My experience as a birth doula is significant piece of my lens as a public health social work student. It was in working as a doula that I began to see examples of disparities and gaps in the maternity healthcare system that leave new families vulnerable to physical and mental health issues when they are most in need of extra support. I lay out here an overview of how I serve families as a doula. I hope you’ll see the parallels between social work and doula work, and the areas where having a public health background helps me think about systems that need to be changed to better support new families. My social work and public health education has helped me to be a better doula when I work individually with clients, and my work as a doula drives my career goals to create equitable programs that reduce disparities for pregnant and birthing people, and their families. Importantly, thanks to Rob for the fabulous pun in the title.
The names and details in this story are fictional. I have crafted this story based on my experiences supporting birthing people and their families as a birth doula. I have tried to make this an accurate depiction of my role supporting a family, while protecting the privacy of my clients. During this story, I will refer to the pregnant person as a woman. Not all pregnant people identify as women, and this does not by any means replicate the experience of every pregnant person.
It’s 10pm and my phone starts ringing at maximum volume. I open a text that says “I think things are happening… I’ve been having contractions like every 7-10 mins for the past hour or so.”
“That’s great!” I respond. “Are you able to rest through them at all? I’d highly recommend eating something, drinking something, taking a shower, and trying to take a nap. That’ll either slow things down or speed things up.”
“Ok I’ll try that, thanks”, says Kelly.
“Great. Let me know if anything changes. My phone is on!”
I walk to my closet and pull out my doula bag. I dig through, taking a quick inventory. Essential oils, diffuser, EmergenC, phone charger, rice socks, Rebozo (a Mexican woven cloth used for various comfort measures in labor), TENS unit, hand massagers, and olive oil (for massage) – everything is in order. I place the bag by the front door. Next, I go to my drawer and pull out my yoga pants and ‘game time’ shirt, which reads “Vaginas do open, babies do come out” and put it on the chair next to my bed. I pack my back pack full of snacks, a book, water, and Kelly’s birth preferences sheet. Then I crawl into bed and try to sleep, knowing that I’ll likely be called in a few hours.
Kelly is a 30-year-old first-time mother, who is now just past 39 weeks into her pregnancy. She’s had a healthy pregnancy and is planning to have her baby a hospital under the care of a large OB/GYN practice in the area. She’s got the support of her husband, Devon, but given her history of rape and anxiety, she decided she wanted a doula for extra support during her pregnancy, labor, and the early postpartum period.
Kelly and Devon took a childbirth education class at the hospital she is birthing at, and she is planning to breastfeed their baby girl. She wants to wait to get to the hospital until she is pretty far into labor, because being in the hospital tends to make her anxious. During the course of her pregnancy, she has told me that being in the hospital reminds her of being in the ER following the rape. However, she wants to have the option of pain medication if the pain of the labor is too intense.
Kelly and Devon have been married for just over a year. They live in a small 1-bedroom apartment near a large city. Kelly has a graduate degree and Devon is still in school. They have a significant amount of student debt and were not really planning to have a baby at this time. They are definitely stressed about money because Kelly has just started at a new job and doesn’t have any vacation time accrued yet. She has been able to qualify for 6 weeks of unpaid disability time, but they cannot afford for her to take any time off beyond those 6 weeks because Devon only works part-time.
During the pregnancy, I met with Kelly and Devon twice and we talked about their desires for the birth. We spent a lot of time processing Kelly’s fears and concerns about the birth and how it might trigger her PTSD from the previous rape. I recommended a couple books for Kelly and her husband to peruse that were appropriate given her unique history – one about giving birth as a sexual assault survivor, one about remaining in touch with your body while birthing.
We also talked about the benefits and risks of pain medication during birth. I told them that for some survivors, being numb from the chest down creates feelings of powerlessness that can be incredibly re-traumatizing. For others, the physical sensations of labor can bring back memories of the assault, and pain relief can make the whole experience more positive and empowering because women have the ability to take control of the experience. And for even others, the experiences are completely separate and the one does not affect the other. I told Kelly that her husband and I would focus on creating a safe space for her to labor both at home and in the hospital, and that we can communicate openly about her pain medication options throughout the labor. Kelly had already told her doctor about her history of sexual assault, but asked me to share this information with the nurse and doctor present at the delivery so she wouldn’t have to.
During the course of her pregnancy, I was available to Kelly 24/7 via phone and email. She would often check in with me after her appointments and sometimes she would call with questions about things she was feeling physically. When she started to have some bloody show (light bleeding when the cervix begins to soften), she sent me a picture and I assured her that it looked like a normal amount of bleeding.
As a doula, I am not a medical provider. My role is to provide physical, emotional, and informational support to pregnant people and their families during the pregnancy, birth, and early postpartum period. In our modern maternity healthcare system, this kind of support no longer comes from the woman’s medical provider. In practice, this looks a lot like a woman coming to me with questions they might feel silly about and they’re not sure if they need to pass onto their provider. I’ve seen enough normal birth, and received enough training, to be able to say to Kelly “Yup, that looks normal to me! If you’re at all concerned, definitely check in with your doctor.” Often times, this reassurance is all she needs.
