The do's and don'ts of a doula for a homebirth

I love doulas. Truly, I do. I am a formally trained doula and have attended more than forty births in the capacity of a doula. I only attend maybe one birth a year in this role now, as honestly, hospital births are exhausting to me physically, mentally, and emotionally. I remember well as a doula, loving to attend birth center births and home births, as they were so much nicer and less intense than a hospital birth. 

Now that I am on the other side, in the role of the primary birth attendant/traditional midwife, I can well understand why some midwives don't like or see the need for a doula in a homebirth. I can also see why some midwives insist on a doula being present for a homebirth. I'm just going to lay out here the pros and cons of a doula at a homebirth. Realize that I am making an assumption here that the homebirth midwife you hire is willing and able to support you physically and emotionally during your birthing time, that they bring an assistant with them, and that they are mostly hands off when it comes to interventions. I realize that not all midwives are like this, but let's start with that typical scenario.

Pros:

1. A doula will be with you from the very beginning of your labor, if you want them there, your midwives most likely won't be hanging around with you if you are only a centimeter or two dilated.
2. A doula is often willing to help your significant other set up the birth pool or can be there for you while your partner is doing this, making sure you are not left alone during a contraction.
3. A doula is there for support only, and has lots of specialized training in comfort measures for various stages of your birth.
4. A doula can transfer with you to the hospital if the need arises, allowing for a continuity of care with someone you know and trust in the position that you hired them to be in, some midwives can't or won't transfer in with you.
5. A doula can remind you of what you wanted for your birth plan, and of what you wanted to have happen in certain birth scenarios that you discussed prenatally.
6. A doula can take over for your partner for brief periods of time so that they can refresh themselves with food, drink, a bathroom break, or a nap and you won't be left without a primary support person. (Please bear in mind that your doula will also need these breaks!)
7. A doula can bring you drinks, snacks, etc. as you need them.
8. A doula can help you get breastfeeding established after the birth.
9. A doula may offer placenta encapsulation or other related services (like childbirth ed classes, babywearing classes, cloth diaper sales, homemade herbal remedies, etc.) to you at a discounted price (granted, most homebirth midwives, myself included, do a lot of this too).
10. She can often take pictures or video for you.
11. She can often help with your older children (clear this with her first, doulas are not nannies)
12. Doulas have been shown to decrease c-section rates, induction rates, pain medication need, etc.

Cons

1. There's an extra person at your birth.

Basically that's the only real "con" to having a doula at your birth, home or otherwise.

That said, as a provider, I will tell you the kinds of behaviours that I have seen from doulas at homebirths that were NOT helpful. In one case I had to warn the doula to stop acting how she was or I was going to ask her to leave. And these types of behaviours are why so many homebirth midwives don't care for a doula at a birth.

Here's what your doula should not do at a homebirth:

1. Give clinical advice or care.
2. Give herbs, homeopathics, or any other kind of medication to you without first discussing it with you and your midwife.
3. Get in the way of your midwives (don't make me trip over your doula or make me push her out of the way).
4. Treat a homebirth in the same way that they would a hospital birth (being aggressively proactive for the client as if their midwife is not also their biggest advocate!).
5. Try to tell the midwives what they "should" be doing (suggestions or questions are welcome, commands are not).
6. Tell you to do or try something that is the exact opposite of what your midwife just told you to do or try (see point one).
7. Smell badly.
8. Eat in front of you without asking first.
9. Talk loudly or about inappropriate subject matter.
10. Deliver your baby (see point one, unless it's an emergency, she shouldn't be acting in this capacity).
11. Persuade you that it's ok to have an unassisted birth if your midwife is unavailable or if you don't want to go to the hospital (see point one).

When doulas are good at what they do and don't bring an aggressive mentality with them, it's great. When they are bad, they are bad. Homebirths don't generally require a doula to be micromanaging and looking over the provider's shoulder to be sure an unnecessary episiotomy is about to be done, for example. A doula should be more laid back in the homebirth arena. Homebirth is much more chill, much less medical.

And yes, like it or not doulas, at a typical homebirth, if there is not a doula present, I am doing what you would be doing, AND doing all the charting, fetal heart tone checks, etc. So in that way a doula is superfluous to a homebirth. However, I do like having a doula there for my clients when possible. 

"So, are doulas at homebirths necessary?" No. 

"Are doulas at homebirths a good thing?" Almost universally Yes!!!

"Should I get a doula for my homebirth?" I'll answer that with a question. Can you afford one? If yes and you want one, get one.

"Is a doula worth the extra expense?" Yes, every penny, and if you can, tip her. I bet she's undercharging you. Most of us do, both as doulas and as homebirth midwives.

"My midwife says she won't work with the doula I hired." This is tricky, the birth world is fraught with politics and less than "sisterly" behaviour. Find out why she won't work with that particular doula. She may have good reason, like the points I addressed above in what is bad behaviour in a doula. Or, she may not like doulas in general. If it is a general dislike or she has a personal vendetta against the doula, either find another midwife or if you love your midwife, you'll have to drop the doula. Honestly, it's a red flag to me if any provider, be it doctor or midwife doesn't want you to have a doula.

I hope this was helpful. When looking for a doula, be sure to ask lots of questions about her training, experience, birth philosophy, etc. just as you did with your midwife to be sure that you are a great fit.

By the way, the photos here are by sweet moments photography and niki torres, respectively. I highly recommend either of them for birth photos, maternity, family photos, etc. They are both excellent and very professional!