What does a doula do?

Last week, I shared what a doula is- this week, I want to share what we do!

Like I said in my last post, a doula offers emotional, informational and physical support during pregnancy, labor, birth and postpartum. But what does that actually look like? 

I want to take you on a step by step journey with me on what I do for my clients, from start to finish. 

The support I offer starts long before the first labor pangs, oftentimes around 20 weeks gestation- sometimes earlier, sometimes later. I've had people hire me at 12 weeks and I've had people hire me at 36 weeks! 

My care for my clients starts with an interview- but it's not just to gather information and to see if we are a good fit. During the interview, I am intentional about learning about the potential client- their preferences, fears, desires, their vision for their ideal birth and first few months with their baby. I am running through the resources in my head, thinking through who can best help them. They are seeking a provider who specializes in VBACs? I know the best doctor in the area for that! They are having round ligament pain? I know a chiropractor close to them! I'm also paying attention to whether or not I am truly the best doula to meet their needs. If they are expressing a desire to have a doula with a certain kind of training or a specific price range, I don't hesitate to point them in the direction of one of my colleagues. Because for me, doula work isn't about getting the most clients or making money- it's about connecting women to the resources that they need most. 

After the interview, I will email the potential client my contract, which is carefully constructed to protect them and me. It's clearly worded and easily understood so the client knows exactly what is expected of them and what to expect of me. 

Once the contract is signed, I set up my first prenatal interview. For birth clients, this looks like becoming acquainted with the family, discussing the birth plan, listening to their past birth stories, etc. For a postpartum client, this meeting is about discussing their postpartum plan, the current labor division and what is expected of me during my care. 

For birth clients, they have a second prenatal appointment in which we discuss birth positions and comfort measures, as well as directions to the hospital/birthing place. 

In between these visits up to the birth, I offer support by checking in regularly with my clients. I ask them how they are feeling, seeing how that doctors visit went, being available to answer questions and be a sounding board. 

I am on call from 36 weeks on- which might seem early, but babies often arrive when you least expect it! 

I am usually on the phone with my birth clients more at this stage, answering questions about mucus plugs and possible labor pangs. I make sure I'm available at all hours to respond quickly and that I'm ready to leave for the birth at the drop of a hat. I'm taking time to exercise and make my muscles stronger to prepare the extreme physical demands of holding up a woman in labor. My birth bag is freshly packed and in my car. 

And then, the phone rings with the special ring tone I've chosen for my clients, and I hear the most exciting words- "I think I'm in labor!”

There's usually multiple phone calls during the next few hours- me reminding them to call the care provider and see what they say, them calling to tell me they're going to try to sleep and finally, the call to come to them- "I think I need you now."

Birth for each person is different, as is the need for support. Most people want me to come earlier rather than later, to be there reassuring them that things are going well. 

During labor, I make suggestions on position change, offer food and water, squeeze hips, and help them walk around. I hold space and make sure the room they are in is quiet and peaceful. I reassure them that they are doing amazing- because they always are. 

For hospital or birth center births, I offer advice on when to leave. When the time comes, I swiftly follow in my car and take care of as many details as I can- carrying the bags, pushing the wheelchair, aiding in check in and continuing to do comfort measures as the client labors. For home births, I may be the one to call the midwife, help set up the birth tub, or move cars so there's a place in the driveway for the birth team. 

During pushing and birth, I am often up next to the woman's face, breathing encouragement and comfort into her ear. I pay attention to her needs- sometimes, they need a lot of reassurance. Other times, they need me to just be there and be present. I am aware of the room- of where the doctor needs to be and if I need to move out the way, if the partner wants to be close to the mom and I need to step aside, if the birthing woman needs a drink, and so many more. 

And then, as the baby is born, my job shifts. My role then is to get out of the way and hold space for the new parents. Often I'll snap some candid pictures so they have those first memories forever and marvel with them as they observe their new human.

I always stay with my birth clients for at least an hour after their birth. I usually help with the first latch if they are breastfeeding and stay present in the room as they get to know their new baby. The doctor and nurses often have other tasks and patients to attend to and the midwife is often busy taking care of mom, so it's not unusual that I am the one being emotionally available to my clients. I’ll help them process the birth and get them food or drink. Once I feel that my clients are ready for privacy, I'll excuse myself and quietly leave. 

I make sure to check in with texts in the following days, and set up a postpartum visit within 4 weeks of the birth. During that visit I listen to the parent's version of the birth story and answer any questions they have. I offer breastfeeding advice and offer to do some housework while I am there. Then, when it comes to saying goodbye, I make sure I say "see you later!" And I make sure to check in via text once a month or so- because support shouldn't end at the postpartum visit. 

For my postpartum clients, my role is very different. 

Postpartum care can start as soon as 24 hours after birth and can last all the way up to the first or second year of the new child's life.  As a postpartum doula, my role is to 1) provide practical care for the family so mom can totally rest and enjoy her new baby and 2) provide accurate and current information about safe sleep, breastfeeding and formula feeding, baby care and emotional, physical and mental health care information  for mom.

My first shift with my clients is usually a time to listen to their birth story and answering any questions or concerns about the baby's health or the moms needs and figuring out how the household runs. Where the dish soap is, how they wash their laundry, how they want the baby held, etc.

In the next few days/weeks, as I become more familiar with the family and their particular set of needs, I become even more helpful. Mom doesn't have to do the mental work of "directing traffic" while I am there- she can fully rest, knowing that I understand what to do and how it needs to be done. I not only provide practical help, but mental and emotional relief during a time that can be very, very stressful for the new mom. 

Postpartum doulas can also provide overnight care, which can be sanity saving in those first few weeks. I will arrive in the evening, right before bed and keep myself busy with quiet housework until the baby wakes for the first time. I might feed the baby a bottle or quietly bring her to mom and set water and a protein bar by the bedside for her to have while she nurses the baby, then snuggle the baby back to sleep while mom gets much needed rest. 

I also help the people around the new mom figure out their rhythm during these first few weeks. I show dads, boyfriends, grandparents  and partners how to show hands on and emotional support to their loved one and have confidence in caring for the new baby.

I usually end my postpartum care at 12 weeks, when the parents have found their footing with the new lifestyle change. However, my support doesn't end there- I continue to check in with the family at least monthly after I stop physically coming over, making sure everyone's physical and mental health is doing well. 

All of my clients are always in my heart and on my mind- I never stop caring for them! 

As you can see, a lot of what a doula is following my intuition and being aware of the clients needs. It's a skill that takes fine tuning and practice. 

I hope this was helpful and answered any questions you might have had about doula work! 

For even further explanation on what I offer in my particular doula practice, check out my link tree here: 

https://linktr.ee/Rachel_Francis