At 3am my phone starts ringing again. I roll over in bed and pick up the call, “Hi Kelly, how are you doing?”
“Well they’re definitely closer together, like every 5 minutes now.”
“Ok that’s great! We’re looking for these to get longer, stronger, and closer together. Sounds like you’re making great progress! Can I stay on the phone with you through a contraction?”
In the next couple minutes I hear Kelly start to take some deep breaths. She starts to whimper a bit. About 20 seconds into the contraction, I say “You’re doing amazing. How does this one compare to the last one?”
Kelly pauses for a few more seconds, then says, “It’s about the same. They’re definitely stronger than they were, but they’ve been like this for like an hour now.”
“That’s great!” I respond. “And where in your body are you feeling these?”
“That’s the thing, I feel them really bad in my back. It’s like someone is stabbing me out of the back.”
“Ohhh ok.” I say. “Well it’s possible baby is in a funky position in there. There are several positioning things we can try. I can either send you some instructions, or I can head your way if you feel like you’d like some extra support at this point.”
“I think it would be good if you came now. I’m just so tired and this really hurts.”
With that, I head to Kelly’s home. Over the next four or five hours, Devon and I help Kelly move through a variety of positions to encourage the baby to rotate into a better position, combined with restful positions to preserve her energy. I remind her to drink water between contractions, prepare snacks to keep her and her husband’s energy up, and remind her to pee frequently. I sit with her and demonstrate breathing deeply through the contractions, and then her husband and I breathe with her. I talk to her about making low moaning noises, rather than tight whimpering noises because holding tension anywhere in the body creates tension in the pelvic floor and slows things down. I show her husband how to apply strong pressure to her back during the contractions to reduce the back pain. Her contractions remain about 5 minutes apart for about five hours, but between her husband and myself, Kelly feels safe, supported, and in control. Then we start to see a noticeable shift.
“I think the pain is moving to the front now” Kelly says.
“That’s really great. Hopefully baby is turning” I reply. I’ve been timing her contractions for about 20 minutes of each hour and they have definitely gotten closer together in the past hour.
“I’m not sure how much longer I can do this.” Kelly says.
“Ok” I respond, “You’re doing an amazing job. I definitely think these contractions have gotten closer together. I don’t think there is any rush to get to the hospital, but we could head that way any time you feel ready to do that.”
About 2 hours later, we pile into our cars and make our way to the hospital. Kelly wants to have her cervix checked and she’s thinking about getting an epidural. When we arrive, a nurse listens to baby’s heart rate and checks Kelly’s cervix. She is about 7cm dilated.
“That’s amazing!!” I say. “Kelly, you’re doing an amazing job!! You’re really close to meeting your baby! What do you feel like you want? You’ve been coping beautifully on your own, but I know you were definitely thinking about getting an epidural when we talked prenatally.”
While Kelly and Devon talked about the options, I dimmed the lights in the hospital room. I hooked up the essential oil diffuser and pumped some lavender into the room. Kelly chose to get an epidural, took a nap, and she was ready to push her baby out about 4 hours later. While she was pushing, I worked with her nurse and doctor to find positions that were effective for pushing, while protecting her back and hips from being over extended since she could not feel them with the epidural. I reminded the doctor that Kelly really did not want to have her perineum cut unless there was a medical emergency. I placed a cool compress on her forehead as she worked hard to push her baby out and showed Devon how to support her head and leg while she pushed. I reminded the doctor that she wanted to delay clamping the baby’s umbilical cord after birth until it had finished pulsating.
Once the baby was born, I strongly advocated for Kelly to get to keep her baby skin-to-skin on her chest. I snapped photos of Kelly, Devon, and their baby girl in the first moments of her life. I also helped Kelly and her baby establish breastfeeding and showed Devon how he could help her find comfortable positions for nursing. Once baby finished nursing, I placed her skin-to-skin on dad’s chest while mom had a well-deserved meal.
Over the next several days, I checked in with Kelly to make sure she was feeling well and to answer questions about breastfeeding, newborn care, and postpartum healing. About a week after the baby was born, I visited Kelly at home. I administered and Edinburgh Postnatal Depression Screen to screen for postpartum depression. I talked to Kelly about her labor and birth, filled in the gaps in her memory, and answered questions about the experience. I gave her resources for some local breastfeeding and new moms support groups. I talked to Devon about his experience with the labor and birth and gave information about a local new-dads group if he was interested. With that, I encouraged Kelly and Devon to reach out to me any time and thanked them for including me in this critical time in their lives.
The role of the birth doula is to fill in the gaps in support that are often experienced by birthing people and their families in our current maternity healthcare system. The support I provide varies based on the needs and dynamics of each individual and their family. I think the intersections between doula work and social work are abundantly clear, and I am passionate about making this support more widely accessible for the families that need it most. If you’d like to learn more about doulas, you can check out my certifying organization DONA International.