“I feel adequately supported by your team and don’t feel like I need a doula.”

“My husband, or partner, will be my doula.”

“I don’t want someone telling me what to do.”

“Having a doula is not something I can afford.”

“I want it to be a private, intimate event with just me and my husband.”

“I think you (the Midwife) want me to hire a doula because you do not want to have to work as hard.”

This is just a sampling of some reasons I have been told as to why someone has hired me as their midwife but does not want to also hire a doula. Many people see having a midwife to be necessary and having a doula to be a luxury. It may be low on the priority list or something that a family does not desire at all. In this article, I want to share my thoughts and what I have observed regarding midwives and doulas after attending hundreds of births with some going well, and others going very poorly, or even, dangerously.

Picture Credit: Dorothy Rodriguez Photography

First off, I think there is a misunderstanding about what midwives do. My job is to keep a bird’s eye view of your labor, how it is progressing, if your baby is healthy, and if you are healthy and coping well. This requires that I do the following, whether you realize I am doing them, or not:

Observe you and your overall demeanor, contraction pattern, and response to those contractions
Listen to your baby’s heart rate, determine if it is normal, and note if your baby is moving
Take your vital signs, note if they are normal, and decide what to do if they are not normal. This can be as simple as realizing you need to get out of the water birth tub because you are getting too warm to the other extreme of noting you have an infection and we need to transport immediately
Observe if your amniotic fluid is starting to release, the color of it, odor, and if you are releasing anything else, like blood
Monitor you and your baby as your labor progresses and offer cervical exams to help determine where you are in labor and what may be best for your situation
Advise on what may help your labor progress normally, including position changes or other techniques
Assist you in pushing, however that looks including position changes and coaching
Actually catch your baby, help your partner catch your baby, or help you catch your baby
Assess your baby immediately, assign APGAR scores, and resuscitate your baby if necessary
Facilitate skin-to-skin contact and breastfeeding
Continue monitoring your baby in the hours after birth to determine if your infant is healthy and if not, take steps to resolve the problem or facilitate transport to the hospital
Assist you in birthing the placenta and making sure delivery is normal and complete
Monitoring your bleeding and demeanor after the birth to make sure you are recovering normally and that there are no developing complications
Assess for vaginal tears, or lacerations, and suture as necessary
Continue monitoring both mother and baby for wellness, complete the newborn exam, communicate postpartum instructions and what to expect until the next postpartum visit
Discharge, or release the mother and baby from care, only when stable and everything is normal. Make a plan for follow up postpartum care
Chart everything and complete the birth certificate

As you can see from this list, NONE of this includes if a complication arises or if labor is long or difficult. Many births greatly add to the list of duties that a midwife must carry out to keep mother and baby safe. The list above is very simplified to communicate what is done at every labor and birth by a midwife and her birth assistants.

A note about birth assistants: These lovely ladies are their to help the midwife with whatever is needed to also keep mother and baby safe. This includes taking vitals, monitoring the baby, charting, and assisting in emergencies. I strongly believe in having two birth assistants at every birth if time allows everyone to arrive. This insures that there is one person to care for the mother and one for the baby and one to chart everything if a complication arises where both mother and baby need assistance. The birth assistants are not midwives and are not doulas. They are there to assist the midwife in medical tasks.

Picture Description: Doula Abby Supporting Client. Picture Credit: Erin Beth Birth Photography

Now, you may be wondering what doulas do. Doulas do whatever you need them to do to help you stay out of the fear, tension, pain cycle. If you don’t know what the fear, tension, pain cycle is, check out this article. Every labor is different and so women often need different kinds of support, whether verbal affirmation, physical support, coping techniques, or simply knowing a compassionate woman is holding space for them. Here are some examples of what doulas may do to help you cope with labor and have the birth you desire:

