I’m always interested in why clients decide to hire a doula. (And I’m always so thrilled when they choose me to play that role!) One common refrain, of course, is “I don’t want interventions.” Some are set on staying out of the operating room, while others know they prefer as natural a birth as possible—no drugs, no IV, no monitoring.

The interesting question is this: What can a doula do to keep those needles, tubes and instruments away? Can a doula really prevent interventions?

I think the answer is yes and no.

–A doula is not in charge of the birth. We make no decisions about clients’ care. Decisions are between mothers and their care providers. If the care provider is making all the decisions, that means the mother has not yet found her own voice to assert what she wants. As a doula, I can say “Do you have any questions about that procedure that Dr. X is about to do?” but not “Dr. X, my client does not want that procedure.”

–The best time for these discussions to take place is not during labor. It’s during prenatal appointments. I consider my prenatal meetings with clients to be an extremely key part of my role—we firm up birth preferences and make sure the client and her partner are educated about all the various things that can happen during birth. Likewise, prenatal visits with your OB are the right time to ask questions. Feel awkward about it? Do it anyway! It’s your right and responsibility to be informed. And it’s a lot easier to take in information before you go into labor. So, as a doula, educating clients and encouraging them to talk things over with their doctors is one way I can certainly make interventions less likely.

–Once labor has started, the doula’s role becomes intimate, direct, hands-on. I am giving counterpressure on a client’s sacrum to make her contractions less uncomfortable. I am reminding her to drink water and take in some nutrients. I am helping her find the optimal position that will keep labor moving along and maybe prevent her from receiving Pitocin. In a hundred other ways, I can try to keep things as mother-friendly as possible so that the labor can progress as her body and her baby direct.

–Yet the OB and other hospital staff have a lot of power to change the course of events. A well-meaning anesthesiologist, dropping by to chat about epidurals, can alter a laboring mother’s psychology. An OB who orders an induction has already changed the entire birth story from the very beginning. In a hospital setting, the reality is that mothers and doulas alike have to work with events as they unfold.

–Mothers may say “I don’t want an epidural.” Yet some find, when labor gets very intense, that pain relief is sounding pretty good. Hiring a doula will not in itself keep you from getting an epidural. If you are not prepared within yourself with some tools to manage the sensations of labor, a doula may not be able to talk/massage/aromatherapy you through a long labor process.

So, in short, it’s complicated. But the statistics do show that doulas make interventions less likely. My advice for moms who want more natural births? 1. Choose your care provider and your place of birth with the utmost care. 2. Prepare yourself for labor physically, mentally, emotionally, spiritually. And yes, 3., hire a doula! Because no matter what else is going on, having a good doula with you, someone you connect with, will make your labor and birth better than they would otherwise be.