Labour support is a timeless art, which
has just been given a new name - DOULA. Doula is an ancient Greek work for "a
woman experienced in childbirth who serves another woman during her childbirth
It is funny to call myself one, because I have been a midwife for twenty-seven years now. Webster's Dictionary says that a midwife is 'a woman who assists other women in childbirth'. These definitions lack something and seem confusing similar. In French a midwife is called 'sage femme' wise woman - even better definition. Basically, whatever you want to call them, it is women helping women, the power of the women's circle.
A doula needs to have given birth herself. In all history the women helping another give birth are other women in the community who have already given birth - that in itself is knowledge. I have difficulty with a man being a doula - historically it just doesn't fit the explanation or the job but anything is possible in this new century.
A doula is very much like a midwife except that she is doesn't have "hands on" to help the mother deliver the baby and she doesn't have medical responsibilities. She is dedicated to serving the mother in whatever way is needed, from helping focus breathing and relaxation, to massage during labour, to teaching/reviewing the birth process in classes/discussions. I see the role as encompassing a huge area - she adds to the mother's education, and boosts her confidence by her warm and caring presence.
The Doula does not replace the doctor, nurse, midwife, partner but works together with them to ensure that women have the optimum birth experience.
The word doula literally means "slave" although many doulas prefer to translate it as handmaiden. However, the essence of becoming a doula is to serve the mother with everything we have: our bodies, our minds, our hearts, and our spirits. In the spirit of this service, we become voluntary "slaves" during labour and birth putting the needs of the labouring women before our own needs. (Quote from Kelli Way, International Doula, and Co-Editor)
Nature Sets the Example
There's a great story in John Robbins' recent book, "Reclaiming Our Health." It seems an elephant went into labour in a North American zoo and her keepers carefully put her in a pen all by herself away from all the other elephants. The labouring elephant became frantic and hysterical, crashing back and fourth in her pen. The zookeepers, concerned that she would harm herself, called a European zoo that had recently had a successful elephant birth.
"Where are the midwives?" the incredulous European zookeepers cried. "Where are the other female elephants to help with the birth?" Once the other female elephants were allowed to join the labouring mother elephant they surrounded her, stroking her with their trunks, calming her and helping her throughout her labour. When the baby elephant was born they cleaned it and kept watch over it while the new mother rested.
Fear and apprehension seems quite common when a woman thinks about the impending experience of childbirth, especially if she's a first time mom. Ina Mae Gaskin, author of the classic book "Spiritual Midwifery" said, " Women are far more afraid of childbirth than they were 25 years ago. We are just one more generation away from the days when a girl grew up on a farm watching the sheep and pigs give birth. Anyone who saw that year after year knew that giving birth was a natural process, a process that could be trusted."
Ina Mae went on to say, "Women don't seem to know today that a woman's body knows how to work. We rely on drugs as if our bodies couldn't get along without them." It's true that in our Aspirin, Tums and Pepto-Bismol culture women are encouraged to take something for PMS, something for menstrual cramps, and are told later in life that they couldn't go into menopause without Estrogen. In childbirth a woman often is given oxytocin to speed things up, Demerol "to take the edge off" (which slows things down), and then an epidural to numb things out.
No one should be expected to go through agony just to have a "natural childbirth, but how much of the pain is fear and tension based? How much comes from our pain-free culture?" Again, studies show that women who are more relaxed and in a mental and emotional framework of excitement and involvement feel less pain and "forget" to ask for drugs. The body can be trusted. And, generally, when it is trusted, women have an easier and more memorable birth experience.
The birthing process can be transformational and a powerful rite of passage for the mother, as well as an incredible high for both mom and dad, but only when innate fears of the unknown are replaced by confidence and understanding.
The Father's Role
The father has a vital role to play throughout the birthing process so that the experience for both mother and baby is as rich and fulfilling as possible.
Will the Doula take over the father's role? Or, "With a Doula present will the father feel unnecessary?" A Doula should honour and support the dad's vital place with the mother of his child. The Doula can't possibly provide what he provides for the mother in the way of loving protection and tender surround. Who better to get a mom to relax? Who better to make a mom feel safe and protected, especially in the strange environment of a large hospital?
What of the nurse or the midwife, you say? More and more women are selecting home birth with a caring midwife for this very reason. Even with home birth, when the baby is actually coming, the midwife is at the business end of the woman and the presence of a Doula is still helpful to both mom and dad. Also, a home birth can turn into a hospital birth if complications arise and, again, the Doula's presence throughout the unexpected and sometimes frightening hours of transfer and medical intervention can be vitally important.
Hospital nurses certainly offer, "experienced support, "but rarely, because of their other duties, can they offer the continuous and familiar support provided by the Doula.>
Care For The Baby
What about the baby in all of this? What is this bright, intelligent, super sensitive little being experiencing as he or she moves down the birth canal? Does he or she feel safe? If it is a transformational experience for the mom and dad, it certainly must be powerfully impacting the baby.
If the mom, no matter how difficult the labour, stays conscious of her communion and communication with the baby, the baby feels cared for. Then, it matters less what the physical outcome of the labour process is. Whether or not the mother has a forceps delivery, a big episiotomy, a Caesarean section, all the things she wrote on her Birth Plan that she didn't want, the atmosphere of love and "home" can prevail and be the positive part of the birth memory for both the mother, the dad, and especially the baby. A Doula can help her achieve that.
Finding a Doula:
So, how do you go about finding the right Doula? Please go to Life Passages Links page and you will find a lot of doulas and other people who will help you in your quest for education.
Penny Simkin, author of The Birth Partner and co-author of Pregnancy,
Childbirth and the Newborn, had a primary role in starting the current "Doula"
movement, as well as
She will not rest, she says, until "every woman who wants a Doula may have one."
What does a Post Partum Doula do? Here is an excellent link to a good explanation of http://www.dona.org/mothers/faqs_postpartum.php
Here is the information sheet from their webpage: What Your Doula Will Do
A DONA International Postpartum Doula Topic Sheet
What might the postpartum doula do when she comes to my home?
The role of the postpartum doula is fluid. An important part of her role is to come alongside the parents and together decide what type of support they will need. Some families need educational support: breastfeeding, infant support, and how to care for the new mother. Others rely more on the non-judgmental emotional support that the DONA International postpartum doula has to offer. Still others have more practical needs – like feeding the family and running errands. Most families find that their doula provides all of these things, according to the needs that develop, as well as the ever-important communication between the doula and her clients. That said, prospective parents and their families sometimes wonder – just what will the postpartum doula do when she comes to my home?
A postpartum doula supporting a family during daytime hours might...
A postpartum doula supporting a family during the “overnight” hours might...
The relationship between the doula and her clients requires the same maintenance as other important relationships in life, such as marriage or close friendships. It is important that communication remain open, as clients’ needs or priorities may change with time or experience. The doula anticipates these changes and will be prepared to remain flexible in her role.
"Holding the Space": A Doula's Best Gift
-- by Pam England, CNM, MA
author of BIRTHING FROM WITHIN THERE ONCE WAS A HOSPITAL MIDWIFE IN ALBUQUERQUE WHO EARNED a favorable reputation for her unusual form of labor support: sitting in the corner of the room and knitting. At first I was troubled when I heard mothers describing their "knitting-midwife" and wondered what they thought of it.
I anticipated they would complain she was not really present, but in fact, every mother was comforted by it. They described her presence like this, "I would finish a contraction, open my eyes, and look to see her knitting in the corner. That let me know everything was fine, I was fine, and I could do it. In fact, it was when she got up to do medical checks, I began to wonder a little bit if something could be wrong. So long as she was knitting, I knew nature and I were still on course."
I now view this kind of labor support as a continuation of what traditional healers and wise women have always done, and I like to call it "holding the space."
