​One of the most crucial things we do as doulas is help parents make decisions. It's not as glamorous or often discussed as giving massages, squeezing aching hips, or whispering words of comfort and encouragement (not that any of those things are particularly glamorous). But it's one of the most important things we do.

Decision-making happens frequently during pregnancy. Choosing a care provider, a place to birth, which breast pump to buy through your insurance, what kind of birth preparation class to take, what sorts of things to register for, and so on...the decisions to be made sometimes feel endless.

But during labor, things are different. No longer is there a stretch of weeks or even months before baby is on the way - things are happening right now. Add to the urgency of time the fact that most laboring families are not necessarily calm, cool, and collected the way they might like to be when making decisions. Parents often don't even understand the implications of the options their care team is presenting.

That's where we come in.

In our prenatal visits and birth classes, we often use a tool well-known in the birth world. In fact, it's a tool now used by many who encourage healthcare literacy as a helpful way to approach decision-making with care providers. This tool comes in handy no matter where you're birthing, but we find it's often especially helpful for clients who are having their babies in a hospital setting.

The tool is an acronym: BRAIN. When a question comes up in labor, or a procedure or medication is suggested as the next step, our first suggestion is always to stop and take a breath. Sometimes these situations can be nerve-wracking in labor. So give yourself a moment rather than responding quickly and impulsively.

Once you've gotten a nice breath or two under your belt, take some time to go through the acronym letter by letter and ask some questions. 

B: Benefits The first question to ask is what the benefits of the suggested procedure, medication, or change to the situation would be. Remember to consider benefits both for you and for your baby. We've found that usually care providers answer this question even before you have to ask it, because their suggestion is made with the intention of giving you and/or your baby a certain benefit. But if you have any additional questions about the benefits, ask them!

R: Risks Next to ask is, what are the possible risks to you? To your baby? Usually in a medical setting the answer to this question reads more like the side effects listed on a drug label. While this is good information to know, there are other indirect considerations to think about which sometimes fall outside the realm of the care provider's role in that moment.

For example, sometimes our clients ask their nurse or anesthesiologist about the risks of an epidural. Usually we hear care providers mention things like the possibility of a drop in blood pressure, headaches, nausea, itching, etc. 

However, I've never heard a care provider mention the increased risk of a longer pushing phase, the increased use of medication to augment a labor slowed by epidural (pitocin), or the increased difficulty of breastfeeding after births involving an epidural (probably due to the IV fluids that accompany the administration of an epidural). These are things we discuss with our clients if they're considering an epidural, along with the benefits including "therapeutic rest" if labor has been long and hard. 

If you ask about the risks of your care provider's suggestion and receive information from the drug label, also ask if there are any other indirect risks they know of. (And check in with your doula too, to see if they have any other information that might help you as you make your decision.)

A: Alternatives Ask your care provider if there are any other alternatives that can be tried first before proceeding to the suggested procedure or medication. There may be something less invasive or more temporary that might help address the issue at hand. 

​Often care providers and medical staff are much more comfortable with medications and medical technology in birth than parents are - primarily because they're around those things all the time. They see highly medicalized care help families every day. But most expecting parents aren't in that boat. Our clients are often surprised that their care providers suggested something more invasive when there was a less invasive alternative. Understanding where your care provider is coming from can be really helpful in this case. And of course, if your care provider suggests an alternative or two, make sure to use your BRAIN when exploring those options as well.

I: Intuition What does your gut say about this? How are you feeling about the situation at hand and the proposed next steps? Studies have actually shown that the intuitive, ancient part of our brains (the part that gives us those gut feelings) often works faster than the more analytical part of our brains. Here is a fascinating article on the subject.

It's important not to discount the sensations in your body we refer to as a gut feeling because what it can mean is that some part of you already knows the answer. It may just take a while for the rest of your mind to catch up and figure out the "why." Pregnancy, birth, and parenting involve a LOT of intuition. Don't leave your intuition at the door when you enter the birth room.

N: Nothing Also known as, "What if we wait an hour?" This question can help you determine whether your care provider feels the situation is an emergency or not. If the answer to "Can we wait an hour?" is "Sure, I'll come check in later," you know you have time to think things over. But if the answer is, "Waiting isn't an option - we need to make a decision now," obviously that gives you a different picture.

​If the care provider's response to waiting an hour is positive, sometimes parents are surprised they were being asked to make a decision earlier than necessary. It's important to keep in mind that care providers are often on a schedule and juggling multiple patients at once. Sometimes the timing of things has more to do with their patient load than with your particular situation, which is another reason why it's important for parents to be asking these questions. This question is especially powerful for parents who want to minimize medications and medical technology in their births. 

