Written by Jessica Pretz, Surrogate Coordinator at Circle Surrogacy, and 4-time gestational carrier and birth doula of 12 years, who has had the unique opportunity to support gestational carriers and their intended parents.
What is a doula?
Women have been using doulas – from the Greek word meaning “a woman who serves” – for centuries to assist them during childbirth. Today, doulas are professionally-trained birth coaches who provide guidance and support to a pregnant woman during labor.
In the case of a surrogacy birth, the doula provides support and guidance to both the gestational carrier, as well as the intended parents.
While doulas do not provide medical care, they are trained to provide continuous one-on-one care, as well as provide information, physical and emotional support to a woman giving birth and her partners and intended parents.
Why do women use doulas?
At the time of the labor and delivery, the environment can be quite hectic, and nurses and the care provider can be busy providing service to many other patients. A doula’s role is to be the constant support focusing on the woman in labor and her support system, while the nurses and doctors focus on the baby.
With a surrogate birth, intended parents may be unfamiliar with the birthing process, have questions about labor and delivery, or can be international intended parents where there may be a language or cultural barrier. Medical professionals may order or suggest medical procedures that may be unfamiliar to the intended parents. This is where the doula can offer support and explain what exactly is going on, and why it may be occurring.
Here are 4 ways doulas support surrogates and intended parents during a surrogacy journey and birth:
- A doula helps surrogates and parents prepare for the birth.
In a surrogacy birth, a document that outlines preferences and plans for delivery day is filled out by the gestational carrier and her intended parents. As a doula, I talk to both intended parents and surrogates about their options and bring up possible scenarios, in case their birth plan doesn’t go as they anticipated (which can happen in any birth, not just surrogacy births). I always encourage my clients to discuss this a few times with their OB/midwife and then again once they are at the hospital. At the hospital, a doula can gently remind the staff of everyone’s wishes for birth and immediately after birth.
During one of my client interviews, the intended mother expressed her desire to be involved in the delivery. This was very much welcomed by the gestational carrier. As the gestational carrier started the pushing phase of birth, I gently reminded the birthing team of the intended mother’s wishes for immediate skin-to-skin after she caught her own baby. In the unfortunate event that the IPs miss the birth, their wishes – while legally may be written into contracts – and their preferences for their baby can also be written into the birth plan.
- Doulas offer emotional support.
The labor can bring on a wave of emotions for both the surrogate and her intended parents. The anticipation and excitement can quickly turn to fear. Many intended parents have experienced loss, so having that additional emotional support present is beneficial for both the gestational carrier and the parents. A doula may also provide support to the Intended Parent(s), however, her main focus will always be the gestational carrier. The excitement of the intended parents and the bustle of medical professionals can make a gestational carrier feel a little lost or out of sorts. A doula’s job is to support the carrier during labor and immediately after birth, and make her comfortably emotionally.
- Doulas can be the delivery room “middle (wo)man”.
During a surrogacy journey, intended parents plan to be present at birth of their baby(ies). However, labor is unpredictable! Situations have occurred when intended parents are either en route to the hospital – or possibly not able to present – for the labor and delivery. When this happens, if the intended parents wish, a doula can be very beneficial by keeping the intended parents up-to-date with the progression of labor.
One of my doula clients who was also a gestational carrier had intended parents who were only 2 hours away from her. However, labor progressed quickly, and the parents found themselves rushing to get to the hospital. While my focus was on supporting my client (the surrogate), I would send the intended parents quick updates when I was able. At one point, the intended mother called me and I reassured her that her post-birth wishes would be followed. This eased her mind during a stressful and emotional time, and helped them feel like they were still a part of the labor even though they weren’t present.
- Doulas help surrogates process the birth experience.
This is a time where the doula talks to the gestational carrier either by phone or in person. As a 4-time experienced gestational carrier and a doula, I find this time to most beneficial. During this conversation, the carrier can discuss her labor and delivery, or even the journey as a whole, in a place she feels safe and comfortable to do so. Not every birth will go as planned, and a doula can support the carrier so she does not feel guilt, shame or any remorse about how the birth transpired. Doulas often take quick labor progression and delivery notes so later she can help the gestational carrier to piece together the birth story. Often due to emotions, exhaustion or other factors, a carrier doesn’t remember specifics about the labor and delivery. Discussing how the gestational carrier felt as she worked so hard to bring the intended parent’s baby into the world can make her feel heard and supported. The doula will give these notes to the gestational carrier so she can write her birth story later. Additionally, the intended parents may desire to keep these notes for their baby book.
It’s important to note the things that doulas are not – and are not responsible for – doing.
Doulas do NOT:
- Perform any clinical tasks; in fact, they do not provide any medical care.
- Give medical advice or diagnose a situation.
- Make decisions for the gestational carrier or the intended parents.
- Take over the role of the surrogate’s partner or another support person.
- Pressure the gestational carrier into certain choices just because that’s what they prefer.
How much does a doula cost?
Doula costs vary by both region and experience, and can range from $800 to $2,500, with the average cost around $1,200. Some doulas charge by the hour, while others have a flat fee. Their services include a prenatal visit, labor and delivery, and a post-delivery follow-up.
It is recommended to hire a doula as early in the process as possible. This allows everyone to get to know one another. Most often a doula is secured by the start of the third trimester. It is highly encouraged to interview several doulas and find one that fits your personalities and needs. What one woman finds appealing in her doula, might not suit a gestational carrier. As mentioned earlier, a doula will serve both intended parents and the gestational carrier, but her primary focus for labor is the carrier. Selecting a doula should be the responsibility of the surrogate, as she needs to feel comfortable with the doula.
How do I find a doula?
There are several websites that have doula directories.
With my involvement in local surrogacy and parenting and pregnancy groups, I have found that word of mouth is the primary way doulas get their clients. Many doulas provide their business cards to OB offices, but it is more common to book a client via the doula directories.
Doula support for a gestational carrier is becoming increasingly popular as there is a great benefit for all parties involved by adding this additional level support during an emotional and exciting time. There are now doulas who are trained specifically to support the gestational carrier and the intended parents, and they understand the process better than doulas who have not been further educated on surrogacy.
Gestational carriers can never have too much support!
Photography by Jennifer Hamilton.