Doulas are great for any birth, even if there are epidurals and medication involved

March 21 | Guest post by Sarah Day

We asked Sarah, Offbeat Tribe moderator and certified doula to weigh in on this question…

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Photo by Marina Johnson.
I'm 21 weeks pregnant with our first child, and have been really thinking about having a doula. My husband is wonderful, but totally introverted. He won't be able to be much of a liaison with any medical personnel when we're actually laboring, and frankly, God love him, I doubt his stamina if things get long and drawn out. I have no close girlfriends nearby — at least not anyone I'd want in the delivery room — and my family is all out of state, too.

The catch? I'm not planning to give birth without medication. If I'm managing the pain well and it happens that way, great, but I'm totally pro-epidural. My draw toward a doula is more for emotional support backup. But is it even worth it to have a doula if you don't really need them for medication-free-birth advocacy? That's all I ever really hear about them doing. — Rebecca

First of all, YOU BET you can have a doula at your hospital birth. Doulas handle hospital births just like they handle homebirths, water births, birthing center births, accidental births that happen when you're driving with your pregnant best friend to go mini-golfing and have to call 911 from the side of the road… you get the picture.

The skills and mindset your average doula brings to a birth are going to be useful regardless of where you end up delivering. A doula can provide emotional support, be an extra pair of hands, or just be a listening ear during the rigors of labor. I understand your concerns about hiring a professional from a fairly crunchy field for your medicalized birth, and here's the thing:

Many doulas, myself included, have opinions about the benefits and risks of medical and non-medical birth. Some of them may have opinions about your choice to deliver in a hospital. And you know what? It's really not their place to judge how you choose to experience your birth, because it's your birth.

You don't need to defend your choices to anyone. A good doula will want to empower you to make healthy, well-educated decisions with which you're comfortable, period. Her entire job is to support you through your birth experience. It shouldn't matter where that experience takes place or what interventions are involved.

One thing it's worth noting is that a doula is not a medical professional. She can present your birth plan to your doctors and nurses, and she can remind them of your specific desires for the birth, but she cannot advocate for you on a medical level — that is to say, she cannot determine when and how you get medication, or whether certain interventions and treatments are necessary. She can advocate for you and be your voice when you're in the depths of your labor, but she can't make medical decisions about your care. Only you and your doctors can do that.

Regarding your concerns about your husband's experience, I think hiring a doula would be a great way to make him feel more at ease and capable during your birth. Plenty of new moms worry that their partners are going to freak out during labor, and studies have shown that not just mothers, but parents have more positive childbirth and postpartum experiences when they hire a doula. Offbeat Mama also recently talked about how doulas are there to support you AND your partner.

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  1. I'm due in mid June with our first baby and we just hired a doula. We are planning to do have our baby at a birth center but our Doula talked extensively about how she worked both in hospitals, home births and birth centers.

    We personally chose to have a doula-not to bypass my husband but to make him more comfortable. We felt our doula would empower him and guide him in certain aspects of the labor. It is important to me to have him involved and engaged.

    39 agree
    • This is exactly why we had a doula. My husband is an amazing supporter (I actually found out how amazing he can be during my birth), but it really helped to have another person whose job it was to be a liason between us and hospital staff. (We didn't intend on birthing in a hospital, but at 42+1 weeks it is illegal to birth in a birth center in my state, so I had to be induced. Knowing what I know now, I would opt to do a home birth with a different midwife, but that's a different story.)

      We actually had a male doula, which was fabulous for my husband, and for myself, because there were SO many women. While I absolutely could've done the birth without him (the doula), he freed up my husband to be able to just support me and not have to worry about my "birth plan" (ha!). I'm super happy with my choice to have a doula, and I'd do(ula) it again in a heartbeat. (see what I did there?)

      4 agree
  2. I planned for an all-natural birth, but ended up with pre-eclampsia and a c-section. I'm still glad we had a doula though. She was a great support through two weeks of failed inductions and although she missed the c-section because it happened fairly suddenly, I was really glad to just know she was on my team. She ended up on the phone with my husband a few times when I had complications after the delivery and I think she really helped him through it. It was also great to have her around to ask questions of through the pregnancy and afterward for breastfeeding support.

