Q: What's a Birth Doula?
A: A doula is a woman who provides supportive care to pregnant, birthing, and postpartum women and their families. She does so by offering information with which the woman can make empowered choices about her options in childbirth, and, in a non judgmental way, honours those choices. A birth doula also tends to the woman's psychological/emotional preparation for birth and motherhood, and during labour, provides comfort measures to keep her and her partner feeling relaxed and able to focus on the amazing transformation into parenthood. A birth doula also respects the needs of the newborn, and helps to facilitate breastfeeding and bonding, as well as help the parents process their birth and breastfeeding experience.
Q: Where does the word “doula” come from?
A: Technically, if you were to research the word, you would see it is Ancient Greek for “slave”. Perhaps it was because in ancient times, it was the lady of the house's favourite handmaiden (technically a slave) who would care for her when she birthed and mothered her baby. Basically, taking all the translations into account, “doula” has come to mean “in the service of women”.
Q: What's the difference between a doula and a midwife?
A: A doula and midwife play very different roles for the birthing women. A midwife is usually a woman's primary caregiver, providing clinical care and monitoring the health of the baby and mother, treating issues that arise. She “delivers” the baby, and is responsible for Mom and Baby's wellbeing. A midwife usually attends births at home, at out-of-hospital birthing centres, and sometimes in a hospital as well, depending on what the laws are in your area. When a midwife is the primary caregiver and the pregnancy and birth are normal, a woman does not normally have medical care, though she may use the resources of a hospital for certain tests. If a serious medical issue arises in pregnancy/birth/postpartum, the midwife transfers care to a doctor, but continues to support the mother.
A doula provides ONLY non-clinical care. Because she is not clinically responsible, she is free to tend to the woman's need for information, emotional support, and physical comfort, as well as provide support for the woman's partner and family. Doula and midwifery care complement each other very well.
Q: I am planning a homebirth with a midwife. I feel like I would really like to have the support of a doula too. Do you only attend hospital births, or would you work in different settings?
A: We LOVE homebirths! In this case, our role is different. In the hospital we protect the birthing space from too many interruptions, answer questions, liaise with the staff, etc. In home or birthing centre births, we do continuous labour support so the midwife can get some rest if she wants (at a long birth, a midwife needs to spare her energy, as she needs to be alert to catch your baby and care for you...because doulas are not clinically responsible, it is less important to your wellbeing if we get really tired). We prepare food, keep the space clean, and help with other children if you need. In some parts of Canada and the US, midwives always work with doulas.
Q: Are MotherWit Birth Doulas militant about natural birth? I'm interested in seeing how far I can go in labour without an epidural, but I'd like my choice supported if I end up feeling like I need one.
A: While we believe the vast majority of women can absolutely give birth with minimal intervention, our job is to outline your options clearly so you can make the most informed choice possible. If an epidural is what you end up choosing, it is our job to support that with no judgment. We have one real agenda, and that's for you to have the happiest birth possible, whatever that means to you.
Q: Do doulas attend planned C-section births?
A: Yes. If you need to have a C-section, a doula's help can be very valuable. If you do not have a partner, or if there is a reason your partner cannot join you in the operating room, a doula may support you during surgery. If your partner goes in with you, depending upon the hospital's policy, a doula can either support your partner with the baby while you are in recovery, or help you with breastfeeding while you recover.
Q: I would love to have a doula attend my birth, but my partner is concerned that he'll feel excluded. What exactly is his role if I have a doula attend my birth?
A: A doula's job is to actually make your partner's experience of your birth more enjoyable. Not so long ago, men were relegated to the smoky waiting room of the hospital to wait for the announcement that their babies had been born, getting their first viewing from behind a glass wall. Now there is an expectation for partners to be able to keep track of contractions, schlep all the stuff to the hospital, communicate with the staff, help deal with pain, all the while maintaining an identity as an emotionally connected partner and father. Phew, this is a lot to ask! While many partners are very enthusiastic about being hands on during labour (and if they are, we absolutely encourage that), some are a little unsure, and struggle with anxiety as to how they'll be able to cope with the stress, never mind actually be helpful.
