The first time I heard of the word “doula” was when my sister-in-law was pregnant with her first child. She told me she was hiring a doula (pronounced DOO-lah) to basically coach her through the birthing process since she wanted to have a good birthing experience. A do-what?! I thought.
I couldn’t wrap my brain around the words “birth coach” and “good birthing experience.” Didn’t the doctors or midwives already coach you through the labor and birth?! And was there really such a thing as a “good” birthing experience if childbirth was all as painful as TV, movies, and other moms made it out to be? Then when my sister-in-law told me how much she was paying for the services, I nearly choked.
I would never pay that much for someone to “coach” me on giving birth! I mean, come on. Women have been having children in caves since Neanderthal days…right? They didn’t have doulas!
Fast forward two years later, we were at brunch with my brother-in-law, sister-in-law, and nephew after a fun morning at the Museum of Ice Cream. I was only about 8 weeks pregnant, but we had announced it to them that day in the alphabet wall room, since we wanted to do it in person and our gatherings were not that frequent. After all the excitement of the news settled down a bit, my sister-in-law asked if we were considering a doula.
My husband and I are both in the medical field, so I thought perhaps we didn’t really need one. I mean, my husband has even delivered a baby before…..a long time ago! But I admitted I was more curious about the doula experience now that I was actually pregnant. One had to keep an open mind when it came to the health of a baby. My sister-in-law had nothing but positive, glowing things to say about her doula and her childbirth experience. Wow, someone who actually enjoyed her pregnancy and delivery?! That was certainly unheard of to me.
My interest was piqued, so my sister-in-law suggested I should at least request a meeting with her doula to see if we were a good fit and then go from there. And she suggested I book early if I did decide to hire her doula because the doula was very popular and had limited clients. We were actually quite busy with back to back travels during that time (all planned before I knew I was going to be pregnant), so I almost just wrote off the whole thing. But I really didn’t want to regret the decision in the long run, so we somehow made it work.
I remember squeezing in a meeting with the doula right after we got off a plane ride back home, before we were about to jet off on another trip. The plane was actually delayed an hour coming home, and I remember furiously texting the doula that morning at 7am but luckily, we were just able to bolt from airport to coffee shop in time for our first meeting. And as the title of this post implies, yes, we did hire a doula—indeed, the same one my sister-in-law recommended to us!
So what swayed two medical professionals into hiring an expensive (albeit very experienced) birth coach? It turns out there were so many advantages, and there was so much we didn’t know to expect of childbirth! Hiring our doula was one of the best decisions and investments we’ve ever made. Now, I will disclaim that not all doulas offer the same kind of services and packages as ours did, and I’ve had friends that say my doula is almost like a “celebrity doula” with the royal treatment…ha! But I’ll give you an idea of what I found to be very helpful as a first-time mama in my doula, so perhaps you can look for some of the same things in your search for one!
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1. Extreme Familiarity with the Childbirth Process
A good, experienced doula is advantageous to have on your team because they’ve seen so many births that if for some reason, your birth does not go according to plan, they would have the best experience and decision-making wisdom to provide you. The thing about pregnancy and childbirth is that things most likely will not happen exactly the way you imagined it. In the moment, you will also probably panic and forget everything from all those prenatal classes you took because you’re just trying to ride out the contractions.
My doula recommends that someone who has done over 100 births is considered more experienced and would be well worth your money. Ours has done over 800 births! She did three in-person home visits with us, in which we reviewed how the actual childbirth process happens, female anatomy, pain control options, how to labor, what medical decisions and choices we would be presented with in the hospital, what labs and tests would be required during pregnancy and the implications of the results, and much more. We discussed the right birth plan for us and she helped us write up a formal plan to bring to the hospital. She never pressured us to do anything one way or another; she merely laid out the information and research for us to make an educated decision.
Even though I am a biology major and a clinical pharmacist, when my doula explained how babies descend the birth canal and enter into the world, I honestly could not remember that part of my education. Or was it even taught?? Point aside, all the classes I took from my medical providers did not go into as simple, concise, but to the point and crucial knowledge that I took away from our private sessions with my doula. She brought up important topics that they never even covered in the birth classes.