Encourage you via text, phone support, and in person leading up to your labor. This may include processing your fears and concerns around birth so that you can begin the process of staying out of the fear, tension, pain cycle long before it starts. Building this relationship before labor is also important so that you trust your doula and do not feel inhibited by her presence in labor.
Help with determining where you are in the labor process once you starting having signs, including contractions. Doulas have attended many births and they can help you know what to do, especially when you are in early labor. Doulas offer ideas and coping strategies before your midwife comes to your home, or joins you at the birth center, so that you can stay in the right frame of mind to meet the finish line.
Prompt you to be active, or relax and sleep, depending on what is the best strategy for you at the time. It is easy to get in your head and over think, especially with your first baby. Your doula will help you get out of that state of anxiety and rest, or be active. A place of no rest and no activity is not ideal for progress in labor.
When you need to rest, your doula will help you know what position to be in to facilitate that while also helping baby to be in an optimal position. She may also suggest additional comfort measures like essential oils or magnesium oil to help you sleep.
If you are having a contraction pattern that may indicate your baby is not in an optimal position, your doula can help you with Spinning Babies Techniques and other methods to help your baby into an optimal fetal position so your labor can progress. Depending on your situation, this may need to occur many times through your stages of labor.
Once you are in active labor, your doula helps you with coping techniques including massage, back pressure, hip squeezes, position changes, distraction methods like holding a comb, or being in hydrotherapy like, a shower or water birth tub.
Through labor and birth, your doula will remind you to empty your bladder every hour. It may not be fun, or come easily, but your doula knows it is vital to keep your bladder empty so your baby can come down and out.
Doulas also prompt you to eat and drink through labor. Because IV hydration is not a routine intervention at planned home and birth center births, it is vital that you eat and drink, sometimes after every contraction to maintain the energy you need to have your baby naturally.
When things get difficult, your doula is also there and ready to help you breathe and remind you that you can do this! Sometimes we need someone to breathe with us through every contraction for hours and that is NORMAL. Women have always supported women for centuries through labor and birth and it is normal and natural to want and desire this support.
After your baby is born, your doula will assist in whatever you need including helping with breastfeeding. Sometimes the first latch comes easily and other times, it does not. Your doula will help you however you decide to feed your baby.
Your doula will also help you eat and drink after your birth, just like she did during labor. This is so important so that you are not too weak to get up and use the restroom after the birth. Most people are very tired after they have their baby and eating and drinking is important. It is also ideal to have your doula do this so you and your partner can bond with your baby. Partners should be with you, not running around after the birth.
For partners, doulas are there so that if they need to step out for a break, a nap, or to have someone get them a bit to eat. Many partners do not pace themselves or take breaks and they need someone to make sure they are taking care of themselves so that they do not become a liability. Doulas also help partners know how to implement comfort techniques so that partners can be as involved as the family desires.

For all these reasons and more, research shows that people who have continuous support during childbirth from a professional labor support person who is NOT a medical person and NOT part of their social network ie family member of friend experience a:

39% decrease in the risk of Cesarean; the largest effect was seen with a doula
15% increase in the likelihood of a spontaneous vaginal birth; the largest effect was seen with a doula
10% decrease in the use of any medications for pain relief; the type of person providing continuous support did not make a difference
Shorter labors by 41 minutes on average; there is no data on if the type of person providing continuous support makes a difference
38% decrease in the baby’s risk of a low five minute Apgar score; there is no data on if the type of person providing continuous support makes a difference
31% decrease in the risk of being dissatisfied with the birth experience; mothers’ risk of being dissatisfied with the birth experience was reduced with continuous support provided by a doula or someone in their social network (family or friend), but not hospital staff

Because of this research and actual experience in attending births, I believe having a doula at your birth is actually safer, reduces your risk of having complications, and reduces your likelihood of transporting.

Picture Description: Birth Team Supporting Client Picture Credit: Picture Credit: Erin Beth Birth Photography

I also know that it is not realistic–or fair–to expect your midwife to fill the role of a dprofessional doula. As you can see, midwives serve in many ways, as do doulas, and a great doula is her worth her weight in gold. I firmly believe that for a midwife to keep a bird’s eye view of the labor and complete all necessary tasks for safety, she CANNOT fill the role of a doula. To think your midwife will do this for you is unrealistic and actually, very unfair to your midwife. Unless your labor is quite short, she cannot complete all of these tasks and do them well with a clear mind and also be with you every contraction. If you expect your midwife to be your doula, you need to communicate this and set expectations or it is likely all parties will feel disappointed.

There are exceptions where I have offered counter pressure while a mother is having a fast birth and she is on hands and knees. I am right there, ready to catch her baby and that is something I can do. Can I do this for hours when someone is having their first baby? No, because I have a lot of other tasks to complete during long labor. Plus, women having their first baby need and deserve the support a doula can offer for every contraction.

