I hear statements like these often at births:

“Mama, I’m going to ask you a few questions.”

“You got this, Mama!”

“Mama, you are going to meet your baby soon!”

While I don’t think these comments are meant to be negative or derogatory, they are directed at a watered-down version of the person being addressed. There is no use of a person’s name in these interactions, only the new label as mother/mama/mom.

Let’s think about this though. Pregnancy, let alone birth, is a life-changing experience. It is one in which women struggle to maintain an identity for themselves despite being a mother. It starts from the very beginning. As their body is overtaken by the growing baby, everyone, even complete strangers, feel compelled to reach out and touch the swollen abdomen, an act that one would never consider doing on an unpregnant belly!

Consider these unpopular truths that are the reality for some. What if the person giving birth is not excited about motherhood? What if she is petrified of her new role? Perhaps her relationship with her partner is not the best, or it may be that the partner is not eager to welcome a baby. Is might be possible that she never wanted to be pregnant in the first place, and she is still trying to wrap her head around it. Birth is not always a joyful occasion. Would she want to be called, “Mama?”

But even if the woman is thrilled to meet her baby, shouldn’t we address her by name? For in the event of giving birth and meeting her baby, she will also be reacquainted with herself. She may be a little different than before, but she will still be herself. She is so much more than a mama. And she may have years of struggling to see that and convey that to a world that pigeonholes her into the motherhood identity.

I recognize that in the hospital setting it can be particularly difficult to recall the names of several patients in your care. But I also see the dry erase boards in every room with names listed. And when the computer screen is opened the patient’s name is visible. There are ways to find out on the sly. Or simply ask her if you don’t know or remember. So you can address her by her name.

Empowerment can be found in giving birth. But it can also be lost in it. Please don’t initiate the loss of self by calling her mama. Call her by her name.

I have always found peace at the beach. The waves that crash upon the sand and recede, as predictable as time itself, bring reassurance in their steady rhythm. I have been drawn to the beach more this past month than usual. I think I’ve been pining for the beach in part as a refuge from the crazy nature of my work and the busy pace of summer vacationing. But I have also relished those times because they have been fleeting. I have longed to go to the beach, but I sadly have had to pass on it due to weather or work obligations more than expected.

I have found myself in a new season. It’s rather uncertain for me, as I am accustomed to going full throttle all the time. But my body, while strong for my age, is getting tired. It is feeling the pull to the beach for the relaxation and restoration it brings me, body and soul. My recovery time from births is taking longer, I require more recuperative sleep, and my joints don’t have as many hours of kneeling, squatting, and counter pressure as they did in my 30s and 40s. I want to continue serving clients in birth but to do so I must make changes to prevent burn out and to honor the needs of my aging body and the needs of my family.

I have started off my 2024 client bookings being very intentional about limiting the number of clients I am able support. I will only take 4 clients due in a month, which is still more than some doulas take. I will maintain availability for repeat clients without limit and am open to taking clients who have previously birthed. However, I will only have 2 of those spots each month for first-time parents. Truth be told, those are the births that take the longest and require much more support and recovery. My hope is by limiting the first-time birthing parents, I can serve them to the fullest while also allowing opportunity for physical and emotional recovery.

For this reason, it will be more important than ever for potential clients to reach out early in their pregnancy, and for me to have discernment in deciding which couples (and which providers) are the best fit for me. I have been blessed to book early for many years and anticipate the reduction in clients will continue that trend. We are blessed in Hampton Roads to have an amazing community of doulas and I will happily provide resources when I am contacted and unavailable to serve.

I look forward to this new season and hope that these changes will breathe new life in my body, my spirit and my resolve to serve birthing families so I can continue this work for many more years. I am forever grateful to the families who have trusted me in their intimate birth space these past 20 years and will continue to be honored by the invitation to serve at any births to come.

Maybe it’s because I’m a doula and it is my job to encourage and uplift. But have you ever noticed obstetric terms and how negative and judgmental they are? The words used to describe and address the pregnant and birthing person make one feel as though they must prove that their body can birth. One might wonder if there is even a decent shot at a straightforward birth experience without a complication. What kind of backwards approach is this?

Here's what I mean. The following terms are the first to come to mind:

 Trial of labor

Geriatric pregnancy

Unproven pelvis

Incompetent cervix

Failure to progress

Arrest of labor

Arrest of descent

Failed glucose tolerance test

Unfavorable cervix

Lazy uterus

Irritable uterus

Failed induction

Rupture (of membranes)

But there are many more.

