Tuesday, December 18, 2012

Teaching Parents About Doulas in Birthing Classes

by Ananda Lowe

Over the years, I have attended numerous childbirth classes – as a doula accompanying my clients, as a childbirth educator-in-training, and as a pregnant woman myself.  These included natural childbirth, prepared childbirth, twins birth, hypnosis-based birth, hospital-affiliated, privately-run, paid and free classes.
What struck me is this:  although the evidence is clear that doulas may be the most important intervention to utilize for parents desiring natural childbirth, even doulas themselves tend to undervalue their role when teaching childbirth classes — which is unfortunate, I believe.
The last time I observed a natural childbirth class, I timed the portion of the class on the topic of epidurals, and it totaled over 30 minutes, while there was no formal time dedicated to the topic of doulas.   (To be fair, some of my educator colleagues have reported to me that they do provide instruction on the topic of doulas in their classes.)
Imagine the impact childbirth instructors could have if every family leaving their classes had a clear understanding of the medical benefits of doula care, how to find a doula, and how to afford the expense.  Here is an array of suggestions childbirth educators can use to make sure the topic of doulas is central to their classes:

  • Invite a doula to be a guest speaker at your class

  • Ask if any of the parents have interviewed doulas, and if so, to share with the class what they learned

  • Hand out a list of local doulas compiled by the childbirth educator or the facility she works for, and/or the Web sites of the major doula organizations.  Give parents the homework of visiting the Web sites to learn more about doulas

  • Explain that doulas-in-training are typically available to volunteer or at a low cost, and make parents aware of community-based doula programs, if parents are concerned about costs or unprepared to pay the full fee for a doula (while being careful not to suggest that labor support should not be paid work)

  • Bring several books (not just one) on doulas to class to emphasize the importance of the topic, such as Bearing Witness:  Childbirth Stories Told by Doulas; The Doula Advantage; The Doula Book; The Doula Guide to Birth, etc. for students to browse through at class breaks

  • Share anecdotes about your role as a doula at births you have attended

  • As you discuss a variety of topics in your syllabus, explain how a doula would be beneficial in common birth scenarios, such as staying home in labor as long as possible before leaving for a hospital birth, coping with a long induction, spelling the father or partner in the middle of the night, supporting a family through a long early labor at a home birth before the midwife arrives, etc.

  • Explain the difference between the role of doulas and the role of fathers/partners.  A partner’s role is to love the woman in labor, and fully experience the birth of his or her baby.  A doula serves as an encyclopedia of labor techniques, so that fathers/partners are not expected to take sole responsibility for relieving the mother’s pain

  • Respectfully approach students who have shown interest in finding a doula, and offer to contact your network of doulas on their behalf, to locate someone who is definitely available for their due date

  • When I teach childbirth classes, I try to incorporate most of the above strategies, so the topic of doulas is infused throughout the class.   If you are a childbirth educator, I urge you to review your teaching plans and try to assure that you allocate as much time to the topic of doulas as to other subjects such as epidurals, especially for a natural childbirth class.  If you are a doula, please share this article with your childbirth educator colleagues, and brainstorm with them about ways they can more fully integrate the topic of doulas into their classes.
    A dad who was my client once said, “Asking a father or partner who has never witnessed childbirth to be an expert on what to do in labor is like asking him to take a weekend class on a sport he has never seen, and then go coach the Olympics.”  As childbirth educators, we owe the parents we teach more options for support than this.


    1. In the New York City area, most of the CCEs I know ARE doulas, or have been doulas at some point in their careers. With or without that history I find that the topic is woven seamlessly into every single part of our class structure. Whether we're discussing medical interventions, pain management, or natural coping measures - the doula's role remains front and center - given its appropriate weight and justification. In the NY area where hospitals births are highly interventive, couples often feel it's a deficit NOT to hire a doula. At the same time, I have to say that no one wants to feel pushed into hiring a doula any more than they want to be pushed into an all-natural tub birth. Each couple comes to their own decisions hopefully based on the sound and evidence-based information we impart. (CEA/MNY Certified Childbirth Educator)

    2. Ann Marie Lindquist, AAHCCDecember 18, 2012 at 2:16 PM

      You’ll be happy to know that we do discuss doulas in Bradley classes. There is a page in the official workbook on doulas. In my own class I bring up the topic frequently, have three different doula books (including yours) in my lending library, have a list of doulas used by former students available in my classroom, and often encourage couples to consider using a doula. We are very much focused on training the partner, so sometimes couples are wary that the doula will take away from that relationship or be unnecessary, but to counter that I share my own personal experience of using a doula, and that a good doula will support the couple in the way that the couple needs. One of my favorite things to tell them is that they just can’t know how long labor will be, and if it’s a long one, both mom and partner will be grateful for the extra set of hands!

    3. Thank you for another thoughtful blog! I am redoing my class outline for January and will incorporate your suggestions.

      Sharon Davis, CD(DONA), ICCE

    4. Thanks for the information. Since I am a Doula and Childbirth Educator, I also teach about Doulas throughout my childbirth classes. I teach Lamaze based natural birth. I show the books: The Doula Book by M. Klaus, and The Birth Partner by Penny Simkin. I use the video: "Healthy Birth Your Way: 6 Steps for a Safer Birth" by Lamaze and Injoy. Step 3 is about continuous support and having a Doula. I also use Penny Simkin's (who is a PT,Doula,and CBE) videos: "Comfort Measures for Childbirth" and " Relaxation, Rhythm,and Ritual: The 3 R's of Childbirth".

    5. Hi mayber you can help me I have been looking at different kinds of lamaze classes for my wife which do you suggest?

      1. Philip, what city and state are you located in? I will try to help you find a class. You can also email me at thedoulaguide@hotmail.com.

        Sincerely, Ananda

      2. Thanks for your help Ananda but my wife was a step ahead of me. With this pregnancy she has always been. Go figure... ;)