Why *reverend* + doula?

I am a reverend and a doula.  I am an ordained minister in the United Church of Christ (UCC).  I currently work as a part-time chaplain at a hospital in Austin.  I’m also a DONA -certified birth and postpartumdoula.

I’m really interested in the ways these two roles intersect—I’m developing a theology of birth (what I call birtheology).  I blog on this occasionally, if you’re interested in reading more.  One of my goals with birtheology is to give families some tools to reflect on the process of pregnancy and birth as a spiritual experience.  I write specifically from a Christian perspective, as that is my own faith tradition.

It may be that because I have reverend in my business name, you might be wondering whether if I am your doula, am I going to go all Jesus-y on you?  And the answer is no.  That is, unless Jesus is a meaningful part of your own practice of spirituality.  In my doula work and even in my chaplain work, I don’t bring up God unless the person I am working with does so first. Just because my faith informs who I am, that doesn’t mean I expect faith to be a part of who you are.  I do my best to meet people where they are, and provide emotional and spiritual support that is responsive to who they are as individuals.

Obviously, I have my own religious beliefs.  But a huge part of my chaplain training involved learning how to put my own beliefs aside to be able to be fully present and responsive to the person I am serving.  The same skill is necessary in doula work.  Of course, I have my own preferences and beliefs about birth.  I have twice given birth myself, so I have personal experience with the process!  But my birth is not your birth.  My choices may or may not coincide with your choices.  I strive to put my own beliefs aside to be able to be fully present and responsive to the person I am serving, whether I do so as a chaplain or as a doula.

Really, what I do as a doula and what I do as a chaplain have a lot in common. Obviously, the situations will differ, but the care I provide for families facing major transition moments in life together involves:

  • listening carefully to their hopes and their fears,
  • naming and helping them to address the fears that are keeping them from finding hope,
  • and helping them to embrace the moment they are in, whatever that may be.

What does a doula do?

The word doula in ancient Greek means “female servant or slave.” In modern usage the term has come to mean “a woman who serves.” But serves how? There are at least two kinds of doulas: birth and postpartum. Here I am talking about birth doulas (for the difference between birth and postpartum doulas, take a look here).

The standard, official answer to this question, from DONA International’s own birth doula FAQ page, is this:

A birth doula is a person trained and experienced in childbirth who provides continuous physical, emotional and informational support to the mother before, during and just after childbirth.

To that I would add that I also provide spiritual support, but otherwise I think it is a pretty good definition, and pretty clear, except for the middle bit. Just what does continuous physical, emotional, spiritual and informational support look like? Let’s break it down.

Continuous.

This means that as your doula I will not leave your side (excepting, of course, the occasional potty break. And the I-sense-you-need-a-moment-alone-with-your-partner break. Otherwise, no breaks in care!). You should know that your OB/GYN will only make sporadic appearances, if s/he is on call during your labor at all. Your labor and delivery nurse will have other tasks/patients to attend to, and then she will go home when her shift ends. But I will stay with you no matter how long it takes to get your baby out. Plus, you don’t have to wait until you are in the hospital to call on me for help. I will come to your home, if desired, and help you labor there before we all head to the hospital together. That is, unless you’re planning a home birth, in which case we will stay home together.

Physical.

The sort of physical support I provide includes:

 photo courtesy of  Shelley Moon Photography

photo courtesy of Shelley Moon Photography

  • creating a calm environment: dimming the lights, working to keep the door closed, explaining in a polite but firm way to your persistent and unwanted visitors that now is not a good time to hang out.
  • suggesting different body positions. Read any book on labor and you will discover that lying flat on one’s back is usually not the optimal labor position. I can suggest a long list of positions to try, tailored to assist you where you are in your labor and what sort of pain you are experiencing.
  • touch: even something as simple as holding a hand can be a huge help to a woman in labor! I am also skilled at certain kinds of comforting touch, counter pressure and hip squeezes, which can make all the difference in avoiding or delaying the use of pain medications.
  • bringing a hot or cold pack and putting it in the right spot at the right time, keeping you well supplied in ice chips.
  • helping you make use of water as a pain management tool, either in the shower or the tub.

