Doula for a 4th birth?

[wombatclay]

Right off, I'm a doula myself (though not practicing at the moment) and I'm very pro-doula.  I've had a doula for each of my previous three births.  I know all the benefits a doula can bring to a birth, and my DH has always enjoyed having the doula there!  But I'm still uncertain and would love some feedback...

--I had a c/s with my first child... she was big, posterior, asynclitic, my water had broken on it's own a day before contractions started, and despite everything that birth ended in the OR.  Since then I have had two hospital VBACs.  This will be my third hospital VBAC and, because of the local birth climate, I will be traveling about an hour to a VBAC supportive hospital.  This is where I had my second VBAC, and this birth is being attended by the same midwife group as during that birth (so while I can't be sure I'll have the same midwife as last time, I am familiar with the whole group and with the hospital itself).  This midwife group is VBAC supportive, I have access to a shower/tub, they're ok with intermittent monitoring, I can eat/move/whatever as long as no complications arise.

--Money is tight.  Very tight.  Local rate for a doula is 600-1000 dollars (two prenatal visits, birth support, one pp visit).  While there are sliding scales, and doulas willing to work with payment plans or for free during certification, because the hospital is so far away and gas is so pricey I don't feel comfortable asking for a reduced fee.  We would pay the full amount and probably a bit more to cover gas.

--After three births, DH is comfortable being a support person/advocate and is really familiar with my birth philosophy/needs.  He isn't sure how much help a doula would be this time round, especially if it was someone doing a certification birth (meaning DH would have more actual birth support experience than the doula).  He is willing to do what it takes to get a doula if I want one, but he doesn't see a need for one outside of a "worst case scenario" where I needed a repeat c/s and he'd have to go with the baby.  The hospital would not allow a doula into the OR with me after DH left, but she would be able to be with me in recovery.

--My births have gotten faster and faster... dd1 was 24+hrs of active labor (as in, 5cm or more), dd2 was 12 hours start to finish, ds was roughly 4 hours from start to finish.  It is possible that a doula wouldn't make it to the hospital in time (especially given the drive, we live closer to the hospital than the currently working doulas so for them the drive would be anywhere from 1 to 1.5 hours).

--The doula we adore (and had at our last two births) no longer attends births.  So we'd be hiring someone we'd never birthed with.

So... if someone told me they were planning a hospital VBAC without a doula, I'd probably tell them they were crazy.  But now that I'm the person on the other side of the equation I just don't know!  If money wasn't an issue I'd probably say "let's find one just to have one", but since money really is an issue... I just don't know.  I know these providers, this hospital, my own birth experiences, etc.  DH is comfortable in the birth suite, he's been there for me three times already, he has his "fighting face" ready in case the hospital or providers try to give me a hard time, and so on.

Any fresh eyes and opinions?  I'm just talking myself round in circles!

[~Amy~]

I had a hospital VBAC (induced actually) a few weeks ago and opted not to have a doula. I had an awesome birth experience, no epidural, no other interventions that I didn't want, the nurses and doctors were fabulous and completely respected my wishes. It was a much better experience than my first labor, where I did have a doula with me. Unless for some reason DH is unable to be at our next child's birth, I won't have a doula again.

[ewilkins_doula]

I think you could go either way, it sounds like you don't want one and your reasoning for that is totally legit.As you can see in comments like the one above, a birth without a doula can be totally awesome! It sounds like you and your husband make a great team, and it could be a beautiful, unifying experience!

The one thing I would say in a doula's defense is that you never know until you get to the hospital if the staff are truly going to be on your side. Whether or not you've done it before, birth is intense for both a mom and dad and sometimes if things don't go like you expect them to (you get a bad/unsupportive nurse, your midwife surprises you by trying to do something you don't want, baby's positioned weird so labor takes longer, etc.) it's harder to deal with and harder to make sure your voice is heard. A doula could be good as a safety net/ back-up person to have there to make sure that everything goes smoothly

Also, being a doula yourself, it might be hard to relax into birthing hearing all the medical lingo without a doula presence. As a doula, I know that any birth lingo thrown my way has my head spinning and I'm immediately working through it with a doula's brain asking myself questions like What does this mean for the mom? How's the partner doing? What can I be doing to make this better? Is everyone comfortable? etc. That being said, that is just the response of  a certain personality. With a doula, you have someone to give that role and you can rest easy knowing someone else is thinking about all that and looking out for you and your husbands best interest.

I think you'll do great in whatever you decide and hope you have a great birth! :)

[Comtessa]

I had always said that I would not step foot into a hospital L&D wing without a doula at my side.  But in the end, we opted not to have a doula at either of our two hospital births.  The first was a planned HB, so my MW filled the 'doula' role when I transferred.  For the second, a planned hospital birth, I had a bit of anxiety about opting out of a doula, but in hindsight, I'm glad we made the decision we did. 

For this most recent baby, DH turned out to be all the labor support I needed, and his mom and my mom were there to give him the support he needed.  It helped that I had a really excellent CNM who I trusted implicitly, and the nurses were very hands-off and very respectful of my birth plan (and I had been assured ahead of time by everyone I knew who had birthed there that this would be the case).  DH was well-prepared to fight for what I wanted, but it ended up being unnecessary.  In fact, I had found that even in hard labor at the hospital during our first birth, I was still able to advocate well for myself, and did not need to rely on him or my HB MW to do so, so I was less anxious about having someone around to do this for me this time. 

A few things that helped make our decision:

- The few doulas we knew personally were not able to attend our birth, and we were less comfortable with it than we would have been if we could have hired someone we knew.  We didn't really want another stranger at our birth.  (The L&D nurses were bad enough, IMO.)

- Since DH is our only income-earner, money is pretty tight right now. We really couldn't afford a doula fee without some serious reorganization of our budget and digging into savings. 

- We suspected this birth would be fast, and it was.  From the time I arrived at the hospital till the baby was born was just over 2 hours.  (By comparison, I was in labor with my first child for over 3 days!!)  I would have been pretty annoyed at shelling out a doula fee for 2 hours' worth of (pretty easy) labor. 

- DH really wanted to be my primary labor support, and did not want a doula around to help.  I thought this was silly, but he was adamant about this.  As it turned out, he was great.  This birth was much more intimate because for most of my labor, it was mostly just the 2 of us (plus our toddler, some of the time), rather than the whole pile of people we had at our first birth.  It was a real bonding experience for us.  I would not change that for anything. 

It sounds to me, OP, that you have a fair amount of trust in this MW practice/hospital, and lots of confidence in your DH as a birth partner.  If both of these are true, as they were for me, I'd say you're pretty safe birthing without a doula this time around.  You might find, like I did, that it brings you and DH closer to have that privacy/intimacy during your labor.