You should be able to take your time in making your decision unless there is a medical emergency at hand.

After you've had a chance to ask your questions, request a few minutes alone without your care providers in the room to consider your options. (If you have a doula, it could be beneficial to have them in the room with you as you talk things over. But if for any reason you'd be more comfortable having the conversation alone, by all means let your doula know.)

Once you're ready, let your care providers know you've considered your options and made a decision. If you are choosing to accept your care provider's recom-mendation, often the conversation will be fairly straightforward. But if you're choosing instead to try an alternative or wait a while before trying anything else, sometimes care providers can feel that their expertise is being undermined or that someone is convincing you not to accept their recommendation. This is a very human reaction!

To help diffuse any tension if this happens, speak from your HEART when communicating your decision to your support team.

H: Hear "I hear what you're saying and I understand why you recommended this..."

E: Empathize "...and I know you want the best for me and my baby..."

A: Affirm/Assert "...but I intend to wait a while longer before considering x, y, or z." OR "...I would rather try this alternative instead."

R: Reassure "I will let you know if anything changes."

T: Thanks "Thank you so much for your time and for taking good care of us."

These kinds of conversations can be difficult, especially if any medical concerns are present. These tools will give you an anchoring point when making decisions in labor and beyond.

​Remember to use your BRAIN and HEART!

​Megan has been serving growing families since 2014. She is an Advanced Birthing From Within Mentor and doula based in Orange County, CA. She is passionate about providing holistic guidance for her clients, helping them cultivate resilience and openness on their journeys to parenthood. In addition to offering birth doula support, she also teaches birth and parenting preparation classes. Megan practices in partnership with her wife, Marlee, who is also a birth and postpartum doula, childbirth educator, and lactation counselor. Together they serve families of all shapes and sizes with respect and compassion. Find out more about her by visiting Hero Birth Services, or her Facebook page. 

I've been a doula for over 10 years. I've seen a lot of doulas come and go in this profession for many reasons, but the one reason for leaving doula work that always hits at my heart, is when other doulas say "There's too much competition". I wish to flip that perception.
 
​Take a step back, and think of where you heard the term doula. Was it from a friend? You're own birth? In the news? Chances are, it wasn't a common discussion, no matter where you heard it.

Statistically, in the US (because nothing is coming up for Canadian doula stats) only 6% of birthing families chose to have a doula. If we are talking about over saturation in the job market, that number would be a lot higher! It also goes on to mention that another 27% would have liked to hire a doula.
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I like to look at that as a challenge. Obviously, we know that the word doula is still relatively unheard of in most mainstream circles. For as long as I've been a doula, I still run into people that say - I don't know what that is.
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How do we change this? How do we get the word doula to roll off the lips of every beautiful birthing person? This is the challenge; to make it part of everyday conversations.  The way for it to make it into more conversations, is if it becomes the norm, and a way to make it the norm, is if there are more doulas! Abundance.

I often share fellow local doulas info, blogs, etc on my business page. I have people ask me all the time why I do this. Why should I share and promote the "competition". To that I say, until every family on this vast planet knows what a doula is and does, I will keep sharing. I share because I'm not the right doula for everyone. I share because my doula sister has some great info, I share because even if I don't get the client, I know they are getting who they need and now one more family has doula support. One more family can now share the word doula with honour and love. Abundance.

I'd like to change the word competition (rivalry for supremacy) to abundance (overflowing fullness). If we believe that we do this work out of love, then we need abundance. The world we raise our children in, that we bring future parents into, needs more love. By believing in abundance of love and support we all win. 

When we flip the idea that other doulas are competition, we lose the fear, we start to see how strong we are. We start to see the tribe of support that stands around us, holding the space for big things to come. That there is strength in numbers, and with those numbers, we have the power to create a birth world revolution. ​

​Natasha is the mother to 4 spirited children who, along with their dogs, cats, and reptiles reside in Spruce Grove Aberta, Canada. 

Natasha has been a practicing doula for over 10 years, and has worked in all Edmonton area hospitals, along with the local Lucina Birth Center and home births. 

She takes her role as doula very seriously, and in doing so she is forever upgrading her skills.  Natasha has taken training through DONA, Stillbirthday University, and GK University. She is currently enrolled in The Cultured Doula Program, and has recently completed her Masters Rebozo with GKU. As a placenta specialist she trained with PBiU.

