Doulas: what to ask
January 12, 2019 6:17 PM Subscribe
We have interviews scheduled with professional doulas, what should we be asking/looking for?
We’re using a matching service to engage the services of a birth doula. Please give us your advice on what to look for, ask, avoid. Any personal experience you guys can share would be great. Any issues you wish you would have discussed with the doula would also be helpful.
Relevant information:
1. All doulas we are matched with have exerperience with at least 100 births.
2. We are an athiest, science-believing pair of future parents who’s birth plan is to deliver at a hospital.
3. Both of us have anxiety issues around medical settings and medical professionals, which is one of the reasons we’re hiring a doula.
Anything you think we should know at all- we’d be happy to hear it.
We’re using a matching service to engage the services of a birth doula. Please give us your advice on what to look for, ask, avoid. Any personal experience you guys can share would be great. Any issues you wish you would have discussed with the doula would also be helpful.
Relevant information:
1. All doulas we are matched with have exerperience with at least 100 births.
2. We are an athiest, science-believing pair of future parents who’s birth plan is to deliver at a hospital.
3. Both of us have anxiety issues around medical settings and medical professionals, which is one of the reasons we’re hiring a doula.
Anything you think we should know at all- we’d be happy to hear it.
What is the doula's policy if they can not attend your labor/birth (due to illness, being with another client, etc.)? Do they have a backup doula they can call in and when can you meet that person?
posted by fussbudget at 8:02 PM on January 12, 2019 [4 favorites]
posted by fussbudget at 8:02 PM on January 12, 2019 [4 favorites]
If things go off track, which obstetricians do they use? This is how I found my first obstetrician, and if I had to do over again, I would have gone back to him for the second childbirth (different insurance).
Seconding asking who the backup doula would be. My preferred obstetrician was not available the second time, with less than optimal results (my daughter was fine, but I had some complications.)
posted by TrishaU at 8:34 PM on January 12, 2019
Seconding asking who the backup doula would be. My preferred obstetrician was not available the second time, with less than optimal results (my daughter was fine, but I had some complications.)
posted by TrishaU at 8:34 PM on January 12, 2019
Give the doula a hug or ask her to massage your hand or shoulders, and see how you feel about the way she touches you. A doula will see, touch, help reposition, and massage the mother during the intensely physical act of labour (ie, nude, sweating, pooping on the table, latching an infant onto a breast...) so make sure mama finds the doula's physical presence and touch comfortable, soothing, powerful-feeling, and grounding.
posted by pseudostrabismus at 8:34 PM on January 12, 2019 [2 favorites]
posted by pseudostrabismus at 8:34 PM on January 12, 2019 [2 favorites]
We interviewed three and were torn between two: one whose personalty and interests were very similar to ours but who was somewhat inexperienced, and one who was different from us but had a ton more experience. We picked the second, wondering if her personality would annoy us, but she was great. When I was in tons of pain, I did not care about any of that other stuff (like what her interests were, heck no); I was just enormously grateful that she knew how to calm me down and do the kind of massage that eased the pain. And when a scary situation arose at the time of birth, it seemed like she really knew what to do. So my advice is: go with the most experienced, competent person you can find. You want someone who will respect and support you, but it's not exactly about personality fit.
We moved, so in finding a new doula for our current pregnancy, some of my other questions included:
- Tell me about your approach / philosophy.
- How do you decide when to come? (This one is huge. I was in painful early labor for 30 hours before going to the hospital and really could have used some earlier support. My friend's doula was so slow in getting there that my friend succumbed to the pain and got an epidural. On the other hand, someone obviously can't be on duty in top form for 48 hours straight. The right answer is probably along the lines of "whenever you feel you need me," but then your follow up might be along the lines of "Suppose I feel I need you, but it turns out to be fairly early on. How do you manage your own stamina?" The doula I picked replied that she does a lot of back and forth to her house. "Sometimes people who are getting induced can use support right at the beginning when they're getting checked into the hospital, as that can be a bit overwhelming. But then they stay there without much pain, waiting for the medicine to get things started. So I'll come and make sure they're settled in well, to set the stage for a good start to the process, then head back home for awhile." I thought that was a great approach. Other doulas work as part of a team and manage stamina that way. But basically, you don't want someone who manages things by waiting as long as possible to come.)
- What kind of preparation do you do with clients before birth? (Some do one on one meetings; some hold group classes and sessions; some provide preparatory handouts, etc.)
- What kind of contact do you have with clients after birth? (Mine came about a week post-partum, checked on me, referred me to a better lactation consultant than the hospital had, and walked through a timeline of the birth. She provided that by email, too. You'd also want to know that she'd make herself available to talk through things further if you wanted.)
