Birth Companions: Perspectives on Doulas and Nurse Midwives in ASL and English

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The Appointment P: Hi Kimberly. K: Hi. P: How are you? I see you have your baby here. K: I do. This is Miss Selina. P: Hello, Miss Selina. And what can I do for you today? K: Well, I think I may want a doula. I’m kind of not really sure what that means. P: Okay. K: To be honest with you, - Whew! excuse you (to Selina) – to be honest with you, you know, my first birth was not exactly what I wanted. And you know, having never gone through it, I didn’t really know what I wanted, to be honest with you. Back to Appointment in English

P: (overlapping) Exactly. Exactly.

K: And, um, some friends had suggested a doula and I really didn’t know what that was, so I went online and that’s how I found you, through the CAPPA and DONA web site.

P: (overlapping) Okay. Okay.

K: But, um, at first, when they were telling me what a doula was I thought it was crunchy, granola, have to have my baby in a field…

P: (Overlapping) Yes. (Laughter)

K: …and we’re not really looking to do that.

P: Right.

K: Um, you know, I’d be more apt to have a baby at home, but my husband, it ain’t gonna happen. So, he’s not there. So, I called you..

P: Okay.

K: …and you came recommended and wanted to hear about you and what you can do.

P: Well, I’m a modern doula, no granola here. (Laughter) Our company is called Accessible Doula Services and what we do is provide services to mothers – quality, professional, doula services and we do it based on your ability to pay.

K: (overlapping) Okay.

P: Not necessarily on any fee, set fee, but it’s on a sliding-scale fee…K: Okay. P: … but the point is not really how much it costs. The point is what we offer.

K: Okay.

P: What we offer is continuous emotional, physical, spiritual support before, during, and immediately after your birth. Um, the most important thing of our work is to advocate for you. We are there to be your support system.

K: You’re not gonna replace my husband, right? ‘Cause he thinks that you might be kicking him out…

P: You know, that’s like the number one answer – the number one question that we get from just about every single one of our couples, and a lot of times, I like to interview the father, along with the mother, so that he has a chance to ask all of our questions, but I understand that we couldn’t do that this time..

K: Right, and like I said before, I’m limited to about a half hour for this meeting…P: Right. K: …and then, um, we can do the in-depth whatever with my husband.

P: Absolutely. K: Okay. P: Absolutely.

P: Well, when your husband does come here, what I’m going to be telling him is that our whole purpose is really to support him as well as to support you. Yes, a lot of the focus is on the mother because she’s the one in labor and she’s the one going through the experience. But the father’s going through the experience as well. He’s having the experience of becoming a father….again. K: Right. P: Having the experience of seeing the woman that he loves in pain, and in, in struggling, and having all these problems.

K: And my husband, for the first one, he was awesome. He was there. He was supportive. I, uh, I fell in love with him all over again. But, he only knows what he knows. P: Exactly. K: You know, and he could only do what he knew what to do. P: Exactly. K: We kind of felt like if we knew more what to do, we would have done it. But you know, and originally, the midwife we had said, “Oh, I’ll be there. You know, I’m not a doctor. I’m a midwife. I’ll support you. The nurses can help you.” Even with lactation, breast feeding, all that. “Oh, we’re there, we’ll help you.” Well, they had other patients. I mean, the reality is, they had other patients, so we were left on our own. P: Absolutely. K: So, I don’t want that to happen again. So, that’s why I was kind of looking for you.

P: And one of the things for a doula that we emphasize the fact that we are continuous support. So, we don’t have any other patients. We don’t have to check the charts. We don’t have to write any forms out. We are there with you from beginning to the end…

K: So, you won’t have anybody else who you’re doula-ing? Er, if that’s the word…

P: (Overlap) When we sign your contract, in order for you – in order for us to work together, I would –my contract states that I would not take any other clients without your explicit permission.

K: Okay.

P: So, for example, if I do have another client who comes up around your same due date, I would still be your primary doula meaning if she happened to go into labor before you did, my backup would take her.

K: Okay. So, I wouldn’t lose you?
P: No. Yes, you would not lose me.

K: Because I also, you know, even looking on the internet, you see all these other doulas, all this other information, but it’s so intimate…P: Right. K: …we both need to, uh, get a feel for you.

P: Exactly. K: You know like that kind of thing… P: Exactly.

K: So… and we need to pause…

(Break for a diaper change.)

