Ask A Doula - Part 2

Megan Crawford

More questions, asked by my millions of fans… I mean a couple of friends.

4. What window of time should I consider a doula? How early in pregnancy should I start finding a doula?

So, this is going to depend on the doula you hire, but for the most part it really depends on you. What are you looking for? Many doulas will take clients the minute that little line turns pink. Pop them in the calendar right then and there. I personally offer three prenatal appointments for my birth clients - one in each trimester, and an extra optional one if they started later in pregnancy. I want enough time to teach them about their options during birth, a tiny bit about what to expect when giving birth at a hospital or birthing center, and make a birth plan that covers all the bases. Once they are on my calendar they are welcome to contact me with any and all questions they have concerning their pregnancy and upcoming birth (though until I’m on call at 38 weeks, I might respond the next morning if they email me at night). Some of their questions can be answered by me, some I will have to advise them to call their provider about. But it’s nice to have another person available to remind you that your concerns are valid.

Some mommas don’t want all that. They’ve had five babies, they just want the birth doula. That’s fine, too. A client can opt out of any services I offer without judgement or offense.

Either way, I am available. I have some learning tools and experience that I am more than happy to share. And two weeks before your estimated due date, I am on call 24/7 for my clients. And if you go into labor early, I’ll be there. And if you need an emergency c-section, I’ll be there. And if you go into labor at 36 weeks or 32 weeks or whenever, I’ll be there.

5. How long after birth are other doula services typically available?

Very good question. Here, it’s important to explain the difference between two common types of doulas.

A birth doula is someone who’s focus is around the birth. We want to help prepare for birth and support you during your birth. Birth doulas typically leave the location of the birth shortly after the baby makes their appearance. But this can change.

I like to stick around for an hour or two if needed. Sometimes the parents are overwhelmed and need someone to be their go-between with the care team. Ask for extra blankets, grab an extra diaper, that sort of thing. A new partner parent shouldn’t have to be searching the cabinets for a peri bottle, and the birthing parent certainly shouldn’t have to. I can get food, make sure beverages are topped off. Mainly, though, I will be helping birthing person and baby get comfortable, and initiate breastfeeding if that is in the plan.

Four babies and lots of education, and breastfeeding was still always hard for me. That adorable little pecking baby bird doesn’t listen when you try to tell them where the nipple is, and they won’t open their eyes when you need them to. The latch may not be deep enough, but baby sucks anyway. If mom is not a seasoned pro at this, or if she is but still feels unsure, I can help with the basics of breastfeeding. And if there is a problem that is out of my scope of practice, I can call the International Board Certified Lactation Consultant (IBCLC), who is usually a nurse or is staffed by the hospital. If it’s a home birth or a birth center birth, the midwife is usually very trained in breastfeeding, and even if she is not she will have the phone number of an IBCLC on her rolodex.

Sometimes what the birthing person wants is just another educated, supportive person in the room.

And sometimes they don’t.

If breastfeeding is in the plan and takes off without a hitch, if Partner seems to have everything under control, if Birthing Person is smiling and dozing and baby is skin to skin with them or the non-birthing parent, I’ll ask if they need anything and make my exit if they don’t. It’s a beautiful moment and it is my belief that that moment is for parents and baby only. They don’t need me staring at them, asking questions, whatever. I might snap a few family pictures to send to them later, but this time is for family. And it’s beautiful.

Except sometimes it’s not.

Sometimes our worst fears come true. In the terrible case of an infant death, I’m not about to leave. You’ll have trouble kicking me out. I might sleep in the hallway if I need to. But no one needs to go through that alone. And I’ll be there and I’ll STAY there if that happens. I’ll help make arrangements for the next few hours (phone calls, etc). I can help make arrangements for the next few days (line up food for when the family gets home, childcare if there are other kids, make sure there are family and friends ready to take care of the grieving couple). And I will absolutely cry with you, pray with you, talk with you, whatever you need. I will make sure parents stay fed and hydrated. There’s nothing I can do to take the pain away, but I will be there to help with the logistics and for emotional support.

Sometimes baby lives, but needs to visit the NICU. This is another instance in which I would not just leave. I still want to take care of the parents. I want to make sure that if one partner is with baby, the other partner is resting. I want to make sure they are eating nutritious food and drinking plenty of water and sugar. I will pretty much take their lead at this point - if they need me with birthing parent, that’s where I’ll be. If they need me with non-birthing parent, that’s where I’ll be. If they need me with baby, that’s where I’ll be. And if everything is fine, I can go home and get some rest so that I can come back the next day to assist.

And this takes us into the second type of doula: a postpartum doula.

Assuming everything goes well and baby is scheduled to go home with parent(s) at the normal time, a birth doula will usually have one postpartum appointment to schedule. This can be a week or two after baby gets home. We talk about the birth story. Show pictures. Go over breastfeeding issues. Parents can ask questions, and if it is within my scope of practice to advise, I will. (I can answer “what color should baby’s poop be” but not “why is baby always lethargic”). Ideally, this appointment takes place at the exact time the parents are starting to get exhausted from lack of sleep and it’s just setting in their minds that this is their new normal. I can swoop in and clean some bottles, do some baby laundry, may make a casserole or something for dinner for the next couple of nights. I can help plan the logistics of having a new family member: sleeping, eating, showering, and relaxing don’t come naturally when there is a new baby in the house. And, if I’m very very lucky, I can hold the baby while the new parents shower, eat, relax, or nap.

