A Doula’s Manifesto
Julia Mannes is a professional birth consultant and DONA International certified doula. She provides down-to-earth support throughout prenatal planning, labor, delivery, and the postpartum period. Julia is also a vinyasa yoga instructor specializing in prenatal and parent-baby yoga. She is skilled in acupressure, massage, photography, baby care, and bringing ritual to life cycle events. Julia teaches workshops in babywearing, holistic newborn care, and yoga for labor and delivery. A native New Yorker who has traveled and lived in Israel, Morocco, Australia, and Europe, she received her Bachelor of Arts in Psychology at Vassar College and worked in the music business for many years. But it was close to home where she answered the calling to serve pregnant women and new families in NYC. Julia served as Marketing Director for Coalition for Improving Maternity Services (CIMS’) The Birth Survey, and Ambassador with Choices In Childbirth, helping with distribution for the New York Guide to a Healthy Birth. Learn more at www.juliamannes.com.
1) What is a doula?
The word “doula” comes from the ancient Greek meaning “a woman who serves.” Doulas provide physical, emotional, and educational support to families before, during, and following their birth. The doula’s role is to stay with a woman throughout her entire labor, delivery and immediate postpartum period – this continuous support is the hallmark of a doula’s care. A doula is distinct from a doctor or midwife – a doula does not attend to the medical aspects of your birth.
2) Why do you think it is so important for a woman who is considering starting a family to connect with a doula?
In the past, a doula wasn’t so important, but today women often haven’t seen a birth, or breastfeeding, or even held an infant until their own. Families are spread further apart or just wouldn’t dream of attending another family member in labor. But women have given birth with the support of other women throughout human history. It is helpful to have someone minimize bright lights and distractions, massage a sore spot, and keep you focused on productive activities – kind of like a sister or good friend with a few tricks up her sleeve. It is helpful to have someone knowledgeable about birth and skilled at active listening nurture your trust in the process. A partner alone with a woman may (lovingly) ask, “are you ok?,” while a doula can emphatically say to the laboring woman “This is within the range of normal. You ARE (or will be) ok.” Women are built to birth, but they are laboring under conditions markedly different than the women who came before them. Doulas help women learn how to navigate those conditions, change them when appropriate, and simply bear witness.
Studies have shown that when doulas attend birth, women rate their experience more positively, labors are shorter with fewer complications, and babies are healthier and breastfeed more easily.
3) What do you think are the main issues concerning women’s health in the obstetrics field today?
Around the world, the great injustice in birth is the lack of access to basic medical techniques that would improve birth outcomes for both mothers and babies. Unfortunately the great injustice in the United States is the over-access to medical interventions that haven’t improved birth outcomes. In 2010 the US ranked 41st in the world for mothers’ deaths in childbirth, last among all other industrialized nations. The United States has more neonatologists and neonatal intensive care beds per person than Australia, Canada and the United Kingdom, but its newborn death rate is higher than any of those countries. The countries that have the lowest newborn and maternal mortality and morbidity rates are the countries where the majority of births are overseen by highly trained and skilled modern midwives.
4) Why do you think the U.S. has among the highest rates of c-sections in the western world?
If you ask me, it is because the majority of births are overseen by surgeons. An OB/GYN is a trained surgeon, and since they attend the majority of US births, you will see more surgical births. Midwives are experts in physiological birth, and in cultures where they attend the majority of births, there are more vaginal births. You can read this for a more thorough explanation of this complex issue.
The World Health Organization recommends the cesarean rate be about 10%. The rate in the United States is 32% and has steadily increased for 12 years straight – that is 1 in 3 births. Yet famous midwife Ina May Gaskin who started the birth community at The Farm in Tennessee has a 1.5% cesarean rate and better overall birth outcomes with fewer interventions than the national average.
5) What role do you play on the day of delivery?
Doulas can support women at a birth center, hospital, or at home, and have proven helpful whether or not the client chooses or needs an epidural in the end. The techniques I use include counterpressure, acupressure, massage, aromatherapy, hydrotherapy, use of hot and cold, suggestions for positioning to help speed labor and make you more comfortable, guided relaxation, and breathing exercises. You don’t need all these techniques and there’s no one best way to breath or move.
I am alerted as soon as my client starts laboring, and I typically offer suggestions and await another call until I am needed more. I often help couples figure out how to get some sleep to conserve their energy at this stage. Once I arrive it is my job to nurture a “rhythm, relaxation, ritual” triangle – helping women remember to move rhythmically, manage just one contraction (or surge, or rush) at a time, stay focused on the techniques that are working for as long as possible, yet help take decisive action to change what is not working, and facilitate communication between partners. We avoid getting caught in a “fear, tension, pain” triangle – fear causing tension, tension making the body more rigid, rigidity reducing comfort, and less comfort triangling back to increasing fear.
6) What role do you play after delivery?
I help establish initial breastfeeding, and after the baby is born I stay by the mother’s side – she still needs to deliver the placenta and may need stitches, she may need support cleaning up, getting out of a tub, changing position, getting some food into her system, or processing her emotions. She may be hot or cold, high, low, or shaky. I do my best to make her comfortable. I also can help minimize separation from the baby, make the room cozier, or navigate the family in the waiting room. I speak to my clients on the phone at least once or twice in the day and days following the birth to make sure all is going well. I can offer support before an issue becomes acute. I visit clients at home a week or 2 after the birth to answer questions, help process the birth, and receive feedback about my role. This can all be very helpful since typical birth protocol involves discharge from the hospital with no follow-up until 6 weeks.
All the above pertains to my labor clients. I am also a postpartum doula, and for these clients I help with household tasks like shopping, laundry, and dishes, light meal preparation, registry/thank yous, and practical baby- and parent-care including breastfeeding, diapering, babywearing, yoga, and postpartum healing. I also remind people that if birth doesn’t go as expected all is not lost and we can recover from setbacks.
7) Anything else you want to add?
I suggest you interview a few different types of care providers – hospital or birth-center based midwives, family practice doctors, obstetricians, home birth midwives (read some research about the safety of homebirth here). Even if you love your current provider personality-wise, make sure you also jive philosophy-wise.
A final word – I loved my birth! It is helpful to know people have had positive birth experiences. Try to inform your psyche with positive stories. My daughter was born at home 2 years ago.