Someone recently asked me for advice on an unepiduralized birth as they had heard that was my experience with my son. My biggest advice is always, “Hire a doula.” To which they commented to me, “I don’t believe I need a doula because my nurses will support me as a doula would.”
The comment came from a place of complete innocence - but also, complete ignorance. And I mean this in the least offensive way, as I made a similar error of thinking when planning my own birth. I thought that I did not need a doula because I was planning a birthing center birth with a midwife team I wholly trusted. It’s true that my birthing center midwife was *far* more present and supportive in my birth experience than any OB I’ve ever worked with has been, and the nurses I had were very hands on and helpful. {That’s not to say there aren’t super amazing OBs who are there physically providing support throughout labor, or even that there are much less stellar midwives who plan to only show up for the actual birth.}
BUT this thinking makes a huge grave error – both your provider (whether OB or midwife) and your nurse (or birth assistant if you’ll be at home) are there making every effort to ensure the ongoing safety and health of the birthing person and the baby being birthed. Your nurse, like your provider, is part of your healthcare team.
This belief of nurse acting as doula completely discounts the huge amount of responsibility that rests on a labor nurse’s shoulders throughout their shifts. Your labor nurse, in some ways, works as an extension of your care provider during your labor. For many births, families will only see their provider after fully laboring, and then pushing to the point that baby is crowning and ready to be born. Until this point of near-birth, your nurse will be the one to monitor the health of you and your baby, administer any necessary or desired medications, draw any needed lab work, make sure you are “comfortable” and hydrated, provide suggestions for positions and pushing, update your provider on your ongoing status, make sure any potentially needed equipment is available and ready, and chart every last detail of all this work.
And often, they’re doing this for 2 birthing patients at a time, or at the very least helping their co-workers through other challenging assignments.
YES, when everything is going well (as a good majority of physiological birth does), a good birth worker (whether nurse or provider) will do what they can to hold space for you and provide physical and emotional support to you and your family. And most nurses have stories of spending shifts providing hips squeezes or holding a mom’s hand, or something else along those lines. But if issues happen to arise, a good majority of their focus must turn toward the medical management side of labor and birth.
Throughout all of this, a doula would be by your side continuously with the sole purpose of supporting your comfort and helping you have the most positive birth experience possible.
A doula is someone who has worked with you throughout your pregnancy assisting you to understand your values and goals for birth and helped you work through your fears and trepidations about childbirth and parenthood. A doula encourages you in those final days of pregnancy when the end seems as if it will never come. A doula is by your side continuously from the point when labor is intense enough that you need extra support – even if you’re still at the point of laboring at home. A doula works with you and your partner, contraction after contraction, to find ways to aid labor progression and/or give you rest and comfort. When things get scary, as they occasionally do in birth, a doula is the calm force holding your hand, helping you and your family understand what is happening. A doula provides follow up care after birth to allow you to question and process through your birth experience, give you space to voice questions about your first steps in parenthood, and connect you with resources for ongoing success.
A doula is an entirely separate role from your healthcare team. Just as a doula does not replace your provider or nurse’s role in safeguarding your health and wellbeing, it is unfair to expect a nurse or provider to fulfill the role your doula holds at your birth. I totally underestimated how much I could benefit from the support expertise of a trained doula out of my own ignorance about the roles that each member of my healthcare team played.
And now, working as a labor nurse and birth doula, I’ve come to understand the underlying balances in the healthcare team and how it often functions. Many shifts, I’ve felt the frustration as a labor nurse of not physically being able to be continuously present to provide the high quality support that my patients need and deserve to help them reach their birth goals. It’s no secret that I wish all of my patients would have an awesome doula – no matter their birth plan – to walk with them toward their own victorious birth stories.
Don’t make the mistake I made, learn what role each person on your birthing team plays, and then hire yourself a doula. You won’t regret it.
