What I've learned from 30+ births

Doula Lessons from 30 births

Some doulas gain experience very quickly, routinely booking 2-4 (or more!) clients each month. I've attended births as a doula much more slowly than that. In the past 4 years of doula-ing, I've averaged about 8 births a year, slowly but surely learning more and more about pregnancy, birth and labor support techniques.

Since attending births here in Tulsa since February, I've realized that I've integrated some really important lessons that I couldn't have learned from reading about labor support - I had to really learn them by watching over 30 clients labor and give birth to their babies.

I hope that some of this information can be useful to other doulas, families preparing for the birth of their baby, and anyone providing labor support.

  • As a doula who is also a massage therapist, I live and die by my ability to press, squeeze, or rub on the right spot to give some relief during a contraction. Many of my clients have hired me because they love to get massages and dream of being massaged throughout labor. But I've learned in these first 30ish birth experiences that not everyone wants to be touched in labor, and that even for those who do, sometimes it's far more powerful for a loved one to squeeze her hips, rub her back, or press on her sacrum. Those are the births where I sit on my hands, speak softly and encouragingly, and give the couple space to be in it together.

  • There are times when you need to offer comfort in labor, even if it means that labor might slow down some. In most cases, early labor is a good time to rest up and take it easy, ignoring your labor until your contractions get so strong that they can't be ignored any longer. Sometimes early labor contractions persist for a long time at an intensity that is too strong to ignore, but not strong enough to be active labor. If you are exhausted by a long, non-progressing early labor, the best thing to do might be to take a warm bath or something your care provider agrees might give you some rest. This will likely make your labor taper off for a while, but by resting up some more, you'll have the energy to make it through what's to come.
  • There are other times when you need to do things to help labor progress, even if it's not very, ahem, comfortable.  Once active labor has begun (generally when contractions are strong and 3-5 mins apart, lasting at least a minute), this is a good time to do what you can to keep things moving smoothly, as long as you can stand to do these things. Coping strategies like rhythmic movement, counterpressure, and massage provide a lot of comfort at this point, and the focus of your doula or support person will mostly be on helping you to cope with contractions. But say you have been stuck at 7 centimeters dilation for a while and your nurse tells you the baby is not in the best position in your pelvis. It probably won't be very enjoyable (and that's an understatement), but doing lunges or pelvic tilts for a few contractions would likely create enough change in the shape of the pelvis for baby to be able to wiggle into a better position, ultimately paving the way for labor progress. So a few minutes of hard, intense work could shave a chunk of time off your labor!
  • Things can change really fast in labor - in the labor itself and for the support team. When you are a labor support person, don't get attached to any one tool or technique. Maybe lower back massage has been working magically for the past hour... and then suddenly she's pulling away from you during a contraction. Something has changed, and that kind of pressure doesn't feel good anymore. Don't be offended, just stop the lower back massage and try something else with the next contraction. 
  • If you are wondering if she is thirsty or needs to pee, the answer is probably yes. Always offer water. Always suggest a trip to the bathroom.
  • Sometimes in labor, you need to hit an emotional wall. You may need to feel grumpy, whiny, angry, or frustrated. Don't avoid the hard feelings -- dive into them. Usually you'll hit that wall and then break down in tears, laughter, or both. That catharsis can really clear the path for major labor progress ahead.
  • In your first birth, if you can get out the door quickly in labor, it's probably too early to go to the hospital or birth center. In my experience, it's common to rush to the hospital because it seems like labor is getting intense, but as you put your shoes on and make your way to the car, labor sometimes slows way down. Ideally, your contractions should stay just as demanding and come just as often even as you transfer. With my clients, if labor seems to suddenly feel easier as we get ready to leave, I might suggest that we consider laboring at home a little longer.
  • Having said that - you should listen to your gut and consult your midwife or doctor if you feel like it's time to head to the hospital or birth center. You are the ultimate authority on what makes you feel safe in labor, not your doula.
  • Even with my funniest, most upbeat clients, there's a point in labor where labor gets too serious, and my client isn't laughing anymore. This is a good sign to everyone that labor is well underway. If you are a support person, it should also be a sign to cut out extraneous socializing, and get serious about giving over all of your attention to the demands of labor.
  • During labor, if I hear my client suddenly say "I'm going to throw up!" or "I think I need to poop!," I've learned to say, "Yay!" Most of the time, neither of these things happen, but the feeling that you need to is a really good sign that big things are happening. If you think you need to poop all of a sudden, you're probably close to fully dilated, or about to push your baby out!
  • Doulas are sort of infamous for our bags of tricks and tools. I remember being so obsessed with what should go in my doula bag when I was starting out! I still have a pretty big tote that I take with me to births, but most of the time all I really use are striped bendy straws, oil for foot or hand massage, a soft-sided cooler that I fill with ice and a few washcloths for cold rags, and my rebozo. Oh, and my snacks! This is a pretty small collection of items compared to what I usually drag along. The point? There are lots of items that could come in handy at a labor, but very few that you probably need.
  • Childbirth education makes a difference. The best classes include practice time to get familiar with labor coping skills, discussion of possible interventions and birth outcomes, and information on breastfeeding and preparing for postpartum.  A childbirth class series will reinforce your self-advocacy skills and help you understand birth as a normal bodily process. It will help you feel powerful and involved in the decisions made during your labor.
  • Possibly THE most important factor in being able to give birth the way you want is picking the right care provider. You want a doctor or midwife who routinely practices in a way that is compatible with your birth preferences. How will you know that this is true? By finding out their statistics for interventions, asking them open-ended questions about how they would handle various situations, and talking to other expecting and new parents you know that have the same desires for their birth that you do.
  • If your heart or your gut is telling you that you and your provider are not on the same page, listen to that feeling. It's pretty much never too late in the process to seek out a new care provider. Though it might feel daunting to transfer care, I've had lots of clients and friends do it successfully. You want to have the utmost confidence and trust in the person you choose to manage your labor and birth, so you aren't battling them on your baby's birthday. Yes, this is probably more important than hiring a doula in most cases! Doulas can do a lot, but we can't change the way your provider practices.
  • What doulas can and will do is provide continuous support throughout your labor. This is my favorite part of being a doula: watching the entire process of your labor unfold, pretty much from beginning to end. Especially for first-time parents, labor can be a shockingly wild ride. Your care providers - doctors, midwives, and nurses - will not be with you for much of the labor, and when they are present they are mainly focused on your clinical care. A doula is there to provide encouragement, support, comfort and suggestions every step of the way. Hiring a doula to join your birth team and complement the care of your partner and your awesome care provider can set you up for the best possible birth experience.
  • And yet: Even when you have a care provider whose practice style perfectly match up with your desires, an experienced, well-matched doula, and a comprehensive childbirth education series under your belt.... There are no guarantees that you'll get any specific birth outcomes. Parents AND doulas need to hold this knowledge in their hearts.

Are you planning to give birth in the Tulsa, OK area and looking for labor support? I am here to help you, and I am taking new clients. Click the button below to schedule your free doula interview. I'll help you get the support you need to labor and birth with confidence, connection, and calm.