Frequently  Asked  Questions
		"Just as a woman's heart knows how and when to pump, her lungs to inhale, and her hand to pull back from fire, so she knows when and how to give birth." ~  Virginia Di Orio

I have a supportive partner/family member/friend who will be with me throughout labour. Do I really need a doula?
A doula works with the mother and her partner or other birth companion(s) to provide support and assistance, helping them work together.

A doula is also professionally trained in childbirth, and has a repertoire of coping techniques and skills she can suggest to mothers and their support people. Her knowledge of birth, experience and calm can help everybody involved get through a long or challenging labour. While your doula cannot provide medical information, or carry out medical tasks, she can help you understand the normal physical and emotional milestones in labour and birth.

In addition, while you develop a bond with your doula, it is not the same as the bond between partners, family or friends so it may be easier for her to remain objective and calm during labour. 

For more information, see the  Partners & Doulas section.

What's the difference between a birth doula and a midwife?
A birth doula provides non-clinical care in the form of education, information, emotional support and hands-on physical comfort. Doulas do not provide prenatal care, perform medical procedures such as blood pressure checks or internal exams and does not catch babies. Fees are not covered by OHIP, and are negotiated between the client and doula.

Does a doula replace nursing staff? 
No. Doulas do not replace nurses or other medical staff. Doulas do not perform clinical or medical tasks such as taking blood pressure or temperature, monitoring fetal heart rate, doing vaginal examinations or providing postpartum clinical care. They are there to comfort and support the mother and her birth companions.

What effects does the presence of a doula have on labour, birth and postpartum?
Numerous studies have found that having a labour doula offers measurable physical and psychological effects for mothers during labour and in the first six weeks after birth:

:: 45% reduction in Cesarean sections
:: 10% to 60% reduction in requests for epidurals 
:: 31% reduction in use of pain medications
:: 50% reduction in use of oxytocin (Pitocin) 
:: 25% reduction in length of labour
:: 34% reduction in the need for forceps
:: 13% decrease in postpartum depression
:: 12% decrease in anxiety
:: 15% increase in self-esteem
:: 22% increase in breastfeeding rates
:: 39% reduction in feeding problems

What effects does the presence of a doula have on the mother?
When a doula is present during and after childbirth, women report greater satisfaction with their birth experience, make more positive assessments of their babies, have fewer cesareans and requests for medical intervention and less postpartum depression.

What effects do the presence of doulas have on babies?
Studies have shown that babies born with doulas present tend to have shorter hospital stays, fewer admissions to special care nurseries, breastfeed more easily and have more affectionate mothers in the postpartum period.

Will you advocate for me?
A doulas role is not to run your birth, but rather to help you and your partner take charge of your birthing experience. If you ask me to, I will suggest options or questions you might talk over with your primary care giver or nurse. If a suggested procedure or course of treatment is unclear, I will help you get the information you need to make an informed choice. Whatever decisions you make, I will support your 100%. 

I do not tell you what you should do. I do not tell other care givers what you want, voice your concerns or refuse procedures on your behalf. You, or your partner, must communicate directly with midwives, doctors and nurses on these issues. 

Is it true that doulas push unmedicated childbirth and won't let their clients have epidurals?
Any decisions about medical procedures, such as pain medications, are made between a woman and her midwife/doctor. A doula cannot prevent you from having any medication or procedure you and your primary care giver deem appropriate and safe for you and your baby. I will support your decisions, whatever they may entail.

Doulas have a great deal of education and experience with the normal course of labour and birth. They know that most women can give birth medication-free with no complications, and that an unmedicated birth has many advantages for both mother and child. Doulas also recognize that circumstances may arise which make interventions essential or the use of pain medication desirable.

My role is to help you have the birth you desire. At our prenatal meetings we will talk about the risks and benefits of a range of interventions, your thoughts and feelings about the wide variety of options available to you for labour and pushing, your preferences for pain relief and establish a “code word” or protocol to follow should you ask for pain medication during labour. 

If you wish to, I will help you write a birth plan or birth wishes sheet and develop a list of questions for your primary care giver prior to labour and birth.

If I choose to have an epidural or take other pain medication, will you leave?
Only if you want me to leave. Having an epidural does not mean that you will not require support. Some women find an epidural does not provide complete relief, or that the epidural works in some areas but not others. They still wish to have shoulder and neck massages and someone to talk with about what’s happening and what is to come. I can also get food and drinks for you and your partner, stay with you while he takes a break etc. 

Also, epidurals are often reduced, or have worn off, by the time you are ready to push your baby out and I can support you through pushing and in the time right after your baby is born. 

If I require a cesarean section, will you leave?
Again, only if you wish me to; I may not be allowed into the operating room if you have a partner or other support person present, but I can wait outside and accompany you to the recovery area if hospital policy permits. I will stay for up to two hours following your baby’s birth, help you initiate breastfeeding if you wish, give your partner a chance to leave to make phone calls, eat etc. and help you cope with some of the common after-effects of surgery.

If you are scheduled for a c-section, I will attend if you wish. Again, if your partner or another support person will be with you please be sure to confirm with your doctor/midwife that an additional person is allowed in the operating room with you. I will also accompany you in recovery or once you have been moved to the postpartum floor if you wish.

Do you attend home births?
Yes. I believe that woman have the right to have their baby where they feel the most comfortable and secure.

