Letter to a midwife from a doula

Dear Midwife,

What you do is amazing. You are a multi skilled, compassionate person who does an incredible job under sometimes frustrating conditions. I’m constantly in awe of the work you do, and humbled by how you can fight to support a woman’s wishes and protect her space during a birth.

I’m often asked if I want to train to be a midwife, but I don’t. I actively made a choice to be a doula as I wanted to support women in an emotional sense. My training over the last 8 years has taught me more about how the unconscious works at a birth than how a uterus functions and that’s just how I like it to be.

Some doulas just attend home births, but I feel that it’s hospital where a mother needs a doula more, when you are busy and have paperwork and maybe have more than one couple to attend to, I can be there constantly. I also attend a surprisingly large percentage of births that are considered higher risk, not just because the mum wants a normal birth, but because we have prepared in a way that reduces her anxiety and helps her create a familiar, loving environment for the birth. All the high-risk births I’ve attended have been normal births, in spite of the odds being stacked against the mum.

I know you may sometimes see what I do as part of your role, the part of your job you perhaps enjoy the most, but I also know contact time with a midwife can vary, some women will be lucky enough to see you throughout their pregnancy others not so lucky. For those that are not so fortunate I have the luxury of time to get to really get to know that woman and her partner, unhurried, to know them as a couple and for them to get to know me. We both know that good continuity of care leads to better birth outcomes.

The mums I attend have great affinity with some midwives, not so much with others, that’s how it is with life. Some people you get on with others you don’t. Believe me, my heart leaps when the mum’s eyes light up because a community midwife she really likes steps through the door at her home birth. I know that if those mothers could choose their midwife and have continuous care throughout their pregnancy and birth my job would be redundant, and I would rejoice!

I’m not just a doula that is on shift that night, the mother will have interviewed me alongside other doulas, and she will have chosen me because I ‘feel’ right. This doesn’t happen with everyone, there are women I just know I’m not the right doula for and who I don’t feel that connection with.

Sometimes at a birth, I do feel like a spare part, I may sit and read, I may make you a cup of tea and have a chat with you. You may think I’m doing nothing, but in fact I know that this is what the mother needs. Sometimes I’ll be helping her breathe through each contraction, quietly (always quietly) encouraging her. Whatever happens I will be there from when she needs me until the end, the longest I’ve been away from my family is 24 hours.

Sometimes, the mother will want you to tell me first before if you want to do an observation, so I can gently prepare her. There is an unconscious interaction going on with this that makes the mother feel familiar and safe, not me being a guard at her door. Although sometimes I feel that this is what you think! If I sense that a mum has really bonded with a midwife, I will fall into the background, and allow this relationship to develop.

One thing that I want to be very clear about is that a woman’s birth plan is not my birth plan. I have not advised her or told her how she should birth her baby. This is not my job. A woman will often come to me, or hire a doula, because she has already done her research, she’s well educated about birth and she knows what her choices are. She may know that they are unconventional and she wants someone to support her that she absolutely trusts to help her navigate her birth, to help her through and keep her as close as possible to her plan. She knows that care fluctuates dependent on policies, which hospital she is attached to whether she is as home, at hospital, midwife led or consultant led.

I don’t make medical decisions or give medical advice. If you feel an intervention is necessary for medical reasons I can help you explain it to the mum in way that I know she will understand based on how I’ve got to know her and her partner and their wishes for the birth. Importantly, this also means that I can help her sensitively reflect on this, I’m trained specifically in this. But, I have to do this with integrity; she wants me to help her stay as close to her choices as possible, and I  have to do this while not obstructing you in your job. I recognise you have responsibility for the safety and care of that mother and baby. Sometimes this is difficult for me, and the hardest part of being a doula.  Sometimes I worry I step over the line, and that I have done more than I should. This is not my intention.

We know, in any profession, that information presented depends on a person or a practitioner’s own experience and training, not always what might be best for that mother or that baby in those unique circumstances. I may point you in the direction of her birth plan if something is suggested that goes against her wishes. I may ask for your help in suggesting things that help her keep close to her birth preferences. I can help her and her partner reflect and explore questions that give them ownership of their baby’s birth, I certainly don’t have all the answers. I apologise if this makes your job harder, and takes your further from the guidelines that you feel comfortable with, but I know that this will help the woman have a better experience emotionally.

Although I’ve done training in positioning and massage, I will nearly always follow your lead on this when you are encouraging a woman to move about or use certain massage techniques for specific points in labour. I’ve learned some incredible things from midwives over the years including some great aromatherapy mixes!

If I’ve helped them prepare using mindfulness, relaxation or hypnosis, I’ve tailored it to them, so I may give them confidence to let go and make as much noise as they wish or internalize and work with their breath.  They may be very quiet and focussed. This means that they might not want to talk to you, that’s ok. Sometimes they don’t talk to me either.

Being a doula, is not an easy job, but I love it. It’s a job of balance, diplomacy, of compassion and of love. If you find yourself with me at a birth, remember I am just her second birth partner, one who may know a bit more about birth than other birth partners, but she still needs a loving, compassionate and skilled midwife like you to support her in the birth of her baby.