And as a side note to clear up a common misconception, just because you hire a doula, it does not mean you need to have a “natural birth” or “unmedicated birth.” If you do, that’s fine too! But a doula is there to honor your wishes and help to make it come to fruition.
2. Familiarity With Hospitals in Your Area
This point was something I hadn’t considered when I got pregnant. I thought I knew which hospital I wanted to deliver at since I work for a large network of medical clinics that are associated with a few hospitals. My own patients would come and go to these hospitals as well, but I personally had never worked in these hospitals, as I was in ambulatory care and not inpatient.
My doula has delivered in probably every major hospital in the Bay Area (where I live). Don’t quote me on that, but she has even delivered for patients who lived 2-3 hours away who insisted on her services despite her discouraging it. When she asked me where I would be delivering and I told her I had planned to deliver at one of the hospitals associated with my medical clinic, she was very supportive but she also encouraged me to check out another hospital equidistant from our house and still in the same network. She had delivered at both of these hospitals before and was merely suggesting we not limit our options.
We actually ended up going with the other hospital she suggested after touring both. It was a newer hospital, which was what made me a tad nervous, but she assured me she had delivered plenty of successful births there. Regardless of where we chose to deliver, she would have supported us anywhere. When it came time to go to the hospital, my doula was waiting for me when we got there and knew exactly what floor to take me to and where to go. She even knew some of the nurses and midwives in the hospital already, which was also reassuring because I knew no one!
3. Excellent Prenatal Care Leading Up to Delivery
I’m not sure if all doulas work with you as early on in your pregnancy, but I started working with mine around 13-14 weeks. My doula is also a certified Ayurvedic practitioner, so we did do a complete health assessment and intake so my doula could help my overall health be the best it could be in preparation for the birth. She would coach me on things to do to boost my digestion, suggest supplements and probiotics, advise me on daily self massages and breathing exercises, etc. These breathing exercises definitely came in handy when I was in labor as I had been so used to doing them daily already.
My doula helped me calm down when I didn’t pass my first glucose test; she helped me with recommendations to pass the GBS test. When the due date was nearing, we realized I had been gaining weight a little too suddenly and wondered if my baby was going to be a big one. At 36 weeks, the ultrasound was already estimating my baby to be 8.5 pounds! Of course, estimates are only 30% accurate per my OB/GYN, but it was still quite alarming to me that I might cook this girl for another 4 weeks or more and who knows how big she would be by then?! I’m a petite Asian woman, and I didn’t want to be pushing any 9-pounder out of my tiny hips!
A week later, when I was already full term, my doula helped me titrate the evening primrose oil supplements I was taking to naturally ripen my cervix and help me start labor naturally. I wouldn’t have known what doses to take, even as a pharmacist, because supplements and dosing are not as regulated. I was grateful for her help in this, and I did end up going into labor on my own at 39 weeks. My baby was a healthy weight and not actually over 8 pounds! Whew!
Also, my baby seemed to be in a sunny-side up position during that latest ultrasound. I was beginning to worry, but my doula recommended a good prenatal chiropractor in my area to see. Aligning the hips and making sure there was optimal room for the baby to rotate would be an excellent idea, according to her. The chiropractor also taught me exercises to do to help rotate the baby. I’ll never know if the 2 sessions I had were instrumental or not, but I do know my baby did not come out sunny-side up or breech. Hurray! I just felt like I could trust my doula’s referrals as well, and that was a nice resource to have.
4. Preparing You For Labor (And Minimal Tearing)
One of my biggest fears about having a baby was the childbirth part. I imagined that I could live with the pregnancy part of it quite well. It would be fun; I could sit all day and relax and eat all the ice cream I wanted, right? (Spoiler alert: not even close!) But labor and delivery…ooo, it made me cringe to even think about it because I thought I had such low pain tolerance. (Spoiler alert: it turns out it was higher than I thought!)