During such a vulnerable time, how then can we expect a person to feel encouraged or optimistic about their pregnancy or birth journey if they are faced with such negativity and judgement? These terms are outdated and rooted in a patriarchal medical model. Surely in 2023 we can come up with better ways to describe the pregnant and birthing body!

One can argue that the labor and delivery unit is the one area of the hospital in which there often is no true need for medical intervention. It’s more of a just in case location in which to give birth. Things might (and often) proceed safely without medical assistance. But even if complications do arise, it should not connote failure or incompetence on the part of the woman or her body.

There are so many variables at play in every single birth, even in the same birthing person. Birth by its very nature is inherently unpredictable. The failure to control, plan, or contain it is part of the miracle of the process. It is a humble reminder that the power of the human force of birth will always retain an element of mystery. And the person birthing should be encouraged and uplifted in the way they are addressed, and in the words used to describe their body and the details of their birth.

 The failure lies in the incompetent verbiage used to describe the life-giving force of pregnancy and birth. Shame on the medical patriarchal model for the negative and judgmental terms that leave a sense of performance anxiety in their wake. It’s an embarrassment. These terms need to change.

These beads began as a fun craft project. They were a way to keep a count of the births of all the babies for which I was the doula. When I first began to compile them, I poured over birth notes and stories written 15, nearly 20 years ago to find gender. Information was scattered in several places in the beginning of my doula work. My record keeping became more streamlined in recent years. But I was determined to have the right number of blue and pink beads. (FYI, the early numbers were a guess since I did not note gender of the very first doula babies.) But as I dove deeper, I reacquainted myself with the stories behind every single bead. And I was humbled and overwhelmed. And the colors of the beads paled in comparison to the rainbow of hues represented in each journey.

Such a great number of these babies were born over many hours of difficult decisions that required their moms to let go and let the journey unfold. Some came in a straightforward way that was surprisingly normal, as far as birth goes. But is birth ever normal, really? Friedman’s Curve tries to put it in a box of expected duration and contraction pattern, but we all know that birth is inherently wild and unpredictable. There was the time that a baby was born in the parking lot, or the one born right outside the ER entrance, or the one most recently born in the bathroom of the hospital lobby. And there was the baby that was born in the foyer of the house before anyone got there because the shower was such an effective comfort measure, she relaxed herself into transition, and crawled out of the shower to give birth in the entryway. That was an accidental homebirth, by the way, not intended for home. Baby chose home. And I can’t forget the time, only once, where I was there at home alone with my client and realized too late it was time to leave for the hospital. (The midwife had told us to wait.) And my client’s water broke and I did what I had to do and I caught the baby. Then we called 911. It is the only time I ever caught a baby but even today remains one of the highlights of my life.

There have been tears. I’ve seen women cry tears of disappointment, defeat, fear, and sheer exhaustion. But I have also seen joyful tears of jubilation, euphoria, relief, and pure love at the sight of a child born. Fathers cry too, for all the reasons just listed and more. They shoulder a huge responsibility to keep their birth partner safe and cared for, and the baby makes that responsibility multiply in significance. It’s a lot on a person, especially the first time. And those daddy tears are moving.

I have sat outside OR doors with nervous fathers, retelling fond memories of their courtship, or confessing their fear and concern for the woman they love heading into surgery. I have picked up the pieces after a birth that didn’t go as expected, or a birth that went all wrong. I have walked through the wreckage of birth trauma and even the loss of life. The white beads in the jar are for the babies who did not survive. I remember them all by name. Those beads are the most precious of all.

I have also seen healing in birth. Many clients who experienced loss or trauma, sought my assistance to walk beside them to a new day, a birth that was healing and redeemed a previous experience that left a painful scar. Those births are like a salve. It never erases the previous experience but adds richness to it and can empower the one birthing and facilitate a solid postpartum recovery as well. Those births often bring tears to my eyes too. Those and the really long ones. They are a struggle for everyone. Being tired just makes everything more difficult.

As of today, my bead jar numbers 924 babies, but tomorrow it will contain 925 beads. I will keep counting to 1000. After that I’ll likely keep counting. I will never fill the jar. I would have to attend births for 20 more years at the busy pace I have maintained the last 10 or so. And I know I can’t do that. These beads have shown me all I have poured into my work over the years. And they have also reminded me painfully that my body can only do so much. One day I will have to stop the birth work. But not yet. Not today. I will keep going, but at a slower pace. I will continue to bear witness to the journey and stories contained within the beads of this jar, past, present, and future. You may see blue, pink, and white, but at their core, the beads are as varied as the subtle nuances of color in our technicolor world. Every birth as unique as the birther and the baby being born. And I am honored to be there for it.

