A doula? What’s a doula, you say? Well, I was in that very same boat up until a year ago when my close friend, Rachel, became one. For those of you who don’t have a doula for a friend, I’m going to share mine with you.
Sunday afternoon after a leisurely brunch, the two of us are sitting in Rachel’s sunny living room overlooking Commercial Drive, sipping green tea and talking. Not unlike any other day, except today, I have a mini tape recorder hidden between the couch cushions, for the sake of ease, and I’m doing my best impression of a seasoned journalist.
Can you explain what a doula is for everyone who doesn’t know?
A doula is a woman knowledgeable in labour and birth and pregnancy who has not necessarily experienced it herself, but has been around it, been trained in it, who accompanies women as their main support person, while they’re in labour and giving birth. That’s it in a nutshell.
In a nutshell. Okay. What is the origin of the word “doula”?
It’s a Greek word that refers to the main female servant in a household, the one who does the birth care and is the most knowledgeable about female health and sexuality. It means to help or be a helper.
What are the main differences between doulas and midwives in terms of responsibilities?
A doula’s role is to provide emotional support, informational support, and physical support to the mom. Midwives do provide that kind of care, but they don’t necessarily stay with the mom throughout the whole labour, and they do more of the clinical stuff. They do tests, internal exams, they deliver the baby, deal with any complications, and they can prescribe medication. They have a lot more medical sort of knowledge.
Is there as much emphasis on pre-labour consultations?
There would be a different focus. In the same way that a woman has a doctor while she’d pregnant, she’d have a midwife instead. She’d go for an appointment with her midwife once a month throughout the pregnancy. Her care would be focused more on clinical stuff like the growth and development of the baby; whereas, when I meet with clients before the birth, we are discussing the actual birth itself. What do you want? What’s your plan going to be? What are your preferences for pain medication? And comfort? We’re getting to know each other.
That’s what I was going to ask. How many times do you meet with the woman? Is it individual?
Two. Well, the initial time when we have an interview and figure out if we want to work together, and then after that two times. Then we talk more in detail about the birth plan and, depending on the mom and dad, if there’s a dad, depending on what they need, their specific situation. I might provide different kinds of information or education.
I know you can’t speak for all doulas, but can a doula complement a hospital-assisted birth, or do doulas, in general, prefer to assist primarily natural and/or home births?
Personally, I would prefer only to do home births, but that’s totally my personal opinion. Some doulas agree and some don’t. But, I hardly ever do them. I mostly do hospital ones because, like I said before, midwives do some of the work that doulas do, and so women who have a home birth usually have a midwife because they already get a bit of that work covered. There aren’t as many home births happening, there is not as much work, and the more experienced doulas tend to get those home births. Our work is totally able to complement hospital births, and that’s sometimes where it’s most useful, where traditionally women are not empowered, and where pregnancy and delivery is really medicalized as being treated kind of like an illness. Having a doula there can really help to switch the focus back to the mom and baby, and that this is a major life transition, and its beautiful, and it’s not necessarily medical, and it’s not necessarily an emergency. In that situation, if the woman does really want a natural delivery, or has specific preferences, the doula can be there to help the mom to remember her preferences and to remind her about sticking to the birth plan even when the hospital staff might not be working in accordance with it.
Can that almost be more satisfying then, when you’re able to bring your work into a more medicalized setting?
I wouldn’t say more satisfying. Definitely satisfying, but it’s a completely different context and experience when it’s in a home, and I think that’s more satisfying because it doesn’t feel like you’re fighting. It feels like you’re just going with a natural process.
As a whole then, doulas aren’t against medicalized hospital births?
No. It’s to support the mom, to support the woman in what she wants. If what she wants is to have lots and lots of drugs and an epidural, then your role is to support her to get that. Different doulas have different philosophies about it. We’re hired independently by the mom and that’s why we have the initial interview time, to be like, “okay, are we going to mesh well together? Does my philosophy of birth match yours?” Some doulas won’t do births where the mom wants an epidural and drugs. They don’t believe in it. I don’t believe in it for me, but if someone else wants it that’s my role. I don’t necessarily agree with lots of women’s choices, but if that’s their choice then I want to support them to get it. And, I don’t tell the woman what my choice would be if they ask me.
No, because that would influence their decision-making.
Yeah, and that’s not what I want to do. If they say, well, what would you do in this situation? I say, I’m not able to tell you that. First of all, I haven’t had a child. I don’t know what I would do. And second of all, I don’t want to get my personal opinions involved in their decisions. I tell them, “I don’t need to tell you that.”
Okay. When and why did you decide you wanted to be a doula?
When and why? When. Pretty much as soon as I heard that you could be a doula, and that people would let you come to their births. As soon as I heard that that was possible, I knew that’s what I wanted to do. That happened a few years ago, when a friend of mine became a doula. I’ve always been really interested in birth and pregnancy and women’s health and sexuality and motherhood. For years, I wanted to be more involved in that world, in the birth world, and never knew how. I’m not a doctor. I don’t believe in that kind of stuff. I’d thought about being a midwife, but not really concretely. It just came at the right time.
