I know the value of a doula in hospital, but I have to say that I really love a good homebirth gig!

I am referencing homebirths attended by a legally recognized and skilled care provider, usually a midwife. Our presence at an intentionally unassisted birth is out of the CAPPA Labor Doula Scope of Practice for good reason.

Please take the time to use the links under “For Further Study” below as a prerequisite to the guidelines in this article, especially if you are new to homebirth and the profession of homebirth midwives. It is also a good idea, before accepting a homebirth client, to have a time of self-reflection to examine your motives and to reveal any fear or bias involved. Your fear could affect her chance of success; your over-excitement could also cause unintended tension. Professional doula support in addition to midwifery care could also help her achieve her goals of birthing at home, a decision that is usually well thought out and researched in advance.

Is having both a Midwife and a Doula an unnecessary duplication of effort or a complementary meshing of our individual strengths to benefit a client?  Many midwives I know are grateful for knowledgeable and compatible doulas on the team, and some discount their services for clients who have a Doula and/or have taken an independent childbirth education class supportive of the homebirth environment.  Some midwives practice in a way that they are present for early labor, and do not see the need for additional doula support. Like all things “doula,” it depends on what the woman wants, and on how informed she may be about the pros and cons as she makes her birth choices.

Some practical ideas to consider if you have the opportunity to serve at a homebirth:

Pre-Birth

• With client permission, attend one or two prenatal appointments ahead of time, to hear how the midwife and the client see your role.  Make your scope clear, but offer to take any task which is not medical and supports your client.  You are not working for the midwife, but be open – this is not a hospital birth and she already may provide many of your usual duties.
• If your client approves, ask the midwife to lunch or coffee/tea. Ask her directly what issues she may foresee with your presence, and ask about both her good and problematic past experiences with doulas. Ask how you can best support her relationship with her client and the family. Listen!
• Ask to have at least one of your meetings at the home where the birth will take place. Help the client set up the birth environment she wants, and to figure out the supplies and food she will need stocked up.
• Learn about setting up/taking down water birth tubs, remembering universal precautions for blood and amniotic fluid.
• Find out what the midwife recommends the clients has ready at home and what will be in her birth kit.
• Your usual doula bag and preparations will be good—just think about how to adapt them to this client and to this birth location.  Your own gloves, for instance.
• If the baby (unintentionally) comes before the midwife?  Discuss and practice options for precipitous birth well in advance, with the entire birth team in agreement and prepared for their roles.
• As with any birth, find out who all will be there and how you can support them. Make friends with any pets or siblings who may be present.
• Know where to park and the parking limits. Do not be in the way of any car needed for transport.

At the Birth

• Go when the client feels she needs support. She will not be leaving for the hospital, so relax and only give early labor the attention it demands. Too much support too early at a homebirth may actually cause a longer labor.
• Make sure that the midwife has been called and kept informed of progress. The midwife may or may not want to talk to you directly about your observations – do not diagnose but describe the best you can and with the client’s permission.
• You may not be called on to advocate, or have to be so very on-guard about interventions at a homebirth, but it is always appropriate to ask your client if she has any questions of her midwife if she seems unsure. Most procedures will have already been talked about–conscious informed consent is always her right.
• Do not expect the midwife to teach you midwifery. She is there for your mutual client, not you.
• Watch and learn, but don’t be tempted to cross the line and do anything medical. The midwife should have an assistant, student or backup midwife to help in a true emergency; if not, the partner or a family member should be next choice to assist medically unless they are unable to do so. Watch to see where you can support appropriately.

In Case of Transport

• Some homebirths require a transport to hospital for either the mother, the baby, or both; the majority of transports are not for emergency reasons.
• Assume the planned roles you will have identified ahead of time:  many times the midwife will need to become the doula at the hospital and you may be needed to support family members.
• Follow the midwives lead. She will be the most familiar with what is needed on behalf of your mutual client, and with the local politics of homebirth transports.
• Do not give medical information to the hospital staff. This is the Midwife’s responsibility and her license and livelihood may be at stake. She will want to be as accurate as possible and she will have the charts.
• If the midwife is not there for some reason, it is the client’s and her partner’s responsibility to pass on medical information. If you have taken notes with times, etc., offer to give them to the client/partner.
• I suggest that you stay or go as requested by your client, or as needed by the midwife. One of you should stay at the hospital until she is settled after the birth of the baby, but if there are too many people there, you may be the one who is requested to leave. Be OK with that – it benefits your client.
• The transport itself is an unexpected outcome and may need to be grieved regardless of the necessity of help at the hospital. Be prepared to support for any outcome. Postpone any emotions you may have until you can meet with a mentor, your backup doula, or other confidential support to debrief your own feelings.

After the Birth

• Enjoy your post-birth high, but remember not to out-celebrate the parents!  Resist Facebook….
• Assist where most needed at the time or pre-planned by the team. Ideally the partner can stay with the new mama and baby while the midwife attends to placenta delivery and medical monitoring of mother/baby, and while other tasks are done by the birth team:
• Pictures
• Breastfeeding – Initial Latch
• Tub draining and take-down.
• Laundry
• Post birth hot drink and meal for the mama, refreshments for the team.
• Cleaning up and preparation for the guests to come.  There will be no L&D nurse to do this!

I hope this helps you and the entire homebirth team have a good experience working together toward the goal of supporting women in their right to choose their birthplace, their caregivers, and their labor support team.

Happy Home birthing, and feel free to pass on any other helpful tips you have or may discover!

For Further Study:

• Childbirth Connection; Choosing a Caregiver
• Midwifery Today; The Homebirth Choice
• Midwives’ Model of Care
• Citizens for Midwifery; Doulas and Homebirth

Terri Woods CLD Terri Woods has been acting as a doula since 2004 when she made her first trip to the Philippines and assisted in birth centers there with her sister and daughter, both Certified Professional Midwives. Since then she has provided educational, physical, and emotionally nurturing doula services to families in the USA, the Philippines, and New Zealand, and was a guest speaker at the New Zealand National Homebirth Conference in 2009. She is now working on establishing a Volunteer Doula Network on the Central Coast of California in order to serve low-income women while mentoring newly trained doulas, and has vision for the meaning of “doula” – women serving women—worldwide.

Copyright CAPPA 2015