As a doula, I know how incredibly valuable a doula is when it comes to creating a positive, empowering birth experience. I was so lucky to have my amazing doula, Brandy, when Elijah was born, I don’t think I would have had a good birth experience without her. And I feel so honored to be able to help families now in the same way she helped me, I know I’m doing great and important work in this world.
So why am I not hiring a doula again this time around?
This is a question I’ve thought about a lot, especially as I spent the weekend attending the Colorado Midwives Asscociation’s annual spring conference, where I was lucky to hear Penny Simpkin, very likely the world’s most renowned doula, speak. She spoke often of the roles of doulas and midwives working together, and how each are an invaluable addition to a mother’s birth team, and I found myself wondering, am I doing the right thing? Should I be hiring a doula? Just because I am a doula doesn’t mean I’m going to be able to doula myself through my own birth.
We broke into small groups at one point to talk about the roles of the doula and the homebirth midwife (which are very distinct, it is a personal pet peeve of mine when I explain what I do and people say “Oh, like a midwife?” No, nothing like a midwife, midwives are health care providers, I am not), and it helped me to piece together some very practical reasons why I would decide not to hire a doula this time around.
Doulas are not as necessary at a home birth
I am probably shooting myself in the foot by saying this, and I know there are some doulas out there who will be angry to hear me say so, but I just don’t think it’s needed quite as badly at a home birth. Don’t get me wrong, doulas are a very nice and convenient thing to have at a home birth, and if you can get one I say go for it, but do you need one? No, I don’t think so. In a hospital birth a doula’s role is different than in a home birth. The doula must act as an advocate of sorts, helping the family stay aware of what’s going on and reminding them that they have options. The doula also makes sure that there is always an expert and helper near by, so the family never feels alone and abandoned in an often frightening situation, an unfamiliar place, with people they don’t know. But that stuff is not as much of an issue in a home birth. Homebirth midwives are not known for sneakily adding pitocin to your IV the minute your baby comes out, or other things like that. Midwives form an intimate relationship with you and your family, and make sure you have full and clear understanding of everything they are doing along the way. Furthermore, they are always there, if not right next to you, then in the next room. They are never with another patient or waiting until the nurse says you’re in transition. And you are in a comfortable, familiar place. The most important things a doula offers, the thing that makes them INDISPENSABLE in a hospital setting, are just not issues in home birth.
Now, doulas do lots of other things, such as help with positioning and relaxation techniques and do little chores like getting warm towels and drinks and snacks so that family members and health care providers don’t have to do them, and that can be great in any setting. It can really free up a midwife to focus on her clinical tasks, and take a lot of burden off your birth partner. One small group at the conference described the midwife-doula team as having a life guard and a swim coach, and I loved that analogy. But if you’re going to be having a lot of family at your birth, like I’m going to have, family members could conceivably fill those roles. I have given my mom The Birth Partner, by Penny Simpkin, and that combined with her experience as my birth partner when I had Elijah and the knowledge she’s picked up by osmosis living with me while I became a doula should hopefully be enough for her to cover any additional comfort measures I may need. Jeremy’s mom and sister will be great at refilling water, getting snacks, getting towels, and the like. And all of them can help entertain and wrangle Elijah as needed.
We’re taking a really good childbirth education class
I feel really confident about how Jeremy is going to provide comfort and support as a birth partner. I feel this way because we are taking really good child birth education (and, being supportive, calm, and strong in difficult situations is just how Jeremy rolls).
This is another area where I might be shooting myself in the foot, but I believe if you can only afford one or the other, I think child birth education should be a priority over a doula. In a hospital birth, especially if you’re wanting an unmedicated birth, you really should do both, but if you really can’t do both, for whatever reason, do childbirth education. But do GOOD childbirth education, something with 8 hours of class spread over several weeks at least, and not a hospital class. A hospital class is just going to teach you what the hospital wants you to know, which more often than not is not what’s in your best interest.
Jeremy and I are taking a twelve week course founded in Bradley and a few other childbirth philosophies. It focuses heavily on preparing the birth partner and I see definite results in Jeremy. Because of this, I feel like my mom is more of a stop gap measure for comfort. She’s there in case Jeremy needs am extra set of hands, or needs to take a break at any time to eat or pee or whatever.
You just don’t want a ton of people at your birth
I’m planning on having a LOT of people at my birth. I’m happy each one of them is coming, and I wouldn’t think of uninviting any of them, but there’s going to be me, Jeremy, my mom, Jeremy’s mom, Jeremy’s sister, my midwife, my midwife’s assistant, and Elijah there, and adding someone else would really make for a crowded home birth. Now, if you’re not the type to want parents and siblings and children there, a doula is a reasonable and great person to have there, because you’re probably going to appreciate an extra set of hands at some point. But if you’re like me and want a lot of family, you’re going to have enough hands. Of course, if you’re not terribly close and open with your family, spending the money on a doula is probably a better idea, but I’m very close with my family, and can’t imagine my birth without them nearby.
Hiring a doula would be cost prohibitive
If we pay for everything out of pocket, a hospital birth is WAAAAAY more expensive than a home birth, but the fact is that thanks to my health insurance, in my last birth all I had to pay was the copays at my prenatal appointments, so I had a little more disposable cash to hire a doula. This time, not so much. We are paying the midwife out of pocket for our care, and getting reimbursed by our insurance company later. This means we have less disposable cash to hire a doula. Doulas are worth every penny of what they charge (which isn’t much, they are probably worth much more, just like midwives), and many can get you at least partial reimbursement from your insurance company, but when we’ve got all these other things lessening our need for one, it’s easier to say that a doula is just an expense I don’t need.
Now, if you are having a hospital birth and/or don’t have an appropriately supportive family to help you and your birth partner through the birth process, absolutely, you need a doula. It is an expense you really do need to make room for, because having a satisfying birth experience is well worth the $400 (or whatever the going rate for a doula in your community is) you’ll spend on one. Cost should not be a deciding factor, and I’ll tell you that you can easily find a certifying doula in your area working for drastically reduced prices either by looking on craigslist or contacting DONA,CAPPA, or ToLabor.
And of course, if you’re looking for a doula in the Denver metro area, feel free to drop me a line. I’m accepting clients through June, but from July through September I’m going to be on maternity leave. If you are due in those months, I’d be happy to give you a referral to another great doula in town!