Either way, the birth doula takes care of the partner too. By making sure his physical needs are met and his concerns addressed, he can ease into his role of being there for his partner however she requests. If the doula is relaxed, the partner usually senses it's okay for him to relax too. If he has questions that need answering, the doula will make sure they get answered. If he needs to resource himself by getting some food or going to the bathroom when his partner absolutely cannot deal with a contraction without someone rubbing her back, then he can go take care of himself knowing she is in good hands until he comes back. Or, we can fetch food and make sure he's as comfortable as possible doing the back rubbing. It is not unheard of for us to actually feed a father or hold a cup with a straw to his lips while he works.
We also respect privacy. We know that often the couple wants to spend some time alone together in labour. In this case, we take a walk for awhile, staying close to our phones so we can be called back if needed.
We are not kidding when we say at the end of a long birth, it is often the fathers who come up to us with tears in their eyes, give us big hugs, and say, “I couldn't have done it without you!”
The wellbeing of the mother's partner is as important to us as her wellbeing, as it is he who has to help take care of her afterwards. That is easier done when he is relaxed. Our presence helps the partner take on a more meaningful, connected role.
Q: Some of the things I want for my birth may be in conflict with what is normal at the hospital I'm birthing in. Will you tell the staff not to intervene with my labour? Will they get angry at us?
A: As doulas are not primary healthcare providers, we can never step in and make any kinds of medical decisions for you. When you give birth in a hospital, there are some routines you cannot really avoid without quite a lot of tension, and these change from hospital to hospital. While MotherWit doulas are not promoters of birth plan writing, we do think it's important to get some things clear in advance with your doctor, and write down what was agreed upon just in case another doctor ends up being there for your birth. Knowing in advance if your doctor insists upon certain routines you don't want, and know other doctors who don't have the same expectations, you can always switch caregivers to someone who is more supportive of your desires. We have seen this happen successfully many times.
While a doula can't say, “don't do this to my client ,” as we are not qualified to know what is appropriate medical care for you, we can encourage you to ask why a particular intervention is suggested. Then you can make your own decision based on what your caregiver's reasons are. If labour is too strong to converse, your partner can speak for you. If that's not an option, we can relay the information that you prefer to keep interventions to a minimum, but we cannot decide for you. Obviously, if a situation occurs that requires immediate and intensive medical care, we will not interrupt a doctor or nurse from his/her important job. We will focus our energies in supporting you and your partner throughout.
Whether or not someone will get angry at us for asking a question for you, is out of our control. However, at MotherWit, we are adamant about diplomatic, non-confrontational communication. We trust everyone is on the same page to make sure you and your baby are well, and don't feel like its necessary to go into a hospital in “fight” mode. If we receive a very strong reaction for simply asking a question in a neutral tone, we will not engage in argument, as tension does not create a nice birthing environment. In this case we will work more with buffering the tension for you.
Q: I want to stay at home for as long as possible before I go to the hospital. Will you come to my home and support me there?
A: Yes, depending upon where you live and how advanced it seems your labour is, we will support you at home until you or we feel like it's time to get going. In fact, busy hospital staff members are usually pleased to have women arrive in active as opposed to early labour. We as doulas do not perform vaginal exams to determine how your labour is progressing. More than anything, we watch your body posture , listen to the sounds you're making and watch your diminishing attention span. If you happen to suddenly begin having the baby without much warning, (which is EXTREMELY rare for a first time mother), and it is clear it is unsafe to move to the hospital for fear of the baby coming out en route, we will call 911 to ensure you get transported to medical care as quickly as possible. Most experienced doulas have caught a baby or two who were in an hurry to arrive, but it is never our intention to do so.
Q: How much does a birth doula cost?
A: MotherWit birth doulas have over 300 hours training, not to mention other training and work experience they have received in their lives, and have all gone through apprenticeships and supervision. Our doulas range in experience from having attended 20 to 400 births. Typically, a MotherWit Doula charges anywhere from $700 to $1200, depending upon the services you need and the level of experience the doula has.
