Choosing A Doula: Creating the Birth Experience I Want

I first heard about Doula’s during Fem*Ex, a community class on gender, power and privilege, that I took in Washington, DC (in 2012). The class was very much focused on the female experience, so we had a module on motherhood, including pregnancy and adoption. I was miles away from any intentions of motherhood at the time, so I don’t remember a huge amount. I do remember learning a little bit about Doulas, the non-medical women who are present at births to provide emotional support to the mothers. And then, one of my good friends and classmates became a Doula! She loved it.

A doula is like a personal birth coach. Not only are they providing emotional support to the mother and her birth partner/s during labor, but Doulas also provide a lot of information that the medical professionals might not offer up. They’re not medical professionals, but they know a lot about labor and birth. They’ve done their research and are armed with the latest knowledge and science on birth. As well as their own experiences supporting countless women through the process. Some specialize in after-birth care, and are knowledgeable about breastfeeding, bonding with babies, or settling colicky babies. 

Photo by Aditya Romansa on Unsplash

I didn’t think about birth or labor for a really long time. Actually, that’s a lie, I started watching Call the Midwife on Netflix and convinced myself I was doing research. Mostly, I was focused on other things - preparing for the baby, moving house, staying healthy and happy, etc. Once I got to England, I started to think about it more, actually watching birth videos and reading more about it. Funnily, I haven’t watched an episode of Call the Midwife since we arrived here!

When I arrived here, I pretty much knew I wanted to work with a Doula. My personality type is very much to check with the experts. If I’m cooking, I’ll look up a recipe. I might alter it and add my own flair, but I will always consult the oracle (aka Google). Any time I’m doing something new I’ll look it up online. I put a lot of trust in things like science and “experts”. I saw working with a doula as working with someone who has been around birth so many times they could support me and help me understand what to expect and how to prepare. I also knew that they would have methods and strategies for staying comfortable and positive during labor beyond what Steve or my Mom could offer me.

A doula meets with the mom-to-be and birth partners in the run up to the estimated due date. They help mom prepare for labor and birth, share resources, and work with them to create birth preferences (sometimes called a birth plan, how you want it to go down). Once you get to 38 weeks, the doula will go on call for you - basically meaning that they can be by your side at the drop of a hat when you go into labor. The on call period is typically from 38 weeks to 42. The doula will join you at any point in your labor, as you request, and will stay until after the baby is born. The average first baby labor time is 8 hours, but it could be 18! The doula is there as much as you need. Usually they stay until the first successful feed with the baby. Then they come back a few days later for a postpartum check. If you want more postnatal support you can hire them for additional work, but the main thing I wanted was the birth support.

My Doula Team

I did a few basic Google searches for doulas in the UK and found a website listing registered doulas in the UK that I could search by location. This means that the doulas on the website have gone through some kind of qualification course, and then spent a year being mentored and completing paperwork and having feedback assessments from clients (including first time moms, experienced moms, vaginal births, home births, hospitals, c-sections, etc) to finally become a registered Doula. Once registered, considered more experienced and held to high standard, they can charge a little more for their services. There are a few registrations in the UK and the doula, and the mom to be, will pick the one that aligns with their own ethos around birthing. I can’t say I was actually that specific, I was like, oh this looks good, sure let’s find someone.

That led me to Alex of Bumble Beginnings. Alex had a career as a neonatal nurse, so she has a medical background and specifically with babies that need extra care after birth. When I asked Alex why she decided to become a doula, she talked about seeing many situations where the medical professionals are so focused (rightly) on taking care of the baby or emergency that no one is really supporting the mother through it. No one is there to make sure she understands what’s happening or why, or make sure she’s feeling OK emotionally. It was that gap Alex was motivated to fill.  Additionally, once the baby is born Alex saw that there’s actually little support for a new mother. When pregnant, in the UK, you see the midwife regularly as they want to check you and the baby are progressing well on the way toward birth. Afterwards, they basically check you can feed your baby (breast or bottle) and that it’s growing OK. Then you’re on your own. 

My estimated due date falls very close to the Easter holiday break for schools here, and Alex has her own kids and vacation plans. So she proposed a shared-doula package with Sophie, a doula she’s worked with before. The idea being that I would get to know them both, they’d both help me prepare my preferences, and then the two of them would split the on-call period. So either one of them could be present at my labor. 

Sophie became a doula after having her own children. She initially wanted to be a midwife, but after shadowing some births realized that her passion was really about supporting the women giving birth. Similar to Alex’s experience, she recognized that gap in care. Also, she saw up close how understaffed and overstretched NHS midwives are. Alex told me Sophie brings a passion for funky, hippie things (my words), like aromatherapy to her practice. I figured, since I live in California she couldn’t possibly exceed my limits for hippie shit! Besides, I love aromatherapy so I was excited to meet with her.

