Almost as soon as I got the positive pregnancy test with my third baby, I started having panic attacks. I would wake up, anxious and scared, from a dead sleep. This was a surprise pregnancy that I did not plan. In my mind, the timing wasn't right. 

​I dealt with these panic attacks as best I could. They came in the day and in the night. When I found myself begging my husband to come home from work and help me cope, I realized I was dealing with more than just a little bit of scared feelings. ​

In my experience, many pregnant people FEAR THE BIG BABY! I myself fell prey to this when pregnant with my first child. I went to an OB visit that happened to be on my due date. My doctor said to me, "Are you ready to get this over with? Because I think he's getting kind of big." In my mind, there was nothing scarier than THE BIG BABY! I didn't want THE BIG BABY! I had read in "What to Expect When You're Expecting" (or as I refer to it, "What to Expect When You're Paranoid"), that doctors don't induce unless it's medically necessary. At that time I figured if it came from my doctor's mouth, that meant it was medically necessary. And because I was afraid of THE BIG BABY, I agreed.

Sometimes a cesarean is necessary and a family knows this before labor begins. This gives them a chance to prepare in ways they may not have thought of during a regular labor-turned-cesarean birth.  ​

Sitting still, baby kicks
Belly squeezes, baby stills
Mind races, breathing slows
The waiting time is over
The waiting time has just begun.

Ready partner, strong support
Doula helping, steady hands
Midwife present, eyes bright
The storm is calming
The storm has begun.

Eyes closed, sound within
Mother loving, triumphant face
Baby grimaces, seeking the breast
The journey is over
The journey has begun.

​With my first child, I had no idea there was such a thing as a doula -- I had never heard the word. With my second, we moved while I was 7 months pregnant, and I had since learned what a doula was; as I was away from home and family, I thought about finding a doula to help me through that birth, but in the end, the fear of the cost left my husband and I on our own again. With my third child, I finally decided I deserved a doula!  

And do I ever love her!

Once my contractions began and we headed for the hospital, we called two people: My mom (who was three hours away), and my doula.  My doula, Alicia, met us soon after at the hospital. She came ready to serve with her doula bag, her calm demeanor, and her gentle smile. I felt instantly better as she walked into my room, like "now I can do this."  

My husband had been with me through two other labors and births -- he wasn't a newbie.  But Alicia could intuit what my needs were without even asking. She was so good at helping me, she was almost like a fixture in the room -- the one handing me cold wash clothes to put on my hot belly, the one adjusting the bubbles in the Jacuzzi tub, the one giving the soft physical and verbal encouragement when I hadn't even realized I was struggling.  

From my husband I had love and security; from my doula I had nurturing and normalcy. Now I know, if I ever have another baby, I absolutely will have a doula.

​I’ve noticed a lot of confusion from the general public about doulas. And it’s understandable. Doulas aren’t portrayed in television or movies. You don’t hear about us on the news. Most people will never even meet a doula; and if they do they may not ask any questions. (I’m pretty sure my dad thinks I’m a doctor of some sort.) So, I thought I’d spend some time today clearing up the five most common misconceptions I hear about doulas. 

1. We’re essentially midwives. Umm, no. Not quite. Midwives handle the physiological aspects of birth. They monitor the health and status of mother and baby, diagnose and treat problems, and are medically trained in healthcare to some degree. Midwives are essentially OBGYN-replacements. Doulas give emotional, physical, and informational support as well as advocate for the rights and wishes of the birthing woman. As a doula, I offer knowledge (from training) and experience (from practice) in an attempt to normalize birth. There are many unknowns in birth and women can feel scared or threatened. A helpful and familiar doula who can offer advice or encouragement, without the burden of (midwife/OB) responsibility, can help the woman achieve the birth she desires.

2. We’re all patchouli-loving hippies. I actually hate the smell of patchouli. And while I admire hippie women who live free and uninhibited lives, I like my medications, Iphone, high heels, and smooth legs. Doulas come in many varieties. This misconception is based in a (sort of) truth in that modern doulas arose in response to the medical births of the early and mid 1900s. Our first doulas (and midwives) were a group of hippies in the 1970s who began the natural birth movement. Hospitals were putting women under so many medications during labor and birth, they were unconscious, also known as Twilight Sleep. But while hippies may have started the movement, options in birth has become a mainstream idea. I know medications can be successfully used in some birth situations. I simply advocate for a woman’s right to choose where and how she gives birth.

3. We only attend natural births. In my personal practice, this couldn’t be farther from the truth. I attend far more births where the woman is utilizing some sort of medical intervention, be it pain relief or induction. Some doulas may choose to decline medicated births for personal reasons. But not me. Don’t get me wrong, I certainly have (very) strong opinions on what I believe are the best ways to give birth. But I’ve already had the pleasure of planning and experiencing my own births. As a doula, I help other women with their births. If my client wants medicine, I want it for her, too. If she wants to be induced, I support that fully. If she wants to schedule a cesarean, I will stand by her side.

4. We replace the partner in the birth room. That would be a terrible thing, indeed. I am constantly including the partner in whatever I am doing for the birthing woman so that the partner can be a part of the experience. The truth is that this birth is their memory, not mine. I won’t be invited to the child’s birthday parties or high school graduation. I am in their life for a short, yet sacred time. I strive to be an addition to the birth team; to be the part that seemed to be missing. I cannot replace the loving bond that connects the woman to her partner and their new child. 

5. What we do is easy and should be offered for little or no cost. It’s not easy. It’s hard work. Doulas must create their own small business and run it. We network with perinatal providers in the community to attract clients and spend a lot of time and energy in letting pregnant women around us know that we are available. We must build an intimate relationship with our client (akin to a counselor) in a very short period of time, while tailoring our services to their specific needs. We study, learn, and grow constantly in our knowledge so that we can hopefully be of help in every sort of situation. We put ourselves on-call and contract to drop everything else (family, friends, commitments) when our clients go into labor. We support women (physically and emotionally) on little to no sleep with the diet of coffee and adrenaline. Most importantly, we hold space. We witness birthing women and see them without making any judgements. All the while, we sometimes witness hard and scary things during birth that can make us question just what the heck we’re doing. But we love it. Doulas are compelled to join women during labor: to stand with them and support their choices. And in valuing other women, we must value ourselves: our time, our knowledge, our strength, our service.
​ 
I hope that this has been informative for you in clarifying the role of the doula. If you have any questions or comments, please write them below. I’d love to hear from you!

​Kelly is a DONA-certified birth doula living the dream in Austin, TX. A mother of 3 daughters and a lover of exercise and taco food trucks, Kelly incorporates a modern and urban dynamic into her work as a doula. She serves women of all backgrounds and identifications, with all types of care providers and in all settings. Kelly's clients value her honesty and relentless desire for informed decision-making. Kelly also provides trauma-informed care and helps each woman she meets screen for Perinatal Mood and Anxiety Disorders. Find her on Facebook as @kellybolerjackdoula, Instagram as kelly_bolerjack_doula, or her website www.kellybolerjackdoula.com to find out more.

​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.