Sona Jany – Louhivuori is a certified hypnobirth doula. In the first part of our interview we spoke together mostly about Sona’s experiences that directed her to the profession of a doula. In this article, we look closely at the doula’s responsibilities and her position in the life of a couple expecting their child.
For the start we should pay attention to the difference between a doula and a midwife:
“Midwife is a specially trained nurse and she has skills and permission to make also some of the medical interventions. Of course, one set of her tasks is also to comfort a person who is in labor. Doula on the other hand accompanies pregnant people and their partners during pregnancy, through the childbirth process and also after the child is born and the new family is at home. In other words, a doula doesn’t have permission for medical interventions. Doula can offer mental, emotional and practical physical support.”
Being a doula was for a long time completely voluntary work and many experienced doulas don’t have any special education or certificate. Their professionalism came through life training. There is also no legislation targeting who is a doula and no certification is required. In fact, a doula might also be your friend, who accompanies you during the labor as psychological support. Maybe she already went through the labor herself and is the best support you need at that moment.
Yet there is a difference between the amount of knowledge and skills of a certified/experienced doula compared to your friend’s support. Nowadays trained professional doulas are familiar with the medical language used in labour, they are aware of possible offers of medical interventions and have several tools of natural methods of pain relief like birth breathing, massage, rebozo, Tens – machine, acupressure etc.
Sona suggests you think about your expectations. After you know what you need, you can choose the right doula for you. Somebody just wants to have a partner or a close supportive friend around.
“In Finland, there are voluntary (uncertified) doulas and their services are more about emotional support, but they usually don’t offer any other services. If the doula works as a professional, expectations are different. Every professional doula has a portfolio of services she/he offers. We in The Nest Doulas+ also make some attempts on how to differentiate between the friend-support, voluntary doula and professional doula. Because truly it is kind of unclear at the moment…”
Professional doulas usually offer a package of services that might differ, but most likely she meets the couple at least 2 times during the pregnancy and she supports them during the whole duration of labor. She stays with the couple a few hours after the child was born and she visits family about 2 times afterwards at home. Every doula has her own package of services and it’s recommended to familiarize with that offer. Most importantly, I thought you should click personally with your doula. Trust and a good vibe is in my opinion even more important than a big range of skills.
“During the pregnancy, there are preparation sessions. Every doula might do it differently. In The Nest Doulas, we cover these topics: what is a couple’s labor story? What emotions do couples have about labor? We aim to find out what kind of experience a couple has with a previous child birthing process. We cover labor from the physiological perspective – from the view of a child as well as a pregnant person. We speak about the role of hormones, about what is going on with our body before, during and after the labor.”
The doula helps the couple to choose their labor preferences and to set up their child birthing plan for different situations that might occur. Doula aims to calm down becoming parents by offering information. Ideally, a couple feels more convenient regardless of what happens during the labor.
Doula teaches breathing techniques, different positions that can relieve the pain. But she also helps partners. She can show them how to be more supportive, how to use massage techniques, press massage, how to use a Rebozo scarf or how to work with visualisation.
“We support pregnant people in learning how to switch off their rational/thinking part of the brain. It is important to encourage them to be relaxed and find a connection with the instinctual part of the brain, the so-called lizard brain. They should be in a sort of bubble, my colleagues speak about “the birth land”. It’s ideal if the person in labor doesn’t have to answer any questions. By answering she has to come back from the instinctual brain to the rational brain as she has to think about answers.”
For a person who is giving birth to a child, it is very important to feel safe and to have a feeling they are taken care of.
“Person in labor can choose beforehand several pictures that can remind her how to breathe and that baby is closer with every contraction. Affirmations are extremely important. I work with the hypno birth techniques, such as relaxing recordings and while listening to them, a person in labor can relax and come throughout the whole child birthing process. I also use recordings with affirmations such as: every contraction is getting me closer to my baby. I also work with aromatherapy. Fragrance might be also supportive. I introduce them to essential oils and let them choose their favourite ones. During labor they can smell the fragrance and it can help them to be more relaxed and calm.”
During the labor it’s the doula’s responsibility to remember the plan and preferences of the family. She advocates for what they had chosen with medical personnel. The doula can bring water or offer a person in labor a bit of a date for increasing her energy… Most probably, the doula has been present during the childbirth many times, therefore she has a greater overview of the situation. She has the skills to sense things in advance or to mediate communication between parents and medical personnel.
“After the childbirth, every doula should know the basics about supporting the lactation process. In Finland luckily, there is a good policy when it comes to bonding. A child is immediately put on the mother’s body. They let the umbilical cord be tapped, which is very important for a child, that he/she gets all the blood from the placenta. The child can be immediately put on the breast or supported in independent crawling towards the nipple. The child has a reflex to crawl and it has meaning. Crawling stimulates the mother’s womb and eases expulsion of the placenta. The first latch is very important for successful breastfeeding afterwards.”
Mother doesn’t have to know how to breastfeed automatically. On the contrary, it is a skill that needs to be learned. Nowadays, we don’t see around so many breastfeeding women as back in time. Proper healthy breastfeeding shouldn’t be painful.