Steve and I have met with Alex and Sophie together and separately. After the first visit with them both, which was before formally signing a contract, I knew that this was the support I wanted. They are both super knowledgeable and bring a lot of experience to the table, and they’re also easy to talk to and nice. I felt like I could really feel relaxed with them. Afterwards, Steve said that he could see how they would play the role of “keeper of the vibe” at the birth, since both he and my mom have a tendency to not be super chill. I would add that we did meet another doula before making a decision to work with Alex and Sophie. She was also lovely, though I could tell we didn’t have the same kind of connection or vibe. I also felt that Alex and Sophie would handle Steve and my Mom better! This other doula is very involved in mother meet-ups around the area, and her name is recommended by lots of people I talk to with regard to postnatal breastfeeding support, so no doubt we will stay connected. 

Each time we’ve met with Sophie or Alex they have left us something - informative books on labor, a bead necklace to help visualize the stages and what to expect, a Mexican rebozo scarf that can be used for comfort during labor (we practice our techniques!). And they’re available all the time on a WhatsApp group. I text them updates every time I’ve seen the doctor, midwife, or had a scan. Each time they have more resources or experiences that help me understand my options and what’s available to me that the medical professionals might not have mentioned because they focus so much more on their procedures. 

Building Birth Preferences

Steve and I attended an “active labor” workshop put on by a local midwife. It was all about the stages of labor, what to expect and how to manage discomfort. I don’t use the word pain because not everyone feels contractions as pain. I want to be in a mindset that isn’t focused on pain. One that’s about discomfort and managing that through movement, water, breathing, as much as possible. At this class, the instructor recommended The Positive Birth Book by Mili Hill. It provides all sorts of birth choices for us to think about ahead of time so that we know what to expect and how we might want to answer. Our doulas have encouraged us to use this so that at our final meeting with them before the birth we can prepare a list of birth preferences. The book includes all sorts of settings and scenarios, including home birth through to c-section births.

A very basic image to represent the scientific research I've been pouring over!
Photo by Alex Kondratiev on Unsplash

We’re still in a bit of limbo with creating birth preferences because my baby is still in a breech position. Since my post about that, I’ve found out he’s footling breech, or incomplete breech. According to my research, this is the most tricky position for a successful vaginal birth. It’s the most likely position in which the head could have difficulty passing through the cervix and in which the umbilical cord could be crushed, preventing oxygen getting to the baby. According to the most renowned research, 1 in 20 breech babies born vaginally do not survive. And there’s a 45-50% emergency c-section rate for attempts of vaginal breech birth. No, we can all understand that not all scientific research is created equal and some studies may have flaws, but even so, those are risk levels Steve and I are not comfortable with. I’d rather just have a c-section than have to have an emergency one. The problem is further exacerbated because since this research came out, the NHS started encouraging more and more breech babies to be born by elective cesarean section. Fewer midwives and obstetricians have actual experience delivering breech babies now. They’re losing the skills, making it even more challenging for mothers who want to deliver vaginally. There’s a huge positive birth movement where women have had good breech birth experiences, and they encourage others who want this to find an experienced midwife. I believe it can be done, I’ve read the success stories, but it’s not for me.

There’s a lot to think about and I’ll post about my birth preferences separately, but really just wanted to demonstrate the support from my doula team. They’ve provided books about cesarean sections, they’ve sent me links to the research papers on breech babies. They’ve also recommended ways that I could try to encourage the baby to turn - like I mentioned previously, the spinning babies website. There’s a procedure the doctors are recommending called an ECV - external cephalic version. They try to turn the baby into head down position by pressing hard on my tummy. It has a 50% success rate. It’s my best chance to potentially have a vaginal birth because although some women have had babies turn right before labor or in early labor, only 1 in 8 babies turn by themselves after 36 weeks, so it’s not likely.

I’ve had three midwives and one obstetrician tell me my ab muscles are so firm that it’s hard for them to tell what position the baby is in. They’ve asked what I did for work, or if I worked out a lot before getting pregnant. I guess all that working out did do something! This kind of makes it unlikely for an ECV to work. The doctor didn’t actually say that, but she said it is typically more difficult for first time mums with firm muscles. A friend of mine had an unsuccessful ECV. She said it was so uncomfortable that she wouldn’t do it again if her next baby was breech late in the game. It made me wonder if I should even try. Ultimately, Alex’s best advice to me was to trust my gut. I’m not sure it will work, but I also don’t see the harm in giving it a try. I meditated on it for a while and decided I’ll go to the appointment and think positive thoughts! 

The doulas are on hand after the ECV appointment to prepare whatever birth preferences make sense for the type of birth Steve and I decide to have. I’ll write more about all that at a later post, probably once we know more about our options. I'm really happy with our decision to work with Alex and Sophie. They provide so much knowledge and additional emotional support that I don't get from the NHS midwifes or obstetricians. It's way more personalized and attentive care.