K: So, now that we’re back… P: We’re back. K: She’s changed and happy as you can hear.

P: She’s dry. I can hear that. K: That’s right.

P: And while we were away, I went ahead and got some materials that I usually give my clients. K: Okay. P: This is our business card and our brochure. K: Okay.

P: And there’s usually an, uh, actually an interview questionnaire that I fill out but I prefer to do that when your husband is here. K: Oh, okay. P: But, um,

K: Do you want us to take those and look at all the stuff or just wait?

P: We’ll wait… K: Okay. P: …we’ll wait. A lot of the stuff I’m kind of asking you now but that’s okay because we get to know each other.

K: (overlap) Okay, great.

P: So, that will still work.

K: I’m just going to put this down here. P: Sure, just put that down there.

P: I was telling you before, um, before Miss Selina decided to give us a natural break there, that one of the main points about having a doula is the fact that it is continuous support. And you won’t have to worry about us switching shifts. You don’t have to worry about us…

K: (overlapping) So if it’s long ... cause my first was about 18 hours…
P: (Overlapping) We stay there as long…18 hours actually is average.
K: Oh, okay. P: Yeah.
K: So, you’ll be with me…
P: the entire time.

K: Okay, now, what happens…am I talking to you beforehand, during the pregnancy? Are you helping? Are you doing anything?

P: Um, one of the things that we would do is we would have a pre-natal meeting.
K: Okay.
P: That pre-natal basically involves what we are going to do, what our plan is going to be for the birth. I really want to get a full sense of what kind of birth you and your husband would like, the type of experience you want, what you want to avoid… K: Okay. P: …because you’re a second time mom, you know exactly what you don’t want. K: Right.

(Selina making happy noises throughout.)
P: So we go over that, and we develop what our plan is going to be in order to make that happen. K: Okay.

P: Now, of course, I can’t guarantee your birth outcome. Nobody can do that, but we can plan, and if you fail to plan, you plan to fail. And that’s what we’re gonna do, we’re gonna plan.

K: Okay, okay.

P: I’ll also go over with you some of the massage techniques that I’ll be using with you…

K: (Overlap) I like massage.

P: Yes. Very good. Very good.

K: Massage is good.

P: You’ll get used to the touch, because it’s going to be a lot of touching. A lot of physical work is going to be happening. Um, there are back massages. Foot massages. Neck massages. Hand massages. There’s all kind of massages that I usually do. I’ll also be showing them to your husband so that he can learn how to do them as well.

K: Okay. Okay. So, um, when labor starts, I don’t want to go to the, I want to avoid the hospital as long as I can. P: Absolutely. K: Do you help us do that? Or…

P: (overlap) Absolutely. Normally, at the pre-natal we go over that as well. We talk about what we’re going to do when you go into labor. First of all, the minute you believe you are in labor, you call me. Even if it’s just like boop, you call me.

K: Okay. Two in the morning?

P: Two in the morning. 1:30 in the morning. I really, it really doesn’t matter. My phone...two weeks before your estimated due date. Two weeks after your estimated due date, I am on-call for you 24/7.

K: Okay.

P: Continuous. Phone, e-mail, fax, pigeon, whatever you want to use. K: Okay. P: I’m there for you. And even before your two week window, I’m still available. You can call me for any questions that you have, if you’ve gone to the doctor. (Selina squeals)

K: Do you go to the doctor with me or no?

P: If you want me to, I can attend a doctor’s appointment with you. Normally, I do not. But if you, if there’s something that you kind of feel you need a little extra support with, you feel as if, “Okay, I’m trying to get this doctor to understand this is what I want and I’m not really getting the words out right,” I can certainly come and support you with that.

K: Now, do you find that the doctors like having you there or don’t like having you there?

P: Well, it’s been about 50-50… K: Okay. P: …is what I have to say. Um, some of your more experienced, old school is the word I’d like to use, doctors, you know, they’re not really into that other person trying to kind of come in on my territory. Um, but then there are other doctors, even the old-school ones, who appreciate the fact that I’m glad she’s gonna have someone who is going to help her to be comfortable. And that’s the point.

K: Okay. Do you find, though, even if it’s an old-school doctor? Because there are all different doctors in my practice and I don’t know who I’m gonna have. Or even midwife, there’s a whole bunch of midwives … that’s one reason I want a doula, to have at least one person that’s constant. P: Okay. Exactly.

