Doulas: What do they do?

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AnnaRO's picture
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Doulas: What do they do?

I know a lot of the midwife questions will be answered on Monday when I go for my consult, but I was hoping for some input from some of you experienced and BTDT ladies.

I know the midwives will take care of all my prenatal care and refer me for any necessary ultrasounds and I'm thinking a doula won't really be a necessary added expense if everything goes well and I can deliver at the birth center. However, a doula might be necessary if I end up at the hospital, even for a c/s just to have someone there specifically to stand up for my rights. The closest hospital has a de-facto ban on VBACs and doesn't have the best ratings for surgeries at all. I want to vomit just thinking about ending up there.

Anyway, there are no doulas practicing here that I can find, except one. She recently moved here and is looking to build her portfolio. She posted on a local FB group I'm on that her fee is $200 for 3 prenatal visit, labor, a post partum visit and placenta encapsulation (though I'd be fine with encapsulating it myself). So I guess what I'd like to know is, what exactly does a doula do and how much should I rely on her for? It seems almost silly to pay someone $200 just to be in the room for my birth, but I also know that some people find them priceless. I feel strongly that I could have benefited from one during DS's labor. What kinds of questions do I need to ask to find out if she's forceful and strong willed enough to really take on the the anti-vbac bullies should it come to that?

Also: If I deliver at the hospital, I will have to have a court order to keep my placenta since it is considered medical waste and they don't just release it. To get a court order for it can be pretty expensive. Should I try to get the court order in advance just in case I end up at the hospital? If I deliver at the BC, there is no court order necessary and the will happily hand it over for free.

Ugh, so many things to consider. I'm going nuts here.

eliann's picture
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Doulas are great because they never leave your side. They are there to support you and don't have the responsibility of the health stuff. I am a bit undecided on my doula experience. On one hand, she never left my side, she massaged me for every contraction and validated my decision to get the epi. I know that last bit sounds crazy since doulas are supposed to talk you out of an epi, but I was a mess after deciding to get the epi. I was sooooooo emotional and she calmed me down and helped me focus.

But next time I might go with another doula because I really needed physical contact like hugs and hand holding and I didn't get that from her or DH...but I expected it from DH because he is a nervous kind of person. She also didn't help me with relaxation exercises nor did DH. I felt sort of alone.

But I think its very important to interview them to see if you mesh well. I had a different post partum doula that I loved and might use her for my next birth. She came to my house and and gave me lots of hugs and stroked my hair as I sobbed to her...haha.

I will say there is no way I would have ever made it 17 hours of contractions, 4 of those hours with pitocin contractions without my doula. So I think they are indeed priceless.

Where in Texas are you? I forget.

AnnaRO's picture
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I'm in Midland. I asked her a few questions kind of targeted to what I would have wanted out of a doula if I'd had one last time. She answered well and told me that she'd pretty much risk her life to stand up for me and my rights and wishes. I was pretty pleased with her response, so I will be keeping her in mind as I do my research and get to know my midwives.

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I wouldn't bother with a doula if you have a contracted midwife. If you need to transfer, the midwife will accompany you to the hospital and even if she can't assume primary care for you, she will assume the doula role. Make sure that's in your contract. If it's not, then you need to re-negotiate your rate to accommodate the very reasonable $200 this other woman is asking for.

As for the placenta question, that's a tricky one. Whenever someone says, "It's the law," I ask to see the statute because often the actual statute doesn't say quite what that person is saying, kwim? But I've encountered this myself even in a state where you are supposed to be able to take possession of your own placenta, but in real world circumstances you have to physically take possession of it before anyone else does. After Tiven's birth, her placenta was sent to pathology and what wasn't taken for testing had already been destroyed before we thought to ask for it's return. That was about 9am, just 12 hours after her birth. Lesson learned: pathology is open all night, and they work fast! Kid #2, another c-section, but at least this one we were both there & conscious, but in the immediate moments after his birth we were focused on him, and when we asked, less than 20 minutes after his birth, his placenta had already been disposed in medical waste. Grrrrr.... So my advice to you would be to have someone designated, your doula or midwife, to grab that thing ASAP after birth. Have a gallon size zipper baggie or a Rubbermaid container ready to put it in, slip it in there, and then act like you don't know what happened to it, LOL! Check your state's law to make sure that possession of a placenta isn't a felony or something first, but I've never heard of anyone *not* being able to leave with their own placenta once they'd taken possession of it. Offer to sign a waiver of liability if they press the issue, that usually shuts them up!

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I had a doula and a midwife for my 3rd birth. It was a homebirth. My husband really liked having her there so that I was never left alone (if he had to deal with stuff in the house) She also took some "interesting" pictures. I think the biggest thing for me was that she cleaned up the mess after the birth, but if you are in a birth center you wouldn't have to worry about that. I also had my placenta encapsulated, but I had another person do that as my doula didn't do that. All in all though it cost me $500 for the doula (that was the "friends" rate, normal rate is $1000) and $200 for the placenta encapsulation, so for $250 I wouldn't hesitate and hire her. It's nice to have an advocate that is a step away from the situation, especially if you are trying for a VBAC.

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I can't say much because I'm a FTM but I understand they are birth support, sort of like an advocate but also a help-all. For that price though, and because she wants to get started, I would maybe consider it. Up here a doula costs over $1500, and that's just for support. I haven't found anyone to do placenta encapsulation yet and I know it's also expensive.

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I haven't had a doula, but in your situation, Anna, I think you can skip it at the birth center but at a hospital, $200 is a small price to pay for the support and even just peace of mind that you have someone knowledgeable and caring there advocating for you. After what you went through with Kole, I think it would be worth every penny if you like this woman and she seems like someone who would make you feel supported during your birth in a less than ideal environment.

I don't know exactly what you asked already, but if you decide to pursue this further, I would ask for examples of births she has attended and what her positive and negative experiences have been so far. I think both would give you a lot of clues as to how she would approach you and your birth.

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I wouldn't rely solely on your midwife for emotional/physical support. My midwife, although in a hospital setting, kept saying "Elizabeth you have to relax and breathe.". It was frustrating...I was like you try to relax and breathe. She has never given birth. My friend had her baby at a birth center and had a similar experience, her midwife was doing a lot of work and couldn't be there for her emotionally. I think its up to you and your personality. I think if you are the kind of person who needs complete silence and dont want people to touch you, maybe you can go it alone or with DH's help.

I just remember when it got really bad for me. I was so glad I had a doula. She also helped when Dh went to the bathroom and got food so I was never alone.

AnnaRO's picture
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I think I'll pass on her either way. She's 19, has attended 3 births and is new to the area, so not familiar with the local hospital policies or anything.