12 Things a Doula Wants You To Know for a More Supported and Empowered Birth
In fact, birth is literally a doula's business. They are trained to offer support, guidance, and advocacy throughout a clients' pregnancy, delivery, and postpartum. And they've likely attended as many (or more) births than your average OB/GYN or midwife.
People who've worked with doulas claim better birth outcomes (like shorter labor), fewer medical complications, and more positive birth experiences overall. Plus, they've also felt more supported and empowered during one of the most important and pivotal moments in life.
Here, we tapped Celina Sainte-Rose, birth doula and childbirth educator, to learn top doula tips for having the best birth experience possible.
1.“Interview” your doctor or midwife
Apart from you and your baby, the next most important person in your labor and delivery room is your doctor. And the way they treat you can make or break your experience. “Your provider ultimately sets the tone for your birth and determines your birth outcome in so many instances,” says Sainte-Rose.
Yet, we often don't put as much time and research into choosing doctors as we do with other life events. “Think about your birth the same way you’d think about your wedding—you don’t necessarily hire the first venue that you visit or first caterer you meet,” says Sainte-Rose. Same goes for your provider. You should take your time finding the right fit.
The best way to do this is by “interviewing” each one. “See if the way they practice aligns with your values and the things that resonate for you in birth,” says Sainte-Rose. Come prepared with a list of questions and pay close attention to their answers. How they respond can give you a sense of their practice style.
"The way people speak can offer little clues (and sometimes red flags) to help you decipher if someone is right for you," says Sainte-Rose. For example, a provider should never say “you can’t do this” or “we don’t do that,” because birth isn’t a one-size-fits-all thing, and “no one’s your parent or your boss,” she adds.
Another thing to look for is how well they will support your choices. Your provider should believe that you’re the expert of your own body—that is, you know what's best for you and your baby. While they offer guidance, they should never try to push you into anything.
“Nonjudgmental care is so important,” says Sainte-Rose. Take, for instance, if you choose to schedule a C-section or formula feed (instead of breast/chestfeed) your baby. You want a doctor that’s going to say, "okay, how can we support you in your goals?" Sainte-Rose adds.
Sample questions to ask providers:
- What are your induction, C-section, and episiotomy rates?
- How do you feel about eating and drinking in labor?
- How do you feel about intermittent or wireless monitoring?
- How do you feel about laboring and pushing in different positions?
- How do you feel about hands-off or non-coached pushing?
2. Learn about your right to informed consent
Say you planned for an unmedicated vaginal birth, but your labor isn't progressing. Now your provider is saying they should intervene, but you're not sure what that means, or whether you want them to do anything at all. Scenarios like this are common. And in the heat of labor, you may feel the pressure to say "yes," even if you're uneasy about it.
In these moments, it's important to use your powerful tool of informed consent.
Informed consent means “having all the information and then from there, choosing a decision,” says Sainte-Rose. Very often, you have many options, but you’ll likely have to ask your care team to elaborate on them. Before you agree to something, you can ask:
- What are the risks, benefits, and alternatives?
- What if I do nothing?
- Is this a recommendation or an emergency?
- Can I have the data on this?
The answers you get will help you make an informed decision about your care—not one based on fear or feeling rushed.
Another note: Consent also means people should ask permission to touch you, says Sainte-Rose, especially when it comes to putting their hands on your genitals. This can be very traumatizing for people, particularly those with a history of sexual abuse, she says. For example, your provider should ask whether it’s okay to do a cervical check. This shows respect for your bodily autonomy and puts you in charge of the situation.
“Without people fully explaining your options, they’re essentially coercing or manipulating you into something, and this leads to a real loss of control,” says Sainte-Rose. And when you feel powerless or mistreated, you’re more likely to feel your birth is traumatic, she says.
3. Remember, you can say "no" to anything
Even if you’re usually outspoken, it can be hard to find your voice during pregnancy and birth. With so many physical and emotional changes, you may not recognize yourself, or feel like you’ve lost control. In turn, you may question whether you know what’s best for you (and your baby), or feel like you must defer to the experts in the room.
But if at any point throughout the process something doesn’t feel right—physically or emotionally—you can always say "no." Just like you have the right to understand all your options, you also have the right to refuse them, too.
Remember, “you are the boss of your birth,” says Sainte-Rose. “Everybody in that space works for you. No one feels that way, but it’s so true.” This goes back to choosing the right provider who trusts that you’re the expert of your own body, she says.