K: So, do you find the people who tend to be more old-school, afterward have you found they do like having you there or they still have issues?

P: I’ll be honest with you, the majority of our work is during the labor. The doctor is normally not there. The doctor is usually arriving just when the baby is born. He delivers the baby.

K: What about the nurses?

P: The nurses, um, from what I’ve experienced, appreciate us. They may not – they may feel a little bit uncomfortable at first, but once they realize once again…”Wow, she has this continuous support, and they are not getting in our way. They’re not trying to take over our job. They’re just basically there supporting us as well.” Which is what we do. We support the entire birth team.

K: Okay. So they can end up using you…helping?

P: (overlap) Absolutely. Absolutely. I mean I won’t be going to another one of their mothers, but..

K: (overlap) Right. Don’t leave me. Just don’t leave me. I mean that’s one of the, you know, some of the hospital staff, we’ve found, have attitudes, especially any time I asked a question, or “Why are you doing what you’re doing?” they kind of just wanted us to hush and not answer things. I wasn’t real sure on what was going on. And I just don’t want to feel that way again.

P: You know, one of the really good things about doulas is the fact that we are experienced and we know the types of questions that are normally asked by mothers. We can ask the question in just the right way so that it can get them to open up that door and say, “Oh, okay. This is what’s going on.” A lot of times, you’re just not asking the right questions. Not because there’s anything wrong with you. It’s just you don’t have the experience to know the question to give them.

K: Okay.

P: And a lot of time they try to anticipate what your questions are because they’ve been doing it so long. I mean, how many babies are born in the hospital every single day. K: Right, right. P: They try to anticipate your questions not realizing that you might be going down a different road. So, because you and I are in communication, I may know more where you’re coming from and be more able to ask that specific question and get the answer that you need.

K: Okay, now, um, medications….P: Okay. K: Like I found the hospital just kept wanting me to take medicine. It’s like it would be easier for them if I would just take some drugs. I don’t want to…I mean, they’re there if it’s needed, but I don’t want an epidural. I just want to see what my body can do. P: Right. K: But have it there if it’s needed kind of thing. So, are you not going to let me get medicine if I need it or...?

P: Here’s how it works. It’s your birth. It’s your birth experience and what you want to happen. I am only there to give you the information so that you can make the informed choice as to what you want to do and what you don’t want to do. And there’s always the next best thing, so perhaps you started off saying, “I don’t want any medication. Don’t offer me anything. I’m through.” But as the labor goes on, it gets a little bit too hard and you need some intervention and that’s why medication is there. Thank God for medical intervention because in the past, we’d have mothers who would die in childbirth or babies who were born deformed. We don’t have that happening as much because we do have the interventions in place. However, let’s not get so far into the interventions that we forget that birth itself is natural and it has a natural process that needs to be followed. The hospitals, yes, would tend to offer you the medications because most mothers want it. Because they’re not informed. That’s why they ask for it. If you are in pain, and no one is helping you, and you have no support, of course you want to stop being in pain. But if you have support, and you have someone explaining to you what’s going on, why it’s going on, and the fact that it’s not going to last much longer, you can stand it.

K: So you might help me through it? I wouldn’t need—

P: (Overlap) I would help you through it. Exactly. And if it comes to the point where you do need it, then absolutely. K: Okay. P: I would encourage you to get it if that’s what you need.

K: Okay. All right.

P: What other questions?

K: I think a lot of stuff, like I said, we’ll have to go over with my husband… P: Right. K: …because his biggest fear is you’re gonna replace him. And he is very hands-on, and very involved. But again, it was more, we only could do what we knew… P: Right. K:…and we thought, ‘cause the midwife said, they would be there. P: Right. K: And then they weren’t. Whether it was paperwork or other moms having babies, or whatever the reason, we just, were kind of on our own trying to do things, and just looking for the guidance is the biggest thing.

P: I often tell my husbands-- the husband, not my husband—the husbands that I interview, and I give them a very simple scenario. “I can’t replace you because you are first of all, a husband, a father, a lover, a companion, a best friend…I’m not any of those things. I’m your doula.” So there are things that you and him are going to be able to experience, just simply look in each others’ eyes and know what’s going on, that I can’t replace. And I never could, and I wouldn’t want to either. My goal is to allow both of you to experience that birth the very best way that you can. Empowered and informed.

K: Okay. Alright. Is there anything that I should be doing now, you know, anything different that helps get ready or…?