When people consider hiring a doula as a member of their support team, they often envision the skilled labor companion who knows a variety of comfort measures, key positions, and can provide emotional support on the big day (or night) of birth. This image is short sighted, however. For many of my clients, much of the work I do occurs before or even after the birth itself. And there is a lot that happens behind the scenes that they may be unaware of. 

When I am officially hired by clients, I secure them on my client calendar, thus taking up a spot, and limiting my availability to other potential clients. The deposit is assurance to my clients that I am committed to them and available to serve them. Once the spot is taken it’s taken. I am available to them from that point on, for resources, emotional support, or just to connect over email or phone. For many of my clients, the birth is the culmination of all the emails, texts, phone conversations, lending library pickups, and more. And for a far greater number, the birth is the longest time we spend together. But both views are short-sighted. Just ask my family. They see what doula support truly looks like from the back end. And it doesn’t look quite like that.

Being a doula also requires a certain lifestyle commitment. A sacrificial one. Let me put it another way. I am the most reliable person to my clients, but the least reliable to my friends and family. What I mean is, I never know when I might need to cancel on someone, miss a night out, give away tickets or never use them, or leave a friend stranded in the middle of an event…all because a client wanted me for birth support. These calls away are for an indefinite amount of time, which can pose more challenges than the initial leaving. I may be gone 3 hours; I could be gone 33 hours. I’ve been gone even longer than that. And there have also been false alarms—texts and calls through the night that didn’t end up as labor, rather just a sleepless night without a birth, leaving the potential for another sleepless night when labor does come.

I’ve worn my doula clothes to social events and carried my doula backpack with me everywhere. I am always begrudgingly beholden to my phone, and I mean ALWAYS. I wish I could turn my ringer off and be assured of an uninterrupted night’s sleep, but I can’t. Most of these urgent “it’s baby time” calls come in the darkest hour of night when the most people are at home asleep and very few are on the road. And I always must watch my alcohol consumption, careful that I am able to drive if needed at all hours. Along those same lines, I also closely monitor my gas tank, trying not to let it creep too low for too long. If I do, I will invariably get the call on an empty tank and must stop for gas on the way, wasting precious minutes and possibly taking a risk depending on the hour of night.

I can’t ever take trips, not unless I schedule them eight months in advance, or a miraculous opening presents itself between due dates, or babies blow through expectations by birthing all over the place. This happens rarely, so when it does, I take advantage. My husband spends more time driving to visit my family than I do, as I hang back to be ready should my clients call in labor. I have missed many opportunities for out-of-town visits because I was on call for clients and couldn’t leave the area. 

Please know when you pay the fee for a doula, it’s so much more than being at your birth. It’s about being present and available from the time of hire. It’s the huge impact it has behind the scenes on your doula’s life, and the lives of her children and partner. It affects her friends too, as they love her even though she might cancel on them last minute. It’s very demanding work, and downright unsustainable if there is no passion for it. 

And that’s just it. Being a doula is my passion. It’s not just a job. It’s a way of life. It’s a deep drive in my heart to be present for women and their partners as they become parents. And my position is a place of humility at the foot of the birthing woman, as I am there to serve her, despite changes in plans, unexpected twists, and turns, and even in the rare times when everything goes just as expected. The fee covers the hours I spend with you during your birth. But it also covers the weeks and months I can be a resource for you before then. And finally, it covers the complete lifestyle commitment to the work I do that is a constant in my personal life, regardless of any one client’s particular due date. My family gets it though. They are on this roller coaster with me, and they realize how important it is that I am available to my clients when it’s baby time. Plus, they also understand that most holidays can be shifted. ;)

Me and my kids, August 2021

They are the inspiration for the work I do.

I am thrilled to announce that I am branching out on my own in my childbirth education and will no longer be affiliated with BirthWorks. This exciting change will give me the freedom to teach the aspects of birth preparation that I feel are most relevant and current, without feeling tied to a particular organization. I will bring my experiences from nearly 800 births attended over the past 17 years to give the best preparation all types of births in our local birthing community. For while birth is timeless, the circumstances in which we live and give birth are not. And differences in birth options and hospital policies by city and even hospital can be vast. You want to know what to expect where you plan to give birth.