A postpartum doula is who would take over after that. Or as early as the parents get home from the birthing site, if that’s what they want. A postpartum doula can work during the day or during the night. Each doula differs in what they are willing to do, but generally they do very basic housekeeping: baby laundry, baby dishes, tidying up the nursery. They might cook a meal for the family. They council the family. But again, it’s kind of whatever the parents need at the time. A daytime doula might care for the baby and siblings long enough for the parents to shower and eat and nap and finish their Zoom call. A night doula would stay near the baby, feed them when they wake (or take them to breastfeeding parent), change diapers, rock baby back to sleep. Basically do everything they can to make sure parents get a good night’s sleep. I also like to do a load of baby laundry and dishes and have breakfast ready for the parents when they wake up. I don’t want them to wake up and feel like they are already behind for the day.

Postpartum doulas are usually hired by the hour, and you usually book a number of hours at a time. Each shift is a minimum of 4-8 hours, depending on if it’s during the day or at night (can also depend on the driving distance to get to you!) Some clients want help every night for the first month and then are fine, some want help twice a week for the first six months. It’s completely up to what helps them the most. As a rule of thumb, I generally take new postpartum clients for up to six months after birth. I have worked with older babies for families who still needed me, and they will always be close to my heart.

The TLDR version: whatever the parents need.

What I’ve described is my own guidelines, and other doulas might do it differently. This is another reason it is SO IMPORTANT to not just hire the first doula you find, but to interview a few. Shop around. See how they are different. And choose the doula who’s logistics match your needs but also who’s personality and birth/child raising philosophy fit together with yours. If you are a gentle parenting type of parent, you don’t want to hire someone who spanks kids, no matter how cheap they are. And if you need a postpartum doula every single night for the first six months so that you can go back to work during the day, you don’t want a doula who doesn’t have backup. And if you are an attachment style parent, you don’t want a doula who will let your baby “cry it out”.

Oof. My alarm just went off to do the next thing on today’s list. Let’s wrap this up. (You never know how long an answer I’ll give to what feels like a simple question, huh?)

6. Can you go with me to ultrasound appointments/Lamaze classes/doctor visits?

Yep! If you want extra prenatal appointments, you if you want to change one from (for example) “birth planning” to “doctor visit”, that is absolutely your perogative. Perogitive. Per. It’s your choice. I’m here to support you, whatever that looks like to you.

And I TEACH Lamaze classes! How cool is that?

I probably would not ideally want to go to a childbirth/lamaze class with you, just because that’s a place for you and your partner to learn and make decisions of your own. I will 100% discuss everything you learned, though, and answer any questions I can. And if you really do want me to go to a childbirth class, I will make it happen. There’s just not a lot that I can do there, and I hope I already know everything they would teach you. But if it helps to have my presence, I’ll be there. If your partner cannot make it to your ultrasound and you need someone snapping pictures, I’ll be there. If your care team is suggesting you get induced at 36 weeks and you want someone to remind you of the questions you should ask before making this decision for yourself, I’ll be there. I don’t have any real hard guidelines that say I will NOT help you through any certain thing. Well, I do have a couple, but they are unrelated to this topic (and if one of those popped up, I’d try to find someone who could help you, I’m not just going to say “no” and leave). As a full service doula, I am there to support the parents, whatever that looks like to them. My terms are pretty fluid. And I would guess that’s true for a lot of doulas.

7. Can you support me through an at-home/water/free birth if I choose not to birth at a hospital?

So here’s where that one hard “no” comes in.

I will absolutely support you at your home birth. The location of the birth is not my concern. Wherever you are, wherever you need me, that’s where I’ll be. And if I could get everyone in the world to have a water birth, I totally would. If I gave birth again, that would be my priority.

But here’s the rub: you MUST have a care team.

At the hospital, there’s doctors and nurses. Some doctors do home births. Most midwives do home births. I am not legally able to do any medical stuff, and I am not trained to notice when something is about to go wrong. I will not do a birth without a doctor or midwife present. Some doulas do! If you want what is called a “free birth”, for whatever reason, I can get on my doula network and help find someone who will support that. But I do not feel qualified to help you deliver your baby without a midwife or doctor present.

Does that mean you can’t call me if you are looking to have a freebirth? Absolutely not. Like I said before, I will help you find support.

Does this mean that if your midwife is late arriving at your home birth and misses the actual birth I’m going to yeet myself out the door? Absolutely not. I’m staying with you. But honestly, if you’ve called me to your home because you are in active labor, you’ve also called your midwife, so that’s an unlikely scenario.

When you fill out my intake form, you tell me who your care provider is, whether it’s an OB or a midwife. I have their contact info. You tell me where you plan to give birth. A planned homebirth can be so so beautiful. And for a healthy, low risk pregnancy, I truly believe a birth with a midwife at home or at a birthing center is the best option (and statistics and evidence back me up on this). As long as you have someone qualified to deliver your baby, we could do it on a ferris wheel for all I care (except that’s probably not legal).

Reminder to ask your doula about what they support. Some birth doulas only support hospital births. Some only do birth centers. Some only do home births. Most of the doulas I know will go wherever you want for your birth, but it’s definitely a question to ask when interviewing a doula.

Goodness, I’m long winded!

To be continued!