What I actually do as a doula

Leanna Mae is an author, women’s health educator, and birth doula. Her degree is in health sciences. She is passionate about patient education. She loves to teach! She is also passionate about patient rights and healthcare ethics. She became a birth doula in 2008, a certified breastfeeding specialist in 2014, and graduated college in 2018. After graduating, she started teaching classes. She now offers online classes and in-person classes in western Ohio as well as birth doula services in the Dayton/Springfield area.

You’ve heard that a doula is a professional support person for birth, but maybe you’re not sure what that means exactly. Here is a breakdown of the things that I do prenatally, at the birth, and postpartum.   

Prenatally

We have a couple of prenatal appointments.

• Our first appointment includes the intake. This is where I get to know the family and more about what they want for their birth. I ask about learning styles, preferences on a lot of things, and go through a list of things they may want more information about.
  
• We talk about birth plans! I want to know what is important to them. Things don’t always go as planned, but it always matters to me to know what matters to them. I want to know what’s most important, what they are looking forward to most, what they fear, and how they feel on different things such as pain management or interventions.
• We also talk about their experience so far in the healthcare system with their maternity care. I ask them how they feel about their care, how they are being treated, how communication is going, etc.
• We talk about patient rights.
• We also talk about navigating communication in the healthcare system.
• If they are not happy with their care, I offer insight on birth locations and providers that may align more with the care they are looking for.
• My favorite appointment is the class on coping with contractions. We talk about a lot and really focus on learning the different options for preparing to labor.
• I assist the dad in learning how to take care of his wife during birth.
• If momma wants to have other family members or friends support her birth, they are invited to the prenatal on coping with contractions. I will teach them how to support birth as well.
• If they need it, we can go over the basics of childbirth education. In that, we also talk about ways to help labor progress and what kinds of things I can do that may help them have a shorter labor and smoother birth.
• If needed, I also have a breastfeeding basics class we can do an additional appointment for.
• If requested, I can attend one prenatal appointment with their provider.

 
Outside of those appointments, we keep in touch.

• I’m available by phone whenever they need me. That’s not just for the birth. If they have questions prenatally, they can text me anytime.
• The client may give me a quick update after prenatal appointments with their provider.
• I check in by text every now and then to see how everything is going.
• I am always available for education and support related to their pregnancy, birth, postpartum, or healthcare. Ask me anything.
• I share resources in the community or online that they have asked for or I think may be helpful to them.
• I email or text educational links and videos.
• I write handouts and blogs by request.
• I can also research questions for them so they don’t have to take the time to do so. Want to know the top-rated car seat? I’ll do that research for you. Looking for statistics on something? Let me hunt that down for you. This saves the parents time, and I enjoy research.
• As we reach the end of the pregnancy, I double check my list of the topics they wanted more information on.
• I also send emails/resources to prepare for postpartum.
• Of course, I send breastfeeding education as needed.
• My goal is to get mothers and their husbands as prepared for birth educationally, physically, mentally, emotionally, and spiritually as I can.
• I also pray for my clients to have healthy babies and healthy pregnancies + births.

 
Throughout the pregnancy, we communicate regularly. I get to know them better and that allows me to serve them better at the birth. 

At the birth

When it’s time for the birth, I come as soon as they want me to. Some want me right away. Others want to let things pick up for a bit first. Some want me to meet them at home. Others want me to meet them at the hospital. If she goes into labor naturally, it tends to be at night. There’s something about going out to my van in the middle of the night carrying all my bags in the cool air under the stars that I absolutely love. It’s invigorating. I’m a night owl to the core, and am more than happy to head out to work at 2am.
 
Support looks different depending on where she is at in labor. This is also highly individual. In early labor, things are generally pretty casual. I may be fairly hands-off because she doesn’t need any hands-on support yet. As things get more intense, I get more hands-on. There’s a stereotype that women don’t like to be touched during transition. For some, that’s true. For others, they get clingy during transition (which is actually my preference). What support looks like is going to vary a lot from person to person and birth to birth. I always tell my mommas what I need most from them is to be comfortable communicating with me. Don’t hesitate to tell me what you want and don’t want. I am here to serve you.
 
LABOR
Here are some things that I typically do during labor. What needs done when is a very intuitive process.
 
