For those who haven’t hired one themselves, the role of a doula might be a bit of a mystery. At least it was for me. Katinka Locascio is a labor doula, licensed massage therapist, herbalist, fertility awareness educator and the founder of Earth + Sky Healing Arts. I asked her to tell me everything about being a doula — the good, the bad, the hard, the surprising.
My choice to become a doula stems from a desire to be a part of a really wonderful and important life experience. I didn’t want birth to remain behind closed doors until it was my turn. I came to it circularly: About 15 years ago, six months before I was set to attend medical school, I decided to train in bodywork (an alternative medicine that has to do with breath and energy). I didn’t think about it too much; it sounded cool to get a massage every day for six months. But when I got there, I realized, Oh, this is really profound. I decided to forgo medical school because I wanted to study the body from this other vantage point.
Then one day, somebody called me up — a person I knew and really respected — and said, “Hey, do you want to come to our birth?” It was at this moment that I was like, ‘That’s it! I want to be at a birth!” It was amazing, magical and also scary. I really wasn’t prepared, but I was hooked. I started training as a doula.
Sometimes I’ll get the question, “What’s the difference between a doula and a midwife?” I totally understand why someone unfamiliar with the process would ask that question, but from my perspective, they couldn’t be more different. A midwife is a licensed medical practitioner that is responsible for the health of the mother and the child in a very legal and medical way, the same as an OB. A doula is non-medical — an emotional, physical and informational support person. I bring comfort and support to the couple. I’m in the room as someone who isn’t afraid of the process of birth, who’s been through it before. I only answer to the parents. And because I also offer fertility counseling, I’m often with them through the whole process: As they’re trying to get pregnant, while they’re pregnant, during the birth, after the birth. Every woman deserves support and undivided attention through that process.
I’ll never forget someone describing having a baby in a hospital, “like trying to take a poop in the middle of a shopping mall.” It’s hard to relax and get to that quiet, focused space in a very public setting. Studies have shown that extra support systems, such as doulas, reduce the chances of problems in the birthing process. There’s just something about mammals where, if they’re in a place of fear, it’s really hard to have a baby.
There are some common hospital practices that are based on old, kind of patronizing ways of doing things. Like something as simple as women eating during labor. Most hospitals have a policy that says women can’t eat in labor, but when you dig into why, you’ll discover it doesn’t need to be so black and white. Most women don’t eat at the end of labor but they might want to eat at the beginning of labor, and that’s totally fine. It’s one of those policies that we’re seeing change as it’s been increasingly questioned. Being informed and understanding those trends is a really important part of my job. Everybody should feel informed and empowered to make decisions that are best for them; I’m there to help.
Another example is the hospital approach to pain relief. It’s unethical to deny a woman pain relief, but in a hospital, your options are morphine, anesthesia, Demerol, etc. They’re pretty intense. But, particularly in birth, there are so many other options. Like touch, massage, hot-and-cold compresses, hydrotherapy — side-effect-free, proven measures of pain relief that a doula or anyone can provide, but that aren’t covered by our insurance system. That’s where you see evidence of a more pharmaceutical-driven medical system.
After being a doula for a number of years, I felt clear on what I wanted when I had kids for myself, which was nice. I was lucky to have two satisfying and wonderful births. I was in labor for 25 hours with my daughter — it’s not like it was quick or easy — but it was a peak experience of life. I did not believe I could do it until my child came out and then I was like, “Oh my god I just did that. That’s crazy!” I was convinced that everyone on the planet could give birth except me. But then it happened and it was really cool.
That said, having kids has definitely changed me as a doula. On the one hand, it’s really nice to look someone in the eye and be like, “I’ve been there.” You can’t replace that. But it’s also hard to look someone in the eye and be like, “My boobs are about to explode, I really need to go pump, my husband’s going to kill me because I’ve been gone for 40 hours and, oh my gosh, that’s such a hard contraction you’re going through!” It’s also challenging to see women have less-satisfying experiences than I did. I’m still processing whether becoming a mother has helped me be a better doula or not.
In that vein, the hardest part of being a doula is watching people not get the level of care I want them to get. It’s tough to see women be talked down to or condescended to when they’re in that state. As a doula I’m witnessing all of it and seeing it a little more clearly, maybe, than she is. That part can be really difficult.
Another hard part of being a doula is being on-call. I take on about four clients a month, which translates to about four births a month. That means I can’t go away on the weekend, nor have more than half a glass of wine. I don’t make summer plans. I’ve missed Thanksgivings and Christmases, my daughter’s recital, my husband’s play, that kind of stuff. You can’t plan a birth! It can be very physically draining, because I’m missing nights of sleep repeatedly and have to go to work the next day or be with my kids or whatever, and I’m not always getting the catch-up time that I need.
But whenever I’m tired, I just remember that feeling of being in the thick of it. That moment where the birth starts to feel like it’s taking a while. Everyone’s getting a little hopeless about the whole thing and you peer out of the hospital window and see people going to work and drinking their coffee and you think, I’m in such a different world than you. I’ve been up all night. It can be tough. Sometimes I wonder, Why on earth am I doing this? And then, lo and behold, a little person is born and I can’t help but marvel, This is the most amazing thing ever. This is the best job in the world.
I always joke with my clients that I will cry when their baby is born, because it’s such an incredible thing. Crying is a very human response to witnessing birth. It’s so beautiful when a little baby enters into the world. I still know many of the kids I watched get born. The first one I saw is 14 now.
The field has grown in the last 10 years. There are so many smart people in this industry, I learn from them all the time. It’s a really alive and energetic group of people that are called to do this work. I wish that anybody who feels like they want support from this world could have it. In the words of the inimitable Dr. John H. Kennell, if the job of a doula could be made into a pill, it would be unethical not to prescribe it to everyone who wanted it. Birth is a lot of work and can be scary, but women are amazing and I’m in constant awe of the work they do to populate the planet. It’s no doubt underappreciated.