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What Does a Doula do at a Home Birth?

Occasionally someone reaches out to me and shares that they are planning to deliver at home in the Chicago area unassisted by any medical professionals (aka "freebirth"), and they want to know if I would be able to come and assist them as a non-medical professional. I love attending home births, but I will only attend them when they are also attended by a midwife. Read on for my information about my role, and what I do to help during complications.


home birth art created by a home birth client in Chicago showing early labor in bed with her dog and later labor in a birth pool
home birth art from a client

Home birth <3: My clients get to stay in their most comfortable spots. There is no stress on your partner to decide when to leave. No bumpy labor car ride. You chill in your home and then some time later, there is another person in the room. It's pure magic. Home births are attended by medical professionals (a midwife and her assistant) plus all the equipment and expertise needed to handle common complications.


When people refer to home birth not being safe, they are usually referring to freebirth.


Quick Ramble About Free Birth

Freebirth, sometimes called "unassisted childbirth," "solo birth," or "sovereign birth," originated in the US in the 1950s, and is not the same as home birth. Often, people explore this path in reaction to finding out about how medicalized birth has become in the U.S., for example that +30% of people in the US give birth by cesarean. I get it. I believe that everyone has the right to informed consent, but I feel dismayed when half-formed ideas and fear lead to decisions. Freebirth carries significant risk:

  • most common remedies to complications of birth are unavailable without equipment

  • no one is monitoring your or your baby for signs of impending complication

  • add in that many freebirth spaces tend to be quite TERF-y and unsafe for LGBTQ+ folks


A huge part of parenting is weighing the pros and cons and making your own decisions. I can't do that for your and no one else can either. It's up to you. What I can tell you is that I have weighed the pros and cons for myself, and I don't attend freebirths. You can read a full review of this history and literature here.


Home Birth Doulas

Back to what I do at a home birth! Usually I'll come before the midwives and help once you are no longer able to rest but before things are really moving along. I can help decide when to call the midwives if you'd like, or weigh in on what I'm seeing when we talk to them. The atmosphere is usually quite casual since we are in your home and I provide the normal comfort measures. Some other things I do:

  • help set up the birthing pool (don't forget the liner!)

  • keep you hydrated since their isn't a standard IV given

  • stay focused on you as everyone else gets set up and scrambles around

  • bring you snacks post birth to keep your blood sugar up since everyone bleeds at least a bit after birth

  • support you and your partner if their are complications


Doulas and Home Birth Complications

Sometimes there are complications during birth, and that is why midwives are so important. The most common complications are bleeding too much (hemorrhage) and the baby not breathing well on their own. Let's talk about each one.


Bleeding:

  • This is the number 1 complication worldwide and we are so lucky to live in a world where medicine can be administered to quickly stop bleeding in most cases

  • Midwives keep track of all your vital signs and know when there are warning signs for too much bleeding

  • If you are at risk, they will tell you and recommend a medicine to stop the bleeding

  • They monitor you carefully and may recommend other interventions

  • If blood loss continues, they may recommend a hospital transfer (rare, but lifesaving)


My role is to stick to you like glue and be an extra pair of hands, for example if the midwives want to move you quickly from the birth tub to the bed. Often partner is holding the baby so I stick with you, though sometimes we switch. In a transfer, I follow the ambulance to the hospital and stay with you there.


home birth in chicago in a birth tub, baby didn't cry right away so mother put mouth over baby's face and gave a breath
client giving her baby a breath

Baby not breathing well:

  • Babies sometimes don't cry immediately, especially at a peaceful waterbirth, but don't forget that they are getting oxygen from their umbilical cord through you

  • Midwives are carefully monitoring baby's vital signs, including heart-rate and lungs

  • Baby might just need some extra suctioning or a breath from their parent (see pic!), which can be very empowering

  • If baby continues to struggle, midwives might cut the umbilical cord and do some resuscitation


My role is again to stick with you. If things are moving slowly or you are giving a breath I might capture it for you (like above). If there is more urgency, I'll narrate what I'm seeing and bring you some water to help ground you and help you come back into your body.


Both of these complications are NOT more common at home. They are just part of birth, and birth is never without risk (thanks, evolution). The number one most important thing you can do to prevent a dangerous situation is hiring a medical professional you trust with training and equipment to hand handle the most common complications of birth. And hire a doula!


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