nikaLIVE: Who is a doula and how can she help you?

A doula, often confused with the profession of a midwife, is a person who, thanks to the acquired qualifications, offers a number of activities aimed at couples expecting a child and new parents. The process of becoming a mom and dad is not an easy process, but it can become easier by becoming familiar with certain issues. Julita Moonka, a doula and babywearing consultant, tells us what to do and how to prepare for childbirth and parenthood. The recording of the conversation can be viewed at this link .

Julito, I have already introduced you to our viewers, but I think you will tell us in more detail about your role and what you do today. I hope that you are not in labor at this moment, which could possibly take you away from us and that we will have at least half an hour to talk.

JK: Yes, absolutely, this time December is going to be - probably the first time in several years - quiet, without a phone at the table.

Because December is usually the hottest time when it comes to births?

JK: I think that's what happened to me, that the last few years have been like that. However, people are born every month, so there are no rules.

So tell us, what do you do as a doula and how do you help women giving birth or preparing for childbirth?

JK: Doula is already a profession in Poland, although it is called "a woman's assistant during pregnancy and childbirth." When I hear "assistant", I see a lady at a desk, and I don't sit at a desk, so a doula offers a woman, a couple and a family such extensive perinatal support. It can be said that it is continuous non-medical support in response to the needs of a woman, a couple or a family. Non-medical, i.e. information: education, conversation during pregnancy, but also during childbirth and postpartum. Emotional and physical support, I even think that physical support applies more to childbirth and that time after birth. This is very general.

I understand, you are talking about support and conversation. When I remember my births, I can honestly say that I didn't really feel like talking, there were other problems on my mind, but also to put it more specifically - a doula is sometimes confused with a midwife, and a midwife is something completely different. Maybe you would like to explain this difference?

JK: A little more detail: in terms of information support, I run classes at a antenatal school. So maybe it's not a conversation, and especially during childbirth it's hard to say, but more of a preparation. Preparation for the changes that come after childbirth, but also preparation for childbirth. It's better to call it "education." Often, a doula is associated only with the moment of childbirth, but it is also preparation for early parenthood. Every time I say "early parenthood", I think about women
whom I met before giving birth, and we are still in touch when the kids are two years old. They call and make sure everything is OK, they describe their children's behavior and we look for common solutions on how to strengthen them in such situations, but these can already be described as "non-doula" tasks.
On the one hand, education and preparation for changes. This is also the preparation of a loved one, because very often we think of a doula as only support during childbirth, and it is the woman or the couple who decides whether they want a doula to be present during childbirth. Before the pandemic, it was possible for two people to accompany a woman during childbirth, now this may change and we will return to such solutions, but for now, in most places, there can only be one accompanying person. In my work with the support of women and couples, I also see the need for support from an accompanying person. I believe that by supporting and educating our partner, we also generate a lot of support for the woman giving birth, so I think it is important. Regardless of whether this is the first or subsequent pregnancy, this support before childbirth is needed. It looks a little different depending on whether I accompany the family during the next birth, because we know what we did during the first pregnancy, first birth, and the antenatal support looks completely different if I meet a woman who has different experiences with the first birth. , different preparation, knowledge and then the first stage of our cooperation may look different.

Tell us a little more about this preparation of your partner. I think this is a very interesting topic for many women. Let's be honest, many partners are afraid of accompaniment and don't know what to expect. Maybe you can tell us from your own experience what are the most common fears and emotions - often controversial - accompanying partners who are also preparing for childbirth?

JK: I think it's an individual matter. Just like whether you have to go with a partner to give birth, whether it is some kind of fashion, whether it is good or bad - I will expand on this topic in a moment, but very often our fears and anxieties are based on what we see in movies. . What childbirth is like, what can be scary and difficult for us, how to talk to each other - this is what I tell my partners about. To talk about their fears, what concerns both the woman and her partner have. Very often, women preparing for childbirth read a lot, and their partner or close person at that time says "okay, you tell me" or "I am the task person here, when the labor starts I will do it" or "you know what, actually I will be the one" helped around the house”, so it is very individual and I encourage you to sit down, talk and gain this knowledge. Sometimes I meet with couples at the beginning of pregnancy and they assure me that they will definitely be apart during labor, but as preparations progress, it turns out that I am the one sitting and waiting at the door in case one of the partners needs support or replacement. These fears are different, based on such knowledge that "I am afraid of the sight of blood" - here the knowledge of when there is blood or not. Or the issue that I always mention - the role of a person accompanying you during childbirth is not to put out fires, nor to have medical knowledge. This is why there are medical staff, a midwife, and a doctor who appears in the delivery room if necessary. The role of the accompanying person is to respond to the woman's needs, ensure her comfort, and support her in non-medical methods of pain relief. I try to provide a "tool" that can be used during childbirth. Even if a woman decides to have epidural anesthesia, there is also a period when she needs to achieve epidural anesthesia, so it's great if the accompanying person knows such tools, can support not only verbally, not only with presence, faith in the woman, but also have specific tools he can use. And also, we often talk about what to say and what is better not to say.