Natasha can be found at Supermomma Doula & Placenta Edmonton, and her Facebook page.

I sat next to one of my closest friends from college in the hospital room. Her husband and I were desperate to help. The nurse came in to the room: “you seem to be in pain, you should really get some pain medication,” she said for the fifth time with one glance at my friend. It was only a few more hours until my friend agreed and the nurse sent us out of the room while an epidural was administered. Her husband and I went to get some food from the cafeteria. He returned to the room with her mother for the birth of his firstborn. I spent the first few nights postpartum at my friend’s home doing all I knew to help her and her newborn. I was obsessed. In love. Infatuated. Though my friend would go on to be buried in postpartum depression, she saw my passion and suggested I become a doula.

I took as many classes as I could possibly find and attempted to create my own company. My first potential client was excited to hire me. I was petrified. How could they put me in charge of their birth? I had never attended a birth before. Was I crazy to want to be a doula? What if I just wanted to be a mom?

With that thought, my career as a doula ended. The answer was a resounding: yes. I did want to be a mom. With that I turned my back on the birth world and continued my pursuit for a career path, eventually getting two masters and starting my journey towards a PhD. In 2015, I had to drive two hours round-trip to get to work every day. My boyfriend had recently introduced me to podcasts and, in an attempt to find a new podcast to listen to, I decided to punch “birth” into the search bar. The Birth Hour, Birthful Podcast, Longest Shortest Time, and Mom and Dad are Fighting. (Today I have some new favorites: Fourth Trimester Podcast, Informed Pregnancy Podcast, Sprogcast, and All Things Breastfeeding Podcast.) I would come home from a full day spent collecting field notes only to spout birth facts -- until my boyfriend begged me to stop talking about birth.

A year and a half later, in November of 2016, my boyfriend found a job in California, we moved across country, and I decided to be a volunteer doula instead of immediately starting my own company. Volunteering as a doula is a unique opportunity. There are not many hospitals nation-wide that have volunteer programs. What I did not realize back in North Carolina in 2009 was that the University of North Carolina had its own volunteer doula program. Had I decided to volunteer the first time around my life would have taken a very different path.

San Francisco also has volunteer programs at San Francisco General Hospital (SFGH) and St Luke’s. SFGH’s volunteer doula program is well established. It took me five months to get into the program after applying and another month to get my badge so I could work there. 

SFGH is primarily shift-based doula work. We were required to do one twelve hour shift once a month at the hospital’s labor and delivery ward. I did not enjoy it. There were times when I would sit for hours in the staff break room with nothing to do, staring at a screen trying to decipher the abbreviations that at the time meant nothing. When I was asked by the nurses to help a patient out I would find myself in a situation like this: a woman had barely acknowledged her desire for the epidural that was administered. It was explained by several hospital staff how it worked. Once we were alone she turned to me, “what is this?” she asked, pointing to the epidural button.

If I had been there earlier, I could have helped her understand all of her options, cope with her pain, have the birth she wanted, or at least explained to her the confusing birth hospital system she had been thrown into: all things I was able to do while on call with families at St Luke’s. Instead, the women we serve in shift-based work at SFGH only get support from a doula midway through their births, and at that point I was little better than the drugs the hospital had set her up on: another unexpected, confusing intervention to a natural process that modern medicine has somehow turned into an esoteric exercise for medical technicians.
​ 
I no longer do shift-based volunteer work and no longer volunteer at St Luke’s. Instead I work at San Francisco General Hospital for their small on-call program where I help with high-risk births: substance abuse survivors, rape victims, women whose babies will need surgery immediately postpartum, etc. I also started Sweetbay Doula as a doula who works to nurture the relationship between birthing individual and their partner that I believe is so important. And I love my job.

​Since May 2017, Darby Morris has been serving private clients, and volunteers at both San Francisco General Hospital (SFGH) and St. Luke’s Hospital as a birth and postpartum doula.

Darby believes in providing doula experiences based upon continuing education and spreading that knowledge to families. Her business, Sweetbay Doula, is named after the Sweetbay Magnolia tree. Magnolias are known for their strength, flexibility and beauty.  They can be found in both warm and cold climates, and are either deciduous or evergreen, depending on the environment.  Their blooms are not affected by frost so they are able to bloom into late spring.

In short, Sweetbay Doula, like its namesake, is highly-resilient, flexible, and open-minded in all of the ways an expectant parent needs. 

