The Invaluable Deeds of a Doula

Monday, April 25, 2011

I met Megan Tolbert when we were both in high school in Montreal. She was one of my main buds. And you’re at an all-girls Catholic school, friends are like floatation devices in a restless sea of teenaged drama. Megan raised her share of eyebrows back in those days. She was a straight-shooter. Funny as hell, but not one to mince words.

We reconnected a couple of years ago on (where else?) Facebook. Megan still cracks me up, but these days the funny comes from her tales from the ‘hood—as in the motherhood. (She’s a mom to a a 7-year-old smarty pants named Sam.) She’s also keeping my brows up, but this time it’s more, “Wow, Megan, that’s so interesting.”

Megan is a douhla in training.

The reporter in me always comes out when I hear things like this, so I sent a few Qs to my ol’ homey about her new experiences and here are the thoughtful things she had to say in response …

Q: What drew you to midwifery?

Megan Pearson: I’d have to say reading Ina May Gaskin’s book, while I was pregnant in 2003. Ina May is a renowned midwife, and at her birth centre, The Farm, the C-section rate is less than 2 percent. This boggled my mind when you look at North American rates that are around 30 percent.

She writes so beautifully about the physiological and psychological workings of pregnancy, childbirth and breastfeeding. After I read the book I was so psyched—I believed in my body and what it could do for me. The difference between being in a midwife’s care and a doctor’s care was like night and day—no being rushed in or out, no harried nurses, no cervical checks. Just a really mellow, supportive environment.

With a midwife, I was an integral part of the process instead of being merely a patient. I thought there was something fundamental missing from those hospital-doctor birth stories I heard from friends: control, power, choice.

I initially began to pursue doula training as a means towards a career in midwifery. However, the more I have learned and experienced, the more I have settled on the fact that being a doula is really what I want to be. What I am, in fact.

Q: What has been the most gratifying aspect of this work?

MP: Knowing that I make a difference. That because I was there, a single mom with no other support was comforted and safe. That a tired mom who was terrified of needles, but was physically and emotionally exhausted from a week’s worth of insomnia and 24 hours of labor had someone to press her forehead against and someone to hold her hands and tell her how brave she was as she shook through a contraction while having the epidural placed. That a safe and peaceful environment was provided for a water birth. That a woman’s back pain, which was terrifying to her in her first labor, was, although equally painful in her second birth, perceived as being more manageable because her doulas were there with massage and ice and positioning techniques and words of love and comfort.

I also have been so proud to be part of a sisterhood of doulas, learning and working has been an honour and a joy. My brilliant teacher, Lesley Everest (she runs MotherWit Doula Care here in Montreal), has been such a fantastic inspiration and mentor to me. Meeting these women has been a gift.

Q: You’ve mentioned to me before about women walking around “holding on to trauma from their birth experiences.” What have you found to be the “best” way to ease some of that burden, resolve some of pain?

Much of that trauma comes from births in which women are told, implicitly or explicitly, that their bodies have failed. They are poked and prodded; they are subjected to painful vaginal examinations which are very often completely unnecessary; they are not allowed to eat or drink; they are told that they aren’t progressing fast enough according to arbitrary and outdated standards—even when the baby and the mom are perfectly healthy—they are encouraged to take numbing, birth-slowing pain medications as a first resort rather than a last resort.  They are forced on their backs while they are pushing to make it easier for the doctors, even if it would be better for mom and baby to be on hands and knees or on her side. And they are cut open 30 percent of the time. Thirty percent!

Many women come out of these experiences walking wounded, feeling inadequate and often traumatized. And although they have gotten a healthy baby out of it, they have a feeling deep down that it shouldn’t have been that way. Because we as a society hold the medical system in high regard, we are often conditioned to believe that what happened was necessary, because the doctor said so. So the fault must lie with us, and our “dysfunctional” bodies.

Why is it that when a midwife is overseeing a birth, C-section percentages go down to the single digits? Why is it when a doula is present, epidural rates also plummet? As do labor times and intervention rates. Because of a simple fact: A woman’s body is made to have babies. That is its biological function.

The best way to resolve some of that trauma in the birthing room the second time round is to create a space of safety, of comfort, of love, and to hold that space. That is the role of a doula. She is a constant source of unwavering physical and emotional support—the medical staff may change shifts, the laboring mom may be moved from triage to the birthing room, daylight fades and night comes down, and still the doula is there.