Physical support:

• Hip squeezes for days. I do a lot of counter-pressure.
• Prenatally, we talk about and practice different coping techniques. I take notes on what they like and what they don’t. When it comes time, I gently remind them of the things they can do. I never tell them what to do. I always word it as options and there are always alternatives. It’s 100% okay to say you don’t want to try that right now. We’ve got plenty of things to choose from.
• I offer suggestions on coping if they seem like they need it.
• I offer suggestions on positioning.
• I get out the support supplies I bring. I also get out the supplies in the hospital room such as birth balls, peanut balls, squat bars, etc. I’ll give a quick reminder how to use them. In labor, I won’t go over all the options with each support tool. I’ll give one or two and see how she feels about it.
• Throughout labor, I will offer different support supplies or bring them near if we need them. I find some support tools are better at different points in labor. What we do in early labor is different than what we do in transition. Typically, people pick a few tools and those are what they prefer. No one uses all the tools in the bag, and that’s okay. We’ll find what works best for her specifically.
• I come with my walking shoes on. We walk the halls a lot. We also squat in the halls, do counter-pressure in the halls, and smile at the other mommas doing the same. As we are walking, I carry whatever she needs me to. If she’s on a wireless monitor that has a box and strap, I’ll carry it for her. If she has an IV, I’ll roll it. And I might fan her with the hand fan I keep in my front pocket as she labors. One of the things I usually have in my pockets is a hand fan.
• This one might sound weird, but I pay attention to how long it’s been since she peed. A full bladder can hinder the uterus from contracting. If I notice their contractions are spacing out, I’ll ask if they need to pee. Sometimes they have a hard time knowing if they have a full bladder because there is increasing pressure from the baby moving down.
• If they get nauseas, I keep alcohol swabs in my pocket. I can dodge for an emesis bag quickly. If they throw up, I clean them up (and the floor or whatever it hit).
• Bloody show can happen before labor or not. It can be a little bit or a lot. Sometimes it’s drip drops. Other times it runs down their leg a bit. If they get messy, I glove up and wipe them off. If it’s on their thighs, I always ask if they’re comfortable if I clean their thighs off before I touch them.
• I am big on consent. I check in with her often to see what she wants, how she’s feeling about it, what she’s okay with, if she’s comfortable, and seek feedback from her. We talk about this prenatally as well. I always want people to feel safe with me. For example, in my class on coping with contractions I teach hip squeezes for counter-pressure. I will ask if she’s comfortable if I squeeze her hips. Anything that might be personal space for them, I want to check in and make sure they are comfortable with that kind of touch. I know for me birth is normal life and I’m both aware and comfortable, but for them this type of care is vulnerable and they may not know what to expect.
• If they want to get in the shower, I help them with that. I will get the water going, help them into the tub/shower, and stay by their side. Sometimes I will take the showerhead and spray hot water on their back. Other times, I will do counter-pressure while they are in the shower. If they want to actually shower and get cleaned up, I can help with that. They may want a full shower especially if they’ve been in labor a while or they may just want hot water on their back. The shower is a great option when active labor is getting intense.
• If the exercise of labor is making her warm, I’ll grab a cool washcloth. These are great on the forehead or neck. I also have ice packs I can fill up with ice or cold water for her to hold onto or put on.
• On the other hand, if she’s cold I’ll go get her a warm blanket and try to keep her cozy. Sometimes people will go back and forth between hot and cold with all the hormones.
• Another way I support them physically is by bringing a drink of water to them. Depending on the hospital, I may be the one to go refill the water or it may be a nurse.
• I also bring them their snacks. If she needs me to open it and/or hand it to her, I’m right here.
• I do whatever I can to comfort the laboring mother and help her cope with the process.
• If she needs a hand to hold, I’m here. If she needs to lean on me, feel welcome. Whatever you need, let me know or just go ahead and we’ll roll with it.
• The mother leads how hands-on or hands-off she wants people to be. If she wants hands-on support, I’m right there. If she wants to lay down and rest a few minutes, I’m either on the couch or sitting on the chair by her side. If she needs some space, I totally understand.

 
If she gets an epidural, I sit by her while she rests. I keep watch. We can chit-chat if she’s up for it. I can help the nurses reposition her, but I won’t reposition a patient with an epidural by myself. If there are two nurses in the room, they may do it. If there’s one, I help. Whether or not they want help varies by the individual nurse. Even with an epidural, I am still helping with peanut ball positions.
 