    3 agree
  3. My doula was a great addition to my hospital birth team! She held the showerhead to my belly for 4 hours during early labour, held my hands while my epidural shunt was put in place (I hate needles), explained why I was shivering uncontrollably during transition, called for the squat bar when I was ready to push, helped me change positions, held a flashlight for my OB so we could keep the overhead lights dim, and yelled "Mandy! LOOK DOWN!" when I (exhaustedly) gave my final push so I could watch my baby being born.
    I was leaning to an unmedicated birth, but opted for the epidural during my labour. I felt guilty keeping my doula and tried to send her home, but she was like "Trust me, there's a lot of stuff about to happen that you want me for." and she was right. A nice bonus is that after the birth she was able to give me a play by play of the whole thing, and told me about stuff that I didn't realize happened, or had forgotten about right away.

    4 agree
  4. I had an epidural and a doula! I had a drawn out induction, and after being in labor 24 hours, and not sleeping overnight, she actually encouraged me to get the epidural so I could get some rest. The reasoning was that if I could get a few hours sleep, I'd be more likely to be up to deliver vaginally. My doc at the time was counting the hours until a c-section, and getting that bit of rest gave me the energy to bring our daughter into the world on my terms. She also made my husband take a nap at the same time because he'd been up with me the whole night too.

    Overall she was a calming presence in what would otherwise have been a very tense atmosphere. Even though all natural didn't even come close to happening, it was still worth every penny to have her with us. I'm pregnant with our second child now and there is no way I'd even consider going without a doula, the experience was that positive for me.

    2 agree
  5. i just hired a doula today actually! i'm due in just about a month and after hemming and hawing over it, figured why NOT have an extra support person? i'm hoping to have a natural birth but recognize that birth plans can change quickly. the doula i've chosen understands that and it's one of the reasons i felt comfortable hiring her. i already feel more at ease about my upcoming labor and delivery just knowing that my partner and i will have an extra person on our side at the hospital.

    2 agree
  6. Oh my gosh, yes! I hired a doula even though I knew the chances were high that I was going to have a highly medicalized birth thanks to carrying twins. And in fact I ended up with a C-section. But my doula helped *so much* with navigating the hospital procedures and preparing me for what to expect — and her support around nursing afterwards was invaluable too. Just having someone whose sole job was to support and advocate for me during birth was huge. The rest of my family had enough to worry about! I think they appreciated having someone who could explain what was going on hospital-wise very helpful, too.

    2 agree
  7. While I planned on having a natural hypnobirth, this was not the main reason I hired a doula. I wanted to have some back up help – for myself and my husband. This proved to be incredibly good planning as my labor lasted over three days and both of us needed the extra support, being so tired, especially near the end.
    Being my first delivery, I found our doula helped us be aware of all of our options (natural and medical), which the hospitals old school on call doctor did not do. We met with her several times before the delivery to practice breathing and relaxation techniques, which along with her peaceful presence, made the majority of the experience a calm one. And once I got to the point where the back labour was too much, she helped me let go of the guilt I associated with getting a epidural, which made it possible for me to rest and have the strength to push enough to avoid a c-section. Little things along the way – running a bath and checking that the water was the right temperature, rubbing my back, sneaking me little bits of food when the I was in active labour but SO hungry, letting my husband nap – made such a difference. And unlike a lot of women who go into giving birth afraid of what was going to happen, she helped me feel confident that I could do what other women have been doing since the beginning of time. She also helped empower my husband and made him feel like he was an integral part of the experience.
    One suggestion: definitely interview several doulas to make sure you feel comfortable with the person you choose and that you share the same philosophy. Our doula was trained in hypnobirthing, but was also open to certain medical interventions that we were considering as possible options.

    1 agrees
    • I totally agree 100% about interviewing SEVERAL doulas. Listen to your gut feeling! I interviewed two and when the time came, my doula had to call a back-up. Her back-up doula ended up being the right person for me. In retrospect, the original doula rubbed me the wrong way and I ignored that little voice telling me it wasn't a good fit. Listen to that voice!

