Hit Me Up: The Fluid Role of a Doula

“Hit Me Up” is the humble space in which I take a stab at answering the questions I receive most often about my holy work as a birth doula.

The cool thing is, I’m constantly learning that there’s always something to learn.  I hope to be a forever student of Birth.  I am not going to tell you how I “think” a woman should birth, or where they should birth, or that my experience makes me any kind of expert.

{How can someone be an expert in something as mysterious and beautifully unpredictable as birth?}

And I love to hear from other birth doulas, so please add your advice and wisdom in the comments.


Q:  Does your role as a doula differ depending on the manner/setting of birth? For example, do you find you role changes if you are attending a birth in a hospital vs. at home?  Or if you are serving a woman with an epidural vs. an unmedicated woman or one birthing via C-section?

A:  This is a great question that I likely won’t be able to answer succinctly in just one post.  But I’ll try my best to summarize.  

The short answer can be summed up in a sweet little borrowed mantra I haven tucked away in my heart:

{I am operating in my highest good}

Operating in my highest good means I’ve left any of my personal agendas at home and have stepped into THIS birth space as a fresh witness.  I am a blank canvas, a tabula rasa, a newborn in this thing called Doula.   It means I make conscious efforts to notice my own words, expressions, breath, and body language.  It means staying in the moment even when it is enticing to think soley in terms of outcomes.

{I am not always successful at this}

I’ve come to learn that my role as a doula is fluid. The shifts and changes it undergoes has more to do with the energy of the birthing space rather than the manner and setting of birth.

I also have come across some false notions of a doula’s role based on setting (i.e. home, hospital, birthing center), including that a doula does “less work” at a home birth or that serving a woman in a hospital is always grueling and challenging.

Obviously, this simply isn’t true.   Just as birth is unpredictable, so is my job and requirements as a doula.   I am hired to tune-in to a woman’s needs by listening with body and heart.   I am hired to stand by her no matter what course birth takes.  I am hired to be an authentic and trustworthy witness.

But sometimes, all fancy descriptions aside, I end up just performing the beautiful “grunt work” of birth.  Yes, sometimes at a birth, the only “real work” I seem to do is offer a woman sips of fluid, snap photographs, smile, and wipe her brow with a cool washcloth.

The Setting of Birth

Some of my longest and most complicated births have been home births.   Conversely, some of my smoothest births have been in hospitals.

I’ve been at home births were the healthy and happy baby has arrived before either myself or the midwife.  I’ve attended hospital births that have lasted three days and have included every intervention possible.

I’ve had to muddle through thick and difficult energy at hospitals births as well as home births.   I’ve had the pleasure of having one baby slip into my own hands in the birth tub at home and have witnessed numerous nurse-caught babies in the hospital.

I’ve held the hands of women moaning in both ecstasy and pain in all settings;  watched them cross the threshold of motherhood with indelible courage;  talked women through the angst of Transition; and have felt the need to take on a “protector” role in all settings.

There are, of course, some givens about a doula’s role in certain instances.   For example:  There are certain protocol that patients face in a hospital and that doulas need to understand and respect.  One instance is that a doula may be separated from her client when she is in Triage or if she ends up choosing a C-section.   Knowing this beforehand is important and there are tricks to helping her “stay in her bubble” in both situations.

A doula may have to call on a handful of tools of the trade to barter for more time and/or options for a woman birthing in a hospital.   She may have to get creative, think on her feet, and work diligently to create a quick and genuine relationship of trust with the hospital staff.

From a logistics standpoint, hospitals births can sometimes be more physically wearing, as the accommodations are obviously not as comfortable (I’ve taken many a nap on a hospital sheet spread out on the floor).  Cafeterias may be closed, a wheeled-stool may be your only seat, and going out for a breath of fresh air may require a hike.

At a home birth, extra care sometimes needs to be taken to balance the timing of when to call on a client’s additional support team (i.e. midwife, apprentice, family, etc).  In my personal practice, I always remind a woman during our prenatal appointments that – barring emergent situations – I will never tell her when she needs to make these calls.  I trust a woman’s intuition and deep knowing and respect her boundaries.   I have found that women generally know exactly when to make that call.

That said, sometimes women are “feeling” the need for additional support and love but I can tell are having an internal battle expressing that need.   This is where that delicate balance comes into play;  how do you gently draw out this request from a woman without interrupting her birth-flow and flat-out saying “Do you think it’s time to call the midwife?”.

(On a side note, I also wholly respect a midwife’s role and any personal relationship we’ve forged.  That means this delicate balance sometimes becomes even more layered, as I never want to offend a midwife’s valuable skills and services).

The Manner of Birth

Sometimes women who choose an epidural need even more hands-on support than a woman birthing naturally.     I spend a lot of time massaging arms and legs, helping to reposition a woman from side to side, changing out sheets, positioning pillows, constantly monitoring a woman’s level of comfort with her medication, discussing next steps and options, and navigating conversation that usually isn’t present with a woman who is birthing without medication.

On the flip side (isn’t there always one?), for women birthing naturally I’ve applied counter pressure for hours at a time while my forearms shook, reheated a rice sock dozens of times during her labor, climbed in birth pools, supported her weight during squats and “dangles”, prepared smoothies, drove to buy wine and Tylenol PM, followed her around wiping up leaking amniotic fluid and blood, woke up every two minutes from a nap to moan with her, given her partner a shoulder massage, walked through parks doing lunges with her, babysat her kids, managed the concerns and advice of family members, and climbed stairs over and over with her.

The Flow of Energy in Birthwork

I know I’ve rambled, but my point is:  Doula work isn’t predictable work.   Like the shifting tides of the ocean and the MotherSea, a doula’s servitude ebbs and flows.  It is energy work and thus a continual lesson in listening, honing, and trusting.

{I am a constant student of birth}

Often my roles changes numerous times throughout labor based on the roles of a woman’s other support people (partner, doctor/midwife, friends, family).   I can jump in with a hands-on approach when her partner needs a break.  I can sit on my hands and step away when it’s apparent a woman needs her space.  I can become a sounding board when a couple needs to bounce thoughts or insights off of someone.   I can be the quiet voice whispering in her ear during every contraction.  I can be the nodding of the head while sitting cross-legged in the corner.  I can set up and drain the birth pool, I can hold a trash can while she vomits and then brush her hair, I can hold her leg while she pushes, I can man the video camera, and help make the room smell lovely and inviting with oils and candles.

If a birth involves an unplanned change of course, I can be the one putting my forehead to hers as she cries.  I can be on watch over her husband to make sure he doesn’t pass out when the epidural is placed.  I can help gather her clothes and a bag as she prepares to unexpectedly transfer to a hospital.  I can rub lavender onto her temples and wrists as she is wheeled into the operating room.

As a doula, I feel I am most useful when I welcome the tides of birth.  It is then that I settle into a rhythm – even if just momentary – that feels most present and loving.

“Love the moment, and the energy of that moment will spread beyond all boundaries.” Corita Kent


Sharing the Holy Work…

  • Is there a particular setting or time when you (as a doula) feel most useful?
  • Tell us about one of your most challenging roles as a doula.
  • How do you personally manage the tide of birth work?

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