Emotional support and mindset:

• I encourage.
• I also listen and validate. I hear you. If you tell me your back hurts, I’m not going to say something like “You’re doing great!” I’m going to ask if you want to try the TENS machine or get in the shower or whatever I can suggest to actually help you. I hear you.
• I pay attention to how they are coping. When the mind hits its limits, the body may need something else for relief.
• I talk to them in between contractions. I try not to talk to someone during a contraction while they are focusing.
• I follow her lead on how talkative we are. In early labor, we chat more. As things progress, we get more quiet and calm. We go more inward and intuitive with the process. There is a quietness to labor. There’s a lot of in between moments.
• I hold space for her. I’m here. Whatever you need, I’m here to support you. Sometimes that looks like companionship coming alongside someone in moments that they are coping well on their own.
• Labor is a process to get their baby from their womb to their chest. I occasionally direct their mindset to be focused on the purpose here by talking about the baby. How much do you think she’ll weigh? He’ll be here soon. If they have a name picked out, I think it helps to use their name and talk about the person that is joining their family. 
• We can talk through things and process things. If she has a decision to make and she wants to talk through it, we do that. If she needs help processing how things are going, we can talk about it.

 
Spiritually:
I run a Christian business. My classes and doula services are faith-based. In the coping with contractions class, we talk about trusting in Jesus, having scriptures to remind us of truth, and we have faith-based affirmations.

• If they’ve got flashcards made with scriptures, we can hang them up in the birth space if they want to.
• If they have affirmations made, we can hang those as well.
• I do have flashcards and pens in my doula bag if they want to make them. I also have tape.
• I have several playlists of worship music. I encourage them to make a playlist with the kind of worship music they like. If they don’t get time to do that, we can either pick something as we go or we can use my playlists. Worship is the thing that changes the atmosphere more than anything else. They may prefer things to be quieter, but if they are up for music let’s worship during labor.
• If they want to, we can pray. I pray for my clients prenatally and pray on the way to them or the hospital as well. Some want to pray together and others don’t. It’s totally up to them.
• We also talk about God throughout care. I try to keep things Christ-centered.

 
Environmentally:
The environment of the birth space is also something I work on.

• I want to nurture a calm environment.
• I can dim the lights for them or go turn them off.
• I can put up string lights. I adore these!
• If we are at home, we can light candles. If we are in the hospital, I can put out electric candles or battery-operated tealights.
• If they brought anything that comforts them, I may ask them if they want that item. Sometimes they’ll bring their own blankets because hospital blankets aren’t very cozy.
• If mom is up for it, we can play worship music or nature music. I have plenty of playlists with worship music. I also have a whole bunch of playlists with nature music, rain sounds, ocean sounds, soft piano, and other soothing sounds. All of those playlists are publicly available on YouTube.
• I strive to cultivate the birth space to be how she wants it to be.

 
Socially:

• I will ask prenatally who they want there at the birth. I can help them facilitate communication on this.
• I’ll usually hit the call button for them. Sometimes they get nervous or are hesitant to hit the button. Let me know what you need and I’ll let them know.
• Depending on the topic, I can talk to the staff about what they want. The patient has to answer any medical questions and anything they have to consent to, but if it’s things like “She wants to know if she can have Zofran.” or “Are there any more pillows available?” I’m more than happy to talk to the staff for the momma in labor.
• We can navigate communicating with the staff. If there’s something that’s bothering the mom, let’s talk about how we can address it. If she has questions but doesn’t know quite how to ask about something, I can offer suggestions for communication. If there’s an issue with a lack of consent, I will direct attention to the patient by saying things like “Are you okay with ____?” politely and very much in front of the healthcare worker who did not get consent as they should. Or if it’s something like her wanting to emphasize part of her birth plan, I can aid in communication with the staff and we can talk about what that looks like first.

 
Progress:

• One of the things I do in addition to support is help aid labor progress. We’ll do lots of movement. A natural birth is an active birth. I’ll help the birthing mother be calm and relaxed as much as possible. We’ll use things like dim lighting to help melatonin kick up the oxytocin. We’ll get on the birth ball. We may use a peanut ball. I’ll ask what station baby is at with each exam, and I’ll recommend positions based on fetal station to help them through that section of the pelvis. Doulas do more than support birth. We help labor go faster and smoother as well.

 
Education:
I am passionate about education. I love to teach. I continue teaching in the birth.

• I answer whatever questions I can.
• If it’s a question their provider or nurse needs to answer, I can use the call button for them or remind them about the question next time they come in the room.
• I explain what things are and what they are for.
• If something is being done and I can tell momma doesn’t know what’s going on but the staff isn’t explaining it, I’ll explain what they’re doing (or ask mom if she has any questions).

 
Also:

• I take a thousand pictures. I don’t have a professional camera. I have an iPhone and I will literally take hundreds of pictures.
• I support the dad as well. I help him help her. I guide him in coping techniques and supporting birth. I check in to make sure he is staying hydrated and has eaten something.
• I guide the other support people in how they can support this momma.
• I get to stay at the bedside. That is unique to doula work. The nurses spend little time at the bedside. Even if they are in the room, they have to focus on meds and monitors and charting. They don’t get to help very much with labor support. One of my favorite things about doula work vs considering going into nursing is that I genuinely get to be at the bedside taking care of people.  
• I’m a steady person that doesn’t clock out or trade out. That brings them comfort to have someone consistent. In the hospital, they see the doctor very little before delivery. The nurses pop in and out, but may have more than one patient. They do shift work. You will go through several nurses during your time in L&D. There are techs and other workers who make their way in and out of the room as well. Then there are baby nurses and sometimes NICU. That doesn’t count postpartum nurses and lactation consultants. There may also be residents and students that all trade out with shift work. I stay. You will have the same doula your whole pregnancy, your whole labor no matter how many days it is, during delivery, and after birth. After so many hours, I may need to run home to tend to my family or take a shower. I try really hard not to need to leave people though. If that means I’m there for 20some or 30some or even 40some hours straight, that’s why I pack a bag. When the hours pass and it seems like it’s shift change already, I’m not leaving you.

 
DELIVERY

• Sometimes delivery comes quickly and other times we have more time to work with. If there’s time before we start pushing, I like to have a couple things ready. I want to make sure her water is full. I like a freshly cold washcloth ready. Lip balm needs to be out and quickly accessible because all that breathing baby down can cause chapped lips. I also like to put peppermint oil on cotton balls inside a sandwich bag she can sniff if she gets nauseas. That’s what I like to have set up.
• Prenatally we go over options for delivery positions. Sometimes those plans change. Before we get to that point, I’m going to ask if she still wants such and such. A good provider will try different positions and different pushing techniques to find what works best for that person. What works well for one doesn’t always work well for another. It can be a good thing to try different positions.
• Depending on the provider and staff, I may help coach pushing. This is more likely with midwives.
• I may be the one (or one of the people) counting if that is the style of pushing they are doing.
• I am at the bedside right next to her during delivery. If she is delivering on her back with her legs in stirrups/leg rests, I am likely holding a leg (if she is okay with this position).
• I’ve got sips of water to give, lip balm to put on as needed, and I may be putting a cool washcloth on her.
• I give reassurance that things are going normally (when they are). It can be overwhelming to deliver a baby, especially when things are taking a while and surely feels far longer than it is.
• I check on Dad and any support people to see if they are doing okay. I also want to make sure in advance (if there’s time) that Daddy and any support people have had something to eat in recent hours and have water to sip on. Delivery can actually take a few hours. Especially first-time mommas, they may be pushing for 2 or 3 or sometimes even 4 hours.
• One of my goals during delivery is to calm and steady. Sometimes daddies and lay support people can get panicky when it comes time to push.
• I take pictures as able. Sometimes I will hand my phone off to one of the staff so they can get some great shots of the delivery. If the mom wants me to, I can focus on pictures and step back a bit to get photos of the delivery. We talk about in advance what kinds of pictures she wants and doesn’t want.  

 
What if she has a c-section?
In a c-section, I can come in the OR and sit by the mother for delivery. I’m a hand to hold and someone to talk with the momma. We can play music if she wants. I can take pictures. Doulas are for c-sections too. The OR can be a scary place, and I believe the attitude of the people around her make a difference in her birth experience.
 
What if there are complications?
It depends on what’s going on. In most cases, I am able stay right by her side. In some cases, I may need to step back if it’s an emergency. Or I may be right there if it’s an emergency. It depends on what’s going on and largely depends on how the provider + staff responds. Really more than anything else it depends on if that hospital and that particular provider and those particular nurses are comfortable working with a doula at the bedside during the specific event. In cases where I do have to step back, I will return to her side as quickly as possible.
 