      • We interviewed both the back-up and our recommended Doula. We fell in love with both and it was a very hard choice. But it's great to meet your Doula's backup.

  8. What a fantastic piece! I had a home birth and our midwives required you to hire a doula/birth assistant. She was my rock and I recommend hiring a doula to ALL my pregnant friends. We had to transfer to the hospital (after my daughter was born) because she had Meconium aspiration syndrome and I was close to having a 4th degree tear. So, our family was able to experience both environments. I think a doula would be essential in a hospital setting…with or without an epidural. Wishing you a smooth ride for the remainder of your pregnancy and beyond!

  9. Sorry that I have nothing to add to the topic, but can we refrain from referring to certain births as "natural"? Just because you are pro-epidural doesn't mean your birth is less natural! That word is so loaded (and judgmental of women's choices). Doulas for all!

    4 agree
    • I just wanted to point out that while this is an opinion we both share and something we try to be very conscious of on Offbeat Mama, I also don't think it's particularly useful to ask people to alter how they choose to describe different births in comments. I've changed the original post to reflect this (removed mentions of "natural" that I missed the first time).

      I also don't think any comments are meant in a judgmental way. I think bringing this up is legitimate and fair, but it needs to be recognized that "natural birth" has been used so frequently and for so long that it's hard to shake. πŸ™‚

      1 agrees
      • I know it's an opinion shared and expressed on OBM and didn't mean to criticize. I just wanted to assure the original poster that her birth choice was as legitimately natural as anyone else's!

        • Totally understood & awesome. I left my comment partially for you, but more for anyone else who might happen to have had the same thought but either not have read the original post here about the idea, or think that we didn't notice/don't care. Because we do! πŸ™‚

    • The question is mine originally, and I totally agree with your sentiments. My bad on the use of the term "natural birth." I feel the same way you do, that all choices are valid and natural as far as birth in concerned…I just wasn't thinking when I used the colloquial expression for drug-free! πŸ™‚ Thanks for pointing it out!

  10. Just echoing that the right doula will not judge you for choosing to have an epidural. A doula's job is to support you in having a positive birth experience. That means that if you want an epidural, if you think that will help you have a positive birth experience, she should be on board.

    The benefit of hiring a doula, *especially* for a hospital birth, and *especially* if you want to have an epidural, or even if you don't and things move that way anyway, is that she knows her way around the hospital. She knows how to help keep an epidural from cascading into a c-section (all other things going well, and your wishes/desires depending). She probably knows whether this particular hospital will let you do x, y or z with an epidural, and if they won't, how to work with that.

    Congratulations on your impending arrival!

    1 agrees
  11. Thank you SO MUCH everyone on the input! I feel so much better knowing that a doula is a valid and helpful person to have around at a hospital birth — because what people have been talking about are exactly the reasons I want to have a doula around in the first place. I so appreciate everyone sharing their experiences!

    1 agrees
  12. *raises hand* Another one here who had both a doula and an epidural. I didn't plan an epi but was not opposed either, and we kept our birth plan pretty loose. Our doula was really helpful pre-labor in helping us learn about the different kinds of meds (analgesics, epidural, etc) and making sure I was making an informed choice. She also came over while I was laboring at home while my husband ran to work to fill out paperwork for his leave. She was the "other" person helping me physically as I struggled through back labor, including getting me into and then quickly out of the tub (did NOT work for me) and later positioning me for the epi. During the pushing stage she was on one side holding one leg and my husband was on the other, and she already knew what kind of encouragement I did or did not want. Keep in mind that I was adamant that I did not want anyone (family, friends, etc) in the delivery room except for my husband and the doula, so that extra hand was especially important. And when my hubby needed a moment to step away from the intensity, she stayed with me in case I needed anything.

    I would also add to make sure you and your doula are aware of any rules the hospital has regarding what she is allowed to say or ask for on your behalf. As with everything, it's good to know going in what is expected.

    Good luck with your birth!