What kind of schooling and/or training did you undergo?
Very little, unfortunately. There’s not a lot of training out there. Initially, I did a 3-day workshop that was called Labour and Support Training Doulas through Douglas College, and they’re the only school around here [Vancouver] that teaches doula training, and they are approved by DONA (Doulas of North America), as an educational doula training…
Yeah, thank you. That’s the word I needed. It’s the only place to do it around here. It’s not very extensive. You can’t get a whole lot done in three days. There’s so much more to learn and do. As soon as I took that, I immediately started reading books, as many as I could on pregnancy and birth and midwifery and doula work and natural childbirth. I took a few other courses also offered at Douglas College. I took a program to be a breast-feeding counsellor and a course on physiology and anatomy of the childbearing year. Douglas offers a few other on-going training things every year. They have a breast-feeding evaluation day and doula education day. They’ll get speakers to come and do specific lectures on topics relevant to doula work that you may not have gotten through your training. So, there’s always little bit of on-going continuing education provided, and, occasionally, we’ll get different speakers coming through Vancouver that come to do a workshop or a 3-day course. There are also a few advanced doula training workshops out there where you get more specific training.
The onus is kind of on you.
Yeah. You don’t have to do it by any means. There’s no minimum or maximum amount of training that you need to be a doula because you work for yourself. Obviously, the more varied your education, I think, the better. There are a few other ways to get training. Gloria Lemay teaches doula practice. She’s a midwife, but her training programs aren’t acknowledged by the B.C. College of Midwives or by DONA.
But it’s extra knowledge.
If you want to only do things that are approved by the schools, then you can go that route, but there are lots of other ways to get education.
A mentorship-type atmosphere would be a valuable asset then?
Yeah, you really learn by doing it. There are quite a few doulas in the Lower Mainland that have been doing it for ten years or so, and will offer to be mentors to newer doulas, to be available for phone calls or questions. There’s a really really tight network of doulas around, and we all have an on-line email list. It’s really easy to get support from each other.
Is DONA the governing body for doulas? Are you registered? How does it work?
You can buy a membership, an annual membership, to be a member as a doula. Through that you get access to education and information, and you help support the network of doulas. You can apply to get certified through them, which I’m in the process of. It’s a really long process. You have to collect quite a lot of documentation and write essays. It’s good though. It’s thorough. It makes you really think about why you want to do this.
Do you have to have a certain number of births to qualify?
You have to have documentation, which means evaluation forms filled out by all the professionals you work with at each birth, for three births, and that’s often difficult to do. I’ve been at six births, and I don’t have all the documentation yet because sometimes the doctors leave, or the nurse leaves. The nurse at the last birth I was at refused to do it.
Oh, that’s nice. Why?
Well, she said, it was the responsibility of my school to do my training, and that I should have brought my instructor with me. She didn’t understand that I’m already trained. I tried to explain that to her. I tried to explain what DONA is, and why I’m doing this, and what her signature on this form means. I told her, “I don’t want you to be misinformed about what I’m asking you to do.” She wasn’t listening. She was really difficult to communicate with. She just said, “No. I don’t do that. I don’t train you.” So, anyway, it gets complicated to get the documentation. It takes a while. If you’re a certified doula through DONA, DONA is the most well known body of doulas, and there are certain standards of care and codes of ethics that all the doulas that are members of it sign, stating they will work under those standards and codes. They’re really useful for parents and potential clients to look at.
It’s a frame of reference for them.
Yeah, like, what are your boundaries? How do I know that you’re going to be a professional? That this relationship’s going to work? They can look at the standards and ethics that we agree to work by.
Plus, a lot of people really like to see some sort of certification, some sort of piece of paper.
Yeah. So, I work under those standards of care even though I’m not certified.
But you’re in the process.
Yeah. I’m a member of DONA.
To continue the question. Locally, we have a group, a provincial group called Doulas Services Association, the DSA, and that’s our local network of doulas. You also buy a membership to that. The DSA provides on-going workshops and education. It’s a really great opportunity to network with other doulas and get to know each other and have fun. They also have a referral line. You can look up doula in the phone book and there’s a referral hotline number. If you call if, there’s a message that says something like “this is what a doula is, and if you’re interested in possibly talking to a doula leave your information here.” We have a referral co-coordinator, this really great fantastic volunteer, who listens to those messages every day, calls people back, and hooks them up with doulas.
Like a dispatcher for doulas?
Yeah. Each mom that calls the hotline gets given three names and phone numbers. Then it’s up to the mom to contact the doulas and arrange interviews. It’s great. I don’t have to market myself at all. The phone calls just come to me. The referral co-coordinator gets to know each doula, and there are lots of us, I don’t know how she keeps it all straight, she’s very organised. She’ll know what area of the city we live in, which hospitals we’re willing to work at. If we have births happening at the moment or if we’re willing to take more clients, that sort of thing.
For a continuation of this interview, see next week’s Voice: