What if my birth plan is flexible?

A common question that I am asked, and a situation I frequently encounter in the birth room, is what does a doula do when plans change? My tongue-in-cheek, rhetorical response would be, when do plans NOT change? However, the heart of the question is truly this: If I change my mind during my birth, what will my doula do? What if I am not set on an unmedicated birth, and I choose an epidural during childbirth? What does a doula do if I'm not having a natural birth?


A doula is, "a trained professional who provides continuous physical, emotional and informational support to a mother before, during and shortly after childbirth to help her achieve the healthiest, most satisfying experience possible." 

Continuous physical support is beneficial even in the presence of pain medication. You may feel too warm, or chilled. You will need physical assistance for pushing. More pillows, more water, handing you your phone or setting it aside. Dimming the lights so you and your partner can rest. Holding your hair if you are overcome with nausea. Suggesting positions for birth progress. Helping you initiate breastfeeding. Holding your hand if your medical team must act with urgency. This aspect of the doula's role is not impacted by your use of medical or pharmaceutical tools.

Continuous emotional support is beneficial no matter how you choose to give birth. Your professional doula will be there to provide perspective and reassurance throughout the hills and valleys that you traverse during your pregnancy, your birth, and your postpartum. No matter how you feel about choosing medication for your birth, your doula will offer support for your emotions both now and in the future. In those rare moments when medical complications occur, your doula will stay by your side, holding your hand, reminding you to breathe, supporting you the whole time. This aspect of doula care is not impacted by medications either.

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Continuous informational support is beneficial for all births as well. If you have symptoms that indicate blood pressure medication, or a change of position, perhaps a forceps delivery, or simply an explanation of why you suddenly feel shaky, your doula is there to help you ask the questions you need, and to help you get the information necessary to make an informed decision. Sometimes you just need a medical jargon translator. Again, this aspect of doula care is unaffected by how you choose to give birth.

The role of a doula does not change if you decide to change your plans, and neither do the benefits of doula care. Women supported by a doula experienced a 31% decrease in the use of Pitocin, a 28% decrease in the risk of Cesarean, a 12% increase in the likelihood of a spontaneous vaginal birth, a 14% decrease in the risk of baby going to the NICU, and a 34% decrease in the risk of being dissatisfied with your birth experience. These benefits apply for all methods of childbirth. 

Choosing a doula does not mean you must choose a natural birth. Wanting an epidural does not bar you from the benefits of doula care. Planning a Cesarean does not mean you do not need continuous support. Research shows, both you and your baby benefit from the care of a trained doula.

Joyce Dykema