One way to test whether they’ll respect your voice during birth is to practice saying "no" and sharing your birth preferences in your prenatal visits. If they seem dismissive or resistant, odds are they’ll be the same way when you give birth.
“It can be easy to think that we’re not experts on our body, but your gut will tell you,” says Sainte-Rose. Listen to it, trust your intuition, and say no if something feels off.
"It can be easy to think that we're not experts on our body, but your gut will tell you. Trust your intuition if something feels off." —Celina Sainte-Rose, doula
4. Choose the place you give birth carefully
Where you give birth can be just as important as who assists your birth. "Choosing the right place to give birth is very important," says Sainte-Rose. Each facility has a different birth culture. Some hospitals are more medicalized, while other settings (like birthing centers), are designed to be warm and cozy. And then, of course, there’s the homiest place of all—your actual home.
No option is any better than the other. It’s all about what you want for your birth. If you're imagining a low-key water birth, or eating and drinking during labor, then a home birth or birth center may be best for you. But if you're more comfortable having your baby's heart rate monitored, or close access to the NICU in case of emergency, the hospital could be the right choice.
If you hire a doula, you can talk to them about your wants and needs. They’ve attended many births, so they might be able to give you a better understanding of birthing options in your area. You can also get a sense of a hospital’s culture by checking out their maternity care stats (think: rates of C-section, episiotomies, etc.). Leapfrog Ratings is a great online resource where you can find this kind of info.
Ultimately, this research is well worth it. Finding out how each place treats its birthing parents, and how it can support the kind of birth you want, can set you up for a positive experience.
5. Seek out childbirth classes
Yes, childbirth is amazing and mysterious, but it can also be downright intimidating. (I mean, let's be real, the thought of pushing a baby out of your body can be, well, pretty scary.) Learning about the process can demystify it, though, and help you face any fears so you're prepped for the big day.
One of the best ways to do this is by taking an out-of-hospital childbirth class, says Sainte-Rose. Educating yourself about what to expect at each stage of labor, how to manage pain (including all your pain-relief options), and seeing what birth can look like can all go a long way in making you feel more prepared for the physical and mental demands of birth.
On top of that, childbirth education can also teach you about your rights and how to advocate for yourself. It'll remind you that informed consent and the right to refuse certain procedures are tools at your disposal. You'll learn to use them whenever you need—which, TBH, may be more often than you think.
“Advocacy is really important because we live in a patriarchal society where, sometimes, people aren’t listening to the birthing person,” says Sainte-Rose. And sadly, certain groups, including birthing persons of color, are more likely to be dismissed or mistreated.
The more you practice self-advocating beforehand, the better you’ll be able to access these tools if and when a situation comes up during birth. “The goal is to be really comfortable stepping into your power in your prenatal appointments so that you are setting a standard of care for yourself,” says Sainte-Rose.
6. Lean on your partner and care team to advocate for you
Birth is hard work, and sometimes, so is advocating for yourself. When you're in the throes of intense contractions, you might not have the energy to do both at the same time. That’s why support from your partner and people on your birth team (like a doula) is essential. They can help be your voice, communicate your wishes, and hold your boundaries so you can focus on the task at hand—having a baby.
Have a conversation with your partner and team ahead of your due date about how they can help you, says Sainte-Rose. This may involve saying to your partner, “here’s what I want, and here’s what I need from you.”
“Partners [or whoever you choose as your support person] need to take a very active role in the support of the birthing person,” says Sainte-Rose. On top of asking about your needs, they should also do their own birth prep, she says. This could be taking childbirth education classes, watching birth videos (if they’re comfortable), and attending meetings with the doula.
Sainte-Rose loves to help partners figure out how to support and advocate for their birthing person. “The doula is a doula for the entire family,” she says. She encourages partners to reach out to their doulas with their concerns and questions. You can even play out scenarios and practice what to say to doctors and nurses. Trust us: Steps taken by partners to prep before birth will pay dividends on the big day.
7. Labor in whatever position you want (even if you have an epidural)
In nearly every movie depiction of labor, the pregnant person is lying on their back with their knees in the air as they push their baby out. If that's all you know about birth, you might think this is how it has to go. But pushing on your back is not the only option.