​My name is Nicci and I am a Bereavement Doula from Pretoria (Gauteng Province, South Africa), dealing exclusively with miscarriage, stillbirth and infant loss. I have been a "death doula" since 2015 and I am currently one of the most experienced bereavement doulas in the country. 
 
Death humbles you. It leaves many wounded and scared (and scarred!) but also just as many people are awakened to the miracle and the fragility that is life. It opens your eyes to the absolute gift it is to breathe (and have those you love breathe) every single day.  I deal with indescribable pain and heartache. My job is not an easy one, in fact, it’s probably one of the most emotionally challenging professions out there. But it is made bearable by knowing that I could help a mommy or daddy carry the load, even if it’s only for a little while.  There is something unique about child loss. Because you don’t only lose a child you love, you lose the promise of that child’s life. You lose the "could have beens". You miss their first day of school. You miss their 16th and 21st and 30th birthdays. You miss out on every little thing that would have made that child "yours".
 
Like the character in the book The Shack, I carry The Great Sadness with me every single day of my life.  Sometimes The Great Sadness is quite satisfied to sit in the corner of a room or on the roof of my car and just leave me alone – sometimes even for a day or two. Other days, The Great Sadness would just not let go of me. It will cling to me whilst I brush my teeth, when I feed the dogs, when I pray, when I speak to a telesales agent and decline a cellphone contract for the umpteenth time. It will rear its sad head when I walk in a shopping centre and see something or someone that triggers a memory.  Sometimes when I walk passed a baby store The Great Sadness would hug me so tight that I struggle to breathe. But the Great Sadness and I have come to an agreement: Whenever I am with a client, it will not show up for a while. But sometimes The Great Sadness breaks its word and all that I can do is be sad with them.
 
The parents I assist and I usually have a lot of time talk and cry and yes, even laugh. Sometimes it’s much easier to talk about your pain to a stranger – somebody that you don’t feel guilty over because you are "burdening" them with your pain. Someone that won’t judge, just listen – who may shed a tear or two with you but who will not fall apart.
 
As a bereavement doula I am learning more and more about life, death, loss and everything in between every day. I have seen that parents feel guilty because they are experiencing deep grief over the death of their child. Statements made by well-meaning friends may cause them to question the validity of their deep feelings of sorrow – statements like the following: “Just be glad you didn’t get to know her. This way you won’t have to suffer the grief.” Or  “The woman down the street lost all her children in a fire, you are lucky compared to her.”

The fact is that grief cannot be compared – not even between parents. Grief will not lessen just because the grief of another person is perceived to be greater. Also, they may have given birth to another child. But this will be another child, not a substitute for the one who has died. I always say babies aren’t puppies who can fulfill a general need. And to be honest, not even a dog can be replaced, how on earth can people expect parents to "replace" their baby who has passed on with another!
 
Although primarily my focus, I don’t just assist with baby loss but also with other losses.  I have assisted a mother who gave birth via c-section to a healthy, beautiful little baby boy. The reason she needed me though, was because her husband was brutally shot and killed in front of her. This woman was shattered and tears jumped in my eyes when I looked into hers. It was almost unbearable to look at her. But she needed a calm, collected and professional person to assist her during the birth. In hindsight, I was none of the above. I may have appeared calm and collected, and yes, even professional to the untrained eye. But I was falling apart on the inside. The moment the doctor lifted that precious little boy from his mommy’s tummy I had such a huge lump in my throat I couldn’t breathe. The Great Sadness won that day…
 
Because there is such a huge need for bereavement birth workers in South Africa, I have written an Online Bereavement Training Program to enable as many people as possible in South Africa with a heart for bereavement to assist parents going through loss.  Students are equipped with the right information, tools and coping skills to guide families in South Africa going through the unimaginable. 
 
It is my dream that my profession will be formally recognized and acknowledged in South Africa and that bereavement doulas’ services will be covered by all medical aids.  The motto of the bereavement doulas trained by Nicci.doula Bereavement is “to serve with love in loss” – I hope to be able to do this for a very long time to come.

​Ever since the traumatic birth of her firstborn, the subsequent birth of his brothers, 6 infertility treatments, 3 miscarriages and 1 adoption, it has always been Nicci's dream to make a difference in the lives of bereaved parents. She is Birth and Perinatal Bereavement Doula, and a certified SBD Doula®. Passionate about ensuring families of all kinds have the unique support they need, she is the former director at Voice of the Unborn Baby, and Managing Director of Doulas of South Africa. Nicci is an avid writer and has written many short stories on her experiences as bereavement doula. Nicci also wrote a book about her infertility struggles. Besides being a doula, she is also a professional stillbirth photographer. Nicci believes in the power of encouragement, and in building confident and empowered doulas to make a difference in South Africa.  She also believes in dreaming big and working hard. She is passionate about people in general and more specifically about the doula profession.​ If you would like more information on the work Nicci does, please visit www.niccidoula.com or visit her Facebook page. For international bereavement training please visit www.stillbirthday.com.

