a doula with a woman's pregnant belly
Photo by Heather White

The anticipation of labor and delivery, whether you’re on your first pregnancy or your fifth, is an exciting — but stressful — time. What if labor becomes a marathon? Should we have a birth plan? Will I need an epidural? How can my partner help during the birthing process?

While your obstetrician is a wonderful resource, significant patient loads often take away from the time they can dedicate to each mama. This is where a doula comes into play.

Certified birth doula and advocate Milon Nagi recently spoke with us about a doula’s role during pregnancy, how a doctor and a doula differ, and ways that both parents benefit from the support of a doula during labor and delivery.

CKC: First of all, tell us a bit about yourself.

Milon Nagi: I live in Brooklyn with my husband and son, having moved here 10 years ago from the UK.

I became involved in the world of birth in NYC around eight years ago, when I began volunteering with the amazing non-profit Choices in Childbirth. I work with them on the monthly, low-cost All About Birth workshops for expectant parents (an amazing resource for our community!) and as a co-editor of CiC’s Guide to A Healthy Birth.

I’m also a founding member of the NYC Doula Collective and serve on its board.

What is a doula?

A birth doula is a childbirth professional who provides physical, emotional, and informational support to pregnant women and their families. This includes providing continuous support during labor, through the baby’s birth, and the immediate postpartum period.

Research shows that having this kind of support results in a decrease in interventions such as cesarean section and even shorter labors, alongside increased satisfaction with one’s birth experience and better breastfeeding rates.

Given these kinds of outcomes, as Dr. John Kennell said: “If a doula were a drug, it would be unethical not to use it.”

What are the differences between a doula and a doctor?

Unlike a medical care provider such as an OB or midwife, a doula is not a medical professional responsible for clinical care. For example, doulas do not perform vaginal exams, monitor heart rates, etc.

What a doula does is to provide continuous and consistent support during a woman’s labor. She (most, though not all, doulas are female) stays with her client throughout a hospital labor, something medical staff are unfortunately generally not in a position to do due to their other responsibilities and patients.

This constant presence means that a doula is able to offer consistent emotional support, reassuring and encouraging the mother as she works through her labor. She can suggest and help with physical positions, movements, and other techniques which may offer the mother more comfort and even a more productive labor, helping her to work with her baby and help it on its journey into the world.

She can support the mother’s partner as he or she offers their own unique words and emotional support, helping them figure out just the right place to apply pressure on the laboring mother’s hips through a contraction, or encouraging them to slow dance together as their baby moves down.

She can remind the parents of their birth plan and preferences, and help them ask questions and have a dialogue with their medical care team. She can help them navigate changes to their plans or labor.

She can be an extra hand and brain in the room, a repository of information, helping with the logistics of their birth, reminding them of the things they learned in the books and the childbirth education classes, so that they can be free to let go and simply be present in their labor and the birth of their baby.

When during your pregnancy is the best time to begin searching for a doula?

Generally I would advise doing so as early as possible during the second trimester. While it is definitely possible to find doulas late in pregnancy, most doulas take on a very limited case load and can get booked up quite early.

If you hire a doula during your fourth or fifth month of pregnancy, you have the benefit of this knowledgeable sounding board and resource through the majority of your pregnancy. Many doulas feel that some of our most important work is done prenatally, in helping expectant parents find the information they need to figure out their own preferences for their birth and their first days with their baby, and how to make sure these wishes will be accommodated by their medical care team.

That said, it is never too late to hire a doula!

Photo via Milon Nagi
Milon Nagi (Photo via Milon Nagi)

Is a doula available throughout the pregnancy, or do they primarily work with mothers closer to their delivery dates?

Once a doula is hired she is available for questions throughout your pregnancy, with prenatal visits closer to the due date. I usually offer two prenatal visits in the client’s home in the weeks leading up to the birth.

What is a doula’s role during the labor and delivery?

I ask clients to give me a call as soon as they believe labor might be starting. We discuss the different signs of labor and what they might look or feel like during our prenatal visits. So labor support usually begins with regular phone support during early labor, which can range from reminding her to sleep and helping her figure out how to rest if her labor begins overnight (as she will need her energy for the work ahead!), to suggesting positions she may find more comfortable, to simply reassuring her that what she is feeling or experiencing is normal.