Even more scary than the thought of labor, though, was the thought of tearing. I mean…my husband would tell me about what he learned about how severe some tears could get– from one hole…to another. I really, really wanted someone to help me prepare for labor so that I could minimize pain and tearing! The other thing was, I wasn’t sure how I would know when it was time to go in! You can read all you want to about what a contraction feels like and when it is truly labor vs. Braxton Hicks, but I just felt like I still didn’t know how I would discern!
My doula listened to all of my concerns and likely chuckled to herself because I probably sounded like every other nervous, type A first-time mama. Throughout the pregnancy, her breathing exercises and meditations taught me to instinctively breathe a certain way that came second nature during birth time. She prepared me and my husband for all the techniques we could use to help me labor and reduce the pain of the contractions as much as possible. And she even taught me how to use perineal stretching tools to help minimize tearing.
Spoiler alert: I had no tearing (!!)
5. A Responsive and Expert Provider
If you’re a little bit type A, or nervous about a lot of things, or just plain like to ask questions for peace of mind, having a doula for support can be really anxiety-relieving. (Yes, I’m all of those.) My doula would respond to my emails within minutes, sometimes quicker than I could revise my typos back to her. She was lightning fast with texts, like the morning we found out our flight had been delayed and we had to push back our first meeting with her so we could make it on time. Sometimes, she felt like my own personal doula–except I knew she had other clients to tend to as well!
This kind of quick response is likely not always the norm for all doulas, but I think it was also nice just to have another resource/provider who could help me with unexpected pregnancy questions that came up. Emailing my doctors would not always give me the in-depth answer I needed or assurance that I was overthinking things in a timely manner.
Having her available was so comforting to know that someone always had my back during this pregnancy. And it felt nice knowing that someone was “on call” for me when the time came to deliver and knew exactly what my wishes were. She even helped us write up a more thorough birth plan than the default handout that my doctor gave me. Doulas are kind of like…a wedding planner for your wedding, but a birth coach for your birth!
6. Someone to Labor With You and Tell You When to Go In
Remember I said I wasn’t sure how I would know I was in active labor or what a contraction really felt like? Yea, I really didn’t. Thankfully we had my doula!
The day my daughter was born, I went from zero to a hundred in a matter of one or two hours. I had been in contact with my doula all morning, since at least 5 or 6am because of possible Braxton Hicks. But I wasn’t entirely sure if that was what a contraction was?? Up until then, I had never felt a real contraction.
In any case, my doula said she would be in contact all day and she would periodically check in on me. My husband was slightly nervous about going to work, but I told him false labor was possible and could take awhile anyway. Since it was literally his last day at work before taking time off with me, he might as well finish it off. The uncomfortable cramping was very irregular in duration and went away by mid morning.
My sister stopped by to eat lunch with me since she was working from home that day and a bit concerned about me. Right after we finished lunch, I started to feel cramping again. I wasn’t sure if it was just nausea from indigestion, so I texted my doula. She suspected I might have started to labor, but we didn’t know how regular the contractions were.
I sat on my exercise ball because it was the only place where I didn’t feel the enormous pressure on my pelvis. My doula called and walked my sister through how to massage me over the phone and to help me time contractions. An hour later, I went from nonchalantly enjoying lunch with my sister to being on my hands and knees rocking back and forth, willing the surges to stop.
My doula figured out I was probably timing my contractions wrong when my sister sent her the timing logs because it just didn’t make sense with my messages to her that the contractions seemed so intense and yet so short in duration. She called and listened to me labor over the phone. “I think…your contractions are longer than you’ve been reporting and pretty close together. You should go in to the hospital now!”
I was not expecting to hear that. Just this morning, she and I were discussing that I could be having Braxton Hicks for a few days before the real labor set in. And now all of a sudden I had to go in?! My husband wasn’t off work for another 4 hours! And then he still had to drive home! My contractions were only about 3 minutes apart now, per her timing, and I was starting to cry silent tears. (Usually, they tell you to go in when contractions are 5 minutes apart.)
I guess I didn’t realize all the surges and cramping were actually contractions getting closer and closer together! (Hence, my pain tolerance was higher than I expected.) If I hadn’t been on the phone with my doula during that hour, I’m pretty sure I might have just waited until my husband got off work and came home. I thought I could last until he finished his shift, but I never expected to go from nothing to 3-1-1 so quickly!
My doula took over and admonished me. “JASMINE. Call him. Or I will. He needs to come home NOW or meet you at the hospital and your sister can drive you!” I insisted to wait for my husband to come home because everything we packed was in his car. But it was cutting it pretty close because by the time we got to the hospital, I was contracting every other minute and every bump in the road made me feel like I was about to have the baby in the car!
So yes, luckily I had my doula to help me realize I needed to go to the hospital, or maybe I really would have delivered at home or in the car!!
7. Your Personal Advocate in the Hospital
Here’s the thing about most hospitals now too: your doctor is not necessarily on-call to deliver your baby. Your doctor might not even deliver babies anymore! On top of that, a doctor might not even be the one delivering your baby; it’s usually a midwife! My OB/GYN actually did deliver babies frequently, but we actually went to a different hospital than she usually delivers at. So you think, then why do I spend 40 weeks building a relationship with this OB/GYN, only to have a complete stranger be in the room with me when I deliver?!
Yea, trust me, it frustrates me too. But I also get why they do it that way, being a healthcare provider myself. Doctors need rest too and they should not have have to be on call for your baby if they are exhausted from working all night already. You and your baby deserve safe practices and an alert provider who has not been overworked to the bone. That being said, this was one of the BIGGEST reasons why I ultimately decided to hire a doula. I wanted someone in there with me who I knew and trusted during delivery. In one of my most vulnerable moments, I wanted someone there who was MY advocate because she actually knew me throughout the pregnancy and I was not just another statistic.
Continuing my labor story above, once we got to the hospital, I felt so much more relieved to have my doula nearby. She knew where to take me to be admitted; she knew where to grab wheelchairs; she knew how to massage me when I was having a contraction every other minute. When I was in triage, she sharply urged the nurse to get me the epidural NOW. I didn’t have time for silly admit questions; I clearly needed to be admitted. Sure enough, I was 7 cm dilated already while in triage. They wheeled me off to my room and the nurse was still admitting me while they placed the epidural.
But thank goodness for my doula who stood up for me because I needed that epidural more than I possibly knew I needed it!
8. A Positive Childbirth Experience
The phrase “good childbirth experience” seemed oxymoronic to me when my sister-in-law first told me. Did that just mean quick for the baby to come out and no tearing? But no, I came to understand it after I delivered my daughter. And I gotta say, my doula really did help me have a good birthing experience so that I don’t even look back on it as a traumatic event. It sounds completely unintuitive to me when I think about that, but I am so grateful that I did have a good experience.
My doula helped me feel the best that I could and coached me to be as healthy as I could be to give my baby the best environment to grow and the best entrance into this world. To be honest, I don’t recall being in a lot of pain during labor. Uncomfortable, sure. Very uncomfortable at that. Plus a lot of pressure. But obviously, the epidural helped once I got to the hospital, and perhaps the quick nature of my labor made it more tolerable too.
The pushing part was probably the worst because my daughter chose to exit with her arm smashed against her head, and therefore oddly increasing the circumference of what I had to push out. Amazingly, I didn’t tear! But my doula was there every step of the way, and I didn’t stress as much, knowing that she was there and would speak up if she felt like an intervention was uncalled for. The final push to get my daughter out was preceded by the midwife saying, “if you don’t push her out in the next one, we will have to cut (episiotomy).”
I looked over at my doula and gave her a death glare to pass on to the midwife. NO. I did not train and stretch my perineum for weeks only to have them give me an episiotomy in the end! She totally understood me and reassured me everything was going to be okay. And actually, I did push my daughter out on that note (threat)! I have never felt such relief and joy as when she came into this world. I heard her little cries and then I started to cry.
“Did I poop?” I asked my doula, thinking of Ali Wong. “I must have pooped…that egg tart.”
