Tips for Amateur Doulas

In July of 2002, I sent an email to my friend Lyn, with some suggestions on helping our other friend Laura have her first baby. Lor wanted to have a doula (actually, two, Lyn's husband Steve doula'ed, too), but she didn't want to hire a stranger. Lyn is not a doula by training, and had never before attended a birth, though she had done lots of reading on the subject. I had given birth to Adam by that time, and was VeryPregnant with Kayla. I didn't have a doula with either of my births, but I had read a great deal on the subject of birth, including some anecdotal stuff. I thought perhaps others in Lyn's position might benefit from the suggestions I made to her, so I decided to post them here. I have done some editing to remove extraneous comments that wouldn't be helpful to the general reader, and may add to this as time passes. Also, I have used terms like "father" and "Mom" to indicate the birth parents, but in no way do I mean to exclude or insult so-called "non-traditional" families; I do this just for usage's sake.

Incidentally, if you're curious, Lor's and John's baby Rosanna Lyn was born at about 3:30PM on July 22, 2002. She was 7 pounds 2 ounces, 20 inches long. Everyone involved said the experience was greatly enhanced by Lyn's and Steve's participation. Great job, all you guys! Oh, and the labor and delivery were completely pain-med-free! You can read Lyn's account online, as well as John's version.

Disclaimer: I am not a doctor, and nothing I say on this site is meant to be construed as medical advice. I encourage you to read about the subjects of birth, post-partum care, and nursing as much as you can in the time allowed before any expected births. This is only meant as a layman's impressions and suggestions. (Translation - DON'T SUE ME!!)

First of all, get a copy of their birth plan. This'll tell you in detail what they do and don't want to have happen. Once you have that, you can research specifics.

Your first job is to help them communicate their wishes to the staff. You may have to do some serious ass-kicking to make that happen. Talk to the birth parents especially about their wishes for pain meds. If the mother is like me, she'll want to try without, but won't rule out pain meds. If so, work out with her beforehand a way of distinguishing between (1) just-whining-about-pain "give me something for this", and (2) "no, really, give me something for this NOW". With Mike and I, our plan was that I'd say I wanted an epidural, and he'd ask if I was sure. If I said yes, I was sure, that was when he got me the epi. I know it sounds crazy, but it kinda feels good to be able to say the words "give me an epidural" without actually having to go through with it.

Other than communicating their wishes to the hospital, your job is to make the two of them more comfortable. I'll do the father first, since that'll be easiest.

If they're being induced, it could (probably will) be a long labor. MAKE SURE HE EATS. A dizzy daddy is no help. You might want to pack your own bag for the hospital, with spare change for the vending machines, a calling card (in case they forget theirs or ask you to make calls for them), a few semi-non-perishable snacks like nuts, dried fruit, grain bars. Pack a couple of candy bars in there, but keep in mind they're last-resort (sugar low BAD). Make sure he drinks. Water, especially, but he may want coffee or cola. If the labor starts slow (like most inductions) they'll be bored. They're probably packing their own distractions, but it wouldn't hurt for you to have a couple more. Magazines, books, simple games they can play together (bring a deck of cards). Find out whether they're bringing a CD player. If they are, find out what size batteries it takes and tuck a few extra in your bag. Remind the dad to go take breaks and walk around the hospital halls every couple hours or so to stretch his legs. If you can, visit the hospital beforehand, so you know where the important stuff is: bathrooms, vending machines, payphones, quiet rooms (if they have them), waiting areas. Oh, yeah, and labor/delivery and recovery. :) If the labor goes WAY long, he may get easily disoriented and you might have to remind him where one of these things is.

The Mom: Here's where some resources come in.

