As a Childbirth Educator, I strongly encourage all my clients to consider having a doula at their birth. I have met parents who regret not having had a doula at their birth but I’ve never encountered parents who regret having one, they have all said their doula was invaluable and instrumental in helping them achieve their best birth possible.
Recently I had the pleasure of catching up with Tina Ziegenfusz (pictured) from Birthright Doula Services and I asked her all the questions you might want to ask a doula. Here’s what she had to say:
1. Why should women or couples consider having a doula at their birth?
For the same reason they’d take a guide when climbing Mt Everest! A doula is very much like a guide – she knows what normal birth looks, sounds and feels like. She knows the emotional terrain of pregnancy and labour. She has lots of ideas to help a woman stay as comfortable as possible, and to help her labour progress – very important if your goal is to minimise excessive intervention in your birth. She will usually know the options available at your chosen birth place, and can help you and your partner explore your needs for your baby’s birth within the framework of what is achievable there. An experienced and knowledgeable doula is like having a private birth consultant you can take with you right into the birth space – someone who knows the territory, and who you can bounce ideas off through every stage of the process.
2. What’s the main difference between a doula and a midwife?
A midwife’s primary responsibility is the medical care of mother and baby. The medical aspects of birth are not in a doula’s scope of practice at all – so she doesn’t listen to the baby’s heartbeat, perform vaginal examinations or undertake any other clinical tasks. She is concerned with supporting the mother’s emotional, physical, and informational needs. Because she doesn’t have to continually monitor the health of mother and baby and complete hours of record keeping during and right after labour, she’s able to devote 100% of her attention to helping the mother and her partner with the aspects of her pregnancy and labour that the medical model can’t prioritise. The biggest of these is physical and emotional support during labour – something that most hospital midwives don’t have time to provide.
3. How do you work with the women’s partner or birth companion?
My goal with partners is to facilitate their involvement on whatever level they’re comfortable with. So if a partner wants to be very hands on and involved with the birth, I’ll help them find ways to do that. We’d explore ideas for this before the birth and help them to prepare for what to expect, then look at practical ways they can support their partner. On the day, my support for the birth partner can take a few different forms – it might be showing them a particular massage technique, or a certain position they can help their partner with to address her hip pain. Or, it might be helping them recognise when it’s time to leave for hospital. Later, it might be something as simple as going down to the cafeteria to grab them a snack because they haven’t eaten in hours, or picking up the massage so they can have a short rest. Often I spend hours sharing “shower head” duty with partners – we take turns at getting wet! Without the benefit of the hormones mum receives to keep them going, a doula on the birth team can be invaluable for these partners.
If the birth partner prefers a different role, that’s fine too. I’ve even supported couples who have decided not to have baby’s father in the room at all, for whatever reason. My role is fill in the gaps – wherever they may be.
4. Some women only want their partners present at the birth, no strangers, what would you say to those women?
If you’re planning a hospital birth – even a hospital birth with your own obstetrician – the vast majority of your labour will be spent in the care of strangers. In a public hospital, you’ll labour with a midwife who will be allocated to you on the day. In a private hospital, your obstetrician may check on you periodically during labour and will arrive just before the actual birth, but you’ll still be cared for throughout active labour by a midwife you’ve never met.
Having spent many hours getting to know your doula in the lead up to the birth, she’ll probably be the most familiar person in the room by the time labour begins! If you’re sure that you don’t want a doula with you in labour, many doulas offer private birth preparation that can be the next best thing.
5. How does having a doula increase the chances of having a natural birth?
There are a few studies looking at the effectiveness of a doula as opposed to other forms of birth support (for example the woman’s partner, or a midwife or other employee of the hospital), which have found doula support results in more positive outcomes for labour and the postnatal period. You can look into this further here: http://evidencebasedbirth.com/the-evidence-for-doulas/
6. How long do you normally spend with a woman in labour? Or, when do you normally join women in labour?
On average I spend around 12-14 hours at the labour of a woman having her first baby. It can be very unpredictable though – I’ve spent as long as 30 hours with some couples.
My general guideline is that I’ll join a woman when her contractions are intense and she and her partner feel they need additional support. When this point arrives will be different for everyone, so flexibility is key.
