A big role a doula plays in the delivery room is building bridges. In supporting a woman through pregnancy and labor, one of my biggest goals is to encourage and facilitate open, honest, and effective communication between the pregnant woman and her care providers. One of the things I specifically do NOT do is speak on behalf of a laboring woman or her partner, nor do I make decisions for them. I provide support to laboring women and their families to be able to speak for THEMSELVES and make their own decisions regarding their care.
A doula is not a watchdog. They do not "protect" women against hospital policies or practices that they do not want or agree with. Doulas do not fight or argue with doctors or nurses in the delivery room, nor should they be disparaging of the doctors or nurses with whom they work in the community. The reason doulas should not be doing these things is that they can be very counterproductive to the goal of supporting women to have empowering and positive birth experiences.
A doula's role is largely relational. She must relate well to the woman she is serving and that woman's family, and she also needs to be able to relate well with the woman's chosen care provider and nurses. It is the doula's job to help maintain a calm and positive atmosphere in the birth room, connecting the medical team to the needs of the laboring woman and her family.
Here are a few things I think an effective doula DOES do to build bridges in the delivery room and beyond:
- Help clients think about what their desires for their births are and exploring whether or not their care provider and chosen place of birth will complement those desires, or work against those desires. Care providers are not one-size-fits-all, and having open and honest conversations ahead of time can go a long way to saving everyone from grief down the line.
- Help pregnant women and their partners process their emotions and fears in a safe, supportive environment, free of judgement. Pregnancy and birth are times of heightened emotions for families, and it can be helpful to have an objective third person to talk to, vent, and process with when things come up. Allowing the tough emotions to surface, process, and be diffused can pave the way for open, clear, and effective conversations between the woman and her care provider about how she is feeling and what she is experiencing, and how they can work together moving forward.
- Encourage pregnant women and their partners to speak up for themselves in the doctor's office or labor room. Even if they have seen a birth plan, doctors and nurses are not as intimately familiar with a birthing woman's desires. A doula can gently remind the laboring woman and her partner about what their expressed desires were, and facilitate a conversation if and where it is needed and appropriate. And in times when an unwanted intervention or procedure is necessary, the doula can help communicate why that is so to the woman and her family in a way they can relate to and understand.
- Encourage and acknowledge nurses and doctors in the things they do to help make a woman and her family feel safe and supported. A doula's job is to support the family, and at the end of the day she answers to them, not to the doctors or nurses or hospital policies. However, the more a doula can be positive and encouraging of the many things that doctors and nurses do to help comfort and affirm pregnant and laboring women, the better the over-all working relationship becomes, which in turn means a better, more cohesive and supportive environment.
- Acknowledge both sides. Sometimes what a woman wants and what a hospital or care provider can or are willing to provide do not line up. This can create some tension. A doula can help her clients to see "the other side" more clearly, and this can help to dissolve tension and allow better conversations to happen.
Even under the best of circumstances with the most incredibly caring team, it can be difficult for pregnant women and their partners to make a solid relational connection with the care provider, nurses, and staff caring for them in the hospital. Between 5 minute doctor's appointments, practices filled with several doctors or midwives (some of whom the woman may not have even met prior to labor), and the uncertainty of who will be on shift during labor, it is not always easy for effective communication and positive relationships to be fostered. Yet a great doula does that- she finds ways to build a bridge, make a connection, and spark a positive relationship in a short amount of time so that women and their families can walk away satisfied, heard, and affirmed, no matter what the course of labor is.