One of the questions we often get is: "do I still need a doula if I am having a homebirth?"
Of course it can be argued that no one *needs* a doula in order to give birth in any setting. However, from personal experience and studies, we know that having a support person, especially a doula, reduces disparities and interventions, improves outcomes & client satisfaction, and eases transitioning into parenthood and bonding with baby. In our opinion, doulas are necessary and invaluable members of the birth team, regardless of where a person chooses to give birth or who they choose as their provider(s). We HIGHLY encourage all of our clients to have a doula as part of their birth team.
But aren't homebirth midwives supposed to be low-tech, high-touch providers? Why do I need the support & advocacy of a doula? Yes, it is true that most homebirth midwives have been trained to provide and practice using a more low-tech and high-touch model of care that is tailored to the needs of each individual client. One of the most cited reasons for hiring a homebirth midwife is that we practice in a way that supports client-centered decision-making, client autonomy, informed consent/refusal, and we spend time addressing the psychosocial and psychosexual aspects of pregnancy and birth, as well as getting to know our clients on a more personal and intimate level. While this is true, like doctors, midwives are not a monolith; some are better than others; and some are not as transparent with their practices -- some homebirth midwives do not like working with doulas or even say they ONLY work with certain ones -- we support our clients in having a doula of their choice. It is always a good idea to have a support person to help you remember questions you want to ask at appointments, help you find resources when researching options, and to help you process aspects of your care that you really like or think needs some improvement.
Doulas can be essential during those longer hours of early labour, especially for first time parents who do not have the prior experience of giving birth to help them know when it is time call their midwife to have them check on them or come and set up for the birth. Midwives do not typically labour-sit with their clients in early labour, because they are busy during this time squaring away everything else in their lives to ensure that their families are taken care of once they leave for a birth; they double check that their equipment and supplies are packed properly and ready to go; and they get the all important rest they need so that they are fresh and ready for when their expertise and quick decision-making skills are needed.
While midwives are generally warm and fuzzy humans who enjoy supporting their clients during birth, both verbally and physically, their main role is to ensure the safety of their client and client's baby. Having a doula or other support person who can fetch drinks and snacks, rub backs and feet, provide counter-pressure, and fill the birthing tub helps make sure a client is supported in all the ways possible and frees the midwife to focus on monitoring, charting, consulting (when/if necessary), and resting during longer labours. Doulas not only provide support for the client (and client's partner/s), but they indirectly provide support for the midwife!
If a complication or emergency occurs at a homebirth, doulas are essential in helping clients understand what is going on, helping clients remain calm, ensuring clients that everything is being addressed. If a situation occurs that requires the client to transport to the hospital via private car, the doula can help make sure the bag for the hospital (we encourage our clients to have a small bag packed just in case) gets in the car, sitters are called for older siblings (if necessary), and other friends/family at the birth understand whether they are to accompany the client or wait until they're called later. If a situation occurs that requires EMS to be called for assistance or in order to transport client or baby, the doula can continue providing emotional and physical support until help arrives, help explain the situation to other family/friends present at the birth, and in some cases, they may be the one to make the phone call (we provide a script to follow) to request help if the midwife and assistant are busy handling a serious complication like postpartum hemorrhage or resuscitating a newborn.
During the immediate postpartum period, the couple hours right after the birth of the baby, a doula can help arrange food for the new family and make sure the client is comfortable in bed, on the couch, or wherever they plan to nest for the next week or so. Doulas also are an extra set of hands and eyes to help with chest/breastfeeding, pumping, or mixing formula to help make sure baby is getting fed. Doulas can help tidy up the birth area, start laundry, let the dog back in (or out), and wake up older siblings. Some doulas like to help siblings and other family members celebrate by baking a cake or taking pictures as well (ask what services your doula offers). While the doula is loving on the new family, the midwife can focus on monitoring client and baby, charting, cleaning up the messy stuff, and give instructions for postpartum care.
There is definitely a place, many places in fact(!), for the doula at a homebirth. Doulas provide essential emotional, physical, and informational support for clients no matter who their provider is or where they give birth. Do not let your friends (or your midwife) tell you that you do not need a doula for your homebirth! If you do not know any doulas, your midwife should have some recommendations and a simple Google search of "doulas in [your city's name]" should get you some leads.
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Amethyst Midwitchery & Womancraft is putting together an informational #workshop (early Spring 2019) for birth doulas in #Pittsburgh who want to attend homebirths. In the meantime, if you are a doula and you have questions about homebirths, please send them to us.
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