Emotional.

Birth is a hugely emotional experience. That seems so obvious a statement, yet I think we often allow the medical/physical aspects of birth to overshadow this other fundamental aspect of our being. I am skilled at listening, identifying emotional issues and facilitating your working through those issues  before, during and after your birth. And this goes for both the mother and her partner. The transition to parenthood is not easy. Having someone trained in providing emotional support at your side will help.

Spiritual.

I believe birth is a transformative experience, which involves each part of our total being, including our spirits. I mean, you are participating in creating and bringing forth a new life, for crying out loud. What could be more spiritual than that?

I am an ordained minister who has worked through four units (that’s one full year’s worth) of Clinical Pastoral Education (CPE). CPE is designed to help pastoral caregivers improve their ability to provide emotional and spiritual support to others, in whatever field of practice they choose. I choose to work with pregnant women and their partners, walking beside them in this journey to welcoming a new life into the world, helping to facilitate the spiritual growth inherent in the miracle of birth.

Informational.

Read through a book or take a class on childbirth (and these are both really good ideas, whether or not you hire a doula!), and you will see that there is just so much to keep track of. You need help. I read somewhere that having a baby without a doula is like traveling to a foreign city without hiring a tour guide. It is certainly possible, but you are more likely to get stressed out, feel lost, and put a strain on your relationship with your traveling partner. While it has its limits, I think there is definitely something to this analogy. As your doula, a big part of what I do is to help you navigate the confusing world of medical jargon. I can explain what is going on, what you should look out for, and suggest things you might want to try to make the experience more pleasant. My hope is that then you will feel more relaxed and enjoy yourself!

I should make absolutely clear here that I am not a medical professional. I do not give medical advice. I do not contradict your medical care provider. What I do is listen to what you want and help you write out your birth preferences so that you can discuss them with your doctor or midwife. During labor I can help you understand your medical team’s suggestions, enabling you to make the most informed decisions possible. I will give you information, but all decisions made are yours

Is a doula the same as a midwife?

No.

Doulas and midwives are not the same.  Both are birth professionals who sometimes work with the same clients, but there are significant differences. The fundamental distinction between the two is that a midwife is medically trained and a doula is not.

A midwife has as her primary concern the physical health of mother and baby.  That is not to say that midwives are not empathic, and in fact they do offer significant support for your emotional state as well, but their primary concern is the physical wellbeing of mother/baby.  By the way, a similar statement could be made about OB/GYNs and L&D nurses: they often are very caring and nurturing people, and of course those qualities come across in their work, but their primary professional concern is the physical health of their patients.

Alternatively, my primary concern as your doula is your emotional and spiritual health.  That is not to say that I do not know a lot about the physical process of pregnancy, birth, and the postpartum period.  I do.  But my focus is on how to help you approach this process with the kind of one-on-one emotional, spiritual, physical and  informational support that a doula is trained to provide.

To be totally clear, while I do offer physical comfort measures during labor (see “What does a doula do?“in my FAQ), I do not do anything medical.  That means no

  • vaginal checks
  • blood pressure checks
  • fetal heart tones
  • assessing the progress of labor
  • prescribing anything

You should always hear any suggestions I make with the caveat to check with your medical care provider first.

Ideally, a doula and a woman’s other care providers (be they midwife, OB/GYN, or L&D nurse) work together as a team in order to offer the most complete support to their clients.

Why do I need a doula?

”If a doula were a drug, it would be unethical not to use it.” – – John H. Kennell,  MD

There have been several clinical studies done to evaluate the effect of having continuous support during labor and birth.  These have shown that women who received such support were more likely to have spontaneous vaginal births (that is, they were more likely to go into labor without the use of labor inducing drugs or techniques, and they delivered without the use of instruments such as forceps or vacuum extraction or by c-section).  These women were less likely to request any pain medication or an epidural, and their labors were shortened.  They had more positive feelings overall about childbirth, and their babies had higher Apgar scores at birth.