For those who have taken my childbirth classes, rest assured I will still teach the same foundational tenets to prepare for an informed birth experience, no matter the birth you are envisioning. This new curriculum is more current, professional, evidence-based with countless sources cited for further research. It also emphasizes the same information I have always found important, but in a more eye-catching and interesting way. And because I know they are everybody’s favorite part :) , I will continue to add my own stories, handouts, and flair of uniqueness that will make is solely my own curriculum. It really should be called Amara’s Birth Essentials, come to think of it. :) I think this will breathe new life into what I teach and I’m really excited to share in this new way!

For those who are curious, here is a general list of what my classes will cover:

• Making thoughtful decisions about your provider, birthplace, and support people so your birth options mesh well with your beliefs about birth

• Physical, hormonal and emotional aspects of pregnancy, labor and birth, and postpartum

• Nutrition and exercise, and other modalities key for a healthy and comfortable pregnancy, your baby’s well-being, and increasing your chances for a shorter birth and recovery time

• Optimal fetal positioning and incorporating the use of upright and gravity enhancing postures in pregnancy and in labor

• The connection between fear and stress and possible implications on your birth, and making changes in your lifestyle when necessary

• The stages of labor and birth and knowing how to navigate and cope with each one, including a repertoire of non pharmacological comfort measures you can even do at home

• Assessing the risks, benefits and alternatives to medical procedures for both you and your baby so you can make the best decisions for your family

• Strategies for optimizing your postpartum recovery, bonding with baby, and breastfeeding relationship

All Birth Essentials group classes will held at Kimberlin Gray Photography Studio, centrally located in the East Beach area of Norfolk, 4500 Pretty Lake Ave, Suite #102. With vaulted ceilings and an open floor plan, we can safely socially distance while maintaining enough proximity to interact as we learn together. Plus this location is easily accessible from much of Hampton Roads.

If you are ready to register, you can do so here. I would be so honored to have you join us.

Want to hear from people who have taken my classes? Then read and view their testimonials here.

At first glance, this may appear to be the opposite of what a doula would write about. But hear me out. Support and advocate are two words that have been erroneously linked to the doula profession but do a disservice to doulas and to the women they serve when used to describe what we do. Let’s break the words down separately. 

Support. I had never considered this word as inappropriate for doulas until hearing Michel Odent speak of it. Don’t doulas support? Isn’t that the end all, be all of our work? Well actually, it’s not. Stay with me, and Michel, for that matter. If we support someone, we insinuate that they require our assistance. To support means “to bear or hold up; serve as a foundation for.” It can also mean “to sustain (a person, the mind, spirts, courage, etc.) under trial or affliction.” While the second definition is closer to what we do, it’s still not correct. When a woman gives birth, she is the one doing the birthing. It is from her body, her mind, and even her spirit, through which her baby comes forth. She does not need her doula’s support to make this happen. Sure, I hear from many clients following the birth that they “couldn’t do it without my support.” But this makes me feel a bit self-conscious and it is simply untrue. It’s very important to check your ego at the door here and remind your client and yourself if necessary, that it was from her own determination, actions, and choices that she birthed, not because of you.

Looking at the root of the word, doula, can lend some further insight. Doula is a Greek word that means servant. And a servant is someone who is employed by another, or in service of another. Ah yes! Service. THAT is what a doula does for her clients. She serves them. She does not support them, a word that connotates she is required for her client’s success, in the same way a building would crumble without the support of its foundation. A doula is invited into a sacred space to perform humble work in service of another. A doula SERVES.

Advocate. This word has rubbed me the wrong way for about as long as I have been a doula. While it is true that doulas are champions of a woman’s agency, choice, and respect in pregnancy, birth and mothering, it is not the doula’s role to advocate for her clients. Unfortunately, the lines get muddied here, spreading misinformation about the correlation between doulas and advocacy far and wide. We see the word “advocate” listed all over the place in affiliation with doulas—on tote bags, t-shirts, stickers, even in the job description. But at the heart of what we do, we do not advocate for our clients. At least we shouldn’t. Our appropriate role as the doula is to facilitate our client’s ability to advocate for herself. And if she is not able to (i.e., in the throes of labor and unable to focus or communicate because she is too overwhelmed), then her partner can advocate for her. As the doula I will not rob my client of the opportunity to harness her own power and advocate for herself and her baby. The doula empowers her clients to do this for themselves. She is not to strip that power away by seizing it from her client.