Nicci lives in a leafy suburb at the foot of the Magalies mountains,  in the Pretoria area  of Gauteng Province, South Africa.

Through almost a decade of discussions with friends and family, this has been the most frequent question asked: what DO doulas do? A loaded one. In the few instances where someone does know the word doula, I typically see generalized notions picked up from media, college, or that hippy-dippy aunt of yours that had her baby at home, such as labor and delivery support, birth assistant, maid, personal assistant, stand-in for unsupportive partners, etc. And while I could speak on the subject for days, I often find myself explaining over and over again how integral a doula can be in any birthing experience from a planned cesarean to an unmedicated home birth, even a high-risk pregnancy and loss of pregnancy. Doulas wear many labels, often times several: birth doula, postpartum doula, antepartum doula, bereavement doula, etc. This led me to find out what the leading experts say about the modern-day doula.

In the fourth edition of The Birth Partner | The Complete Guide to Childbirth for Dads, Doulas, and All Other Labor Companions, Penny Simkin states:

"The [birth] doula is on call for you, arrives at your home or the hospital when you need her, and remains with you continuously, with few or no breaks, until after the baby is born. The doula is trained and experienced in providing emotional support, physical comfort, and nonclinical advice. She draws on her knowledge and experience as she reassures, encourages, comforts, and empathizes with the mother."

Ann Douglas, in The Mother of All Pregnancy Books, writes:

"[Postpartum doulas] offer a similar service [as birth doulas] during the postpartum period, providing hands-on assistance to new parents during the first few days or weeks of parenthood. Postpartum doulas are “jill of all trades,” who bring a range of different skills to the table."

The Doula Book, written by Marshall H. Klaus, MD, John H. Kennell, MD, and Phyllis H Klaus, MFT, LMSW, explains:

"…a doula needs specific skills and insights. A successful doula is comfortable with giving of herself and is not afraid to love. She also can enter another’s space and be highly responsive and aware of another’s needs, moods, changes, and unspoken feelings. At the same time, she is able to be flexible in this process, adapting herself to each mother’s needs, and has no need to control or smother."

Clearly, there are a wide-range of definitions available for a doula, and often times doulas vary in what they offer to clients and their families. I’m reminded of a term I learned while watching animated films with my husband and son: Inbetweeners. In animation, these are assistants to the animators that ‘fill in’ drawings around the key frames to maintain smooth evolution from one to another. Just like a doula, they do not control the story line (that’s left to the writers, directors, editors, etc.), rather they assist progression to accomplish the end goal of a successful film. In birth, doulas are the Inbetweeners.

Doulas do the inbetween work – applying counter pressure on mom while she leans on her partner, managing meal prep and household upkeep while mom, dad, and baby adjust to their new life together, offering words of encouragement during a challenging transition. She does not control your birthing experience. You may not see her in birth photos (just like we rarely notice credits for Inbetweeners), but she is there, assisting progression to accomplish the end goal of each mother.

Her face isn’t what you’ll carry with you. A birthing experience void of confusion, desperation, frustration, or regret is the ultimate service of a doula, and this is a passive one. She is dedicated to facilitating an experience as close to the wishes of the mother as situationally possible.

What DO doulas do? Everything inbetween.

​​Erica Verbeck, born and raised in Southern Indiana, is the owner of Doula the Damn Thing. She earned a Bachelor of Science in Communication and Culture with studies in Anthropology, Family Studies, and Early Childhood Education from Indiana University.

She values homeopathic restoration of our natural bodies through healthy diet, minimalism (work-in-progress), and unschooling her toddler. She works to balance her traditional upbringing with the ancient methods of our predecessors to enlighten her journey through pregnancy, birth, and motherhood.

​When not playing with her young son or discussing birth and babies, Erica enjoys wire-wrapping jewelry and reading the latest research on pregnancy, birth, and parenthood. Through a mother's most intimate and primal journey, she hopes to build a trusting and informed birth experience for all who desire one. You can find her through her Facebook page​doulathedamnthing.com, or her website, Doula the Damn Thing.