Why I Had To Quit Being A Birth Doula
By Annemarie Plenert
M y first birth was incredibly difficult. I went in for an induction at two weeks past my due date and waited in triage for the first 14 hours because the nurse couldn’t seem to find me a bed; then I waited another 12 hours for the Pitocin to start working. The pain rocketed off the charts and I needed an epidural. One of the nurses really wanted me to have a Cesarean because my water had broken long ago. When the time came, I pushed for two hours on my back, birthed my daughter, then endured 45 minutes of being stitched back together.
My baby girl was 11 pounds, 9 ounces. Without my doula, I would have felt alone and powerless. My husband did his best to help me, but he was as overwhelmed as I was. My doula was the one who sat by my bed and told me it was okay to cry about the epidural, it was okay to cry because I was so tired. She helped me feel better about the fact that everything went the opposite of the way I wanted.
Through all the pain, the overwhelming emotion, the self-doubt, I remember listening to the women around me — including one who screamed for drugs while pushing her baby out. The nurse was trying to calm her down and prep her for delivery at the same time. I desperately wanted to cross the hall and hold her hand; to let her know she wasn’t alone, either. That was the moment I knew I wanted to become a doula.
I was a birth doula for four years. Doulas are birth workers trained in the emotional and physical aspects of childbirth, and they attend all kinds of births in all kinds of places. They offer a continuous presence, information regarding various birth options and the potential effects of interventions, and non-medical support such as suggestions for labor positions, gentle massage, and relaxation techniques. Doulas, particularly those certified through organizations like DONA International, are not supposed to judge individual birth choices or make decisions for their clients.
People have had birth attendants for all of human history. Despite the fact that doulas have become increasingly common in the past decade, misconceptions still abound. Doulas don’t replace nurses, or doctors, or midwives, or partners, and a doula who judges their client’s choices is not doing their job. The best doulas walk into expectant parents’ lives and develop an extraordinary level of intimacy with their clients in a brief period of time; they then use that intimacy, that knowledge, to compassionately guide parents through the overwhelming birth experience.
Births can range from empowering to horrifying, scary to orgasmic, blissful to traumatic — and nothing can be done to guarantee a certain birth outcome. The only universal truth of childbirth is that the baby has to come out somehow. In addition to the enormous physical challenge of bringing a baby out of the womb safely, birth is a complex and draining mental process — I saw my clients scream, cry, shake, curse themselves, curse their partners, give up, do anything they could to reject the depth of pain or the height of emotion they were experiencing. Birth can bring up past trauma; birth can challenge one’s spirituality, sexuality, emotional stability, or mental health; birth can shake parents to the core. All of this contributes to the emotional labor for a birth doula.
The only universal truth of childbirth is that the baby has to come out somehow.
A 2012 Cochrane review found there is a 28% decrease in Cesarean deliveries and a 9% decrease in the use of any pain medication when births are attended by doula. Informed choice and consent are essential to a positive birth experience. While some of my clients may have initially hired me as a sort of insurance policy against interventions they didn’t want, when they did make the choice for an epidural, Cesarean, or any other intervention suggested by their medical practitioner, what they wanted and valued most was my nonjudgmental information and support.
I believe in the importance of supporting the intense work of parents as they bring babies into the world. When I was a doula, I knew I had no purpose other than to guide parents through the changes and extreme experiences of birth. When the birth plan went out the window, I did what I could to help the parents process, ask questions, decide how to go on. When parents resisted transition, I asked them what was holding them back. I had my bag of tricks, as all doulas do, but in the end it was the quiet voice saying I am here, you are strong, you can do this that most people remembered.
When I went into birth work, I tried to remember what had mattered most to me during my birth — that I was given permission to feel my feelings about the things that were happening to me. It was important for me to feel as though every decision was my own, and I did my best to give my clients the same sense of agency.
Two years after my daughter’s birth, I started my doula training and began attending births. I started with friends and family and charged a pittance, slowly raising my fee as I began to feel more confident in my abilities. At my first birth, the midwife played Scrabble on her phone and let me figure out what to do on my own. I tried out some of the techniques I’d learned, but when most of them were rejected, it was the litany of “you’re doing so well, you’re so strong, keep breathing, baby is coming” that kept both of us grounded. My post-birth euphoria was almost as great as if I’d had my own baby.
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At each birth I attended, it was the same: Gentle physical touches, reminders to get up and move around, and a constant stream of encouraging words were the most effective tools I had. It felt so good to offer unconditional support, to see parents in labor hanging onto those words, depending on them. But I also absorbed their fear, their anger, their pain, their grief. I tried to let it roll over me, but letting go has never been my strong suit. I’d come home from an exhausting all-nighter of a birth and the maelstrom of emotions I had experienced would keep me awake for hours. Recovering from a birth was challenging for me, right from the start.
