Women’s bodies are amazing; the process of birth is incredible.
Tabaré Depaep
Doula | doulablebirth.com
My best friend became a doula after she accidentally attended my labor — not the birth but the laboring at home. She just found out that I was in labor and said “Can I come over and take care of you?” At my hospital there was a rule: only two people in the room — my husband and my doula and that was it. So my best friend got kicked out and she was sad because she’d labored with me for a long time and wanted to see the baby born and because she’s interested in birth. She went and took the doula training and then for a year was telling me all her birth stories. She would tell me a story and say “Now, the doctor did this,” or “The nurse told her she had to do that, does she have to? Does she have any rights?” And so the lawyer brain fired up and even though I was at home with my son, I would say “No, you have the right to bodily autonomy, they can’t force you into a caesarean; they can’t force you to get an IV or have a test or a procedure or a drug.” Joanie would march back out into the birth world, armed with the information that “You can say no! Or not right now.”
She invited me to a breastfeeding training because I was already helping all my other girlfriends breastfeed, being a natural helper — lawyers are helpers if you think about it, people only come to us when there’s a problem, so we’re problem solvers. Every woman in the room was a doula, telling their stories and some of them were horrifying, what we would call birth rape, where the doctor’s doing something that a mom doesn’t want and is screaming “No, please don’t cut me” and they’re doing it anyway. So my lawyer brain got really upset, my feminist brain got enraged, and I thought, “Oh my gosh, there’s so much work to be done with this population to empower them and to help them have a better experience, to educate them about what’s this process like.”
I went and took my doula training the very next month, and I never looked back at my lawyering career, which had always been with families. Child abuse and neglect is working with families; they’re broken and dysfunctional families, but they’re still families. And the kids still love them. 95% of the time, my clients just wanted to go home and be back with their parents. I’m still just working with families. Another high-stress, very important time in their lives, crossing over from being expecting parents to parenting.
What I do with couples is try to make sure that they are prepared for the hospital venue, have an inkling of how childbirth works, and a very good sense of what are the physical signs of progress in labor. I negotiate with staff for what they want, trying to help find out what’s possible. I help with physical comfort measures, I give moms massage, I suggest position changes to get into, I remind them to use the toilet and to get onto the shower and to go walking and to lay on a birth ball. I take notes of what happened when so they have a little birth story, so they don’t have to try to remember details of doctors’ names and the third nurse that they saw and so I write all that down for them. I’m doing anything the mom asks for, lots of things she doesn’t know to ask for that I have observed are useful for moms. Trying to control her environment to keep it conducive to feeling relaxed and confident and comfortable and private. This requires talking a lot beforehand with the couple about what they want and what they’re afraid of, so that I can try to manage that.
I have a little kit and anything I ever thought would be useful in a birth, I bring it with me. So, that’s shower caps so the mom can get in the shower at the hospital and not wet her hair. It’s massage tools, it’s heat blankets that I can plug in so mom can get extra warm. Shaving kits for dads who forget theirs, so in their photos they don’t have the two-day stubble. Ear plugs and face masks for mom and dad so they can get some sleep because the hospital has beeping and lights on every instrument that’s in there. The good puke bags: because puking is a normal part of labor for some women. The good puke bags have expandable bottoms so that mom can be lying on her side and still puke into it. Honey sticks for quick energy… oh, you name it. It’s a big wheely cart and my clients call it my Mary Poppins bag because you never know what’s going to pop out of it! Thank you notes for the staff, where I write each person’s name and what they did for mom so that she can write the note to them. I’ve brought affirmations for mom, sometimes they’re specific to mom, sometimes they’re just general ones like “You can do this.” If there was a message that mom told me was particularly meaningful to her, I’ve made little hang-tag affirmations for her to put in the room so she can look at it. Teas of every variety, so that we can have some nice tea in the hospital. I bring all kinds of stuff. It’s a big bag.
Some of my job is managing the nurses and doctors, making friends with people who may never have met the client. And we certainly never met the nurses before… I may have, because I recycle back to the same hospitals a lot since it’s kind of a local job, but mom won’t have met them. Helping them make friends and helping the nursing staff know what mom wants and what she doesn’t. What she’s hoping for, right? Everyone’s hoping for something on birthing day: an epidural. Not an epidural. Avoid a C-section. Don’t let my mother-in-law in the room. There’s a list each woman has and finding out what that is and working to make it happen. If that means I have to text the mother-in-law every hour on the hour, scheduled, so that she knows she’s getting current updates so that she’ll stay at home longer and not come and sit in the waiting room, stressing mom out, that people are waiting for her to finish the job. Because that can be really stressful for a mom. So, you gotta find out what mom is worried about.
Not everybody gets what they wanted out of the birth. They asked for an epidural when they had hoped not to, they get a caesarean that they were hoping to avoid, the baby’s not breastfeeding the way they wanted. I have to prepare mom for the birth she wants and reconcile her to the birth she gets.
I do a postpartum visit once they get transferred home and I help with breastfeeding at home. And then I tell them “Now you have to go off into the sunset and parent.” I have to shift my attention to the next due mom.