P: A lot of times I tell my mothers to get into the habit of moving. Movement is very important in labor. A lot of our hospitals will have you lay in the bed, and they don’t want you to move out of the bed.

K: It hurt. When I was in the bed, it hurt. I don’t know if that was why it hurt.

P: (Overlap) It could have been. It could have been. And a lot of it may have been a liability issue is why they don’t want you moving around much because imagine this, you’re moving around in the hospital and just doing all these things and then you end up hurting yourself in some way. Whereas if you have a support person there, someone who’s going to be able to watch you and make sure that you’re steady at all times, then it will be a lot easier for them to allow you to do the things that you do.

K: Okay.

P: And again, that’s what we’re there for. Um, we were talking about before what would happen when it’s time to go to the hospital. I was telling you how I would come to your home. The minute that you tell me, “I think I’m in labor. I don’t know, I think I’m in labor.” I’m going to give you some specific instructions to do that is going to help me to also determine whether you truly are in labor. Now, I am a non-medical professional, meaning that I do not do any clinical exams. I will not be doing any vaginal exams. Nothing like that. K: Okay. P: A lot of my information is coming from you, and it’s coming from what I know about mothers who are in labor. A lot of it is just basically intrinsic. Some of it is intrinsic and just my past experience with mothers. The patterns kind of go in a very specific way. It helps me to know where you are and what you’re doing. K: Okay. P: So once I get the feeling that you definitely are in labor, I do come to your home. And we will stay at your home as long as we can... K: Okay. P: …basically. I’m not going to let you stay to the point where you’re giving birth, because I don’t do clinical tasks. So,..

K: (overlap) But you do home birth, right, like if was doing home birth…

P: (overlap) If you had a midwife, only if you had a midwife, because I am not a clinical professional. K: Okay. P: So you would have to have a midwife who was willing to come to your home and birth the baby.

K: Okay. Um, are there any books or things that I should read or my husband should read to prepare…?

P: Hmm, you know it’s kind of, some times, a lot of the information that’s out there is information that you need to take with a grain of salt. Um, we can talk more about specific books later on. K: Okay. P: A lot of times what I like to do is I like to see what books you are reading. Tell me about them. Then I can look into them as well and I can give you my opinion about how they might work, and what may be missing or what may not be missing. You know, things such as that. Books are always good. The more information you have, the better. But sometimes when it comes to birth, sometimes too much information hinders you.
K: Okay, well what about…so, then you wouldn’t want us to take a childbirth class?

P: Absolutely. K: Don’t or do?

P: I absolutely want you to take a childbirth class and if you can, um, it would be a good idea to not take the hospital-based childbirth class. Only because the hospital is working with the hospital. If you take an independent childbirth class, such as perhaps Lamaze, or something to that effect, one that focuses on normal birth – is your point, you’re looking for normal birth. You can get just the same amount of information, maybe a little bit more in-depth at times as well.

K: (overlap) Okay.

P: So, a childbirth class is actually very important. What we do at the pre-natal, usually, supplements what you’ve already learned at the childbirth class.

K: Okay. Okay. Um, and also, I think, um, I was, or I don’t remember if you were telling me or someone was saying that um, you could also help me with breast feeding. Because I know in the hospital, you know, again, the first time they said, you know, “The nurses will help you. The midwives will help you, but the nurses are trained.” Well, none of the nurses knew what the heck they were doing and kept saying, “We’ll call lactation,” and lactation never came. P: (overlap) lactation never came. K: So, do you help with that?

P; I am trained in lactation education, meaning that I can help you establish that initial breast feeding. Anything that goes beyond any kind of problems with breast feeding, I can then refer you to a lactation consultant.

K: So you have people that you can refer me to. Oh, okay.

P: (overlap) I do have people that I can refer you to. But then also at the hospital, again, I’m your support person at the hospital. So, while you are now basking in the glow of being a new mother again, I’m going to work to get that lactation person to your room.

K: Oh, that’s good. Okay, I think everything else I’ll hold ‘til when my husband comes.

P: Great. It was wonderful meeting you.
K: You, too.

P: And great to meet you, Miss Selina, with your new pink outfit. You’re beautiful. Do you know what you’re having?

K: A baby. We don’t find out…

P: You like the surprise..

K; We like the surprise.

P: Absolutely. You gotta love those. You gotta love those. Well, great. I look forward to meeting you and your husband.

K: Great. Thanks so much.

P: Sure.

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