I don’t want to have a midwife or doctor present at my home birth. Will you provide labour support in that situation?
No. While I do believe women have the right to choose an unattended childbirth, for personal and legal reasons I am not comfortable being there in my professional capacity as a doula. If you are considering an unattended home birth, I strongly urge you to seek out reputable sources of information on making your labour and birth as safe for you and your child as possible.

Some of my friends have had problems with breastfeeding. Don't I need a lactation consultant instead of or in addition to a postpartum doula?
There's a two-part answer to this question. The first part is that it's important for women to know that the term "lactation consultant", like the term"doula", is not regulated. Anyone can use it, and it does not denote or imply any particular level of training. Most women, when using the term "lactation consultant", are probably thinking of an IBCLC - an International Board Certified Lactation Consultant. This is a very advanced level of training, taking many years to complete. It requires 2500-4000 hours of experience before you can sit the certifying exam. So, if someone tells you she's an LC, you should ask what kind of training she's had.

That being said, most women don't need the services of an IBCLC. Most breastfeeding problems are resolved by fixing the way the mother holds the baby and the way the baby latches on to the breast. A trained postpartum doula will recognize when there is a more serious problem that requires referral to a specialist.

If I choose not to breastfeed, will you still provide birth and/or postpartum support?
Of course. The decision to bottle feed is a personal one and in no way affects the care I will provide to you, your partner and your baby. I can assist you in learning the safe way to prepare formula, sterilize your baby’s bottles and show you optimum feeding positions.

What is the difference between a postpartum doula and a baby nurse?
The role of a postpartum doula is to help a woman through her postpartum period and to nurture the family. Unlike a baby nurse, a doula’s focus is not solely on the baby, but on fostering independence for the entire family. The doula is as available to the father and older children as to the mother and the baby. 

What is a postpartum doula’s goal?
The goal of a doula is to nurture the parents into their new roles. As they experience success and their knowledge and self-confidence grow, their need for professional support should diminish.

How does a doula help the parents adjust to their new roles?
Self-confidence has a tremendous impact on a person’s ability to approach any task, and parenting is no different. A good postpartum doula always takes parents feelings into consideration and helps build their confidence whenever possible. Doulas accomplish this through praise, acceptance and a non-judgmental approach. In addition, the doula will teach parents strategies and skills that will improve their ability to bond with their babies. A calm baby who is growing well will help parents to feel more confident in their skills.

Do doulas help mothers to deal with postpartum depression?
Unlike therapists or psychiatrists, doulas do not treat postpartum depression. However, they can help by creating a safe emotional place for the mother. A postpartum doula relieves some of the pressure on a new mother by helping her move into her responsibilities gradually and providing nonjudgemental practical assistance with baby care and household tasks. By mothering the mother, doulas make sure the mother feels nurtured and cared. 

In addition, postpartum doulas are trained to recognize the early signs of postpartum mood disorders and can help moms and their partners understand what may be happening. They will also provide information on programs which offer treatment and additional support.

Do doulas teach a particular parenting approach?
No. Doulas encourage parents to develop their own style and philosophy of parenting and childcare based on current research and best practices as set out by Health Canada and other organizations which promote healthy parenting and healthy child development.

How do postpartum doulas work with a mother’s partner?
A doula respects the partner’s role and input  and teaches concrete skills that will help the partner nurture the baby and mother. 

I’m interested in hiring a doula. What questions should I ask to help me decide if a particular doula is the right one for me?
The following is a selection of questions you can use when meeting with a prospective doula:
:: Have you been trained as a Doula?
:: When were you trained?
:: Where were you trained?
:: What is your experience as a Doula?
:: How long have you been a Doula?
:: What is your philosophy of birth, and supporting women and their partners?
:: How many clients do you support per month?
:: What do your services include?
:: What tasks do you provide or not provide?
:: Do you have a back-up Doula?
:: How do I keep in contact with you?
:: What is your fee structure?
:: Can you provide references?

For interviewing a birth doula, you might also ask:
:: How many pre-natal visits do you provide?
:: How may postpartum visits do you provide?
:: When do you join us in labour?
:: Where do you join us in labour?

For interviewing a postpartum doula, you might also ask:
:: How do you schedule visits?
:: Will there be pre-natal visits?

You can find my answers to these questions under About Me, Services & Fees and Philosophy. 

How do I go about finding a doula in my area?
Word of mouth is one great way to find a doula. Talk to new moms, other pregnant women and childbirth professionals in your community (your midwife or doctor, prenatal class teacher, public health nurse, chiropractor). Chances are many of them have used or worked with a professional birth and/or postpartum doula.

Check message boards, community information boards etc. at baby-focused stores, in community centres, libraries and cafes. Many doulas will post flyers or leave brochures and business cards with their contact information in such places.

CAPPA-Canada, Doula C.A.R.E. and DONA all offer referal services through their websites. Listings are usually grouped according to community and/or services offered. 
http://www.cappacanada.ca/
http://www.doulacare.ca/
www.dona.org

If you any other questions that you do not see listed, 
please feel free to email me.

trinitydoulacare@yahoo.ca

Trinity Doula Care
Pregnancy, Birth and Postpartum Support

Carla Murphy
416-797-0875      647-343-4830 


cdenisemurphy@yahoo.ca