I recently re-joined the world of doing professional doula work after taking a couple of years off while in midwifery school. I have attended about 150 births in those two years and have learned SO much more than when I put the doula work on pause. I have been asked recently what brought me back to doula work: My professional plans changed and rather than being a staff midwife at a busy birth center, I’ve changed course and will practice midwifery in a small practice exclusively in the homebirth setting so I can be home with my young family more. While things are shifting and I’m preparing for that change, I’ve returned to my roots and am taking birth doula clients and assisting midwives across DFW and southern Oklahoma.
During my apprentice I had the unique opportunity to see lots of doulas work! Since doulas mostly work alone, we don’t often see other doulas in their professional setting. Some of these doulas are excellent; and some were less than great. I believe that there is a doula for every family and there are many different styles and techniques, it is not a one size fit all industry. But there are some basic universal skills and not every doula has them. This experience has brought about many opinions and thoughts, some of which I’ll share as time goes on.
Todays rant - Doulas who do not labor at home with their clients.
Not every single client is going to need their doula to labor at home with them. I personally only needed this with my first birth (hospital birth). For my second and third, I was fine at home and my doula met me at the birth center. What was important was that if I needed her at home - she would come! Recently there is a trend among doulas that they will not labor at home with clients, that they only join in “active labor” at the birth location (hospital/birth center). This has frustrated every single midwife I have talked to about this. I could go on, but as it is, I’m sure I’m going to ruffle enough feathers with this post.
Doulas, if you’re reading this, please hear me. Sometimes your client will need you and they will not be in clinical “active labor”. Something will be going on and they need some emotional support that is not as effective over the phone. Or they will need you to come do positional work/spinning babies etc with them and not just given directions over the phone. I get it! I have been to 70+ hour labors. I have missed sleep and family events and been so exhausted I fell asleep standing up. NO ONE WANTS THAT. You don’t want to go to a labor too early and them not really need you. You can go to them, help with the acute needs and Leave! I’ve labored at home with clients and been able to read the room that they needed intimacy, taught the partner what he needed to know and left to leave them to it! It was a beautiful birth, my client was thrilled that I knew when to step away. I went to a coffee shop 2 miles away and studied for a while until I got the call that they were ready for me again.
I’m not asking you to fall on the sword of being everything to a client. If you aren’t charging enough to be able to go to them and potentially leave, then you need to charge more so you can. If you’re worried that it’s too much drive time to do this, then you need to reduce your service miles. If you can’t bring in a backup doula for a few hours so you can nap at a long birth and they still receive good doula support, you are not charging enough. Stop telling your clients that you don’t provide this service and spinning/selling it to them as if it is out of your concern for their privacy/intimacy in labor. Educate them, let them know that there are situations in which you may come and go. Set appropriate expectations.
This is not specific to first time parents, or birth center births. We midwives have witnessed infuriating situations where the doula would not join the client at home for planned hospital births. First time moms, third time moms, no matter the gravida. When clients are calling their midwives in tears that their doula won’t join them unless they’re admitted to the birth center, so now we’re bringing in a patient too early so they can get the support they’re paying for.
As a doula, I educate my clients about the stage of labor known as “bridging”. I tell them that it isn’t clinical and their doctor would be baffled if they asked about it. This beautiful concept was created by doula Lauren McClain and you can read more about it here. The idea is that women will need support between early labor and clinical active labor. I rarely see a birthing woman that this does not apply to. Doulas, we are the support for this Bridge. If you are a professional doula and you do not offer support at home, please consider your motives. Not everyone needs it, but when they do - are you providing the service you charge for by denying it?