On having a doula (Greek for "female slave")

As we're getting ready to edit our birth stories into something post-able, I have to say, I am so incredibly happy we chose to have a doula, and in particular, that we lucked out and ended up with one that fit us so well even though we bought her services at a charity auction without any prior research. (Local Seattle ladies who are expecting: we used Emma Summer of Baby Day Doula!)

Initially it seemed kind of like a lot of money, especially if we were already having a midwife who would be supporting and nurturing, and given that in a hospital you can yell at the nurse to get you some saltines and water and turn the temperature up and could we have a pillow in the bathtub please. (Note that I did do that a great deal, oh yes!) Plus, I really wanted to be the main support person and I read up a lot and I think some people really consider the doula only if they think their partner won't be able to be right there with them the whole time.

But, I can tell you that it was HANDS DOWN the best $500 someone could spend during pregnancy. Yes, even before the birth classes and childbirth/baby books and the body pillows and all the things you need once the baby gets there. Incidentally, one can definitely get lower rates by looking for newer doulas looking for experience or working on certification, and there are a lot of programs designed to help get doula support for women who can't afford to hire one. (We won our doula at an auction benefiting a charity that provides doulas for incarcerated women giving birth in prison.)

Stephanie had a really unusual labor, in that it was long (2+ days of regular contractions, 27 hours of really being in labor) and never had the closely-spaced intense contractions that last for a minute or longer. When we finally went to the hospital, the nurse and OB resident at triage was convinced that we were not yet in labor and wanted to send us home with morphine. When we finally badgered the nurse into doing a cervical exam (she REALLY did not want to due to increased risk of infection), Stephanie was at 8 cm.

If not for the doula, the two hours (yeah, TWO hours, as in 2!) we spent in the triage room and bathroom before getting admitted (and thus, before the midwife would be coming to the hospital, since there were no other midwifery patients admitted that night) would have been WAY more stressful for me. Our doula helped us come up with a series of contingency plans, did reconnaissance work spying on the conversations in the hallway and reported back to us, helped us realize what our rights and options were, and most of all helped reinforce our instincts because she'd been there laboring at home and has a lot of experience with what births are like.

I like to think I would still have stuck to my guns and insisted on a cervical exam as stubbornly as I did, and maybe I would have, but I really can't know. Sans-Emma, it would have been way more emotionally traumatic for Stephanie and I would possibly (ha, likely) also have had a meltdown, and it certainly would have been really hard for us to pull it together and get back into a groove after finally being admitted.

If we'd been even remotely compliant with what the nurse and OB resident had been strongly urging (and presenting as the only reasonable course of action), we'd have gotten Stephanie on morphine and gone home... and we would have had a narcotic-riddled baby at home or en route to/from the hospital in the absolutely crazy fourth of July traffic.

But, even if it hadn't been for the exciting bits in triage, having a doula didn't detract from my ability to be involved as Stephanie's birth partner, in the slightest. In fact, having her there made it possible for me to spend 100% of my time and energy with Stephanie and helping Stephanie through contractions and resting in between them, and not taking care of any other extraneous stuff (fans, water, food, music, contraction timing, figuring out a good position to try, coming up with a plan on when to go to the hospital, and so on). I felt secure knowing that she was taking care of all of the peripherals, and when she offered suggestions of things to try, it was always in a very unobtrusive, graceful way that definitely reinforced our feeling like a team. (I know that how much we wanted our doula to be actively involved is definitely something we discussed during our first meetings, so it's not coincidental that Emma met both of our needs perfectly. Her level of involvement could have been ratcheted up or down depending on what we needed.)

We'd gotten into such a rhythm laboring with the doula that when we were finally admitted into the birthing room, the arriving midwife only briefly showed up in the the bathroom and said that her job was to let our labor unfold, and then seemingly stayed completely out of our way until the pushing stage.

I know that it might seem like doulas are really only helpful if you are the hippie-dippy type planning a natural birth, but I think that also couldn't be more untrue. In fact, the doula was really critically helpful in navigating all of the interventions and possibilities for interventions. If Stephanie, after the cervical check, had been only 1-2 cm dialated like the nurse was predicting, we would have cheerfully gone with an epidural and pitocin, and even the dreaded misoprostol, without any regrets, knowing we were making an informed choice to proceed and that we had absolutely all of the information we needed.

The one intervention we did end up having, "breaking" Stephanie's bag of waters at 10cm when there was just a lip of cervix left (although it had already broken earlier in the evening, later causing a lot of drama, it was more of a leak and there was a lot of fluid trapped between the baby's head and the cervix), was actually the one we'd rehearsed during one of our last meetings with the doula. The amount of coaching us on how to respond to offered interventions was much more helpful than what was mentioned in our birth class. I feel confident that even if I hadn't read up on everything under the sun and known about the plusses and minuses of using cervadil vs using misoprostol orally, Emma would have navigated us through a very honest listing of all the advantages, disadvantages and alternatives, while ultimately leaving the two of us to come to final decision on our own.

So, yeah, this post can really be summarized by: doulas, they are awesome.

Not only did Emma chronicle all of the times and highlights of our birth experience for us, but she also took some really great photos of the birth itself (which we aren't sharing because they're really personal). At our first meeting Emma said she sees the role of the doula ultimately as being a guardian of the birth experience, and that's totally true. I can look back on all of it and remember probably the best moment of my life so far with great clarity, happiness and no regrets whatsoever. The mess of triage could easily have made things go to hell, but instead, I was able to remain calm and collected throughout, and now I can look back on it with humor and think it makes a pretty great story.

I know we were very lucky to be able to have a birth that corresponded closely to what we had envisioned in our birth plan, but even if we had ended up veering into very different territory (as we were preparing to do if Stephanie had not been at 8 cm in triage), we would still be able to look at our birth experience as really right and positive, and not just ultimately producing a baby.

I know people who have regrets about their birth process still have a baby: they still love their baby and holding their baby is still going to be the best moment of their life. Ultimately, having the baby is what really matters, and the birth story is secondary to that.

However, it is a really great bonus to be able to feel really good and empowered about how the baby got there, too, and I think a doula is invaluable for that.

I encourage everyone, regardless of what their birth plans look like, to seriously think about getting one that they have a good rapport with. Birth is unpredictable and can take on a path that is not at all textbook or what you expected, and having help to adjust to the changing circumstances can make it a far better experience... for the person in labor and the partner of the person in labor, too.