I tend to attract, because of my online profile, moms who are a little bit skeptical about western medicine and would like to try other things first. But I also say on my website that I’m super open to whatever mom wants. I’m a feminist, you get to choose, you pick what’s right for you. The vast majority of my clients are giving birth in hospital and appreciate my lawyer brain for the strength that it has, but also appreciate my hippy upbringing since I grew up — true story — in a commune. Downtown L.A., of all places! There was a student activist group, Students for Democratic Society. They had chapters in a lot of colleges across the country and they were fomenting and agitating against the Vietnam War. The students at the University of Southern California had a chapter and they had a big Victorian house with a 30-year mortgage that made it very affordable to live with lots and lots of people in one house. And then they all started taking drugs and dropping out of school, so they lost their charter but they still had a 30-year mortgage on a huge house and they just turned it into a commune. That’s where my mom landed with me as a single mom in 1975; that’s where I grew up. Crystals, gongs, meditation, affirmations, people were taking est classes [Erhard Seminars Training], all kinds of self-realization, actualization. You name it, the people in the commune were trying it. Home births, midwives, unassisted births were normal.
When we got pregnant, my husband and I, he said “Great, this is wonderful, we have to find a doctor,” and I was like “Great, this is wonderful, we have to find a midwife.” And he had no idea what that was! No clue. He said, “I don’t know anybody that’s given birth with a midwife.” And I was like “I don’t know anybody that’s given birth in a hospital! How do you do that, what is that?” So we compromised and we got a doula.
A midwife is a medical care provider who’s authorized to catch your baby. There’s certified nurse midwives who do it inside hospitals who started off as nurses and did an additional training for midwifery. There’s certified practicing midwives who get their certification by apprenticing and taking a national certification, or licensed practicing midwives who go to school and finish their certification with the test. Everybody has a different path, but they are medical care providers… doulas are not. I don’t have any medical training whatsoever. The doula training doesn’t include medical stuff, it’s childbirth ed and breastfeeding support. The rest of what I’ve learned I’ve picked up from nurses and doctors and midwives on the job or from my reading.
If you’re going to be good at it, I think you have to be flexible. Because I don’t think having your own idea of how a woman should birth… I mean, that’s so anti-feminist as to be ridiculous — how she “should” handle her body. I’d like to see someone tell me how I should handle my body. Not wise. Schedule and induction, don’t schedule an induction; get an epidural, don’t get an epidural; say yes to Pitocin or no to Pitocin… these are decisions that only mom is uniquely positioned to make. She needs a lot of information, but the secret is every mom is making the best decision she can with the available information at the time. Once you truly believe that, then of course the epidural is the right idea, of course a caesarean was the right plan, of course you should have said yes to the induction or said no to the induction or waited until you were a week overdue or whatever. That idea that if you were in their shoes you would have done the same thing because you’d be them. So, believing that I would have done the same thing if I was you. Because I would have been thinking about it the way you think about it and I would have been experiencing it the way you’re experiencing it, and so then of course your decision is eminently reasonable.
Life on-call is really hard. You may book a client who’s due in April and she gives birth at the end of February, and even though your contract says you have an on-call window, you would still have to pay a back-up to go to her birth because she’s your client. So if you’re available, you better go, because you don’t want to lose your fee to someone else. We have a lot of people who are excited and interested after giving birth themselves, and then they realize that life on call just does not fit well with having a young family. That is the hardest: 100%, hands down, by far and away from any other part of it is the on-call part. When I get called to a birth, it could be a 29-week pregnant mom or she’s 43 weeks along and finally getting induced and I have no idea when I’m going to be home. It could take us two days. My longest birth was 42 consecutive hours. I got two naps at mom’s house because it was a birth center birth so we were at her home for the vast majority of the time but it was just a really big-headed baby and it took her that long to get the baby out and to stretch around him. It is not for the people who can’t stay focused in serving someone else for that long. Just putting your own needs second, and your family’s needs not at all.
I’ve done lesbian couples, I’ve done a surrogacy – a lesbian couple for a gay couple. Super cool. I’ve done single moms, total accident pregnancies; I’ve done single moms who did IVF because they’re like “I need the baby, I never found the man; I’m just going to do this myself.” I’ve done teenagers. For training, when I was starting out and you take any birth you can get your hands on and you work with agencies that will provide doulas for free… did some teenagers, VBACs – vaginal births after caesarean, water births, home births, birth center births, lots of hospital births. Epidurals, inductions, caesarean. I’ve seen a lot.
I’m like a tour guide to the land of birth. Which land are we going to go to? Vaginal Land or Caesarean Land? How fast are we going to get there? It could be a precipitous birth, three hours or less, or it could be this 42-hour extravaganza. Will my doctor be on call the night I go into labor? Will I like my nurse, will she like me? I don’t know, but my job is to try to make friends. Yeah, it’s a cool job. It’s totally feminist. My lesbian feminist mom would be very happy. She was not alive to see me turn into a doula.
Who’s got the most interesting job in the room? I win! I have great stories. I’m fun at a cocktail party. Sometimes I think I cross a line about how much information people want about how birth really is. Accidentally. I didn’t know they didn’t know blood was involved or something, but for the most part my stories are pretty well received. I think it’s interesting to talk about birth and other people usually join in on my enthusiasm for it. I think it’s a really neat process. Women’s bodies are amazing; the process of birth is incredible. When you explain how it all works together, people get excited about it, too. I think my enthusiasm is infectious.