Something stirs in me when I see old Native American women sit motionless against their adobe dwellings gazing at the boundless desert out of dark eyes set in brown faces wrinkled by a million creases. I believe in their stillness they are "holding the space" for all of us. When I was pregnant the second time, the image of those old wise women became a living metaphor for me. That was what I wanted from my doula. I asked my doula to do three things:
To wear boots to "kick ass," if that was what was needed,
To make me a chocolate birthday cake; and
To "hold the space, the feminine knowing and trusting space."
In labor, my doula arrived wearing her cowboy boots, made the chocolate cake, and "held the space." She didn't do or say that much, it was her presence that told me she believed in birth and she believed in me. From her I learned the power of a doula's presence. And this is the gift I try to give other laboring mothers -- and the mindset I want to pass on to new doulas.
When doulas go to a hospital birth, there is little that can be done to stop the anxiety and distress of parents and staff, or the steady trickle of routines and interventions. Parents, staff, and doulas are destined to participate in birth rituals not necessarily of our "choosing." In every birth culture, people engage in birth rituals out of years of social and religious conditioning, in response to fears, a vague feeling of not knowing what else to do, and out of a sincere belief and intention to do the right thing.
One thing I know doulas can do is to "hold the space" of quiet, trusting mind in the labor room. Especially in the midst of frenzy and fear, doulas should try to generate a quiet, trusting presence, like the old Native American women. When doulas practice breath awareness or non-focused awareness themselves, their ability to completely relax into whatever is happening brings the mother into harmony with herself and the doula. We can look for ways to renew the mother's confidence in herself, acknowledge her for finding her own way through labor, and embrace whatever medicine she believes in.
A favorite practice in Zen is to "be an empty cup." I'm striving towards being an "empty-cup" doula. Before I open the door to a mother's hospital labor room, I close my eyes, open my heart, and pour out all my ideas and fears. I enter, and fill my "cup" with whatever is unfolding and focus on "doing what needs to be done next."
I strive to drop my ideas about what I think should be done. I look to see how whatever is happening is "working," and help the parents and staff see that too, so they can go with it. To the degree I am able to be a "nurturing" doula, I may help the mother express herself as a protective, knowing, self-confident mother.
I notice that most of the ideas about birth any of us hold fast to protect us from our own fears, and rarely honor or serve the mother we are attending. Righteousness and knowledge buffer us from feeling our helplessness in the midst of this fast-moving event. The fewer fixed ideas and judgments we bring to labor, the more deeply we might immerse ourselves in the birth that is happening, and draw from a flow of creative solutions and support.
Making decisions in labor is complex for both parents and professionals. Even when couples ask for information, I sometimes sense that their "decision" is already made, or that the "decision" they make will be based more on unknown, unconscious factors and beliefs than on what I, or the experts, say. As often as possible, rather than debate the decision, doulas can show genuine support of the mother and her birth by throwing themselves into doing what seems to need to be done next.
As a teacher of doulas, I am searching for words to describe what genuine labor support means. Sometimes it is silent, it may be expressed in a firm voice, a smile, through teaching, or a skillful, timely intervention. Whatever its form, genuine support comes from a positive-intention to "hold the space for the mother" in the belief that she is, moment-by-moment discovering how to birth.
As a doula, I am witness to the unspeakable power of birth, maidens turning into mothers, and various dances of madness in the face of unchecked fears. I am all too aware, when a doula is prideful or too busy doing and knowing in birth, she forfeits being touched by the great mystery of birth. And, if no one in the labor room is in touch with that great mystery, and no one is "holding the space" by being truly present, there is the greatest risk of all -- that the mother, even though she gives birth to the child, might not realize she is also being born -- as a mother -- during her rite of passage. "Holding" the laboring mother in a safe, secure, heart-space is the best gift a doula can give.
To learn more about
Birthing From Within, including the chapter on "Empty Cup" mentioned above,
Click Here to check out Pam's new book - BIRTHING FROM WITHIN: An Extra-Ordinary Guide to Childbirth Preparation.