Planned Home Birth vs. Planned Hospital Birth: The Doula’s Role

A question I’ve heard mentioned a few times is from parents-to-be asking, “I’m planning to give birth at home/hospital/birth center, do I really need a doula in that setting?”

I think it can be easy for parents to assume one setting or another may (or may not) benefit from doula support. 

First I want to say that the doula’s role isn’t to support a particular birth setting, but rather, mom and dad to be as they labor and move through their birth experience. 

The support that your birth doula provides in a particular birth setting may vary, but is equally important. What do I mean by that?

Yes, each birth setting is unique in its own way… whether you choose to labor and give birth at home, a birth center or at a hospital. However, regardless of the your chosen birth location, there are things that all birth settings need:

• preparation

• informed decision-making

• physical comfort measures

• emotional support

• advocacy

• unexpected changes

Let’s look at these a little closer…

Preparation - while I’m a huge supporter of Childbirth Education (so much so, that my first blog post was about it and I am a Childbirth Educator!), that isn’t the preparation I’m talking about here. Birth doulas provide a varying range of pregnancy, labor and birth preparation to their clients. Some birth doulas refer to these meetings as “prenatal visits”, others refer to them as “prenatal sessions” - regardless of what a particular doula refers to these get togethers - this is their opportunity to start preparing you for what is to come. Some birth doulas will meet for one longer prenatal prep session, and others, will meet multiple times throughout pregnancy before the baby is due to arrive.

Informed Decision Making - informational support is one of the pillars of birth doula support. A birth doula's role isn’t to make decisions for you, but rather, to provide you with evidence based information to aid you in making informed decisions. The BRAIN acronym is always used in my personal practice to help parents-to-be as they discern next steps not only for pregnancy and labor, but for baby and mom’s body before, during and after the birth experience.

Physical Comfort Measures - I often hear from those inquiring about birth doula support that they’d prefer to avoid pain medication in labor. For others they say they’d like to hold off as long as possible before receiving any pain medication. Both sets of parents know their unique goals, but aren’t sure how to accomplish it.

 Birth doulas are trained and many have honed their comfort techniques and come equipped with not only tools to help accomplish this, but know how to provide hands on relief with things like:

• Sacral Counterpressure

• Double Hip Squeezes

• Rebozo Work

• Massage

Emotional Support - when choosing a birth doula to be on your birth team, it’s so vital that you choose someone that you really mesh with. This person is going to see you in your most vulnerable time of life. Will you be comfortable vocalizing pain, vomiting, pooping, being in varying stages of nudity in front of this person? Your birth doula is going to see you in and through all of this, and should be that steady calm that is not only encouraging you, but allowing you space to express your own concerns or fears without hesitation. 

Advocacy - this is huge - in any and all birth spaces! You’re doula won’t talk over you, but rather give you voice. Doulas are absolutely masters of creating space and opportunity for informed decision making and ensuring that you are always giving informed consent. Please note, consent and informed consent are NOT the same thing! Regardless of your birth setting - your doula works FOR YOU - not for the hospital, not for the birth center and not for your homebirth midwife - YOU. 

Unexpected Changes - as much as any parent-to-be prepares, sometimes unexpected changes to your birth wishes, goals and values may come up. Planned birth is NOT predictable birth. A birth doula will guide you through navigating those changes by providing information, by providing you space to talk through those changes, and continuing to support you without judgment or fear. 

Sometimes that is a planned home birth that needs a little extra support and transfers to the hospital… your doula will (should) go with you. Sometimes that is moving into a cesarean section birth from a planned hospital vaginal birth… your doula will walk that road with you.

Here’s the thing - all of those bolded items above - they happen regardless of your chosen birth location. The heart of the doulas role stays the same…

• Preparation

• Information

• Advocacy

• Facilitating Communication

• Comfort Measures

• Emotional Support

• Continuous Hands-On Support

• Supporting not only mom, but dad too

The bottom line - regardless of your chosen birth location - a doula provides continuous, non-clinical support in all birth settings.