Doulas have to cope, first and foremost, with the emotions of others. We guide parents through the deep darkness that can surround us during childbirth, the pain and the buried feelings and the shaking of deeply held truths. This is our job, to accept and acknowledge these feelings so that parents can push through the unexpected Cesarean, the epidural they didn’t want or the one they wanted but couldn’t have, the challenge of transition when their bodies and brains suddenly feel out of control, the sudden shock of the first separation from the baby they’ve carried inside their body for months. We help them face and process all these feelings so they can find their way out the other side.
I embraced my clients who wept, crying that it was not supposed to be so hard, not for them; they’d done everything right. I stood outside operating rooms with my clients’ partners, who practically climbed the walls with anxiety. I sat with parents after their baby was whisked away for observation, trying to give them strength without offering false hope. I coached my clients through hours of waiting for an anesthesiologist, past the point of needing an epidural but prevented from getting a reprieve from the agony. And I always, always kept my focus at the moment when the baby was born. The rest of the room would shift, or fade away entirely; it was all about this new life. My clients needed a moment to retreat, to realize what they’d done.
I had to work through so many powerful emotions at each and every birth I attended. After my next two children were born, twenty months apart, attending births with three children under five at home became monumentally tough. Doula work can be highly physical, and my postpartum body didn’t have the strength or stamina I needed to push through its demands. I had to find babysitters who could be on call around the clock. My anxiety over how my own kids were coping without me was considerable.
Coming home after a birth was even more challenging after I had more children. I was able to sacrifice my own needs for someone else’s during a birth, but then I had to go home to more of the same — I found I had little capacity to cope with more touching, tears, conflicts that needed mediating, the constant neediness of my kids. The combination of these two very different types of emotional labor — one at work, one at home — left me with an anxiety diagnosis. Still, I loved doing the important work of being a doula. So I went to my births, I went to counseling, and I swam in an ocean of overwhelming feelings.
I talked to some of my doula colleagues who also have children to see how they cope with going from one type of emotional labor to another. They agreed that the transition is difficult, and that the birth is the part that feels easier. Jane, a practicing doula, only attends births when her husband is available; that way she has the time she needs to attend the birth and recover after. “But I find the physical recovery is more what I need,” she says. “He also has to deal with the kids more in the days leading up to labor when I feel like I want to get more rest or quiet time.”
Gabrielle, my former partner and backup doula, says, “Coming home and ‘coming down’ from a birth far outweighs the challenge of any other portion of birth support. [Supporting] labor is emotional work, which rapidly becomes an emotional burden when faced with the other work of the day. Exiting a birth is jarring, and leaves me feeling emotionally jet-lagged when I attempt to enter a different emotional zone of caring about the mundane immediate needs of family life and personal care.” Gabrielle still takes on births for family and friends, but is no longer willing to approach doula work as a business or profession.
“I know I will be emotionally and physically drained for at least 24–48 hours following a birth,” says Jen, the head of her local doula collective, “so I allow myself rest time and try to keep my schedule light. It is a challenge for me and it keeps me from taking a lot of births. I can totally roll with whatever a client throws at me — the hard part is being on call and the disruption to my family that that causes, the fact that I never know how long I will be gone when I attend a birth, and the fatigue afterward.”
The common thread among all the doulas I spoke with was the need for rest and a gradual transition back to regular life. Without support that extends well beyond the birth itself, doula work can feel like too much to handle on top of the demands of parenting. When I eventually realized it was unfair for me to come home from a birth emotionally wiped out and make my children bear the brunt of my exhaustion, I knew I had to give up birth work. As much as I believe in it, believed in its importance, I couldn’t allow my kids to assume that burden.
I’m now coming up on the anniversary of my last birth as a doula. I already knew doula work was too much for me to handle, but the contract was signed and my fee was paid, so I went. I do not feel I did my job well that last time, and I am ashamed of it. I came home afterwards and let my children watch a lot of Netflix so I could cry and stare at the wall for a week. I let my doula certification drop and took down my website.
There are plenty of things about doula work that I didn’t like. I didn’t like being chained to my phone, being on call for up to five weeks at a time, adding a caveat to every plan I made (yes, I can probably come to the preschool Christmas concert, but I might miss it if my client needs me). I hated lying awake at night, knowing I needed to sleep because a client was in early labor and would call me in soon, unable to fall asleep because the adrenaline was already pumping. The all-nighters were always challenging.
The other parts, though, made it all worth it. I knew the value of a calm voice offering encouragement, strength, and hope — never leaving, never wavering, never judging. Being able to provide that to laboring parents, no matter what the circumstances, connected me to a larger purpose. I knew I was doing work that mattered, that influenced lives, that made the world better in a small way; I felt like a tiny but important cog in the system of humanity and always cherished that sense of interconnectedness.
I still believe in the work I did as a doula, supporting parents through their birth experiences. Midwives, doctors, nurses, anesthesiologists, and surgeons all have crucial roles to play, but as a doula, I was the only one in the room 100% committed to whatever form of emotional support the laboring parent needed. I loved being able to walk into a birth room and say, “I am here for you, no matter what.” When I couldn’t say that any longer, I knew I had to give it up.
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