Doula Myths Busted!

I'm probably not what most people picture when they hear the term doula. No paisley, no Birkenstocks, no sage smudge. In fact, you could confuse me for any professional, because that's what I am, a professional. Don't get me wrong; many doulas do wear paisley and Birks, and smudge their spaces. Those attributes have nothing to do with how professional a person is. I guess what I am trying to say is that the doula profession is like any other, we are diverse individuals with a job to do. Some wear slacks and blazers; others wear flowing skirts, still other wear denim and leather. Stereotypes about the way doulas dress are just the beginning.

Doula work as a profession is a relatively new career path. Anything new has its misconceptions. Let's get right to it and clear up a few of the most common myths about doulas!

“Oh! Like a midwife!”

Yes, and no.

When I tell people that I am a doula, this is the most common response I get. Like midwives, doulas work with pregnant people and new parents. Doulas and midwives both tend to approach birth as a normal physiological process, and have a passion for supporting pregnant people. That’s where the similarities start to fade. Midwives catch babies; doulas do not. You see, a midwife’s job is to focus on the physical health of the parent and baby. Midwives manage all of the medical and clinical aspects of pregnancy, birth, and postpartum. Doulas fill the gap with emotional support and assistance with comfort measures during childbirth.

Doulas are only for homebirths.

Doulas are for every birth! Doulas work with clients planning homebirths and water births, un-medicated births in hospitals, birth centre births, birth with the use of medical pain relief, including epidural and even planned caesarian birth. Doulas are for people giving birth and people who have recently given birth.

A doula will replace (or displace) my partner.

You or your partner might be concerned about how a doula could interfere with how your partner experiences your baby's birth. A doula can never replace a loving partner, who knows you intimately, loves you, and is going through the birth on a personal level. In fact, a doula can help facilitate bonding between you and your partner during labour. Reassuring your partner, guiding them, and teaching them techniques to comfort you are a big part of what your doula can do. Further, I find partners are relieved to have someone else that can stay should they need to eat, step out for a phone call, or use the bathroom.

Doulas don’t do epidurals.

Totally false. Doulas love epidurals. Many of us have used epidurals as pain relief for our own births. For clients that are planning to have an epidural or decide to have an epidural placed during labour, doulas continue to provide the same level of committed support.

Most of the myths and misconceptions surrounding doulas focus on a preference for "natural", un-medicated birth or being a replacement for a midwife. However, at the core of this work is a belief in supporting choices. I am a doula not because I want people to choose or experience a specific way of birthing but because I want people to have the experience they wish. I am a doula because I believe people need support and reassurance, and to feel safe and educated. It doesn't matter to me if the birth they dream of takes place in a birth pool in their living room or an operating room at the local hospital.

 

Doulas Are For Scheduled Caesareans

She had waited until the last few weeks of her pregnancy to decide that she would hire a doula. She had scheduled a consultation with the perfect doulas. Then at her doctor’s appointment, she found out that her baby was still breech and she was trying to decide if she would prefer to schedule a caesarean. She and her doctor discussed the risks and benefits of trying for a vaginal birth versus a scheduled caesarean birth.

She went home that afternoon, her head swimming. She wasn't sure what she should decide. Her husband wasn't sure either; he wanted her to do what she felt was best. And what about the doulas? Should she just cancel her consultation?

The next morning she called the doula agency office. She explained her predicament and was surprised to learn that doulas support planned caesarean births. She kept her appointment, and when she hired the doulas she met with, they helped her go over the risks and benefits of her options. They talked about what her gut feeling was about her baby's birth, and she ultimately decided to have a scheduled caesarean delivery.

The night before her caesarean was scheduled, the doula on call phoned her, and they went over the items in her hospital bag. She talked about her fears and about how excited she was to meet her baby! The doula was able to go over what the process would look like from start to finish.

On the big day, her doula met her in the hospital parking lot. The doula helped her partner carry up the bags and kept the mood light and happy. The doula helped her get settled while she was being admitted. While they waited, the doula gave her the most amazing hand and foot massages ever! The three of them talked a lot about hopes and dreams for life as parents!

They had already been informed that it would not be possible for the doula to join them in the operating room so when it was time to go they hugged, and the doula wished them well. She promised to be waiting in the recovery room.

The nurses and doctor were excellent during the birth. The doctor explained what was happening every step of they way and soon a nurse was holding her beautiful baby boy close to her so she could see and kiss him.

In the recovery room, her doula was waiting. She couldn't help but grin with pride when her doula congratulated her. It was so reassuring to both her and her husband to see a familiar and comfortable face.

Together, she and her doula got her new baby latched, and he had a few good swallows. The doula helped them get back into their postpartum room. With help, she was able to get settled in for some rest while her husband enjoyed some baby snuggles. They said their goodbyes.

The doula visited the first day that they were home from the hospital and was so knowledgeable about how to care for the incision. She also knew lots of tricks for staying comfortable. They sipped tea and talked about the birth and what was to come.

It was an incredible roller coaster of an experience from the beginning! In the end, she felt empowered and supported. She knew she had made the right decision to trust her body and her baby. And while she could have done it without the doula, she couldn’t imagine her birth experience any other way!

How Do I Avoid Perineal Tearing?

 

The thought of a perineal or vaginal tear is, well, tearifying.

Your vagina is required to stretch significantly to accommodate your baby’s birth. And while your body is designed to stretch in this way, that doesn’t always mean you’ll escape the experience laceration-free.

So How Can I Prevent Tearing During Childbirth?

 

While nothing is foolproof, there are some strategies that have proven useful in reducing your risk, including:

·       Perineal massage. Some studies have shown that when giving birth vaginally for the first time, the risk of lacerations was reduced when perineal massage was used. Other studies have shown that perineal massage is not helpful, and may make tearing worse. Talk to your primary care provider about whether perineal massage is right for you, and how to do it safel. 

·       Different positions for pushing. You can try pushing on your side, on all fours, or squatting. Your doula or partner can help you get repositioned. Listen to your body and do what feels most comfortable for you. If something isn’t working, change it up.

·       Professional guidance during crowning. You may be asked by your primary care provider to pant or breathe deeply without pushing for a few moments, giving your perineum time to stretch more effectively. Follow these instructions to help ease your body through childbirth. One trick is to think about blowing like you are trying to keep a feather in the air; a sustained and upwards breath.

·       Warm compresses. Not only can warm compresses be very soothing, using them as the time to push gets closer will help relax your perineum.

 

Perineal tears happen as your baby’s head is being birthed. Most perineal trauma is considered superficial and either requires no treatment or minimal stitching. Should you require stitches the area will be numbed. If all is well with you and your baby, you’ll be busy snuggling your little one while your primary care provider repairs the area.

After birth your bottom will likely be sore, regardless of whether you have stitches or lacerations. You can ease your discomfort by using a perineal bottle (squirt bottles generally supplied by your hospital or midwife) to rinse your vulva while you pee. Rinse the area again after you’re done, and pat gently dry with tissue. You may find ice packs  comforting or, if it feels better, a warm compress.

There are several commercial products available to lessen discomfort as well.  They include numbing sprays, perineum healing sprays, or perineal spray of your choice) and herbal combinations for sitz baths. Talk to your primary care provider about what may work to speed up your own recovery.

If you’re feeling fearful about how perineal tearing may affect your postpartum recovery, talk to your doula or primary care provider. With a little planning for birth and post-birth care, you’ll feel more confident about the process.  Plus, being prepared will help get you back to feeling like yourself faster.  In this case, having more information is a win!