The Doula’s Role
Editor’s note: This article first appeared in Midwifery Today, Issue 125, Spring 2018.
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I believe that doulas need to have some preparation for handling emergency clinical situations: not to take them on, but to be ready in case of an emergency. This is a somewhat unpopular view. However, doulas can never know what kind of situation they may find themselves in. For example, you may be the first to arrive at a homebirth, when the midwife gets a flat tire or, for some other reason, does not arrive in time for the birth.
Another thing to keep in mind is that if you are a doula at an unassisted birth you are the basically taking on a midwife’s role. This is a dangerous position to put yourself and your profession in. It is important to respect your boundaries and those of the profession. If you want to take on births, become a midwife.
I do believe that knowledge of hands-on skills may be of utmost importance—especially because you will not be carrying a midwifery kit. There are many, many more natural ways to work that you can pack into your knowledge kit. The skills needed would still be limited, because as a doula that is not your role. Part of your role—everyone’s role—is to keep things safe as possible. Knowing what to do in an emergency can be a valuable part of this.
Important skills include resolving shoulder dystocia and dealing with hemorrhage. Doulas can easily learn to recognize and take steps to resolve these problems. With hemorrhage, for example, you have the placenta, which is a great stopper of bleeding, and membranes or cord if the placenta isn’t born yet. (See “The Power of Placenta for Hemorrhage Control” by Hollie S. Moyer, Midwifery Today 112, Winter 2014.)
Newborn resuscitation is another essential skill to keep in a mental tool kit. It is appropriate to take a newborn resuscitation class every few years.
We are offering a class called “What Do We Do at a Birth?” at our conference in Bad Wildbad, Germany, next year. Gail Hart, Eneyda Spradlin-Ramos, and I were talking about how some people have a tendency to intervene too much at a birth. You do not need to “deliver” the baby except for one with true shoulder dystocia. You do need to know that the head comes out, restitution occurs, and the baby comes out on the next contraction, or maybe in one more contraction. You also need to know not to pull on baby’s head or panic at this point—like many medically-based people seem to do. This is the natural way a baby is born. Now if the head retracts, turns purple, and does not restitute, you will need to go into action for shoulder dystocia. The concept of less is more is relevant and helpful to doulas and midwives!
You do not need to clamp and cut the cord. You do need to love and respect the motherbaby, including respecting the baby’s microbiome. Carla Hartley’s admonition of “no hatting, chatting or patting” is a good thing to remember, too. With this alone you may help to prevent hemorrhage by not interfering with mom’s oxytocin—which can work to prevent bleeding!
My dear cousin Teresa had a birthing situation where she needed some of these emergency skills. This is her story:
“Six years ago, I began serving as a doula after studying midwifery for 18 years. To be clear: I do not want to be a midwife, but I feel safer having the knowledge to react [appropriately]. My clients feel safer too. Do I ever want to use these skills? No. But knowing that I can enhances my ability to serve my clients and help them have the births they desire. Many clients want to labor at home as long as possible. With that comes the risk of unexpected situations. The most dramatic for me was a shoulder dystocia. I was confident enough in my ability to deal with it: to resolve the dystocia and catch a healthy baby. [Paramedics] would not have arrived quickly enough to help and generally don’t have the skills to handle something like that. Did it freak me out? Yeah; a bit. But I will carry that lesson to every family I attend.
“I think it’s important for any doula who serves clients at home to be able to recognize and handle emergency situations. Many doulas will face a precipitous birth at some point in their career; should they immediately call 9-1-1?
“Basic training in neonatal resuscitation, how to recognize maternal or fetal distress, and emergency childbirth skills can help doulas to be more capable and comfortable attending clients at home. I’m not suggesting that we all carry a medical kit; instead we should carry the skills and knowledge in our doula bag of tricks. We never want to use them, but knowing we can is invaluable.”
Teresa’s midwifery skills came in handy, although being a midwife is not her stated goal. Her knowledge added to her ability to keep things safe as possible.
Midwifery Today conferences are a great place to learn emergency skills, as well as all of the other great doula skills, comfort measures, and so on. Join us for an all-day doula workshop at our Mt. Laurel conference in New Jersey this April 19, 2018. The whole conference has so much to offer midwives and doulas, nurses, and doctors. All are welcome. Visit: midwiferytoday.com/conferences/new-jersey-conference-2018/nj-conference-2018-program.
Toward better birth,