Interestingly, of the women I have transported for epidural pain management and long labor, 90 percent did NOT have a doula. That means 10 percent of transports did have a doula. The other transports I have had were for emergencies and could not have been prevented even with a doula present. This is in contrast to those who achieve their goal of having their planned home or birth center birth. A high percentage of those who achieve this goal DO have a doula. I believe that the reason many women have the birth of their dreams is because they have both a doula AND a midwife to help them holistically meet their goals.

I know there is also a question as to whether your partner, or husband, or another person in your life can be your doula. The research shows that this does not carry the same benefit as a professional doulas, as mentioned above. In my own experience, I have NEVER seen a husband, or partner, be able to coach a woman through labor. Please let that sink in. Someone who has never attended a birth before does not know what to do and it is not fair to expect them to be encouraging, understand what is happening, or help you with all the comfort techniques, spinning babies exercises, or other options to help your labor progress and birth at the site of your choice. Expecting them to be your doula is not fair for them and sets them up for failure. A great doula helps your husband know how to help and also knows when they need a break. Additionally, consider that your loved one seeing you do something very difficult and possibly, painful, is hard on them and being your main support through that may not be fair for them, either.

Since we are on this topic, it is only fair to also discuss that not all doulas are created equal. I have worked with half a dozen doulas which I feel made the labor more difficult for everyone involved. This included the following types of situations:

A doula worked the mother excessively and did not know the balance of rest and being active. It was unnecessary and lead to exhaustion. Great doulas on our recommended list do not do this.
The doula contradicted the suggestions I made including saying it was ok to complete spinning babies techniques incorrectly. In the end, the doula was not a team player and saw me as the enemy to the mother’s birth plan. I have extensive training in Spinning Babies and other body work and it was frustrating to see this mother transport and experience interventions because the team was not on the same page.
A doula did not believe the mother was in labor. This mother was in active labor and coped well. Unfortunately, the doula talked about this openly in front of the mother even though the doula and I discussed privately what was going on. I had attended several labors of this mother and knew exactly where she was in labor. She ended up watching the birth, shocked, and never helped in any way.
Postpartum support offered by doulas is just as important as during labor. I have seen doulas sit on the family’s bed after the birth telling her own birth stories, centering herself instead of the mother and her needs. This is unfortunate and not what I am used to with professional, high quality doulas.

Having these negative experiences with doulas who were not professional or experienced was eye opening. For this reason, I only work with the following doulas because I know their integrity, I know they will be helpful, and I trust them.

Recommended doulas:

Jessica Kelley: 214.769.1635.

Jessica Wiggins: https://theprayingdoula.com/

Lindsay Johnson: 817.480.0436.

Jill Mach: https://www.stelizabethministry.com/

Cheryl Johnson: https://www.ombalance.com/

Krisha Crosley: https://krishacrosley.com/

Ebon’Nae Faith: https://www.royallamerebirthservices.com/

Courtney Butts: https://courtneybutts.com/

Lavondria Williams: https://simplicityofbirth.wixsite.com/website

Abby Rockett: https://www.joyfuljourneysdoula.net/

Bryne Boyer: http://www.bryneboyer.com/

Shelly Brittain with Birthing Naturally: https://www.birthingnaturallydfw.com/

Celia Aldape: https://withguidedhands.com/

NOTE: If you are in my practice and looking to hire a doula and cannot find one that you click with or none are in your budget or available, please contact me and I will help you find a doula that will be a good fit for you and help you achieve your best birth.

Talk to your midwife, or care provider, if you are still considering hiring a doula or have questions regarding working with a doula. For more information check out the following resources on the benefits of doulas:

The Evidence on Doulas by Evidence Based Birth

Doulas: A Documentary

The Doula Book: How A Trained Labor Companion Can Help You Have A Shorter, Easier and Healthier Birth

About the Author: Bethany is a Certified Professional Midwife and a licensed midwife in Texas. Her goal is to bring personal, safe, holistic care to the Dallas-Fort Worth Metroplex.

Many women go through the birthing process without a full understanding of what their care providers are recommending for their bodies and their babies. Because of this, she values ensuring families understand the benefits and risks of their options through informed consent, educating the families she serves, and shared decision making between herself and the mother.

Bethany is passionate about helping families have natural, physiological pregnancies and births where women feel empowered and loved. Through her extensive continuing education, she incorporates homeopathy, botanical medicine, dynamic body balancing, and craniosacral therapy into her practice to help her clients remain healthy and on track for their best birth.