20 things I have learned in 20 years as a doula

20 Years Retrospective header

It’s not about me.

I am not the lead in this play. I’m not even a supporting lead. I’m a bit part in the ensemble, and I need to remember to play my role and not try to hog the spotlight. My goals need to be my client’s goal.

There’s no one right way to birth.

Every client I have worked with has had different values, beliefs, medical history, etc. I’ve been with families choosing everything from home water birth to unmedicated hospital births to planned epidurals and planned cesareans. Every birth plan is a good birth plan!

Pregnant people are as much of an expert as I am.

I might know the physiology of birth better. I might have an extensive set of labor skills I bring. And I might know the ins and outs of the birth locations in my area, but none of that is more valuable than the birthing family’s knowledge of themselves and their instincts. Trust those!

You never know it all or have seen it all.

Not only are there constant variations in the process, the research, technology and protocols constantly change. Never stop learning!

Collaboration is more effective than competition

This applies to relationships with nurses, midwives, doctors and other allied health care providers. Team up to work together to best support your clients. Have empathy and understanding for the constraints and scope of their employment and role. It also applies to your interaction with other doulas!

Never undermine a client’s relationship with their care provider.

Over the years, there have been two care providers I’ve chosen not to work with and I’ve declined to take clients using those providers. But beyond that, I am careful to respect their choice of care provider, just like I would respect any other choice my client made.

It isn’t all love and joy.

I’ve had some really scary and difficult births. Those are the moments when I really need to keep it together and support my client. You can’t go into this business thinking it’s just going to be unicorns, rainbows and sweet smelling newborns.

I’m not the right doula for everyone. And that’s okay.

Early in my career, I wanted a 100% hire rate from my interviews, and I was sad if prospective clients chose someone else. Eventually I got to a point where I realized that my style and strengths were not a good fit for everyone, and sometimes I would come home from an interview thinking “They should hire So-and-so, she’s the best fit for them.” And they often would choose the doula I thought would work for them!

Boundaries are invaluable.

24/7 availability is a hallmark of doula work, especially solo practice. But that does not mean you need to let clients expect immediate responses to little questions all the time. I specifically tell my clients that if a question isn’t an emergency, they should email and I’ll get back during my business hours. I do set specific on call times (37+ weeks) where I guarantee 24/7 availability, but outside that time I will turn off my phone when I go to a movie, or take a spontaneous weekend trip or swim at the pool for a couple hours without checking my phone. If a client does go into labor outside my call times, I will go if I can, but I don’t guarantee 24/7 coverage their entire pregnancy.

I can only empower myself.

I have a bit of a love/hate relationship with the word “empower” – technically, it means to give someone power. I cannot give or bestow any power on a birthing person. They already have it. I can help them learn to claim it, to use it, and to stand up for themselves, but I cannot technically empower them. What I can do is provide them with an example of someone who knows their own value and lives knowing that, and I can stand with them when they exercise their own power. Sometimes it’s easier to stand up for yourself if you know someone’s standing with you. Experiencing using your own power for the first time can be a very empowering experience. Facilitating that is what I can do!

It’s not my birth. It’s not my birth. It’s not my birth.

I can’t care more about the birth than my clients do. If my client is okay with a massive change in the birth plan, I have to let it go and be fine with it too. If I care very much about the timing of cord clamping but my client does not, I can’t let myself get all worked up about it. Sometimes that is hard!

The business end is important.

When you go to a birth, there’s a satisfaction in a job well done. Clients thank you. You see beautiful, intimate, joyful moments and sweet squishy newborns. Your family gets none of that. If you’re not paying attention to the business end, and doula work is a drain on your time, energy, and your family’s budget, it’s going to cause resentment and conflict.

Family has to come second when clients are in labor. Make them come first the rest of the time.

Do your best to make sure you make it to your family’s important events. I once accidentally scheduled a prenatal on the same night as one of my daughter’s choir concerts – and she had a big solo. I called my client up, explained the situation and they were very understanding and happy to reschedule.

Emotional dystocia is real.

The mind is a very powerful thing! I’ve had a client will herself into labor at the start of the induction, looking up at the unused bag of pitocin with determination every time the contractions slowed. She was determined not to repeat a difficult induction like her first birth. I’ve had another client hold off on labor until her unwanted and uninvited mother-in-law flew home. I’ve had VBAC moms stall just before getting to the point where they had a scary emergency cesarean last time, too. I’ve seen mental and emotions blocks quite often in labor, and clients don’t always disclose what that is.

I can’t be everything to my client. Referrals are a good thing.

As much as I might want to be able to help my client with their challenges, I am not a lactation consultant, a therapist, a marriage counselor, or any number of other service providers that my clients might also need. Connecting a client to someone who does have the skills and scope to help them better than I can is the best thing you can do for them.

You can’t schedule clients effectively

I used to think that if I just spaced the due dates right…I would never have two clients in labor at the same time. (You can laugh, I won’t be hurt.) And then I had a mom due February 1 with twins. I was so sure she would have her babies in January! My next client was due February 28 with a single baby. They both called me the morning of February 2 within an hour of each other, to tell me their water just broke! I did use a backup for a few hours, but one birthed quickly and I did manage to make it to both births. Three days later my April client delivered at just under 30 weeks.

The birth room is NOT the place for advocacy.

When you step out in front to advocate for your clients, that is actually telling them they cannot manage for themselves, and they end up feeling powerless. Help your clients advocate for themselves in their birth. You absolutely can (and I would say should) advocate for improvements in hospital policies, midwifery laws, and better acceptance of the doula role, but do it outside of your work with clients. Their birth is not your advocacy tool, and supporting them is much more important.

It’s okay to leave your client alone.

Sometimes doulas take the idea of “continuous support” a little TOO literally. I remember when I had been a doula for about 5 years, there was a big discussion in a doula email group about this. It started when a brand new doula asked for tips on how to support someone through a birth without needing to use the bathroom. There was a big discussion about whether or not it was okay for a doula to take a bathroom break! (It is!) I remember being so shocked that there were doulas who were not eating or drinking at all at births so they wouldn’t need to leave their client to pee. It’s fine to take short, well times breaks to use the restroom, eat, or stretch your legs. I often switch off with my client’s partner or an apprentice doula for this.

On a similar note, the watched pot syndrome is real, and as a doula sometimes stepping back and allowing your client alone time is the best thing you can do. Make sure you don’t show up so early in labor that you’re sitting around waiting for mild contractions to come. I have been doing most of my early labor support by phone, and specifically preparing my clients for that in prenatal visits.

Cesarean birth is not a failure.

It’s not a failure of the doula, it’s not a failure of the parent, it’s not a failure of the system. It might be an overused technique, but it’s a lifesaving technique. If you think of it as a failure, and your client needs to have a cesarean birth, it shows. And it’s not a good thing. I could go on and on but I’ll stop here.

Doula skills enrich your relationships

Since I started as a doula, my kids have grown into young adults (close enough….less than a year before they’re all adults!!) and they all have fought huge battles and done hard things. Whether it’s talking one of them through an anxiety attack, helping them research options and choose a major in college, or deal with unexpected and difficult twists in life, my doula skills have helped me tremendously. Especially as they were teens and matured into more independent adults. I wrote a full article about it years ago.

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