The best results were shown when women were continuously supported in labor by a doula who was neither a staff member of the hospital nor a friend or family member of the woman giving birth.   Still not convinced?  Let me throw down some statistics.  When women were given continuous emotional support in labor, they experienced:

  • 31% decrease in the use of Pitocin
  • 28% decrease in the risk of c-section
  • 12% increase in the likelihood of a spontaneous vaginal birth
  • 9% decrease in the use of any medications for pain relief
  • 14% decrease in the risk of newborns being admitted to a special care nursery
  • 34% decrease in the risk of being dissatisfied with the birth experience

How can the presence of a doula make such a difference?  Put simply, fear wreaks havoc  on the process of birth.  Fear initiates a physical response in our bodies which can increase pain, slow down labor, and lead to abnormal heart rate patterns in baby.  Having a  knowledgeable birth professional providing continuous emotional, physical and informational support throughout labor reduces fear.

Another way to think about this is to say that a doula “mothers the mother.”  This reduces the amount of stress experienced by the whole family, which in turn allows the new parents to put their energy and attention toward welcoming and bonding with their new baby.  Research shows that having a doula’s support can lead to parents who feel more secure, self-confident and are more successful in adapting to their new lives with a baby.  Parents supported by a doula are also less likely to experience postpartum depression and have a lower incidence of abuse.

But wait–there’s more!  There is also evidence that having a doula at one’s birth improves breastfeeding outcomes in the immediate postpartum period and for weeks afterward.  Birth doulas have training in supporting breastfeeding, and they also reduce the chances of having a whole slew of interventions which can interfere with establishing breastfeeding.

So, back to the quote at top.  Now that you know all the potential benefits, if a doula were a pill you could take, or a technique you could practice, or a procedure you could undergo, why would you choose not to use one?

–But I’ll have my partner with me.

One reason a woman may not be sure she needs a doula is that her partner will be present at the birth to provide emotional support. Or perhaps she and/or the partner worry that a doula will come between them in this precious moment of bringing their child into the world.

 Photo courtesy of  Shelley Moon Photography

Photo courtesy of Shelley Moon Photography

The truth is that labor can be a very long, tiring process for the partner as well as the woman giving birth. It can also emotionally be quite intense to watch one’s partner endure (perhaps quite a lot of) pain and to be faced with unforeseen obstacles in the impossible-to-predict process of labor and birth. It is really quite a lot to ask of someone who has little or no experience with birth to remain emotionally engaged during such a stressful event. The good news is that research shows that when a doula is there to provide support, partners tend to stay more engaged in the birth process and are less likely to pull away from the laboring woman when things become stressful.

I believe that most partners want very much to be involved during labor and birth. However, in the moment of truth, they find it difficult to remember all the things they read, heard in their childbirth class, and practiced at home before the big day. With the assistance of a doula, the partner can engage in the birth in a way that feels comfortable. Simply by bringing a nonanxious presence into the room, a doula can set a more confident and relaxed tone for everyone. A doula also helps by reminding the partner about physical comfort techniques to try and by giving assurance when things are progressing normally.

A doula cannot replace a loving partner, who can provide a level of security and comfort that a comparative stranger could never do. This is not a zero-sum game–the choice is not one or the other. Rather, by having both a doula and a partner working as a team to provide support for the laboring woman, everybody wins.

If you’re still not convinced, here’s the way a partner of one of my clients described the experience of having me as their doula:

When Jordan first told me she wanted a doula, I wasn’t sure what a doula was! When I found out, I wasn’t immediately agreeable. I had imagined just her, me, and the hospital staff. I was sure we (read: I) could handle everything on our own, and I expected it to be really awkward to have another person there. But in the end, I was very glad to have you. You were reassuring, kept Jordan confident, and were her voice and sanity when she didn’t have her own! I felt like you were part of my team. I know you kept her sane throughout the process. I know you helped keep her as physically comfortable as possible. You were able to relate with her throughout the experience, something I could never have done. Thank you also for keeping me confident. I knew that if I forgot any of our techniques, you would be there to assist me. You kept me confident that the delivery would go how Jordan wanted it to go (at least what we had control over). We had taken a birthing class, but you initiated a lot of the techniques we had learned about. It was great to have an extra pair of massaging hands and your confident voice in the room.