There is an important caveat to this. When a doula advocates for her clients by speaking for them, she becomes the one communicating with the provider, further blurring the line between doula and provider. If we are to maintain separate roles, then our place on the birth team should remain one in service to the birthing woman and partner. If she seeks more information, we can help her to get it by encouraging her to ask questions and communicate directly with her medical care team. But it is not our place to discuss her care with the provider. There have been situations in which the provider talked with me about ideas for furthering labor’s progress, i.e., various labor positions and comfort measures, but they did not consult with me regarding medical decisions. There is a big difference here. Our clients must be the ones advocating for themselves. Not us.

If we are to stay true to the call of our profession as doulas then we are to serve our clients by facilitating their own process. There is no room for our ego in their birth. We are tasked to come to her side without judgement or preconceived notions, free of self-importance, agenda, and pride. Instead, we are to accompany her, bear witness to her, listen to her, and humble ourselves to her. Remember that as doulas we are servants. Our role is small in reference to the task of the birthing woman. We are mere satellites encircling her as she brings forth life from the depth of her power. She is the one to be elevated, celebrated, and in the simplest and most profound of words, served.

I’ve been doing some soul searching the past few months in regard to birth, and the transition into a new year has brought the feelings and intention for change welling up inside me so much that I need to express them. So here I go. Those who are involved in the birth community of Hampton Roads as birthing families or birth workers, are aware that right before the pandemic hit our country full force, a beloved labor and delivery unit which included a midwife staffed birth center, closed its doors. This was a huge loss for our birthing community, one that was felt acutely by countless people locally but also spanned the globe as previous birthing families had moved away. After all, it had been in operation for over 25 years, and with our highly mobile military presence, their influence on birth and the beginning of parenting has spread far and wide. The Midwifery Center had tubs for laboring and birthing, which were a huge draw for many families. But more importantly, those who were intended to birth in the Center were met with openness. Their midwives listened and gave options, and trusted in the birthing woman and the innate safety of birth. And since there is always the potential for risk, the collaboration between midwives, OBs, and pediatricians, and nurses created the best of both worlds. As risk factors developed the elevated level of medical support was available. However, by and large, birth was safe and low risk, creating the opportunity for women to welcome their babies with minimal intervention. Options like intermittent monitoring, eating in labor to their comfort, laboring and birthing in a variety of positions, and even the option of laboring and giving birth in a tub were the norm. 

The pandemic hit like a tidal wave right as so many were adjusting to ache of such a loss. The OB practice reestablished itself in a different facility, and with change come growing pains. To be frank, there was some resistance from staff in part due to lack of information or understanding, but also because the expectations of birthing women were significantly different than the status quo of birthing the staff had grown familiar with. Women who had come to expect a certain sort of care from their providers, were having to conform their wishes to the hospital rules and protocols, all while navigating the fear and panic brought on by COVID-19. To be fair, the pandemic affected the labor and delivery units of all of our hospitals. They struggled to balance safety and choice, all while incurring the additional responsibilities like COVID tests, enforcing mask wearing, and a higher level of PPE for the safety of all. However, many thought some of the COVID protocols were extreme with the risks and benefits balance questionable. Doulas were excluded from the birth space physically, relegated to virtual support at all hospitals, except one. Only one support person was allowed, leaving laboring women to make difficult choices about who would attend them. Babies were separated from moms with positive COVID tests, and masks were required by laboring women until a negative COVID result was confirmed. Women who tested positive would be required to mask up for the duration of their births. Many families chose to give birth at home where they still had a sense of agency in who would be present and how they would birth. This was a very good thing for our homebirth midwives as well as the families served, for it gave them a higher level of recognition and appreciation, while shining the light on birth as a natural process. Our homebirth midwives had more work than they could handle. And many in the birth community were very excited about it.

Yet here we are nearly 10 months later, still adjusting to this new normal. Some restrictions have been lifted, like virtual doulas and separation of moms and babies, with others in place to maintain a reasonable level of protection from transmission of the virus. But it is possible to normalize, embrace and accept low intervention birth even in the midst of the pandemic. It does not require a huge overhaul in policy, except perhaps the addition of birthing tubs. The change would involve a change in thinking. The time has come. ESPECIALLY in light of the pandemic. Birth is the same as it always was. The way we approach it has changed. At a time when fear for our health and safety has overhauled so many of our daily routines, we need to remember that birth for most continues to be normal and safe. 