7. What does a doula carry in her bag of tricks?
I carry a variety of aromatherapy oils for both massage and burning, a rebozo, balls for counterpressure and stress release, heat and cold packs, acupressure bands, relaxation music & headphones, face washers (for keeping cool in second stage), honey sticks (for energy), flameless candles, herbal teas and a few other bits and pieces. I certainly don’t use all of this stuff at every birth, and find mostly that my hands and voice are my primary tools of trade.
8. Which techniques do you use that tend to be the most helpful? Why?
I use a lot of physical techniques for comfort and labour progress, including acupressure, aromatherapy, massage, creative positioning ideas, rebozzo and others. But what makes the most difference, time and again is just staying close to the mother and talking her through her contractions. Quietly, calmly, helping her remain centered when she needs that help, in whatever way works for her at the time. It sounds so obvious, and a bit trite really – but most women who have laboured with this sort of continuous support for hours on end will tell you it makes all the difference.
For partners, the most helpful thing I bring to the birth is probably reassurance – from being with them at home so they aren’t fretting about when to leave for hospital, to showing them by my own reactions that all is well when their partner is transitional and making lots of noise. Just a nod and a smile at that time, and you’ll see them visibly relax and return to the moment instead of being unsure and afraid. The value of this is something that’s hard to grasp until you’re in the thick of that emotional soup running on two hours sleep, I think!
9. If you were looking for a doula to assist you at your birth, what would be the top 3 questions you’d ask?
I’m not a fan of the cross examination approach to finding a doula – I think it’s much more important to check in with your gut and make sure you feel a personal connection. Is this a person you feel comfortable seeing you at your most vulnerable? Is this a person your partner is comfortable with? Does she listen to you, or does she talk all the time and tell you what’s “best”, rather than asking you what you need? As a doula, I’m always checking in with myself during a first meeting too, making sure that what I offer fits with a woman’s needs as she’s expressing them to me. Every now and then I meet a woman who is looking for a “birth bouncer”, or someone to protect her from a caregiver who isn’t listening to her. This is not what we do.
On a more practical level I’d ask whether they’ve ever missed a birth because of issues on their end, and how often that’s happened. This work is unpredictable by nature, and you need to know how your prospective doula (who probably has children of her own) manages this. Obviously it’s not appropriate to grill her about her day to day timetable, but some level of reassurance that she has systems in place and can come when you need her is going to protect you. Barring illness or emergency (events for which she should have a reliable back up doula arranged), she should be able to commit to being at your birth, NO MATTER WHAT. Her fee can be a heads up here – there’s a broad range of doula fees at the moment so the old adage “you get what you pay for” is worth remembering.
10. What’s your most frequently asked question?
“How do the midwives/obstetricians feel about doulas?”
Many people are very concerned about how they’ll be received at the hospital with a doula, or about their choice to use one upsetting their obstetrician. I’ve worked in every hospital in Brisbane at least once, and I’ve always been accepted professionally into the birth space. I ask all of my clients to let their primary caregiver know they are using a doula well before the birth, and when I arrive in birth suite I always introduce myself to the midwife and make a point of making sure we get off on the right foot and that she knows I understand my role. Sometimes I’ve met their obstetrician at a previous birth, so they know what to expect from me and it’s not an issue.
If your obstetrician or midwife isn’t happy about you working with a doula, it’s probably a red flag to explore further how they might feel about other decisions you’ll be making going forward – both during pregnancy, and most importantly in labour.
11. What do you love most about being a doula?
I love seeing the change and growth in women and their partners over the six months or so we work together. Pregnancy and birth are incredibly transformative experiences, and a time that holds such potential for getting to know ourselves on a much deeper level. It’s so rewarding to see clients claim and embrace that, often overcoming their own personal fears as part of the process.
The best part of all for me is bearing witness to those first moments between parents and baby. It’s the beginning of a life long relationship, and humanity at its most raw and honest. I don’t think I’ll ever get bored of that!
Tina Ziegenfusz has extensive experience supporting Brisbane women and families and has supported births in every maternity hospital in Brisbane, including the Mater Mother’s Hospital, Mater Private, and the RBWH and Birth Centre. For more information or to check out Tina’s Birth Support Packages or Birth Work Labour Preparation Classes visit: