Preparing for Birth: Doulas

28 Weeks Pregnant with Twins
180 Pounds - Measuring 37 1/2 cm

What do doulas do?
I don’t think that most parenting literature and books do justice to describing what a doula does.  And further why do you need a doula when you have 1 or 2, or more labor nurses, midwifes and doctors? I certainly didn’t fully understand until I had one at my side! There are actually two roles doulas fill. Birth doulas attend your birth and support you through it. Post partum doulas help and support you and your baby after birth. In this post, I focus on birth doulas.
A labor nurse has many jobs in managing your labor, measuring your progress, ensuring that there are no complications, monitoring yours and your babies’ vital signs, filling in paperwork and following other hospital protocol, communicating with your doctor and to some extent managing and directing your labor if you are being induced or have pitocin.
A doula is not pre-occupied with those things. She is there to attend to you. To help keep you comfortable, to get you a blanket, to massage your back when it hurts, to help you to the restroom, to give you ideas for positions and techniques  for pain management to keep you company while your hubby runs to grab a snack, to help you progress your labor using every tool available, to encourage you and give you feedback on how you are doing, to give you ideas and options about your labor that may not have known existed (did you know that you CAN get out of bed? Your labor nurse may have forgotten to tell you), and finally to advocate on your behalf, and last, but not least, to catch your husband if he faints.
And doulas are not simply a paid friend for the day. I have plenty of friends who would come to my child’s birth if I asked, but they are not trained in childbirth comfort measures, massage, and lactation assistance or certified by Doulas of North America as so many doulas are. Your best friend may not know to encourage you to try a new position if you’ve been laboring for a few hours without much progress; nor how to help you decide if you are debating between Demerol or an epidural or to trying to stick it out for another centimeter.
I asked Mr. Geek, “As a twin daddy, what do you have to say about doulas?” He responded “Priceless. [Long pause and queue for more info here] They know all the tricks, and it’s nice to have an extra set of hands.”

Doula Resistance
When I asked my hospital birthing instructor if I could have a doula she said absolutely not. I was told only one person may accompany me into the birthing room. Though other ‘normal’ patients could have a doula, since I was having twins, I was to deliver in an operating room instead of a regular birthing room – even if I was having a vaginal birth. Oh the frustrations of having a completely natural and healthy pregnancy, yet being automatically assigned to a statistical category which subjects you to a whole new lineup of protocol that may or may not be justified by actual research. To say the least, I was frustrated.
 Yet, when I talked to a family who had given birth to twins with a doula at this same hospital a few months prior, they let her in. (Mothers of Twins club are a great recourse!)  I don’t see how they couldn’t. We ended up choosing a doula who had formerly been a labor nurse there, and were sure the hospital would agree to allow attend when the time came.
One of the reasons the nurse gave us is that the operating room is small and there are already so many nurses and  personnel that need to be there, physical space is restrictive. But with so many people in there anyway, does one more really change a darned thing? Twelve’s a party but thirteen’s a crowd? I’m sure they don’t want you bringing five of your closest friends if you know what I mean! I eventually found it was all talk and no action, so be persistent in your request and be sure to talk to the charge nurse or other manager of the birth center, and not just someone in a peripheral role (like a birth class instructor!).
Many traditional doctors, providers and nurses seem to be offended by the notion of doulas, as if they aren’t doing their job well enough so we need to get someone else involved. Yet, while some midwives or family doctors will come close to fulfilling the role a doula fills, the vast majority do not.
It is a fact supported by research that births attended by doulas result in fewer C- sections, fewer episiotomies, less anesthesia, shorter labor (9 hours vs. 19!), fewer babies admitted to the ICU and babies more likely to be breastfeeding at 6 weeks, as well as moms who are more satisfied with their birth experience! In fact, after being told years before that I could not have a doula, the perinatologist that handled my second birth highly recommended I have a doula. At the time it looked as though I would be having a vaginal birth without the option for an epidural because of my low platelet count. So hopefully, the medical community is becoming more accepting of doulas as a positive addition to birth support.
I was blessed enough to have two vaginal deliveries of twins, even when both were induced (inductions have a higher chance of Cesarean delivery than spontaneous deliveries). I don’t have reliable statistics, but somewhere between 1/2 and 2/3 of twins are born by Cesarean section. And besides good luck, and physicians experienced in breech presentation, I credit having a doula to help me birth, change positions and aid the natural process. I also waited as long as I could to get an epidural and made sure to move be active and vertical (I was rarely in the hospital bed!) to get those babies moving down and out!

Paying for it
One thing you will notice if you are searching for a doula is that they are not usually covered by insurance. Insurance companies should want to minimize surgery, expensive interventions and NICU stays as well as maternal bleeding complications (which are more common with Cesarean section). So I urge you to call or write your insurance company and urge them to cover doula services. Cite the research that supports the positive implications of doula-attended births.

When you consider if you can come up with the cash to pay for one yourself, think about how much it would cost in hospital co-insurance for a Cesarean birth versus a Vaginal delivery, or a NICU stay or even just an epidural. Also, many doulas are willing to work with you on their fees and newer doulas who have less experience are more willing to be flexible. Less experienced doulas often want to gain experience with twins, so twin mamas in a tight financial situation can take advantage of that and ask if they would be willing to work for a reduced fee or even for free.
The other thing to note is that most birth doulas not only attend your birth, but also visit with you before hand to help create a birth plan and get an idea of what your preferences are before labor begins. They also will meet with you after birth to check on you and baby and offer lactation advice. DONA certified doulas all have some training in lactation.
Finally, some hospitals will provide doulas as part of their birthing package, and some hospitals have an organization of volunteer doulas on call, so be sure to ask about that at any hospitals you are considering. Meanwhile, I say, ‘Just doula it!’. [Insert rolling eye smiley here!]