So you have a list of forbidden topics?

JK: I think it's not a list of forbidden things, but showing the context: what can undermine a woman's strength, power and faith in her agency, and what can actually support her very well.

Since we're talking about the fears and pain you mentioned, I think it's the most common reason why most women are afraid of childbirth. And here you have already started talking about natural methods of relieving pain, but is there any other way, for example a psychological way, to get used to it? How do you convince your clients that childbirth is a natural thing and that they can mentally get used to it?

JK: I think it's hard to talk about conviction here. Doulas, and especially me, do not impose anything, such as the choice of hospital... rather, we provide knowledge, and it is you who will make the best decision, based on the knowledge you have acquired, you will see what is easier, what is more difficult for you, and how you can become even stronger. For me, the basis is to tame the fear of childbirth, to name what we are afraid of, and then we can work on these fears and see if we can influence it. And if not necessarily and it turns out that it may affect the progress of labor and how the woman will feel during labor, then we use relaxation techniques and breathing techniques. For me, breathing is a very valuable tool. Each of us knows how to breathe, and such conscious breathing, on the one hand, has a great effect on relaxing the body, but also on calming the head. In general, talking, gaining knowledge, naming fears, checking what we can still work on - this is certainly quite important. Understanding what this pain is for and where it comes from, i.e. working on contractions, focusing on breathing, and not on the fact that this pain is and will be - this is the preparation of a loved one and the woman, going through it, what the birth may look like, what may be a surprise, what may be difficult to surprise as few things as possible during the birth. The birth process is an unpredictable process, so surprising things still appear, but I think that going through "what may be difficult for me and what physiological childbirth looks like, what may be disturbing" is also important.

Coming back to the issue of the distinction - doula and midwife - I know that many women often have a dilemma whether to choose a private midwife or use the services of a doula. Maybe you could comment on this dilemma?

JK: I haven't said one very important thing yet: the sense of security. During childbirth, a woman needs a sense of security, intimacy and dignity. This is crucial. It is important for every woman - and this includes a doula, midwife and companion - to ensure her sense of security. The biggest difference in working with a doula and working with a midwife is continuous non-medical support. I don't want to speak for every midwife here, because perhaps there are midwives who work not only in the delivery room, but build this relationship earlier, not only during one meeting, but have frequent contact during pregnancy, while I work with a woman I'm building this relationship already during my pregnancy. More than once, I had such birth situations when, thanks to building this relationship during pregnancy, during labor it turned out that "hmmm, why am I here at all", because the woman felt really strong and this feeling compared to the previous months pregnancy looked completely different. A woman most often meets with a midwife in the delivery room. And I also don't care about the fact that a midwife is only in the medical area, because there are wonderful midwives who take great care of the entire birth - both the climate and the woman's sense of security, but very often the reality is difficult. In a hospital, when a midwife takes care of more than one woman and is not able to devote as much time to each of them as she needs, this is the first argument. The second argument is also the knowledge gained from conversations with midwives, I heard it from a wonderful midwife: "you know, I like it when a woman comes to the birth with a doula, or worked with a doula, because she is prepared and the fact that I am not in "Sometimes being able to build this relationship in such a short, intense time of progressing labor, this relationship of mutual trust and sense of security, which are very necessary during childbirth, these teachings of a doula are something that can really support the birth, the couple and the partner." During childbirth, I am also a voice that speaks to my partner, to the birthing father, who may now have a lot of emotions; that what is happening now is okay, this is what it looks like at this stage. The midwife is often responsible for the health and safety of the child being born and the woman, and sometimes may not have space to talk to the accompanying person. If a more difficult situation arises during childbirth and the medical staff has to focus on the action, sometimes the words spoken into the eyes of the woman giving birth are missing: "everything is fine, you are in good hands, steady your breathing, let's breathe together" - and that is exactly what difference. I absolutely do not diminish respect for the work of midwives, but I think that with a doula, this support is continuous, non-medical, and when we build a relationship during pregnancy and during childbirth, I am also with these new parents after childbirth - in the postpartum period. This is another topic we haven't talked about yet, maybe I'll say a few words about it too...