A doula …

  • answers questions, she massages and soothes and encourages different positioning
  • is leaned on during contractions
  • fetches juice for Mom and coffee for Dad
  • asks the busy nurse (who is often grateful for the help, if offered respectfully) if it’s OK for the monitor to come off now that it’s been 20 minutes
  • runs the shower or fills the bath and  she freshens messy bedding
  • holds the vomit basin and washes Mom’s face
  • maintains eye contact, whispering affection and encouragement when it’s time for Mom to push
  • holds that space so that no matter what happens, there is a bubble of peace and safety, of humor and companionship, around the laboring Mom and her partner. Even if things do go pear-shaped and there is an emergency, Mom and Dad have a comforting presence for that as well

Often second-time moms are healed by this kind of birth, if they’ve had a traumatic one for the first, because they are in control, they are safe, they have support and information and a cushion of kindness and love surrounding them.

I want to say, though, that I do not in any way criticize or look down upon a woman who has had a C-section or an epidural. Sometimes those are medically necessary interventions. (An epidural can be a godsend for an exhausted mom who needs to rest so that she can get through the rest of her labor. And obviously fetal or maternal distress can warrant C-sections.) It’s certainly a woman’s right to choose to have a C-section.

My issue is with the system—a medical model of birth that operates with the underlying assumptions that women’s bodies are dysfunctional, and that birth is an emergency. These premises are factually incorrect, and yet so much in the average woman’s birth experience is based upon them.

I’m still learning, of course. I’ve been to six births and have several more “in the works,” so to speak. Ultimately I hope to be accepting paid clients by the end of the year, and making my living as a doula.

There is so much to learn and so much to do—my life is full in a way it hasn’t ever been. I have never been so secure and confident in a life choice. And that is a wonderful feeling.

  • 1
    Christine Oh Chapman says:

    Thanks to Nicole and to Megan for this awesome post! I had 2 c-sections and wonder, had I had someone like Megan to help me through the process, whether things could have been different.

    • 1.1
      Megan Tolbert says:

      Christine, the outcome may or may not have been different, but your perceptions of your experiences may well have been different, you know? I firmly believe that every woman should have a doula if she wants one, and that it should be covered by insurance and/or the government. It would make birth such a different experience for so many women–and be cheaper in the long run, as well!

      • 1.1.1
        Ms. Mary Mack says:

        Great point, Megan. I had an emergency C-section with my son, and I was kind of traumatized for a time afterwards. I didn’t have a doula, and had a good relationship with my doctor. The thought of a C-section never once crossed my mind. So much so, I didn’t even read that section of the book. I was all belly and figured I would have a big baby (he was 8 llbs, 8 oz), but still thought I would deliver vaginally (my doctor came thisclose to assuring me that this would be the case). In the end we went in for an emergency C-section after 9-10 hours of labor. No pushing, but those contractions! Daaaaamn, Gina. The actual surgery was rough, especially for someone who’s never had a broken toe. Looking back I so wish I had someone like you by my side. My husband was fantastic, but a doula would have completed the love circle, you know?

        Anyway, thanks again for having this important conversation with me.

  • 2
    Briana D'Archi says:

    Great article. I hope this will enlighten many people about doulas and the very valuable role they serve during pregnancy and delivery. I couldn’t imagine going through my two deliveries without my doula. Megan, it was great to read about your chosen career path. I wish you many happy births, babies and Moms.

  • 3
    Jamie Wolfe says:

    I just <3 Megan- she is such a darling Doula and I'm so happy there's women like her joining the profession

  • 4
    Kristin says:

    I also had 2 c-sections. At the first, my doula never made it (we had an ice storm) and I do think it would have made a difference – even just confidence and cheerleading-wise in how I handled and perceived the very invasive and 36 hour experience. In the second, my doula (different woman!) did make it and was there to see the rapid-fire decisions and institutional handling of an emergency situation. She helped tremendously in giving us a way (and again, the confidence) to get my daughter into my arms while I was in recovery after the c-section.

    That time it was a huge learning experience for the doula as she had never been (even after almost 100 births!) in a c-section situation.

    Especially in a world where families are far away and everyone is super-busy and used to “doing it all on my own” – doulas are invaluable as support and even observers. Thanks for this post!