• Stages of Labor: Just read this.
• Labor Positions: My biggest peeve with most hospitals is they expect women to be flat on their backs ALL the time. Especially if they're induced. The ostensible excuse is fetal monitoring. There are insurance reasons they have to do this, and you probably won't get around them. But make sure the mom is free to get up and go pee whenever she wants to. If she's uncomfortable lying on her back, suggest to the nurse that she can labor on her knees or in some other position and you could still monitor the baby's heartbeat (especially if they've used a scalp-electrode fetal monitor (more on that later)) and she could get some relief. There are some alternative labor positions here.
• Massage: Easy - ask her what she thinks would feel good, be prepared for her to snap suddenly at you to stop. Skin gets hypersensitive in labor, especially transition, and what felt good 2 seconds ago can be unbearable now. One common request is to apply pressure to the lower back. Bring tennis balls.
• Breathing: One of the worst things to have happen during labor is for the mother to get scared and stop breathing or start hyperventilating. The laboring body needs an enormous amount of oxygen for it to work properly, and it's only too easy to forget to breathe (especially as labor progresses). Early in labor, try to get her to take deep breaths, in through the nose and out through the mouth. You might say things like "breathe in the calming air, breathe out the tension". If she can tolerate it, touch her so you can feel how deeply she's breathing. Mimic the kind of breathing she needs to do. When she enters harder labor, she may need to pant, but DON'T let her do this too much if she can avoid it; that's how you pass out. From transition on, getting her to take ANY air in should be counted as a major victory.
• Relaxation: She'll tense up. Remind her that her uterus has to tighten and contract, but the rest of her can remain limp and rested. The less energy she uses tensing facial, shoulder, leg, arm, and other muscles, the more there is available for the uterus to do its work. Talk to her ahead of time about things she finds soothing, and talk to her about them during contractions. That part you'll have to play by ear. Suggest to her that she prompt you to talk about whatever she wants to hear to help her relax (I often tell Mike to "say 'calm'" or to "tell me about the seagulls" or some other part of our pre-arranged "happy place"). There's some really good stuff on relaxation here.
• Hydration: Most big hospitals won't let you eat or drink anything during labor and delivery, but they may let you have ice chips. Find out what the policy is for the place you'll be using, then remind Mom from time to time to take a drink or suck on some ice chips. I wouldn't feel bad if you slipped her some water or apple juice when the nurses weren't looking; she needs to keep up her strength, especially if this is a long labor. Keep a cool damp washcloth handy to mop her face/head/neck in case she's a sweater. Bring lip balm in case she forgets it (all that breathing chaps them, seriously).
• Fetal Monitoring: Will almost certainly be a given. Both Cytotec and Pitocin, the 2 most common forms of inducing labor, cause the uterus to contract more forcefully and faster than normal. There are risks with both of them, so the hospital will monitor the baby's heartbeat and the force/frequency of the contractions through the entire delivery. They'll probably start with external monitors (little belts that wrap around the belly with monitoring pads that rest on the appropriate parts of the belly), but as labor progresses and the baby moves downward, that heartbeat gets harder and harder to find. They may want to use a fetal scalp electrode on the fetus. This is basically a flexible wand with a filament-thin corkscrew at the end. They twist the corkscrew into the top of the baby's head and monitor the heartbeat from there. It sounds barbaric, but they swear it doesn't hurt. We ended up needing one with Adam. Oh, one other thing: those external monitors move out of position (or the baby does) ALL THE TIME. You will spend a LOT of time chasing the baby with the fetal monitor, or calling in a nurse to do it if you're not able.
• Delivery: There will obviously be a lot of people in the room by the time you reach pushing (or, God forbid, C-section - find out if she wants you in the room for a C, by the way), but Mom probably won't be aware of all of them. See, your "field of focus" narrows as labor progresses, and by the time it's time to push, you're really only able to clearly see and hear people who are within a couple of feet of you, so be prepared to get right in her face to talk to her. You don't have to scream, you just have to be near. Find out beforehand how she wants to push. Does she want people to count for her? Does she want to count in her head? Is she bothered by the thought of lots of people counting in stereo at her? Assert her wishes for her at the crucial moment, because she won't be able to. Pushing typically goes like this: wait for a contraction. As it starts to build, take a deep breath in and blow it out. Take another deep breath in, hold it, press your chin to your chest, and bear down. She may have a hard time knowing how to push, especially if she's had an epidural. It's very much like pushing to have a bowel movement. Try telling her to "push against the pressure" or "push through the pain" or "push down, through her bottom". It will make sense to her at the time. She needs to push as long as she's comfortable, but for no longer than 10 seconds at a time. She then needs to blow that air out and take another deep breath, chin to chest, and push again. Usually you can get 3-4 pushes from each contraction. She should NOT try to push between contractions, and if she wants a break it's ok to skip a contraction or two. Some docs may forget this, the assholes. Above all - make sure she BREATHES. She may or may not need supplementary oxygen.

Other Resources:
How to Support a Laboring Woman FAQ
Some Book Recommendations for Doulas (bottom of the page)
Dr. & Martha Sears' The Birth Book (but disregard all the "doulas MUST be a mother" crap)