Q: Are Doulas covered by Medicare?
A: Even though doulas are known to ease the stress on our overburdened healthcare system by reducing the need for medical interventions during birth, we are not covered by Medicare.
Q: Are there volunteer doulas?
A: If you are a woman who is truly in need (on social assistance, a refugee or newly immigrated), you can obtain the services of a volunteer doula at www.montrealbirthcompanions.homestead.com Most of the MotherWit doulas also do volunteer work with Montreal Birth Companions.
Q: How do you set your fees for the work you do?
A: Births are very unpredictable. There is no real way of knowing how long we will need to be with you. A portion of our fee goes to the prenatal/postpartum work we do with you, as well as being available for phone calls and emails.
There are a few factors to consider. Because we don't know when you will give birth, from 3 weeks before to sometimes 2 weeks past your due date, we have to be absolutely available for your phone call announcing labour has begun. This means special occasions and plans often need to get put aside. Days of work need to be cancelled and rescheduled. Babysitters need to be on call. Our partners' plans need to change. It is quite a feat to be able to drop what we're doing, or sometimes run at 4am to the hospital, and know everything will run smoothly at home while we're gone indefinitely.
Doulas are often required to do their very best work sleep deprived. Births can be extremely long sometimes, and we have to pull out all stops to support you in your labour. Having busy practices and families, often we don't have the luxury of just going home to sleep afterwards. So working “on the edge” like this is taken into account when we create our prices.
It is important to remember, too, that if your birth ends up being very early, late, or long, there is a risk it will overlap with another birth. If this happens, we must send a back-up doula to that birth, and she is the one who gets paid for that, not us. So, as you can see, sometimes income can be lost when it is completely outside our control. Also, the more hours we spend at a birth, the less our overall hourly fee is in the end, as doulas charge by flat rate. So basically, the longer doulas work, the less we make. We don't charge more for overnight or holiday work, and there is no “overtime”. A doula can only take a finite amount of work to be able to tend to her clients properly. As you can see, this truly is a labour of love, because you will always have us happily answering your questions and excitedly staying with you as long as you need until your baby arrives.
It is important for you to know that if your birth is long, hard, or if someone else calls while we're with you, YOU are our priority, and all you need to worry about is focusing on your labour. We LOVE our work...we couldn't do it if we didn't. We charge the way we do to cover the above mentioned potentials, based upon averages of how long we spend with the typical client.
Q: What if my doula is unavailable when I go into labour?
A: Because labour is so unpredictable, this occasionally happens, though in our experience not too often. MotherWit is a collective of doulas, and we strive to make sure our clients get to know all of us. Our “meet and greet” monthly gatherings and the fact we take turns teaching prenatal classes, means you get to connect with all the MotherWit doulas a bit, not only your primary doula. So while you will absolutely most likely end up with her at your birth, if you do not, you will probably not end up being supported by someone who is not familiar to you. And if you do, because you were unable to attend classes or “meet and greets”, she will be someone who has a similar approach to labour support as your primary doula, and will be debriefed on the things that are most important to you for your birth.
Q: If I hire a doula to have a natural birth and it ends up being the complete opposite, do I still have to pay?
A: We understand that ending up with a birth experience you completely did not expect can be overwhelming and disappointing. But it is important to know that it's you, your baby and your primary caregiver who have the say in how your birth goes. We advocate your wishes and support whatever arises, but unfortunately, we cannot guarantee you will end up with the birth you want. So yes, we still require payment, and will help you as best we can to process your experience.
Q: My friend really wants a doula. Can I purchase the services of a doula for her as a gift?
A: Now this is a thoughtful gift! Baby showers are fun, but often women receive things they don't necessarily need. How meaningful to give the gift of support! If you would like to gift your friend with the services of a birth or postpartum doula, a MotherWit doula would be happy to show up at the baby shower to present herself to the expectant mother. This way, she can see if she clicks well with the doula. If she doesn't feel she does, don't worry...MotherWit has several wonderful doulas, and she may wish to meet a few before deciding upon who is right for her. When she decides is when you can begin the payment process.
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