Collaborative care, evidence-based practices, and listening to birthing families, really hearing them out and having a dialogue with them, are what it will take to change the mindset of staff. And above all, trusting the birth process is absolutely essential. Childbirth education, in-depth thorough education about the process of birth brings a confidence to women—confidence in their bodies and their ability to tune in to it. And they also feel more comfortable laboring longer at home. But education and trusting the process must also happen from the hospital side. Childbirth education that goes beyond a standard medicalized birth is just as important for the hospital providers and staff serving laboring women. Yes, the interventions are there if needed or requested, but they should also learn how to serve a woman who does not desire those things.  The care is quite different. Education is crucial to change mindset. For example, when a woman arrives at the hospital in labor, why not trust that they are actually in labor and skip the triage room? Triage brings with it the assumption that a woman might not be in labor, as if she must prove she is in labor before soiling a room. Why not assume she’s right and commit by admitting her to a room? If she has prepared for her birth with an in-depth childbirth education class series, she is much more likely to present in active labor. Education is a win-win scenario.

Things like dimming the lights, while seeming superficial, can do a lot to allow a woman to follow to her instincts and limit distractions. Music can also have a wonderful effect on the birthing environment and the temperament of the laboring woman and her support team. Aromatherapy is another way to do this, creating strong emotional responses that can relax and empower the birthing woman during key points in labor. As she nears delivery, that is not the time for lights to be switched on, a crowd to gather, and lots of rushing about. Late second stage is precisely when a minimal number of necessary support people enter quietly (without loud side conversations!) and take their places. This will better enable the woman to continue to birth in the way she had been up to that point, with limited distractions and the support of her core team. Only a nursery nurse is necessary unless elevated risk requires the presence of a pediatrician. All others are extraneous and very distracting.

After baby is born, and the baby is transitioning well—this does not have to involve aggressive rubbing of the baby for many minutes—the initial birth cry and subsequent movements and color changes are indicators that baby is transitioning. Evidence shows that babies transition best against mom’s skin. Mom can rub the bottoms of the feet to keep baby crying and alert just as well as a stranger can. The trained medical staff can glean a lot by looking and listening to baby. Intervene if necessary, but in most cases it’s not. Covering baby with a towel against mom skin-to-skin is the best way to maintain baby’s body heat. Rubbing the wetness off (and the valuable vernix!) doesn’t amount to much. Keep that towel still on baby she they can remain warm against mother’s skin and also benefit from the microbiome being established in part by that vernix.

And when it comes to breastfeeding, the first hour, deemed the magic hour in birthing vernacular, is for mom and baby to explore each other. It is not the time to rob a mother of her power by grabbing her breast and the baby’s head and show her how to feed her baby. There is plenty of time for that. Remember, one sustained feed in the first 24 hours is a normal expectation, even after presenting the breast every 2-3 hours during the day, and 3-4 hours overnight. Keep the lights dim to encourage baby to open eyes and take in mom, and try to limit lots of extraneous noise and side conversation. This hour is magical, remember. And it is made more magical by empowering mom and baby to learn and discover hunger cues and smells. The help is there if they need or ask for it. But don’t jump to intervene at the slightest delay of a latch.

I would love for women to have the option of laboring and birthing in tubs again. The evidence shows that it is safe and an excellent comfort measure for women in the most active part of labor. It’s a shame that it feels a bit elusive right now, but I know it can happen again with proper planning and exploring resources. Birthing families want options and that is an option in high demand but very limited availability.

I have seen midwives and OBs work side-by-side to insure the best outcomes for mom and baby. But I have also seen these same providers trust birth and trust a mother’s instincts when conditions are right and all is well, to birth how she wishes. I have been welcomed and respected as a member of the birth team, working alongside the medical staff and my clients as a valuable part. I have watched women feel strong, empowered, and trusted to know the best decisions to make for themselves and their babies. And I have seen women move forward into motherhood with the best possible start because of such agency in their birth and the respectful support received. Let’s come together to create normalcy in birth for options, less intervention, and trusting moms, and most of all for trusting birth. It can revolutionize not only the way birth looks, but the way birth feels, and the way mothering begins.