One of my biggest goals in a medical complication or an emergency is to be the calm presence. I want to stay by their side and comfort them. If they know something is going on and they don’t understand what is happening, I don’t want them to look up at me and see fear or panic. No matter what, God is in the room. There’s a whole team in here to take care of this. They train for this. If I’m able to stay at the bedside, I will be talking to the momma during the complication and trying to offer comfort or distraction (if distraction is appropriate). I want to be calm and comforting during complications. I think that makes a big difference in experiencing complications. If the people around freak out, that’s a drastically different birth experience than if the people surrounding her stay calm.
 
RIGHT AFTER BIRTH

• I take as many pictures as I can. I know those first moments after birth the memory can become a blur. I want to photograph every little detail, the wrinkles on the baby’s toes, the vernix on their skin, their parent’s hands on them, all the things. I will try to take videos too. I want the parents to have a clip of their baby’s cry on their first day here.
• I stay by Mom’s side during stage 3 (delivery of the placenta).
• If able (and this depends on the staff) we can show the parents the placenta.
• I encourage skin to skin during the golden hour. 
• I stay on typically an hour or two after delivery. I sometimes stay longer than that. It depends on their needs. I want to get them settled in and comfortable before I go.

Postpartum

• We schedule our postpartum follow-up appointment whenever the mother wants to. It can be a week later or 2 months later. Whatever works for her. That postpartum appointment is to discuss the birth, process through things if need be, ask about her healing physically, make sure the baby is doing well, assess breastfeeding, and ask how the whole family is doing.
  
• I check up on mental health again about 2 months postpartum.
• I personally end services at 12 weeks instead of 6 weeks because I want to make sure they are stable and well-adjusted.
• If they have any questions about newborn care, they are welcome to ask. I can text info, send videos, share resources, or refer to the appropriate source.
• In the early postpartum days, we may continue to talk/text fairly often. As the weeks go on, they settle into their new family and we talk less.
• At 3 months postpartum, I formally close services. I’m still here though if they need to contact me.
  

Breastfeeding support

• The level of breastfeeding support a doula provides is going to depend on the additional credentials she has gained. Some have lactation training and some do not. I am a certified breastfeeding specialist. I am able to help with establishing breastfeeding and uncomplicated cases. If there are issues with lactation or the baby’s ability to eat, I may need to refer to pediatricians or IBCLCs.
  
• I teach breastfeeding positions.
  
• I teach how to get a proper latch.
• I answer their questions.
• If they haven’t breastfed before, we’ll go over the basics.
• After the birth and again at the postpartum appointment, I will check on baby’s latch.
• I’ll check in via text and ask how breastfeeding is going. I want to make sure baby is gaining weight well and diapers are what they should be for a healthy breastfed baby.
• We can do additional appointments for lactation support if needed.

Overall

• Overall, it is my job to help a woman and her husband/partner prepare for the birth physically, mentally, emotionally, and spiritually.
• I want to improve outcomes. Doulas make a difference. Read this blog to learn more about how doulas improve outcomes.
• I want to improve their birth experience. I want you to feel safe, respected, and honored during your birth experience. I want you to feel well-cared for. I want you to be empowered. I want you to be supported. That’s why privately hired doulas that don’t work for the hospitals are such a great asset.
• I take the time during each pregnancy to really get to know that family and think on how I can best support them.
• I stay with you. I don’t clock out. After so many hours, I may need to go home for a break to check in with my family, feed my pets, take a shower, get something to eat, etc. I try really hard not to need to leave. Sometimes labor can last a few days. I do have pets that have to be fed. I need to eat as well. Usually, my family can take care of things at home and I can stay with the momma as many hours as she needs. Typically, I am able to stay even if that means working 40 hours straight (after about 30-35 hours awake I need a little nap). I don’t want to clock in and clock out. I want to genuinely come alongside families and journey with them.
• I continue to check-in with families postpartum.
• And I pray for my clients and students.

 
This is what I do as a doula.
 
As Christians, we are each called to serve others. I love that God called me to serve in this way. It’s a beautiful career. If you had a doula at your birth(s), what was your favorite thing she did for you?

learn more about classes here

learn more about birth doula services here