- What specific areas have you focused on in your training? (massage, hypnobirthing, spinning babies, aromatherapy, evidence-based birth information, etc.)
- What do you think of the various hospitals in the area? (I asked because I can choose where to deliver, but it's also a good check on how experienced they are; you want to see some knowledge of different hospitals' typical practices.)
- Do you know a good ...? (...birth prep class, prenatal yoga class, chiropractor, postnatal doula, lactation consultant -- you want a doula who is connected to a network of other practitioners and can give referrals.)
- What's your fee?
- What other costs should I be aware of? (E.g., mileage turned out to cost me a bunch. My current doula has a time limit, beyond which she charges per hour, but she promises to work with us to keep it under that limit and, e.g., doesn't charge when she's taking a nap in her car in the parking lot or whatever.)
- What's your cancellation policy like? (If your baby turns out to be breech, do you want a doula at a scheduled C-section?)
- Do you have any vacation in the month leading up to the due date?
- Who backs you up if you're out?
I'd mention your anxiety. Worth seeing what they say.
Also, it might be worth asking a semi-sciency question like what her take is on the recent research showing better outcomes for people induced at 39 weeks, or otherwise seeing how her comments jive with the science you're aware of. Ultimately, I don't think you're turning to the doula primarily for science -- in my opinion, her role there would be to support you in getting the scientific info you need from the nurses and doctors -- but it might be nice to see how she replies.
Congratulations and good luck!
posted by slidell at 1:46 AM on January 13, 2019
We moved, so in finding a new doula for our current pregnancy, some of my other questions included:
- Tell me about your approach / philosophy.
- How do you decide when to come? (This one is huge. I was in painful early labor for 30 hours before going to the hospital and really could have used some earlier support. My friend's doula was so slow in getting there that my friend succumbed to the pain and got an epidural. On the other hand, someone obviously can't be on duty in top form for 48 hours straight. The right answer is probably along the lines of "whenever you feel you need me," but then your follow up might be along the lines of "Suppose I feel I need you, but it turns out to be fairly early on. How do you manage your own stamina?" The doula I picked replied that she does a lot of back and forth to her house. "Sometimes people who are getting induced can use support right at the beginning when they're getting checked into the hospital, as that can be a bit overwhelming. But then they stay there without much pain, waiting for the medicine to get things started. So I'll come and make sure they're settled in well, to set the stage for a good start to the process, then head back home for awhile." I thought that was a great approach. Other doulas work as part of a team and manage stamina that way. But basically, you don't want someone who manages things by waiting as long as possible to come.)
- What kind of preparation do you do with clients before birth? (Some do one on one meetings; some hold group classes and sessions; some provide preparatory handouts, etc.)
- What kind of contact do you have with clients after birth? (Mine came about a week post-partum, checked on me, referred me to a better lactation consultant than the hospital had, and walked through a timeline of the birth. She provided that by email, too. You'd also want to know that she'd make herself available to talk through things further if you wanted.)
- What specific areas have you focused on in your training? (massage, hypnobirthing, spinning babies, aromatherapy, evidence-based birth information, etc.)
- What do you think of the various hospitals in the area? (I asked because I can choose where to deliver, but it's also a good check on how experienced they are; you want to see some knowledge of different hospitals' typical practices.)
- Do you know a good ...? (...birth prep class, prenatal yoga class, chiropractor, postnatal doula, lactation consultant -- you want a doula who is connected to a network of other practitioners and can give referrals.)
- What's your fee?
- What other costs should I be aware of? (E.g., mileage turned out to cost me a bunch. My current doula has a time limit, beyond which she charges per hour, but she promises to work with us to keep it under that limit and, e.g., doesn't charge when she's taking a nap in her car in the parking lot or whatever.)
- What's your cancellation policy like? (If your baby turns out to be breech, do you want a doula at a scheduled C-section?)
- Do you have any vacation in the month leading up to the due date?
- Who backs you up if you're out?
I'd mention your anxiety. Worth seeing what they say.
Also, it might be worth asking a semi-sciency question like what her take is on the recent research showing better outcomes for people induced at 39 weeks, or otherwise seeing how her comments jive with the science you're aware of. Ultimately, I don't think you're turning to the doula primarily for science -- in my opinion, her role there would be to support you in getting the scientific info you need from the nurses and doctors -- but it might be nice to see how she replies.
Congratulations and good luck!
posted by slidell at 1:46 AM on January 13, 2019
I was a labor & delivery nurse for 12 years (from 2006 - 2018) and I am very, VERY much in favor of laboring women and their families having a good doula by their side. They're an irreplaceable part of the team.
