What’s in your doula kit?

As a doula with over 12 years experience and doula trainer this is a question I get asked a LOT.

And the answer does vary from time to time depending on what kind of births I’ve been attending and what new and wonderful things I’ve found useful in supporting people. I don’t tend to be a doula rocking up to a birth with a suitcase of stuff but these are some essentials I carry.

Here’s my top 5:

1. The first thing that I probably use the most is a birth pool, liner, and of course the pumps to inflate and empty the pool. I’ve been using the same brand of pool for a while now and always buy a professional grade pool if possible as these last the longest. Owning a pool is incredibly useful as you can lend them out to clients and even hire them out to other home birthers.

2. Secondly it would have to be my Elle TENS. People and TENS machines are a bit like marmite … they love them or hate them. That said I find used properly from early on in labour women/ birthing people tend to find they bring much needed relief, at least in the initial stages. I always have a huge stash of spare pads and batteries. I also have 3 different TENS machines as I tend to lend these out to every client regardless of where they’re planning on giving birth.

3. Of the other tools I have that provided relief from the sensations of labour my favourite would have to be aromatherapy because not only can it be used on the individual in labour it can also be used to relax a space and help create a sense of calm and grounding within a new or medicalised space. One of my favourite forms of aromatherapy is the relaxation roller balls from Jess (an OBC doula) at Oyster and Olive birth.

4. My trusty rebozo wrap has been with me to every birth I’ve attended since I bought my first one (I now have several in different lengths, materials and colours). I’ve taken a long time and done many different practioners trainings to enable me to be confident in using rebozo in the birth and postnatal space.

5. Finally …. labour combs! They’ve become increasingly popular recently and I’ve always found them to be a really effective form of pain management as birthing person has full control over using it, its completely non invasive and as soon as its released from your hand it stops having an impact … so no long term effects!

I also have a huge collection of hard boiled mints and sweets (for me and for my clients,), hair bands, lip balm, straws and an adaptor/ charger. Other bits and pieces - an eye mask (very useful for keeping out those bright lights and building oxytocin) and headphones, and a variety of massage balls and space fairy lights! All these things have been useful I have a small wash kit for me including a toothbrush, pain meds, and some homeopathy.

If I’m supporting home birth I will also take a peanut ball and a birth ball and a night sky projector but I do try to encourage all parents to have a birth ball at home to support them through pregnancy so its not often you’ll find me carrying one around!

Please note this blog post contains an affiliate link for Elle TENS.

Messing with our birth days

How is it that normal has become abnormal?

What do I mean?

Why is it we now can’t wait for birthing women and people to enter labour when the person and their baby are ready rather than having to artificially end pregnancies?

Even if we ignore the fact that due dates are a mathematical equation that less than 95% of babies adhere to (someone really needs to create a new method of guesstimating a baby’s arrival), it now seems we’re unable to “allow” babies to be carried to term. Midwives are insisting on booking people for inductions and/ or sweeps (which the maternity system fails to see as part and parcel of the induction process). And whilst I understand this is based on guidance - are they not questioning why it is that suddenly so many birthing women and people are unable to go into labour without intervention?

I do not exaggerate when I say that I hear from mothers and pregnant people on a daily basis who are feeling the mounting pressure of induction dates looming over head. Who are being told they risk their baby’s life by going beyond their due date. That their placenta’s will suddenly stop working.

We seem to have forgotten how important the emotional state of the mother or parent(s) is towards the end of pregnancy. Instead filling them full of adrenaline, undermining their confidence and their own innate understanding of how their body works.

It is becoming increasingly difficult to cut out “the noise” towards the end of pregnancy that insists your body doesn’t know how to get your baby out, that your placenta will pack up at 40 weeks exactly - because obviously it has its own internal clock???? - and that you only maternity staff know how and when to deliver your baby.

So what can we do as doulas/ birthkeepers?

Whilst most of us continue to support people who will birth in the “system” this is a tricky balancing act. Whilst some of us are lucky enough to work with women and people who are freebirthing or having wild pregnancies - secure in their own innate birthing wisdom, most will be supporting mothers and parents through the NHS system.

From 36 weeks the pressure begins to mount. Otherwise healthy pregnancies are being routinely subjected to late gestations scans (despite the acknowledged inaccuracies in ultrasound technologies for determining size and abnormalities). This tends to trigger a cascade of events that goes something like this:

“Your baby is too big/ small/ too much amniotic fluid/ not enough amniotic fluid, abdomen is too large/ small” (there are plenty more)

“You must see a consultant who will tell where you’re allowed to give birth and when”

Consultant outlines all the “risks” of being too old, too pregnant, baby too big/small etc and then books you for an induction”

Or you don’t even have a 36 week scan and you go to your 38 week midwife appointment and they “do your induction paperwork” to book you in at 40 weeks for your induction, and your stretch and sweep at 39+5.

All of the above sends mums and parents into a spiral of self doubt and anxiety, and ultimately sabotages any chance they have of giving birth when their baby is ready to be born.

As birthkeepers we need to be really hot on our care and support at this time. Prepping clients in antenatal sessions is key. Explaining that this will probably happen and what this will looks like prepares parents when these bombshells are dropped by maternity services, Discuss why this is happening and what parents can do to counter it is incredibly important. Ensuring they feel knowledgable enough and comfortable enough to say No to anything and everything that is “offered”, that all these things are their choice - even if thats not how its put to them.

