Doulas at Homebirths?

What is a doula?

A doula provides non-medical labor support—all the good stuff like back rubs and encouraging words and suggestions for different positions to help with labor. She does not replace the father’s role, but “holds the space” for both mother and father as they take their own journeys/come into their new roles as parents. In my birth classes, I explain that I think one of the benefits of a doula is that it frees the dad up to JUST be the dad and to live his own experience/journey and not have the pressure of trying to remember all the birth “tricks” and book information.

But, why have a doula at a homebirth?

A lot of women planning homebirths do not feel as much of a need for a doula as do women in the hospital. The midwife is capable of providing many of the same functions as a doula, but she also has the monitoring tasks and baby tasks to take care of, while a doula is just there for YOU. Other things to consider when thinking about a doula for a homebirth are whether or not the midwife will be bringing an assistant and what her role will be if there is one–sometimes the assistant is available to fulfill some aspects of the doula role, other times she is observing or otherwise in training for other tasks. And, also consider how many people who want present at the birth–if you’re already having a midwife, an assistant, and say a mother or sister or friend there, adding a doula too may mean too much crowding.

A couple of months ago, I solicited feedback about doulas and homebirth for an article I was compiling for the Friends of Missouri Midwives newsletter. The full article is available here: Doulas and Homebirth. I had anticipated receiving a number of responses suggesting that doulas at homebirth are unnecessary, or redundant. After all, an emotional connection and secure trust is often the hallmark of what differentiates the midwifery model from the medical model. However, the responses I received were overwhelmingly in favor of hiring a doula for a homebirth. Personally, I very much valued the specific and customized postpartum care my doula provided to me after my last homebirth and I’ve concluded that a doula has the potential to offer something unique and precious to families, in whatever setting the birth takes place. I also think that the doula is the most likely member of the birth team to remain in contact with the family in the future. Perhaps it is because, even given the friendliness of the midwifery model, there is less of a “power differential” between mother and doula.

Personal experiences

The decision to hire a doula is a personal one, regardless of in which setting you give birth. My first baby was born at a birth center with the presence of a midwife, a doctor, my doula, a friend, my mother, and my husband. In hindsight, I felt like it had been too many people and that the doula hadn’t really been needed. For my second birth, at home, it was extremely important to me to have as few people present as possible. My husband, my mom, and my son greeted the arrival of my second son. My midwife arrived five minutes before his birth—just in time to catch! My midwife for his birth was so amazing, that I didn’t feel the need for any other professional care. I still miss her! My third baby was a second trimester miscarriage and he was born at home unassisted and just my husband present. Later, a friend who is a doula was very, very helpful to me with postpartum care/doula stuff. I really wished I had a doula there during his birth for emotional support and supportive physical care tasks (not medical support, but tea bringing and towel washing).

It is the little things that matter--here my doula puts warm socks on me following my baby's January birth (baby and I had special matching birth socks knitted by my mom)

And, finally, with my last baby, while I liked and respected my midwife I didn’t have the same warm bond with her and really wanted to hire a doula again, precisely because I was missing some of the emotional component I value so highly in midwifery care. It is really the little things that make doula care so special (see included photo!). When planning my last birth, I chose to hire the same doula as with my third birth, with the primary purpose being immediate postpartum help (“washing the bloody towels and bringing me tea” is how I define it).

Talk Birth in Labor…

And, speaking of my doula, I’ve been meaning to share this photo for a long time. When my doula had her own baby last April, amongst the wonderful photos that our mutual friend took at the birth, I was tickled to see this picture of my doula looking at my website while in labor:
I think this could be an advertisement for my blog 😉

You can read Summer’s intense birth story here and also be moved to tears by the stunning birth awesomeness of her video slideshow here:

6 thoughts on “Doulas at Homebirths?

  1. Hey! I’m famous!! WooHoo!

    Interestingly, I have always felt like the home birth moms don’t need me as much, precisely because of the additional emotional component of midwifery (especially prevalent in home birth midwifery). As you pointed out, though, the midwife really is trying to constantly monitor *both* mom and baby, whereas the doula is only there for mom. Another overlooked reason to have a doula might be that the midwife’s job often intensifies during that last phase of labor and early postpartum, so it is imperative that she is “fresh”, whereas the more emotional role does not require as much clarity….it is really easy to love and support while foggy from a long labor! (not sure if I’m communicating this correctly, it makes sense in my head) The doula, however, is able to take on a more invisible role immediately after the birth…cleaning up (or changing socks!), making calls, waking or caring for other children….while the midwife is busy attending to motherbaby and mom/dad are busy in the haze of new baby love.
    Something else I love about doula care is that it is SO specialized and SO different for each mom/family. No two moms/families are the same and the care reflects that! It also keeps things interesting.
    By the way, thanks again for letting me serve your family. It was so beautiful and meaningful on so many levels. I cherish those sweet memories. ❤

  2. I am currently a midwifery student. As such I welcome doulas for precisly the reason Summer stated. We are very Mom/Baby delivery focused. And while our attention is honed in on a safe delivery we don’t always have the chance to provide some mothers that addidtional care they may need. I am grateful for doulas and the role they play in the home birth process.

  3. I attended a birth last year that spent over 12 hours at my clients home before rushing to hospital in the later stages of the birth. She was set on having a hospital birth…I knew she could have birthed at home but she wasn’t prepared for that. Anyway…I had filled my ‘doula’ role plenty while in her home for those 12 hours. Massages, emptying the sick bucket, fetching glasses of water, refilling dads drinks and feeding dad when hungry, more massage, homeopathic remedy advice, aromatherapy and reading to mum in between contractions. I even managed a small 1 hour nap while mum had a bath with dad. When we arrived at hospital, even though she was 9cm, her labour slowed down considerably and she took another 3 hours to birth her baby. I found myself uncomfortable and unsure of my role and where I fit in. I continued to offer massage, keeping her cool with a wet cloth on the forehead and lots of reassurance. She had a beautiful vaginal birth and all was well. I even got the chance to make her placenta smoothie right there in her hospital room!

    My point is that I felt more useful in her home and more uncomfortable in the hospital but perhaps with time and experience I’ll become familiar with the hospital environment. I am now doing my doula training next month and look forward to learning more about how I can make myself useful and feel comfortable…or appear to be, even when I’m not.

  4. Loved this article! At our recent Home Birth we did not have a Doula, but I had my mother, mother-in-law, sister and Husband there by my side. I couldn’t have asked for a better support team around me during this time. They supported and guided my through my birth. I would highly recommend a Doula if your lacking a support team. Support is crucial:)

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