I specify good doula because I have worked with some truly awful doulas who deeply misunderstand the nature of their role and sometimes provide incorrect and outright dangerous information to their clients.
Doulas are not medical professionals and are not qualified to provide you with medical advice. Like slidell says above, the doula's job will be to help you get the information you need to make the right decisions for yourself and your family about medical interventions, NOT to parse that information in your stead and make recommendations about a treatment plan.
It's a very fine line, I know. Here's an example of a doula offering inappropriate medical advice:
DOCTOR: Family Hooves and Horns, we need to start pitocin.
DOULA: That's a very risky medication and is too dangerous. You could need an emergency c-section. Family Hooves and Horns, don't do that.
And here's an example of a doula being a rockstar:
DOCTOR: Family Hooves and Horns, we need to start pitocin.
DOULA: Family Hooves and Horns, in your birth plan it says that you want to avoid artificial stimulation of your contractions if possible. Are you OK with the plan? Do you need more information? Do you have any questions? Lots of hospitals have different requirements for fetal monitoring, eating and drinking, showering, etc., once pitocin is started--the doctor can explain those requirements before you make any decisions.
During an interview, asking the doula how she would respond to a doctor's suggestion that you receive pitocin augmentation[1] might reveal whether she's likely to give medical advice (bad) or use her experience to help you ask the right questions (good).
[1] Giving birth in a hospital means that unless you arrive there fully dilated and ready to push, it's more likely than not someone will want to start pitocin augmentation at some point in your labor.
posted by jesourie at 3:13 PM on January 13, 2019 [4 favorites]
I specify good doula because I have worked with some truly awful doulas who deeply misunderstand the nature of their role and sometimes provide incorrect and outright dangerous information to their clients.
Doulas are not medical professionals and are not qualified to provide you with medical advice. Like slidell says above, the doula's job will be to help you get the information you need to make the right decisions for yourself and your family about medical interventions, NOT to parse that information in your stead and make recommendations about a treatment plan.
It's a very fine line, I know. Here's an example of a doula offering inappropriate medical advice:
DOCTOR: Family Hooves and Horns, we need to start pitocin.
DOULA: That's a very risky medication and is too dangerous. You could need an emergency c-section. Family Hooves and Horns, don't do that.
And here's an example of a doula being a rockstar:
DOCTOR: Family Hooves and Horns, we need to start pitocin.
DOULA: Family Hooves and Horns, in your birth plan it says that you want to avoid artificial stimulation of your contractions if possible. Are you OK with the plan? Do you need more information? Do you have any questions? Lots of hospitals have different requirements for fetal monitoring, eating and drinking, showering, etc., once pitocin is started--the doctor can explain those requirements before you make any decisions.
During an interview, asking the doula how she would respond to a doctor's suggestion that you receive pitocin augmentation[1] might reveal whether she's likely to give medical advice (bad) or use her experience to help you ask the right questions (good).
[1] Giving birth in a hospital means that unless you arrive there fully dilated and ready to push, it's more likely than not someone will want to start pitocin augmentation at some point in your labor.
posted by jesourie at 3:13 PM on January 13, 2019 [4 favorites]
We hired an amazing doula for the birth of our son last June. We are also atheist/science folks. In addition to what linettasky posted above, here's some other questions to think about asking that helped us determine what doula to use:
- What is their cost, and what does that include? (our doula's cost included 2 visits during pregnancy to check in and go over our birth plan, etc., and then the labor, and then a visit postpartum to check in and help us out with any final newborn questions.)
- This is a bit of a downer question, but we asked about the money and what happens to the contract if for some reason we lost the baby before the labor (our doula had a contract we had to sign and we had to pay a bunch of $$ up front, so we were wondering about this. Our doula was so great, she told us how basically they give all the money back in a case like this because it's such a tragedy).
- We also asked about her certifications, and how often she does continuing education.
- We asked about her vaccination status (i.e. did she have current TDAP, and flu vaccine mainly)
- We asked what happens if one of her other clients goes into labor at the same time as us (i.e., is there a backup doula).
I think how they answer the "what is your philosophy/approach to birth" is probably the most important. We knew we liked our doula immediately based on how she answered this question. Ultimately, you'll need to be very comfortable with who you choose, so take into account how you feel overall after meeting each person. During my labor, our doula was touching me all over - massage, positioning me, etc. and it was so helpful, but I was only okay with it because I felt so comfortable with her based on our pre-labor meetings and the initial interview.
