Doulas Who Do Nothing

It is a hard thing for a doula to admit:

The best births are the ones at which I’m not needed.

Superfluous.  Merely a concierge service.  Standing around twiddling my thumbs or sitting in the corner knitting.

Truth?  Sometimes I’m baffled by my work as a doula.  I’m confused by the mystery that my presence makes an impact.  Especially when I don’t *do* anything.

Take Julia’s birth.  I left Julia’s birth feeling like her three year old did more than I did.  I mean, really.  What did I possibly offer to that family?  And then later, Julia’s husband says I was worth every penny.

It made no sense.

Or Melissa’s birth.  I fanned her.  With a manilla folder.  That’s about all I did.  And then later, she says she couldn’t have done it without me.

It made no sense.

I read about the early studies on doula support.  In those double-blind randomized controlled trials, the laboring women had no idea that the extra woman in the room was a doula.  They’d never met her before.  Yet, their birth outcomes were significantly better than the births that did not get the “extra person.”

It made no sense.

Nearly 8 years into this gig, I think I’m maybe beginning to understand how doulas work.

We’re pacers.

I’m reading an incredible book titled The Worst Is Over:  What to Say When Every Moment Counts.  I bought the book thinking it would help with my kids.  Norah has an anxious tummy and Cedar is ever catapulting from high places.  I never imagined how it might relate to my birth work.  But, of course, women in childbirth are in an altered state of consciousness just like people who experience trauma.  Childbirth is NOT trauma and not always even painful but the brain does go into an altered state.  Women in childbirth are often dreamy, time becomes hazy, thoughts may be confusing, suggestions plant deeply.  I already knew how important language is for birthing women but this book took it up 10 notches.  And it taught me about pacers.

So what’s a pacer?

You know how you modify your body language, voice, words to become more in sync with others?  It’s a normal part of communication.  Or sometimes a strong personality can change the entire mood of the room when that person is having a bad day.  The author describes pacing as “our natural human tendency to tune in to others nearby by matching our words and our behaviors to theirs.”

The author talks about the importance of pacers when people are afraid, hurting, in shock, etc.  Pacing builds confidence, healing, comfort, rapport, and cooperation.

How does this work in childbirth?

Nancy is deep in the birth zone.  She is in an altered state of consciousness.  She is barefoot in the hospital shower–a state that would disturb her any other time.  Usually a very modest woman, Nancy is naked.  Her husband, in swim trunks, supports her physically in the shower.  What am I doing?  I’m leaning against the wall, offering a sip of water from time to time.  I don’t say a word.  But here is the non-verbal pacing that is happening:  Nancy locks eyes with me as she welcomes each surge.  My eyes are confident, grounded, and full of love.  She knows I’ve done this before.  My eyes tell her everything is normal.  What else?  My posture is relaxed.  I’m not carrying tension or shedding adrenaline.  As we lock eyes, I take a deep cleansing breath and release it slowly.  She mimics me.  I smile.

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Sarah sits on her birthing ball leaning on her king-sized bed.  Her husband rubs her back.  Bon Iver plays in the background and the rain is falling outside.  There is nothing for me to do so I sit in the corner and knit.  Sometimes, Sarah looks over at me and I smile.  My calm, slow knitting reassures her that all is progressing perfectly and there is no rush.

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Heather’s labor is showing signs that baby is not in an optimal position.  I show her a technique to lunge during her waves.  Her husband stands behind her providing extra support.  I stand in front of her and lunge with her.  We are exactly in sync as we lunge and lunge and lunge some more.

What makes doulas uniquely suited for pacing?

The doula’s focus is entirely on the mom.  Midwives are amazing pacers but they sometimes have other important tasks that may come first or interrupt:  monitoring baby, checking mom’s blood pressure, etc.  Particularly in those rare cases of emergency, it is vital to have a pacer who can remain focused on mom.

Birth partners, close friends, family members are not always the best pacers.  Why?  They’re emotionally caught up with the experience.  They should be!  I remember catching a glimpse of my mother’s concerned face at my first birth.  It did not reassure me.  Sometimes a birth partner isn’t sure if what the birthing mother is feeling is normal and his/her face can mirror it.  And the birthing mom’s spidey senses can smell fear and uncertainty.

Giving name to this intuitive process has helped to deepen my understanding of what seems so mysterious–how the presence of a doula-who-does-nothing can be enriching and often crucial to the birth.