My doula looked bewildered and amused. She checked and then laughed. “Actually, you did not!!!”
If anything, I think having a doula was good for my mental health during the pregnancy and birth. I was less anxious having an expert to turn to when I had little things come up that bothered me. While I was very fearful of the birthing part at the start of our relationship, I only grew more confident and calm to embrace what was to come by the time my daughter came because of how my doula had prepped me. And because I knew she would be right there by my side.
9. Postpartum Care and Follow up
Now, if you’ve been following along my postpartum journey, you already know that I developed severe postpartum depression and anxiety. Most doulas probably don’t do this, but mine made placenta pills and that was included in her package. I was indifferent to trying placenta pills, but I thought that perhaps the placenta pills would help me prevent PPD based on what I had read. There are a lot of touted benefits to it, but sadly, for me, they did not work to ward off any PPD.
The thing is, perhaps if all the stars aligned and things went smoothly after my daughter was born, then maybe the placenta pills would have helped. I feel that they did help my milk come in more abundantly, but then I had issues of mastitis and issues with pumping and lots of confusing, conflicting directions on how much to pump and when. And that in turn might have contributed to the PPD too.
My doula did offer one postpartum follow up home visit. However, we spent that one visit with her helping me massage out my rock-hard, engorged, painful breasts that I was freaking out about because I didn’t realize that it was my milk coming in. She was able to teach me how to get relief, but it did not last very long. I had issues with breastfeeding and my daughter’s latch, and my doula was able to refer me to a lactation consultant who came to my home to help.
Unfortunately, I could not continue breastfeeding long term despite everything we desperately and frantically tried. Things were just set up in a perfect storm for my depression to take over and become the most pressing issue to deal with. However, I did really appreciate the support and care my doula continued to provide me even after my baby was born. She has definitely become like family, and even just last week (almost a year later), I met up with her with my daughter! It was such a surreal, heartwarming feeling to see them playing together…
10. Doula Services Qualify for FSA Reimbursement
So if all of this sounds too good to be true, I know that the price tag can be the one thing people balk at. Why spend so much money on a birth coach just to have a good story? But it’s so much more than that and completely worth it. However, if the cost of a doula sounds way too hefty for you, keep in mind that another option is that the services can be reimbursed by your FSA if you have an account!
My FSA required a letter from a doctor, which my OB/GYN was happy to provide for me. Currently, the FSA maximum for 2020 is $2750 per person in a year. You can also pay with two FSA accounts (e.g. if you don’t have enough in your FSA account, your spouse can also pay for your care). Most doulas should be able to be covered with the maximum amount, but in some cases (like ours), it may require two accounts. I definitely thought it was worth the tax-free dollars, and it was pretty easy to get the FSA reimbursement!
And there you have it. Maybe I’ve convinced you to search for a doula. Maybe I’ve convinced you that you actually don’t need one after all. Either way, it is so important to do what you think is best for mama’s mental health, before and after birth. If you think that having a doula would ease your anxiety about childbirth or any complications that could arise, I’d say it is worth it. If you have had a C-section before and want to try for a vaginal delivery your second time around (aka a VBAC), doulas can be major resources for that. I know my doula has a very high VBAC success rate!
And if you would like my doula’s contact information (Bay Area), please private message me. I have not posted it here because I don’t want this post to be about promoting her services, though I have no hesitation at all recommending her!
Be well mamas, and let me know if you had a great doula that you would recommend too! 🙂
xoxo,
Jas
*Featured image by Emilie Ko Chuong
**Please feel free to help me pin this post! 🙂
[Update: A colleague of mine read this post and told me that she was unable to afford a doula but she found Ina May’s Guide to Childbirth very instrumental in her unmedicated birth. I thought I would just leave this option here in case other mamas might find it helpful! I completely understand that being able to hire a doula is a privilege, but the purpose of this post was to help people understand what doulas do and how it can be beneficial. I was very clueless myself before going through it and dismissed this kind of service, so I wanted to shed light on something that I should not have been so judgmental about!]