Lastly, I'm pretty sure we used the DONA International reference information to help us with the interview, here's their packet on how to choose a doula in case it helps: Packet
Feel free to memail me if I can help further. I loved my experience with my doula and I highly recommend getting one. She helped me so much, and also helped me advocate for what I wanted during the birth, and helped me to understand the options that were thrown my way during the labor when various stuff came up. Good luck!!
posted by FireFountain at 4:37 PM on January 13, 2019
- What is their cost, and what does that include? (our doula's cost included 2 visits during pregnancy to check in and go over our birth plan, etc., and then the labor, and then a visit postpartum to check in and help us out with any final newborn questions.)
- This is a bit of a downer question, but we asked about the money and what happens to the contract if for some reason we lost the baby before the labor (our doula had a contract we had to sign and we had to pay a bunch of $$ up front, so we were wondering about this. Our doula was so great, she told us how basically they give all the money back in a case like this because it's such a tragedy).
- We also asked about her certifications, and how often she does continuing education.
- We asked about her vaccination status (i.e. did she have current TDAP, and flu vaccine mainly)
- We asked what happens if one of her other clients goes into labor at the same time as us (i.e., is there a backup doula).
I think how they answer the "what is your philosophy/approach to birth" is probably the most important. We knew we liked our doula immediately based on how she answered this question. Ultimately, you'll need to be very comfortable with who you choose, so take into account how you feel overall after meeting each person. During my labor, our doula was touching me all over - massage, positioning me, etc. and it was so helpful, but I was only okay with it because I felt so comfortable with her based on our pre-labor meetings and the initial interview.
Lastly, I'm pretty sure we used the DONA International reference information to help us with the interview, here's their packet on how to choose a doula in case it helps: Packet
Feel free to memail me if I can help further. I loved my experience with my doula and I highly recommend getting one. She helped me so much, and also helped me advocate for what I wanted during the birth, and helped me to understand the options that were thrown my way during the labor when various stuff came up. Good luck!!
posted by FireFountain at 4:37 PM on January 13, 2019
I would make sure she understood that her role was purely to provide physical and emotional support, and that she understood she was not a medical provider. I wouldn't want her to have a "birth philosophy," because that's not relevant.
posted by schwinggg! at 7:58 PM on January 13, 2019
posted by schwinggg! at 7:58 PM on January 13, 2019
Have you worked at my hospital/with my care provider before? The answers to this one can also be super indicative -- ideally, you want a doula who develops a collaborative, not antagonistic, relationship with the medical providers involved, while simultaneously being "on your side.
+1 to this. If it's possible, also ask your care provider ask the same about your top 3 choices.
I also told doulas what things I was absolutely not into, and asked if they could deal with that. Thankfully, the doulas seemed pretty ok with being truthful about it. For example, you might ask if the doula can handle not bringing religion into your relationship (we interviewed a Catholic doula that would not promise that).
posted by freezer cake at 10:39 AM on January 14, 2019
+1 to this. If it's possible, also ask your care provider ask the same about your top 3 choices.
I also told doulas what things I was absolutely not into, and asked if they could deal with that. Thankfully, the doulas seemed pretty ok with being truthful about it. For example, you might ask if the doula can handle not bringing religion into your relationship (we interviewed a Catholic doula that would not promise that).
posted by freezer cake at 10:39 AM on January 14, 2019
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- How long have you been a doula?
- What is your philosophy/approach to birth? This one can be super important. You don't want a doula who spends her entire answer to this question prioritizing a kind of birth you don't want to have. IME, good doulas will talk about how birth is unpredictable, and they want to support people's preferences and not a strict "this is how you should give birth." There are a lot of atheist, science-minded doulas out there.
- Have you worked at my hospital/with my care provider before? The answers to this one can also be super indicative -- ideally, you want a doula who develops a collaborative, not antagonistic, relationship with the medical providers involved, while simultaneously being "on your side.
- What kinds of things do you actually do while you're at a birth?
- How do you work with partners or other support people?
- Can you refer me to other professionals as needed (lactation support, postpartum support)?
- What childbirth class should I take?
I come into interviews knowing when they're expecting, whether this is their first child, and where they're planning to give birth. I tend to ask them what they're looking for from a doula, how the pregnancy has gone so far, and whether they have any special health or other concerns I should know about.
All of the professional doulas I work with primarily attend hospital births. If you're working with experienced doulas, they probably do, too. In my experience, most people choose their doulas based simply on whether they like them, and whether the doula's feelings about birth align with their own. I also frequently get hired by people who are working with a midwife or OB I know and like.
If you have other questions about doula stuff, feel free to MeMail me.
posted by linettasky at 7:12 PM on January 12, 2019 [6 favorites]