“It’s a learning process also for a child. The doula can be helpful and some of us are also certified lactation consultants. If we are not, we can recommend some other help, if there are problems with breastfeeding.”
Birth doula visits the newborn and his parents 1-2 times at home: “During the visit, we also check what is the mother’s physical and psychological condition. Doula informs the mother about baby blues and its symptoms. We can also identify more serious problems, like postpartum depression, and recommend additional care.”
During such visits, the doula encourages the couple to tell their childbirth story and such conversations might have enormous healing effects. If the new mother has some doubts, the doula can help her with self-confidence and self-love.
“It all might seem like little things, but step by step we can help the pregnant person to have the best possible experience with the labor.”
Sona stressed several times how important is preparation for actual childbirth. She said that there is nothing wrong with getting a birth without any preparations and trusting the system. But, doulas have the experience that if partners (and especially first-time parents) are not familiar with the childbirth process, they can be surprised, sometimes shocked afterwards.
“Unfamiliarity with the possibilities is letting you be literally in the hands of others. Even if they are trained professionals trying to do their best… But we know that good preparation and being informed about the physiology of the labour give you a greater option on how to work with your body. If you understand that the pain has meaning, that it is not a coincidence. Nature managed it exactly in a needed way. If you understand it, the fear from the unknown lessens or disappears.”
We have already mentioned how necessary it is to switch off the rational part of our brain during the childbirth process. But to work with fear is equally important: “Fear causes greater solidification and tension. All these direct to tension in a body and affect body organs that are important for survival, but contradict labor. If I fight for my survival, I cannot be relaxed enough for childbirth. That’s why doulas (during the prenatal preparation) try to eliminate as many unknowns as possible. We want to decrease the fear from the unknown and to inform couples about possible interventions that would help the person in labour to be more relaxed.”
Of course, every child’s birthing process is unique. Future parents can’t be completely prepared for all the possibilities that might occur. Nobody can predict how the labor is going to be, or what might happen. The prenatal preparation and the understanding of the process of childbirth can help in understanding what is going on and how to choose the proper intervention.
“The understanding of the process gives you, in my opinion, greater freedom. It raises the chances for making informative decisions and influences the following procedures. If a person in labor can make such an informative decision, it might prevent postpartum depression or even trauma from the childbirth process. If labor interventions are used that were surprising or not decided by a pregnant person, it might return in the future as a feeling of failure.”
As I was listening to Sona I realised that being a doula is a very responsible and intuitive profession. What are the signs of a good doula? After a while, as Sona was looking for the proper words, she answered:
“Being patient and humble. Humble toward the whole child birthing process. Being humble and respectful towards the person in labor. Being a doula is first and most importantly service. That means I am present for somebody else. It is important to realise where my place is… Getting birth to a child is a very very intimate matter and doula has to accept all the natural processes that are present. Labor can be unpredictable and besides knowledge, intuition is necessary. If I enter the relationship between partners, it is like coming into their bedroom, maybe even further… It is essential to be capable of “disappearing” from space and not to be “visible” if I’m not needed. Just let things flow naturally, let the partners cooperate together. And when it is the right time, to actively enter the space again…:”
According to Sona, the doula is always in the process of learning. Every childbirth is a learning opportunity: “I feel that if somebody chooses doula as a profession, she/he should invest into training and preparations. And the sign of a good doula is that she is eager to continue her/his studies. That she/he is curious about what is new because doula has a direct impact on the well-being and condition of a child, pregnant person and the whole family.”
Every doula has her special services and she is continuously studying new options how to even better serve people expecting their child. Sona has some extras in her package too. She adds that the couple chose the doula according to their expectations and they should do interviews with more doulas till they make the final decision.
“In my opinion, I am skilful to read from the body, through my hands, through my masseur training, through the acupressure points. I work with the techniques of hypnobirthing. I also use the spinning babies method, which helps a child to get into the best possible position for childbirth. I am interested in aromatherapy and I use essential oils.”
Remembering my pregnancies and labors I can precisely imagine how rewarding the profession of the doula is. But still, what Sona likes the most about her job?
“During the prenatal preparation, I can enjoy the moment, when I can change the emotions of becoming parents on labor. When I see them being more relaxed. If I can see they have respect, but they are not paralyzed about the whole process. When they realized that physiological labor is well thought through process. I am also still fascinated by the strength of the person in labor. This will never stop wondering me… How the borders and the pain thresholds can be shifted several times. And of course, the euphoria from the first meeting between a child and his/her parents. You can’t get enough of this. (laughing) And what is important for me is when partners are happy with my services, if they can feel supported, respected, and if they have from childbirth a great experience.”
“On Facebook, we have a closed group called Positive Birth Helsinki, where we try to answer questions from people who are expecting their children. Once a month we also organize webinars and twice a month we have meetings with the members of our Positive Birth Helsinki group. In The Nest Doulas, we are inclusive, so we welcome all pregnant people. We don’t distinguish between bodies and we are LGBTQIA+ supportive team.”