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Doula Distinctions

During a recent evening out with two friends, our dinner conversation naturally progressed to the horrors of the labor and delivery process. (I should probably mention: Both my friends are pregnant.)

“Are either of you going to use a doula?” I asked expectantly.

They both looked at me like I was crazy. Apparently, neither of them had ever heard of a doula, much less considered using one.

Midway through my explanation, my friend Sam cut me off. “No, no,” she said. “I’m not looking to have a natural birth. I want medication.”

Many parents-to-be, like Sam, hear “doula” and imagine a woman with dreadlocks and a boho skirt railing against modern medicine. In fact, the hippie image is just one of many misconceptions about doulas. Since doulas have no medical training and aren’t regulated like doctors and nurses, it can be difficult to nail down what exactly they do.

“Doulas aren’t judging how you give birth,” says Maria Pokluda, doula and founder of Great Expectations Birth Services, a doula service that serves the Dallas-Fort Worth area. “We’re there to help you make choices to have the exact pregnancy and childbirth experience that you want. Ninety-five percent of the births I attend are in the hospital. I’m a doula in Ann Taylor.”

The term doula comes from ancient Greece and means “woman who serves.” Doulas do just that.

“Doulas provide educational, physical and emotional support for families having babies,” explains Abbey Robinson, doula and owner of Fort Worth Doulas. “Doula services are really customized for each client. Everyone has such a different type of birth or parenting they want to do. We help them achieve it.”

Since doula services are so individualized, there’s a large range in the type of help they provide to parents, everything from massage and encouragement during labor to grocery shopping and even light housecleaning after the baby is born.

“The world of doulas is an overwhelming and complicated profession,” Robinson says. “Since there’s no licensing, a doula can offer whatever type of service she wants. Most doulas are doing birth services — that’s what we’re known for — but there are many other types of doula services.”

A doula can specialize in just one area of service, or she may perform duties across several areas of service; for example, it wouldn’t be uncommon for a birth doula to also act as a postpartum doula. And there’s often overlap between the care provided by different types of doulas. Still, there are some general categories.

Birth doulas, the most common type, help a family through the labor and delivery process. A family often seeks the help of a birth doula because the parent or couple is looking for extra guidance.

“I wanted the support of someone who could help me manage the intensity of the contractions and provide encouragement,” says Dallas mom Allie Jensen, who used a doula during the birth of her first child in July. “I also wanted my husband to feel supported since we were both nervous about having our first child.”

The birth doula typically meets with the parents a few times before the birth to discuss the mother’s birth plan. When the big day arrives, the doula stays with Mom throughout labor and delivery — unlike like doctors and nurses, who come and go.

“Beyond providing physical comfort like back massage and helping with positioning during labor, it’s about talking to the mom and emotionally coaching her to help reduce anxiety,” Pokluda explains.

Emotional support is huge, since moms who feel in control during labor have better birth outcomes. A 2013 study in the Journal of Perinatal Education showed that moms who used doulas were two times less likely to have a birth complication and four times less likely to have a low birth weight baby.

“It’s also important for moms to have someone with them that’s familiar with the process of labor and with hospital policies,” Pokluda adds. “It’s like doulas know the secret menu at the hospitals.”

That means that when it comes to signing paperwork about the birth or making last-minute decisions, moms have someone who can translate a doctor’s medical lingo into plain English and help them make better-informed decisions.

When an expectant mom has a high-risk pregnancy and is confined to bed rest, she can hire an antepartum doula.

By shopping for groceries, preparing the house for the baby’s arrival and even providing child care for other kids in the home, an antepartum doula keeps the household running smoothly so Mom can stay in bed. The doula also keeps an eye out for the mom’s health and helps her distinguish between normal symptoms and any that warrant a call to the doctor.

“Antepartum doulas also help those expectant moms get into the right head space,” explains Melissa Espey-Mueller, doula and founder of North Dallas Doula Associates. “They sit and talk with the mom about all things birth and babies, offer massage and provide emotional support. If the mom is feeling overwhelmed, doulas can teach different breathing techniques and different meditations and mantras to help her keep calm.”

The second most common type of doula, a postpartum doula, offers support once the baby has arrived.

In addition to offering the same kind of around-the-house and child-care help that an antepartum doula provides, a postpartum doula works with Mom on breastfeeding techniques and establishing a sleep schedule for the new baby.

Crucially, postpartum doulas provide human connection during a time that can be very confusing and isolating for new moms.

“We help moms figure out what’s normal postpartum,” Robinson says. “It can be anything: What bleeding is normal, what an incision is supposed to look like, how to deal with constipation, how to start milk production, treatments for sore nipples. These are things nobody tells new moms about and figuring it out on your own can be really scary and lonely.”

Adoptions are accompanied by a storm of mixed emotions for both parties: It’s painful for the mom giving up her baby, while bringing home — and bonding with — a baby you have no biological relation to can be especially daunting for the adoptive parents. Adoption doulas specialize in providing help on either or both sides of an adoption. They can take on the role of birth doula for the biological mother during labor, explains Espey-Mueller. “Oftentimes, adoptions or surrogacy contracts include that an adoption doula must be present during labor.”

After baby comes home, an adoption doula can also perform the role of postpartum doula to help with typical household duties and support the adoptive parents as they familiarize themselves with their new bundle.

Women facing a stillbirth or miscarriage still have to go through the labor and delivery process, but they don’t have to go it alone, Espey-Mueller says. A loss or miscarriage doula provides the same type of physical support — and perhaps most important, emotional support — that a birth doula would.

“When women are going through any sort of emotional pain, the pain of labor is so much greater,” Espey-Mueller explains. “We’re there with them every second to try and lessen that pain.”

Similarly, bereavement doulas help families who’ve lost a baby.

“The role of a doula is to help a mom grieve for her baby, not to help her recover or let go of it,” Espey-Mueller says. “There’s doulas for every phase of life, for transitioning into it and transitioning out of it. It’s about allowing what’s natural and what’s normal to happen.”