Truth is, you have many choices. “Birth is not one-size-fits-all, and to expect that everyone’s going to want to push and birth their baby in one way doesn’t make sense,” says Sainte-Rose. You can labor however you want—kneeling, squatting, standing, swaying, and even dancing (movement progresses labor, BTW).
The same is true even if you've had an epidural. In case you didn't know, an epidural is a pain medication given during labor. It’s inserted through a needle and catheter into the lower part of your back, essentially numbing the bottom half of your body. Many people think they can’t move once they get one. But that’s not the case at all. With a little help from your care team and/or your partner, you can move into different positions.
“As doulas we support people with epidurals who give birth on hands and knees, in tug of war, with a squat bar, and on their side,” just to name a few positions, says Sainte-Rose.
To be clear, this doesn’t mean you shouldn’t push on your back or that it’s worse than other positions. “There’s not a perfect position to push; it’s whatever’s right for you,” says Sainte-Rose. In other words, if it feels good to lie down and push, you do you. And if something doesn’t feel right to you, your partner or doula can always support you in another position. What’s most important is to listen to, respect, and trust what your body’s saying, she says.
That said, your provider must also be onboard, as well, adds Sainte-Rose. This goes back to advocacy and having those conversations in prenatal appointments, she says. For example, you might say something like, "I don’t know how I’m going to want to push, but I want to have options; how can you support me in that goal?"
If they can’t, or they say you must push in one way or another, they’re probably not the right person for you. Because “it’s less about the pushing and more about what it says about control and bodily autonomy,” says Sainte-Rose. As long as your baby is doing well, you should be able to push in whichever way makes you feel most comfortable, supported, and empowered.
8. Make a birth plan—but be flexible
During childbirth education classes, you'll likely get the opportunity to write up your very own birth plan. This comprehensive plan will outline how you want things to happen in labor and delivery—from the position you want to push in to the pain relief you prefer. This plan can be shared with your provider weeks in advance, and often instills a level of confidence in soon-to-be parents.
"Birth plans are an important part of prepping for birth," says Sainte-Rose. They empower you to learn about all your options and choose which ones might work best for you. But they’re only one piece of a much larger puzzle, she says.
Unfortunately, a sheet of paper can’t guarantee you’ll get the birth you want. Almost always, something happens in birth that’s unexpected. For example, your birth plan may go out the window if there’s an emergency, or you feel differently in labor than you thought you would, says Sainte-Rose. In these situations, you’ll likely have to pivot from your original plan.
A birth plan also doesn’t ensure your provider will treat you the way you want. Meaning, it doesn’t substitute for your self-advocacy work, says Sainte-Rose. In other words, even if you’ve discussed your wishes with your care team, you may still have to speak up for yourself in labor.
So instead of thinking of your birth plan as a hard decree, consider it more like a general guide, or living, breathing document that’s subject to change. Adjusting your expectations might save you a lot of disappointment if things don’t go exactly the way you'd hoped, and help you prepare to roll with the twists and turns that come with birth.
9. Make your birthing space feel cozy
“In physiological birth, you need to feel safe, loved, and supported to be in a mental space where your primal brain takes over,” says Sainte-Rose. And your physical surroundings play a huge part in this. If your space is welcoming, calm, and cozy, your body will likely relax and respond, too.
The good news? No matter where you choose to birth your baby, you can create the right vibe. “Again, it’s like planning for your wedding. People plan cake toppers and bows on seats,” says Sainte-Rose. They have a specific vision in mind about how they want the ambience to feel. You can do the same detailed planning for your birthing space.
First ask yourself how you want the space to look and feel. Then use this image to bring that space to life. Some ideas include, per Sainte-Rose:
- Taking your favorite family photos from home
- Pinning affirmations on the wall
- Using tea lights
- Playing classical music
- Running a diffuser with a relaxing scent, like lavender
The possibilities are endless, even in a hospital setting, says Sainte-Rose. To add to the serene mood, you can also request that people (including your care team) talk in soft voices, remain quiet during your contractions, and gently knock before they enter the room, she adds.
Not only will this comfy environment put you in the right headspace to have your baby, but it may also help move labor along. It’s true: A calm, quiet atmosphere gets oxytocin (a hormone that stimulates contractions) flowing, according to the National Partnership for Women & Families.
10. Know that you can still have an empowering C-section birth
The "c-word"—so many birthing people are too terrified to even utter it. Yep, we’re talking about C-sections, or cesarean birth. C-sections—which involve abdominal surgery to deliver a baby through an incision in your uterus—are often considered the worst-case birthing scenario. And understandably so—it’s a major operation, recovery time can be longer than vaginal birth, and it's often done when there's an emergency during labor.
Though a C-section may not be your first option, it doesn’t have to be a terrible birthing experience. In fact, it can be “equally as valid, powerful, and beautiful” as any other way to give birth, says Sainte-Rose. You even have some control over how things go in the operating room, she says. For example, you can request:
- Your favorite music plays during the surgery
- Nobody speaks (or the doctor narrates every step of the surgery)
- A clear drape is placed so you can see your baby come out
- Your partner shows you the baby
- Vaginal seeding (the practice of wiping a baby's mouth, face, and skin with vaginal fluids after a c-section)
- Delayed cord clamping (when your ob-gyn or midwife waits at least a minute before cutting the umbilical cord after your baby is born)
Even if you’re hoping for a vaginal birth, it’s important to discuss the possibility of a C-section ahead of time. This gives you more time to plan the way you’d like it to go in the event you need one, says Sainte-Rose.
And “if C-section isn’t your choice, but ends up being the route of your birth, it’s important everyone validates that,” she says. This might look like your partner and/or care team saying, "I know this wasn’t your plan, and I’m sorry. What do you need from me? How can we help you to process this?"
By not glossing over your disappointment (and maybe even grief over your birth), you can really hold space for these feelings, validate your experience, and help with the healing process.
"At the end of the day, it’s about how you were treated, not how you birthed your baby," says Sainte-Rose. Being treated with compassion, respect, and dignity can make a huge difference in your birth experience—even if it wasn't the one you'd hoped for.
11. Switch providers if you need to
Sometimes, your doctor can seem really great at first, but as your pregnancy goes along, something starts to feel off. Maybe you feel rushed, unheard, or dismissed. Now what?
If you've expressed your concerns to your doctor, and you still feel uneasy about the care you're receiving, you don't need to stick with them. "People think they're locked into providers, but very often you have a lot of time to prepare," says Sainte-Rose.
If at any point you don’t get a sense of respect, collaborative care, or bodily autonomy from a provider, you can move on, she says. Even if you’re further along in your pregnancy, you don’t necessarily have to stay stuck in a less-than-ideal situation. For example, a lot of providers will take late transfers, says Sainte-Rose. You might have to call around, but you will likely find other options.
Still, we know switching providers so late in the game can be super stressful, especially as you’re dealing with all the third trimester challenges (battling wicked heartburn, setting up your nursery, emotionally prepping to meet your baby, etc.). The best way to avoid this worst-case scenario is to interview your provider and ask the important questions as early as possible, says Sainte-Rose.
It's been mentioned before, but interviewing your provider will give you the best sense of how they practice—and whether they're going to give you what you want. This way, there won’t be any major surprises or disappointments from your care team on the big day.
That said, there are some people who don't have the option to choose or switch providers, like those without insurance, says Sainte-Rose. In these cases, your support from your partner and doula can become even more vital, she says.
12. Consider working with a doula
By now, you know how important it is to have support and advocacy during your birth. Both of these things are exactly a doula's job. Working with a doula is “the best investment that you’ll make in your birth,” says Sainte-Rose.
In an ideal world, every birthing person would have access to doula services. But in reality, they can be too costly for many. Doula services can run anywhere from a few hundred to several thousand dollars. If you really want a doula on your care team, but you’re not sure you can afford it, there’s always someone to help, says Sainte-Rose. “Most of us are in this work because we love it, and we want to help.”
Some ways you can get care at an affordable rate:
- Talk to your doula about payment plans or reduced rates. Many doulas do pro-bono work or work on sliding scales.
- Find community doulas who dedicate their services to low-income folks and those without support
- Check your insurance coverage. While most people pay out of pocket for doulas, some insurance companies cover partial doula costs. (For example, if you live in New York, doula services are covered for anyone on Medicaid.)
- Put doula services on your baby registry. You may have to forego other items, but "your Snoo isn’t going to hold your hand in labor,” says Sainte-Rose.
“Figuring out options to invest in a doula can really change the game in terms of your birthing experience,” she adds. To find a qualified doula in your area, check out DONA International’s search tool.
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