By Marla Lukes, CD(DONA)

It is never too early or too late to hire a doula.

I once received an e-mail from a woman who was not even pregnant yet. She was thinking way ahead about the decisions she needed to make about hospital, caregivers, and labor support. Once I got a call from a woman who was a week overdue and had just heard about doulas from a friend.

The down side to waiting is that sometimes a doula brings new information and perspective to childbirth. A doula can help you discover your choices early so that you feel comfortable with the decisions you've made. Unfortunately, we talk to a lot of second-time moms who didn't realize how much a hospital, caregiver, procedures and protocols could affect their birth. They make different choices the second time, and that includes involving labor support (a doula).

I like to think of a doula as a personal tour guide. You're planning a trip and your tour guide can give you the resources to help you decide on the things you definitely want to avoid and the things you want to include.

We all agree that the birth of a baby is an awesome miracle and the decisions you make are important for you and your family.

What is it like having a birth doula assist you in labor?

Everyone's experience is different, of course, but here's one woman's unique story of a doula supported labor:

"Hiring a doula is like hiring somebody who's there just for you. Even though I'm more conservative, my doula's earth-mother manner was very reassuring. When I went into labor, she met us at our home. I wanted to labor at home as long as possible, before going to the hospital. When my husband and I decided it was time to go to the hospital, the doula came to the hospital to continue the support. Eighteen babies were born in the hospital that day, so our labor and delivery nurse was quite happy to have someone else there to help look after me."

"Having the doula gave me enormous confidence, plus it took the pressure off my husband. He was able to relax and enjoy the experience. The doula stationed him at my back and showed him some acupressure techniques. She locked eyes with me and helped me breathe through my contractions, making suggestions about moving around and trying different pain management techniques. She could read my body signals perfectly, she knew when I was in transition (when I got sick, a pan magically materialized), and she helped me remember to drink fluids."

"When it was time to push, the doula locked eyes with me again, which was absolutely critical. "My doula also helped me learn the art of breastfeeding."

"I couldn't have done it without her. She made me fearless: The lack of fear is what gets you through the pain without drugs. I had complete confidence in her, whereas if I had been looking at my husband and saying, 'Help me through this,' it just wouldn't have been the same."

Mom on birth ball, receiving a massage from her Doula

What if I want an epidural?

A doula’s support is still invaluable.

A doula's goal is to help you have the best birth experience possible, however you define it. You still need continuous support even with an epidural. Once you’ve received the epidural, she will help you stay relaxed, offer information, and remain with you while your partner eats a meal or sleeps. She will be able to help you with pushing positions, (since it’s harder to push when you have an epidural), and assist with initial breastfeeding.

8 Reasons to Hire a Doula Even If You Plan to Have an Epidural

1. Most of the time the woman is required to do some laboring before an epidural can be administered.

• Give you a massage
• Provide you with information about your options
• Get you ice chips
• Give your partner a break
• Be reassuring and nurturing
• Help you with breathing
• Help you with breastfeeding
• Take photographs

What if I have a cesarean?

If you are having a cesarean, a doula is a great help. Your doula will help you be as informed as possible about the surgery and the post-partum recovery.

If your caregiver suggests a cesarean at some point during labor, your doula will guide you in asking questions that will help you gather necessary information about the reasons your caregiver recommends a cesarean, the risks and benefits relative to your particular situation, and any alternatives you may have. In this case, you will likely make an informed decision and will therefore be more satisfied with a surgical outcome. She will also help to reinforce that even though a cesarean may not have been your goal, you are still giving birth. She will celebrate with you, facilitate closeness between the new family, and photograph the baby's first moments.

Other ways in which a doula might help with a cesarean section, planned or unplanned, include:

•Assisting in relaxation during the administration of the spinal or epidural;

•Video taping or photographing the birth;

•Facilitating closeness between the new family;

•Staying with mom while the surgery is finished when baby and mom's partner go off to the nursery;

•Relaying information to mom about the baby;

•Helping mom with the initial breastfeeding;

•Sharing information about recovery.

Can a doula help me avoid a repeat cesarean?

Absolutely! Doulas are especially important if you are planning a VBAC (Vaginal Birth After Cesarean) because she helps you avoid the interventions that increase your likelihood of having another cesarean birth.

Partner and Doula: A Supporting Team

Myth 1 - If a woman has her partner, the doula becomes redundant.

Reality - The doula may be the only person at the labor besides the partner who is there solely for the emotional well-being of the woman. The nurse, the doctor, the midwife have other priorities that compete with the emotional care of the woman: for example, breaks, shift changes, clinical responsibilities, office hours and hospital policies. The doula has few or no other priorities. She stays through shift changes, and until after the baby is born. She is not just another stranger with the couple. She has the woman's needs as her sole priority. In some cases, the couple will bring several other friends or family members into labor with them. Sometimes these people can be uncertain of how to help which leads to confusion and actually adds to the woman's stress. The doula can direct and coordinate the efforts of a group of people, giving them all some-thing useful to do, so they work as a team on the woman's behalf.

Father Bonding with His Unborn Child

Myth 2 - The doula "takes over", displacing the partner and interferes with their intimate experience.

Reality - The doula can actually bring the couple closer. By making sure that the partner's needs are met (food, drink, occasional back rubs, and reassurance), the woman and partner can work more closely together. The doula allows for the partner to participate at his own comfort level. Some partners prefer to be there only to witness the birth of their child and to share this experience with the woman they love. They may not want to play an active role and do not want to be responsible for the woman's comfort and emotional security. The doula can fill in and allow the partner to participate as he wishes, without leaving the woman's needs unmet. When the partner chooses to be the major source of emotional support, the doula can supplement his or her efforts by running errands, making suggestions for comfort measures, and offering words of reassurance and comfort. During a long tiring labor, she can give the partner a break for a brief rest or change of scene. While the doula probably knows more than the partner about birth, hospitals, and maternity care, the partner knows more about the woman's personality, likes and dislikes, and needs. Moreover, he loves the woman more than anyone else there. The combined contributions of partner and doula, along with a competent, considerate and caring staff gives the woman the best chance of an optimal outcome.

Myth 3 - The doula has her own beliefs about how the birth should go, and imposes it on the woman or couple.

Reality - The doula's true agenda is to help ensure that the woman's or couple's agenda is acknowledged and followed as much as possible. If the doula is thoroughly familiar with the couple's wishes and their birth plan, she may actually think more about it than the couple, especially when labor is intense and things are happening rapidly. The doula can remind the staff or the couple of some items on the birth plan that are forgotten, but which later might be important. Sometimes if a birth plan is not followed, the couple later look back with regret or disappointment. The doula helps with decision-making by asking questions that will ensure that the right information is given to the woman or couple so that they can make an informed decision. She may also suggest alternatives for the couple to consider. She does not, however, make decisions for the couple.

In summary, the doula helps make the birth experience to be as rewarding and satisfying as possible. As one father said, "I heaved a big sigh of relief when she (the doula) walked in. I hadn't realized how much pressure I had been feeling. She not only calmed my wife, she calmed me down."

Dad Bonding with Baby