Why Should I Hire a Doula?
During labour with my first child, I experienced a phenomenon called "coupling," that I didn't understand and that wasn't explained to me. You can read the whole story here. Basically coupling is contractions back to back with no breaks in between. I had always been told that people in labour always get a break, so as you can imagine, I was feeling overwhelmed and confused. And scared too. I couldn't even catch a break to ask what was happening!
After my daughter was born, I was finally able to ask the nurse why my labour was so intense. She explained that coupling occurs when a baby is turned to the front rather than the optimal, turned to the back, position. The person's body needs to work twice as hard to both turn the baby and push the baby down in preparation for birth. Thus the double-time contractions.
Since becoming a doula I’ve thought about how in that moment of doubt and fear, when my body was doing something I did not understand, I would have benefitted so much if I’d had a doula with me (I didn’t know what a doula was back then!). A doula would have known to explain in that moment what was happening. A doula would have known me and recognized that I am someone who needs to know details to help me stay calm. Over and above that, a doula may have even explained to me prior to labour, in prenatal sessions, that coupling was a possibility.
Sometimes I revisit this and wonder why no one told me it was a possibility, and only since becoming a doula have I come to understand the potential reasons why:
1. Coupling happens in around 1 in 3 labours, which makes it fairly common, but, people who have an epidural wouldn’t be aware it is happening. And epidural rates are very high (ranging between 85-98% for the past few years at my local hospital). Healthcare practitioners have limited time to present limited information to you (short prenatal appointments). They triage knowledge and provide information that is relevant, but leave out things that may not be relevant (i.e., things that only a minority of people experience).
2. Healthcare practitioners are constantly trying to balance sharing enough information versus sharing too much. For some pregnant people, knowledge is power, but for others having more information induces anxiety. As a doula, I tread this line all the time - I want to give information of the possible “complications”, but not give so much information that it makes people scared. Being scared isn’t helpful for a labouring person (see my blog post here about the relationship between stress and the labouring body). The benefit of working with a doula is that we have more time together. I can get to know you and understand how and when to communicate essential information with you.
3. Coupling has no association with negative outcomes for newborn babies. Interestingly some studies show that people who experience coupling actually have a decreased risk of their birth ending in an unplanned cesearean section. So truly it’s nothing to be concerned about, even though it can feel alarming to the labouring person. I can only assume that this is why my delivery team didn’t explain it to me - it wasn’t arousing concern, so, they just let the labour run its course. The only issue with this approach is that THEY knew it wasn’t concerning, but I didn’t know that. And words of affirmation would have gone a long way for me in that moment.
This experience I had when in labour for the first time, is one of many life experiences that has shaped the way I offer support as a doula. While the birth of my daughter, overall, was an incredible experience, and I mostly felt supported, it would have made a big difference if someone had explained "coupling." If I had been told it was a possibility, and why it happens, I would have felt so much less disoriented and more confident in the process my body was leading.
As a result of this visceral memory of not understanding what was happening and of being frightened, I am deeply dedicated to ensuring my clients don’t experience this. As a result, being able to offer education and reassurance is a critically important part of my role.