Yes Yes! Exactly! Can a doula also support newborn parents in some way after giving birth?

JK: And this is something worth mentioning, because it is also a bit different abroad - when I once worked with a couple from England, they thought that I would just move in with them after giving birth and live with them for a few days. In our case it looks a little different, but it also depends on the needs of the woman or the couple. It rather looks like assistance, accompaniment,
depending on what we agree. It may be one or two meetings, or regular visits every three days, or accompanying at night, because the nights can be difficult and then the doula can take care of the baby when the parents want to rest for these two-three hours. The doula will bring the baby to feed when he is anxious - there are also such options. And there are those that I come when the parents are released from the hospital and what happened in the antenatal classes usually disappears...

Well, after all the emotions associated with childbirth, it's no wonder you don't remember.

JK: Yes, absolutely! Moreover, I have the impression, or rather I am sure, that we work completely differently during pregnancy, changing diapers and bathing the doll, and it is completely different when we have our own child. Even if we have some experiences in the family, our hands shake a little, there are these emotions, the little person is either hunched over or suddenly straightens up and these are often such challenges for parents and with my presence I try to strengthen parents in their competences. When they invite me to their place for the baby's first bath after leaving the hospital, I try not to hold the baby in my arms so that they can do it, to show them and reinforce them with the words: "You're doing it very well! This requires time, patience and peace”, i.e. such accompaniment and a pat on the shoulder titled: "You're doing great." This is very necessary to minimize stress and such unnecessary emotions or fear. To talk about it right away.

When you talk about this stress, I remember the beginnings of our friendship, in 2016, when I met you at antenatal school, I think you showed a massage with Rebozo scarves, if I remember correctly! Then it made a huge impression on me, because there are many things you cannot do to a pregnant woman, so when it comes to massages you have to be very careful, many things are prohibited. And as a way to relax, this massage stayed somewhere deep in the back of my mind, even though I didn't have time to use it myself, I still remember about it. So here the role of a doula is also relaxing, supporting in the fight against stress, which is full of stress in the life of a new mother, but also before childbirth, because there are some nerves preparing for the arrival of the baby.

JK: As you said: childbirth is only the moment when a new person appears and is born, but you have to give yourself time for the birth of the mother, for the birth of the father, and for these new relationships between the partner and the partner. There are a lot of emotions at the beginning, from the biological and physiological side, completely new relationships appear. You also need to learn to communicate with the little person. We have a lot of stress every day and I think that on the one hand it is great that we have Instagram, Facebook, groups and access to knowledge at our fingertips, but sometimes it is difficult for young parents to understand. Each specialist says something different, information is coming from everywhere, and I feel that it's nice to have a person next to me whom I trust, with whom I can make sure that the path we are looking for is the right one. This is very important, because a dozen or so years ago, when I was born as a mother, I have the feeling that it was a little easier, because it was easier to look for us - for me, for my husband - and not to open the Internet and look "is this "Crying means 'feed me' or 'scratch my foot'." And in fact, closing yourself off to what's outside and opening yourself to the little person's messages is very, very valuable. And it's about "slow down, stop, look for what strengthens you", because a doula will not be the best solution for everyone. This is great, but I also try to share it in a larger group, or at a birthing school, to look for what supports us and build our own awareness, awareness of the body and needs. You mentioned the Rebozo massage, it is one of the tools that we treat as a non-pharmacological method of pain relief, but I always say that if a couple goes to labor together, don't leave it for a moment "oh, my water broke, let's go and start now!" - to be there at the end of the pregnancy, wondering, talking - "what will I be able to do then", and not only in the delivery room "ok, so what was it like?" As you said, massaging or massaging around the sacrum, arms and even hands is something that is worth giving yourself during pregnancy. We will see what it will be like after giving birth, whether it will be pleasant for you then or not, so that we can be open to it too. I really, really encourage you to do so.