I like to save at least 1 antenatal appointment in hand so that when this inevitable time arises I can go and be with my clients. Talk with them about how they’re feeling, what their wishes are for their birth, Reaffirm that they know their body and baby best. Repeat the need for real rest and nourishment. Lean into trust and knowing that generations of birthing women and people have done this before them. It’s at this time that I use touch and movement to cement the idea they have the innate power to birth their babies however they choose (and it may be they choose a route you wouldn’t but that’s their decision).

Know that birth works (more often that not) if we leave it alone. Remember you have a relationship of trust with your client and that you are there to support them make decisions they feel comfortable with. That they have agency in their birth.

And remember - You are the antidote to the system that undermines our trust in our bodies, that fails to listen and treat us as individuals.,and expects us to fail at something we’re fundamentally designed to do and have been doing incredibly successfully for thousands of years.

There’s a doula for everyone

“If doulas were a drug it would be unethical not to use it” Dr John Kendell

I strongly believe this to be true! But what does this mean for those who’s finances don’t afford them a doula?

I was recently chatting with one of The Original Birth Connection Birth Worker Training Programme trainees about this and I thought it would be useful to others to share some thoughts.

Whilst in ancient history doulas were in effect slaves without income, modern doulas, or birth workers, aim to make a living supporting birthing women and people, in order to support themselves and their families.

Charging our worth

Because of this we charge a fee. Now many think that this means that doulas are exclusively used by those who have the means to pay the fee. Fees often aren’t small. Whilst the majority of doulas charge between £800 – £1500, there are birth workers out their charging £3000 a birth. There is nothing wrong with this and this is their prerogative!

What must be taken into account by the prospective client is that a birth worker will often be on call for several weeks. At the beck and call of their client 24/7, they will be with you however long your birth takes (4 hours or 36 hours!). They will provide countless resources to you which often included everything from books to birth pools. They will be with you postnatally and they’re likely to only take on a small number of births within the time frame of a potential estimated due date so as to ensure their availability to you. This is in addition to having to pay our taxes, pay for childcare, eat and pay our bills.

Its incredibly important that doulas charge their worth so that their effort and time, care and experience are rewarded financially in a society that requires work to be recompensed finically so we can all survive. Having a doula can ultimately change the outcome of your birth experience (see above quote!). Though this is no guarantee, its likely that having a birth worker by your side will mean you feel informed and supported in your birth choices, seen and respected.

How can we serve everyone…

However, birth workers should be available to all and they really can be. Many doulas offer a sliding scale of payment dependent on the financial means of the client. Payment plans are relatively standard amongst birth workers as well – with payments often being spread over as much as a year. Many doulas will take vouchers in payment so that family members can purchase their services as gifts, and payment in kind for similar services or goods is not uncommon.

There are a few charities that provide doulas to vulnerable birthing women and people and provide doulas for people in prison. Doulas Without Borders is one close to my heart who I work with.

If you’re considering a doula then please approach several as you may find that one will happily take a reduced fee or only expenses. Most doulas will do one or more births like this a year and often build this into the fee they charge for their paid work. And don’t discount new or inexperienced birth workers who will often charge a lower rate whilst they’re building experience.

Where there is a will there will be a way….

The Pause

I recently got to witness the most beautiful, powerful freebirth. It was in incredibly humbling experience to be present during such an incredibly transformative event.  

But it also got me thinking - about several things. Firstly, and this is not the topic of this blog post, its no wonder that our induction rate, our instrumental delivery rate are so high because we have simply forgotten how to wait for birth and respect the wondrous hormonal processes that must occur in order for us to birth our babies in the the world.

Secondly, there was one very distinct aspect of this birth process that reminded me so much of my own first two births and births I've subsequently attended as a birth keeper. The pause.

When labour is discussed in public - in antenatal classes - on social media - and in popular culture. It is talked about as though its a linear process, one that gathers momentum and then keeps ascending (or descending - depending on how you view the process of labour) that once it starts, it keeps on rolling (like a train picking up speed).  

But all too often I see a pause. Not just the pause that is often caused by the necessity for many parents of getting in the car and travelling to their place of birth, but pauses that in medical terms are usually considered a "stall" in labour.  These pauses/ stalls are treated as problematic. Something needs to be done to "restart" labour. Medical professionals (midwives/ obstetricians) will be reaching for synthetic oxytocin drips at this point.

Birth workers (doulas/ birth keepers) can be just as guilty of trying to interfere though. We reach for clary sage (or some other form of "natural" intervention like acupressure, or biomechanics techniques). 

But what I've often wondered is - what is the reason for the pause? And if these pauses can be seen so often in the birth process - is it in fact a natural part of the process. A means for mother/parent and child to rest and recalibrate? 

I've seen pauses occur after very intensely grouped surges that don't form a linear pattern - what might be considered a labour dystocia. A series of surges that are perhaps enabling the baby to find a more beneficial position for birth. The body and baby work hard to find that position and then rest. Labour seems to have stopped. Midwives begin rustling paperwork and hunting in cupboards and muttering under their breath about what to do to "get things going". 

I've seen pauses occur in long labours. Particularly in first time parents where they've labour steadily over days and nights (usually more intensely at night). They need time to rest and recalibrate before the final part of the process where they will need those final reserves of energy to make it through the final stage and meet their baby. 

And I've seen pauses occur in fast labours as well. 

Now there has been research done into these pauses, stalls, plateaus that occur so often in labour that concludes, "Physiological plateaus may be an essential mechanism of self-regulation of the mother-infant dyad, facilitating feto-maternal adaptation and preventing maternal and fetal distress during labor and birth." 

https://onlinelibrary.wiley.com/doi/10.1111/birt.12607