Do I Need a Doula if I’m Planning a Homebirth?

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So you’ve heard of the advantages of having a doula with you if you’re planning a hospital birth. The positive aspects include such things as: continuous support that doesn’t change shift, possibility of laboring in the comfort of home knowing someone will help you decide when it’s time to go in, someone who can help you and your spouse keep perspective and act as a liaison with the medical staff, a friendly person to call directly with questions during those last days before labor, and the list goes on. All of these things sound good, but if you’re planning a home birth, then you don’t need all this, right?!? You already know who your caregiver will be, you’re staying in your comfy home, your midwife will provide support and perspective, and you can call your midwife directly…which means that a doula is totally unnecessary, correct?!? Well, that’s a question I hear often, and I wanted to take some time to explore how a doula can actually be a great benefit at a homebirth, as well. If you’re trying to decide whether or not you want to add a doula to your birth team, hopefully this post will give you some help, and maybe even answer some of the questions you have.

To get some input on this subject, I contacted several different groups of midwives, doulas and birthworkers, and asked them to tell me from their experience how homebirths could benefit from doula support. Their responses were very helpful, and provided the bases of what I am going to share below.

When it comes down to it, a midwife and doula offer to distinctly different services. While both are attempting to provide women with personalized, professional care, they are coming at it from two different angles. A midwife’s job is to help ensure that mom and baby both maintain the low-risk status. She is concerned with providing a safe, professional and knowledgeable environment to women seeking out-of-hospital births. This means that she must put mom and baby’s safety first-which sometimes means that she will have to stop providing labor support in order to monitor heart tones, for instance.  There are also those times when the midwife will need to conserve energy in order to maintain the needed mental and physical alertness needed for the actual delivery, which may mean not being able to constantly apply back pressure for hours on end! For some mamas, especially those who appreciate privacy, a midwife and her assistant may be all that she needs in order to feel supported and cared for, but there are others where this may not feel like enough. As a midwife myself, I seek to provide labor support whenever I can, but I am also always acutely aware of what is going on medically. The role of a doula is that of providing consistent emotional support and physical support. Because she does not have to be responsible for the medical aspects of birth, she is free to focus on helping the couple work together, and helps mom to achieve the space and birth atmosphere that she desires, without distraction.

At a homebirth, a doula can:

  • Give valuable input and educational support during the prenatal period.
  • Provide early labor support, and help the couple decide when it’s time to call the midwife to come.
  • Free dad up to focus on mom by paying attention to other details (like keeping the tub water warm, setting up the bed, changing linens as needed, keeping birth atmosphere tidy, etc.).
  • Keep mom and dad fed and hydrated.
  • Help the birth team to remember mom’s preferences-whether it’s the desire for quiet and privacy, or a certain music playing at a certain time, she keeps everyone aware of what mom wants.
  • Help with comfort measures such as massage, positioning techniques, etc.
  • Provide positive encouragement about progress and what is happening.
  • Give mom support during pushing, especially for those families where daddy wants to catch, and mom still needs support by her head that is focused on HER.
  • Assist with childcare as needed, especially if children are present for the birth.
  • Help the mom to feel an extra measure of help and support, through extended availability before and after, and checking on mom’s emotional well-being during the initial postpartum period.
  • Protect and nourish the new family’s space as nursing and bonding are taking place.

A doula is especially beneficial when:

  • A mom is expecting her first baby or is planning a VBAC. The potential for prodromal labor and/or need for extra physical and emotional support make a doula an especially good choice for these moms! For the same reasons, moms who have a history of long labors may also find a doula an excellent addition to their birth team.
  • Mom is lacking other support systems. For single moms, or those who have no family or close friends nearby, a doula can be a tremendous asset in providing a consistent, dependable support person during the pregnancy, labor, delivery and postpartum periods.
  • When using a very busy midwife, or if your midwife has travel plans over the time you are due. If you know there is a good possibility that you may be using your midwife’s backup, then having a doula whom you have already connected with can help make that a smooth transition, as you won’t have to totally “start over” with your birth team.
  • If your chosen midwife usually practices solo (without an assistant). In these cases, it may be hard for her to provide consistent labor support, as she will have many responsibilities to stay on top of.
  • When mom knows that she needs extra hands and extra support. Some moms prefer quiet, privacy and extreme “hands-off” during labor, while other moms know that they would relax better when surrounded by encouragement, positive input, touch, massage, etc.
  • If you’re planning to have your children present at the birth, and don’t have a specific care-giver for them. This can allow dad to spend time with mom or with the other children, and know that no one is being neglected!

So, to tie all of these comments up, you can see that a doula can be a lovely complement to a planned home birth. The moms who have experienced doula care at a homebirth made comments such as “I wouldn’t do it any other way”, “it was the ultimate support group”, “I gained a trusted friend”, “My doula could be someone my midwives could never be (though my midwives were awesome and perfect for me)…All her energy and focus went to me, she had no other obligations”, “she provided a different perspective”, “the little things made a big difference…her doing things that allowed my partner to stay with me was key”. The midwives who have had doulas present at births say, “Doulas are worth their weight in gold, literally!”, “The women who have both feel SO supported”, “Having a doula…helps to share the load, and each individual has something different to bring to each unique situation”, “Doulas provide a different type of connection”,  “I think there are some births where there is plenty of work for many hands…and some where there isn’t”.

All that said, I do want to underline the fact that each mother and each birth is unique. While having a doula can make your birth experience even more special, I totally understand that it is not the choice for everyone. For some mamas a more private, intimate and quiet birth environment with as few people as possible is better.  And this is totally okay. It’s one of the beautiful things I appreciate about the option of birthing at home…the birth team can be personalized to suit the preferences of the individual mom. Each mom/couple has to figure out what is right for them, as this is what will enable them to relax and give birth in the best way. The goal of this article is not to make you feel like you HAVE to hire a doula! But for those who have wondered if a doula could be beneficial, my hope is that you now have a better picture of how a doula can fit in to your homebirth plans, and how this option can make a mama feel even more supported.

Did you use a doula for your homebirth? Or have you been a doula at a homebirth? I’d love to hear about it! And if you’re looking for a doula, be sure to check out www.doulamatch.net in order to find out about doulas offering services near you! For those living in central PA, I’d be glad to refer you to some excellent doulas who serve the surrounding areas.

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