In an effort to facilitate contacting hospital administrators to return doulas to the birth space, I have written a blanket letter for the intention of distributing as you see fit. Please copy and paste it and mail or email to those in leadership at the facility in which you have chosen to give birth. Feel free to make any changes you see fit. DONA International has also drafted a letter than can be forwarded on concurrently or separately. Whether you use my letter, DONA’s, or your own doesn’t matter. The more letters the better! Just reach out.  If you are looking for more evidence, visit my previous blog post for links.

To Whom it May Concern:

First and foremost, I want to express my appreciation for your diligence in keeping your staff and patients safe during the COVID-19 pandemic. It is no small task, and as with any unprecedented outbreak, evidence and information is constantly being weighed to assess potential risks to your staff and patient population. However, my request to you addresses the safety of your patients and has evidence to back up the benefits to their experience in your facility. I am writing this letter to ask you to please reintegrate doulas into the birth space by acknowledging them as a member of the labor and birth team, not as a visitor subject to the hospital restrictions. At the time of this writing, several Hampton Roads hospitals permit doulas to be physically present in the labor and delivery room. Sentara Leigh and Riverside Regional have opened back up to doulas and Sentara Williamsburg never restricted them. Please consider following their lead to insure your patients receive the support they expect.

The Centers for Disease Control and Prevention’s guidelines on caring for a mother with COVID-19 recommend healthcare facilities follow, “infection control guidance on managing visitor access, including essential support persons for women in labor” (Interim Considerations for Infection Prevention and Control of Coronavirus Disease 2019 (COVID-19) in Inpatient Obstetric Healthcare Settings, February 2020). They go on to state, “If restriction of all visitors is implemented, facilities can consider exceptions based on end-of- life situations or when a visitor is essential for the patient’s emotional well-being and care.” Surely, labor and birth should be considered an experience in which a doula’s presence is essential for the patient’s emotional well-being.

The evidence is overwhelmingly in favor of the presence of a doula during birth, showing a significant improvement in birth outcomes for both mom and baby. A 2017 Cochrane review of 26 trials of continuous labor support and doula care involving over 15,000 women in 17 different countries in high and middle-income settings found many improved incomes for women and infants including: “increased spontaneous vaginal birth, shorter duration of labor, and decreased cesarean birth and instrumental vaginal birth, as well as a lower incidence of the use of any analgesia or regional analgesia, less likelihood of a low five-minute Apgar score and fewer negative feelings about childbirth experiences. We found no evidence of harms of continuous labour support.”(Continuous Support for Women in Childbirth, Cochrane Database Syst. Rev, July 6, 2020).

 In an effort to improve outcomes and lower the rate of the primary cesarean, both ACOG and SMFM came together with a list of guidelines to that end. Using the evidence collected by the Cochrane review quoted above, they encourage the continuous presence of support personnel, such as a doula, due to evidence showing improved outcomes, including a lower rate for cesarean delivery. (Safe Prevention of the Primary Cesarean Delivery, American Journey of Obstetrics and Gynecology, March 2014).

And in a timely response to the Coronavirus, both DONA International and AWHONN made public statements in March 2020 about the vital role of the doula and how the doula should not be a visitor relegated to hospital restrictions, but rather considered an essential member of the birth team. (AWHONN Position Statement: Continuous Labor Support for Every Woman, Journal of Obstetric Gynecological and Neonatal Nursing, 47, 73-74; 2018). Nurses are not able to spend as much time with their patients as the doula can. And it is specifically that constant one-on-one presence that provides the benefits demonstrated by the numerous studies. In fact, with heightened vigilance and increased task load in response to COVID-19, nurses are busier than ever. Laboring women are also dealing with heightened fears and concerns giving birth in the pandemic. Their need for emotional support and attention is greater than average. Clearly the doula is more beneficial than ever, and more essential for every member of the birth team. The evidence in favor of a doula’s presence cannot be ignored. 

It also bears mentioning that I have hired my doula to be present with me during my birth. She is contractually secured as part of my birth team. She is certified and has a skill set that she brings to the birth space, skills different and separate from those of the nurse, and skills that cannot be expressed the same virtually. The benefits conveyed by her steady one-on-one presence may be compromised in the virtual setting. 

For all of these reasons, I respectfully urge you to reconsider integrating doulas into the birth space. With the benefits clearly stated in evidence and the strong desire by your patients for doula support, with adherence to personal responsibility and safety through PPE, frequent and thorough hand washing and sanitizing, I am confident you can see to it that doulas return to the labor and delivery room. 

Thank you for your time and attention to this matter,

(Your name)