As you talk about all this, I can see that you have a lot of patience and such inner peace, but pregnancy and childbirth are quite an exciting period, especially childbirth! So where do you get this patience and peace, how do you deal with all these emotions, which I suspect are a lot? Both on the part of the woman giving birth and her partner.

JK: It's true, there are a lot of these emotions, but if someone from my family heard you... sometimes children tell me that they would like me to talk to them as if they were giving birth. We are only human and I think that the time of birth is a period when there is no room for pretending. And this is what I always tell people accompanying me, that words that strengthen the woman giving birth, that she is doing great, that it is very good, that she is breathing great - if we say it by force, or force a smile, or try to force ourselves to believe " "I'm calm" then it doesn't work. A woman during labor has all her senses heightened and it will come out, so there is no time for cheating. It's hard to say where I get my patience from. I think it's simply a matter of the fact that I love what I do so much. My education was in a completely different field, but I felt that this was my path and I think that's what I draw from my work to have my everyday life as I do. Working with women and couples gives me a lot - on the one hand, I hope that I make the first days or weeks of parenthood easier, but I must admit that it is also a great strength for me. I get emotional, but I think that the main difference between my reinforcement and the reinforcement from the accompanying person is that I have knowledge, education, experience and I experience joy or hardship as much as possible, but I do not have such fear. Due to the fear that sometimes appears in people close to me, I try to strengthen women so that they believe in their own strength. And sometimes, a new father, who absolutely has the right to be afraid, sees how difficult it is for a woman and instead of giving her faith, he would like to help her. And this is the woman's task and the child's, and it can be difficult. So I think that this knowledge and experience allow me to empower women without this fear or something that blocks me inside. And when a person is born, I sometimes say that I may not be professional then, but it brings a tear to my eye.

I think it's natural in this type of circumstances, because even when we watch a movie about childbirth on TV, it happens to everyone that a tear appears in their eye. And please tell me how to become a doula? You said your first education was completely different, and then you changed your professional life, so what courses do you need to complete to become a doula? What does it look like?

JK: It's changed a bit now. In the past, doulas came from abroad and there were courses to become a doula. I am a doula from the DOULA Polska Association and this association organizes the Perinatal Support Academy and these also include trips... the entire course lasts about 9-12 months and various people conduct these trainings. This is also the time for your own work. It is important to strengthen yourself, update your knowledge, complete various other courses to stay up to date. Currently, there are other places where doulas are trained, but I can't tell you about them, I know that there is an AWO academy and, apart from my own work, these are very intensive meetings. Certainly, not resting on your laurels and gaining experience is important. I think that each of us, doulas, is looking for our own path. Some focus on antenatal education,
There are doulas who provide postpartum support, either only during childbirth, or only before and after childbirth, not during childbirth. I am an instructor of Shantala massage, children's massage and an advisor on carrying children in scarves - I always say that these are tools that help parents communicate with their child, take care of the needs of this little person, for whom there are many changes when he is born, but also your own needs. Such activity, understanding what the child is communicating. There are also breastfeeding promoters, i.e. - without going into the competences of a lactation consultant, but also support in breastfeeding. Each doula has her own "horse" in which she further studies and specializes.

What attracted you most to working as a doula? Why did you decide to become a doula?

JK: You know what, life I guess! First, I supported close women, I started by supporting the parents of twins! Even though I don't have such experiences privately, before I finished the courses, I had a friend who became a mother of twins. I had a six-month-old son myself, and I simply went to her and was with her and did exactly what I do now when I visit women in childbirth. I helped with feeding, calming down, calming down, what this night might look like, what you can let go of or what is worth letting go of, that when we use the word "I have to" it becomes much more difficult to do something. Then I came back for three weeks and it was almost like I was living with this couple, because they left the hospital with five-day-old twins and I visited them every day. I supported not only as a caregiver, but also took care of the parents. I asked for their sleep, food, I offered support in feeding, I told them what the path would be and we agreed on what they cared about most. Later, there was the Rodzi po Ludzku Foundation, I was a volunteer, it all added up to one thing: this is what I want to do! Something that makes me feel great! I started completing courses and training, I also completed a course to become an Active Childbirth School instructor. In 2014, I completed the most training and simply started accompanying people during childbirth. As in any job - on the one hand, knowledge, on the other hand, experience. Experience also builds some strength and confidence, and that's why I know I want to follow this path.