presence frees the husband or partner from feeling like s/he must be an expert support in an entirely new and challenging situation. If the labor is particularly trying, difficult, or emotionally charged, a doula’s presence soothes scared nerves and buoys a birthing couple’s confidence.
The Practical Level
There are two kinds of doulas: birth and postpartum doulas. A birth doula meets with a pregnant woman, is present throughout the birth, and helps the couple process the experience in a postpartum visit. A mother doesn’t need to be planning for a natural birth to hire a doula. Indeed, the majority of woman delivering in a modern day hospital setting would benefit greatly from the continuous labor support that a doula provides. For women birthing at home, a doula’s presence offers added support and loving energy to the wisdom that skilled homebirth midwives bring to the table. Birth doulas usually charge a flat rate and often ask for a portion of their fee to be paid prior to the birth.
In contrast, postpartum doulas help new mothers with breastfeeding and responding empathetically to a newborn’s needs. They understand a mother’s need for rest and support in the postpartum period. In a world where families are often separated by days of travel, the presence of a postpartum doula can provide a new mother with essential loving kindness and insight. Postpartum doulas charge per diem.
When seeking out a doula, I suggest interviewing at least two women. An expectant couple needs to find the right fit. Some doulas are closer to the mother’s age and bring a sister-like energy to the birth experience. Other doulas are older and bring a matronly energy to the birth or postpartum care. Most importantly, an expectant couple should feel very comfortable with the doula’s presence. After all, birth is one of the most intimate experiences one can share with another human being. Deep emotions and a great deal of physical touch are involved in most births – and much of this carries over into the postpartum period. A couple needs to feel confident that the doula will be a trusted, nonjudgmental and compassionate presence as they undergo the crucible experience of birth and welcome their little one to this world.
A doula holds the memory of each birth as precious. While she protects the confidentiality of her clients, her very presence also helps protect the mother’s own memories of birth. This matters.
Protecting a Mother’s Memory
“I am a protector of birth memories,” I often tell my clients. “I want you to look back on this experience and remember being supported, heard, and loved. I want you to feel proud of yourself.”
When women feel silenced, helpless, and dismissed in the birthing experience, their trust in both their own body’s wisdom and in their baby’s instinctive energy is eroded. This is true even if the birth experience fits the classic, textbook rendition of “normal.” If the emotional tone and energy surrounding the birth is negative, an unnecessary harm has been done. The impact of a negative birth experience -- sometimes called birth trauma -- can disrupt the secure attachment bonds linking generations and deeply impact a woman’s sense of self.
When women feel emboldened and supported through the birth experience, their abilities to trust their maternal instincts and bond with their newborn are deeply enhanced. This is true even when birthing preferences or plans unfold in ways unexpected. If the energy surrounding a birthing woman is positive, inspiring, and kind the mother internalizes these qualities as she nurtures her child.
The way we approach birth as a society can either empower or disempower women. According to Aviva Romm, a Yale trained medical doctor and former homebirth midwife, “Women can be partners in their care, not subjects of it.” Doulas support women to be fully informed and empowered in their birth experience. Doulas are the ambassadors of change in a culture bereft of the birth’s wisdom present in ages past. Doulas help protect a birthing woman’s memory of her strength, struggle, and accomplishment.
I’ll always remember my first birth as a doula. When the time comes for me to leave this world, I take with me many treasured memories. Some of the most precious involve being present for the wonder, pain, love, and beauty of birth.
In celebration of doulas, I bow.
Originally published in Holistic Parenting Magazine, Issue #3 May-June 2014
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