When my client is ready for me to join them, I head over to their home and stay with them from that point, working with them through each contraction, reminding them when to call their care provider or head to the hospital, and being there with them through the physical and emotional work of their labor.

It is also invaluable to be able to offer a break for the woman’s partner to nap or pop out for a sandwich, knowing their loved one will be well taken care of while they rest and return refreshed.

I’ve talked a little above about what doula labor support involves. However, this emotional, physical, and informational support takes different forms at each individual labor.

While some elements remain consistent, each person’s needs are different. Some women crave a back rub or pressure at just the right point on her sacrum to ease the intensity of a contraction. Others don’t want to be touched at all but benefit greatly from reminders of sounds or mantras they can use as they exhale, or simply just from having someone in the room who they know is bearing witness to their labor, breathing with, and holding space for them.

And again this can change at any stage during each woman’s labor. The key is being able to recognize and respond to your client’s evolving labor and needs.

How long after delivery is a doula available to support mom postpartum? 

A birth doula generally stays with the family for the first hour or two postpartum, helping them with the first breastfeeding and providing whatever support they might need before mother and baby are transferred to the postpartum unit or are ready to sleep.

She will also generally make a postpartum visit in their home within the first week or two and continue to be available for questions and for help finding resources during the first weeks postpartum.

Beyond that, and for more extensive postpartum support, I highly recommend hiring a postpartum doula! These are separately trained and certified doulas (though some work as both birth and postpartum doulas) who specialize in supporting families in their homes during the first weeks and months postpartum. Many have additional qualifications, for example in breastfeeding support or infant massage.

The idea is to “mother the mother” and family as they learn how to take care of their baby — and to leave new parents feeling confident that they are able to do so.

[pullquote]Having someone there to support your transition into parenthood, whatever path that may take, to bear witness to your journey, and to celebrate alongside you, is invaluable for any new parent.[/pullquote]

Who benefits most from having a doula for their pregnancy?

I honestly feel that everyone can benefit from doula support during their pregnancy and birth. People sometimes feel that doulas are only for those who are planning a “natural birth” or a home birth. This is absolutely not the case.

Women who plan to have an epidural in labor can still benefit from the continuous emotional support a doula can provide, from assistance in changing positions in bed to help her labor progress, from hand and leg rubs to soothe her, or from support in having evidence-based dialogue and making informed decisions about her medical care.

Also, even women who are planning an epidural will experience labor and contractions for some time before this becomes an available option, and they deserve the support and tools to help them cope with this part of labor.

Similarly, women who are planning a cesarean birth benefit from many of these forms of support both as they prepare for surgery and as they spend their first hours with their baby whilst also recovering themselves.

Having someone there to support your transition into parenthood, whatever path that may take, to bear witness to your journey, and to celebrate alongside you, is invaluable for any new parent.

What do you enjoy most about being a doula?

I love being there with families during this most intense and personal transition in their lives. Getting to be there to bear witness and support, to walk alongside these immensely strong women and couples at their most vulnerable and simultaneously most powerful moments.

And welcoming a whole new life into the world! It never gets old. This work is not easy but it is an absolute privilege, honor, and joy, and I feel so blessed every single time a family invites me into this most sacred of spaces with them.

What would you say to somebody who is on the fence about hiring a doula for their pregnancy?

I would suggest meeting with a few doulas and having some conversations with them about what doula support might look like for them. Do they have specific concerns or questions which are holding them back? Ask the doula about them.

Doulas are available for all budgets and at all levels of experience.

Sometimes couples are afraid a doula’s job is to replace the partner. In practice, doulas are there to support both parents in their transition and end up freeing up a lot of headspace and stress for the mother’s partner, who is able to just focus on being there for his or her loved one rather than “remembering all of the stuff.” Partners are some of our biggest fans!

So, it’s helpful to meet with two or three doulas, ask some questions, have some conversations. If after this you decide a doula is not for you, fair enough. But be prepared — you may be surprised!

About the author: Christine Bush is a freelance writer for the hyperlocal website, South Slope News, and is proudly recognized as one of the geekiest parents in Brooklyn. She occasionally pretends to be cool by playing around on Instagram, Twitter, and Tumblr, but knows she’s not fooling anyone.

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