  13. I had a doula and a c-section. It ended up that my twins weren't going to come out vaginally because baby A was breech so my doula said she was going to make this the best c-section possible (supporting me with whatever ways were in her power). I was so glad I had a doula. Yes, do make sure your doula is comfortable with the hospital and is not judgy about using an epidural but finding the right one will be helpful if your nurses / doctor don't fully explain things, the doula can guide you to ask more questions, explain the same thing the doctor said in lay words, etc. The main benefit for me with a doula was not being alone in the operating room. Only one support person was allowed but when my husband left with the babies to the nursery, my doula came in and talked to me and held my hand while they stitched me up. And while I was in recovery my husband sent photos of the babies to her phone for her to show me so I didn't feel like I was missing out those first moments in the nursery.

  14. *raises hand* Doula and soon to be student midwife here. Doulas are good for any woman. Even women who have family out the wazoo near her, a doula can still help. At the end of the day, all of your family and friends are there to support you, but they are also there to have the experience of watching (or being in the general facility of) your child being born. A doulas only focus is the woman, nothing else. Doulas give the dads a break to go to the bathroom or get something to eat or when it gets tough, to step in when he can't. They are there to support any decision you make and to give you information when you desire. Even women who decide to go the medication route, having a doula will significantly reduce your chance of having a cesarean section. And then when all is done and your family is drooling over the new baby, your doula will make sure YOU are ok (emotion wise, or if you are hurting then the doula will inform the proper medical professional). Some even specialize in lactation support.

    You can never go wrong with having a doula πŸ™‚

    1 agrees
  15. I'm a doula as well! And I'm going to chime in with Jennifer!

    Doulas do not give opinions!

    We are here for the mamas and to give them support in *their* labor.

    A Doula for *every* mama!

    2 agree
  16. I had a doula and a drug-free birth in a hospital, but I think my doula would have been just as useful had I had meds! In fact, we took a birth prep class from her with another couple, and the other mom went with an epidural and still felt the doula was totally worthwhile. (The doula also had nothing but great things to say about that birth when she told me about it, so it wasn't like she was silently judging the mom for using an epidural or anything.) My husband had fears about his own ability to support me during birth. He turned out to be great, but he and the doula had very different roles in my birth, and having them both there was wonderful. They could also tag team during my 20 hour labor… I never even knew that my husband spent some of my labor watching TV in the hallway. πŸ™‚

    One of the best things about having a doula was that she had been at more than a hundred births already and was able to help me see signs of progress during a process that would otherwise have been quite depressing. For example, when I had to throw up part way through my labor, my own inexperienced head might have played stories about pre-eclampsia or whatever worst case scenario nausea could mean. My doula's response? "GREAT!! That's a wonderful sign!" She was right πŸ™‚

  17. I'm glad for all of this feedback, because while I'm not currently pregnant, I am quite worried about the pressure my SO will feel when that day eventually comes as he's been quite nervous when I've been in the hospital before. Also, he's not that great with blood πŸ™‚

  18. We had a doula for our hospital birth last year and while she is a wonderful person I feel it was kind of a waste of money and an exercise in frustration ultimately. When interviewing her I got the sense she was not really ok with most medical interventions, especially the epidural. My bad for ignoring that sense and not questioning it further because when it came time for the birth, which I was hoping would be "natural" but in reality was riddled with complications and interventions, I felt an unspoken sense of bias (and some judgement) in the room. My advice is to interview very thoroughly and go with your gut on any feelings for or against the ladies you interview before choosing! Also, I had my sister and best friend there as well and found they were better able to be advocates for me because they know me thoroughly and because unlike a doula they could speak to medical staff, question them, etc. They both came from a distance so it was hard to coordinate their arrivals but so worth it in the end. I love doulas and their place in the birth community but personally would not have hired one were I to do it all over again.

  19. Really excited to see this post. Yay doulas! I am one as well, and I would never judge a pregnant person's choice of birthing options. You have to make the right choice for you and your family.

  20. Hi i had a doula and knew i was getting an epidural. i went into labor at midnight and met up with my doula at 8 am along with my epidural. as the day progressed she helped my husband me and family while i labored and slept most of the day. around 8pm i had stopped progressing and she helped us discuss options and i ended up in a csection but it was very helpful having her there the entire time and she was a huge help after with breastfeeding and learning about my "new" body.

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