Born that way

Sarah Geo Walton was born at her parents’ home in the small, central Nevada town of Imlay. Both of her parents were paramedics, and Walton was exposed from an early age to their work, which she said included “going to a lot of first, on-scene things.” Sometimes these were births—and it was something that interested Walton from an early age. As a high schooler in Reno, Walton said she was “heavily involved in volunteer work” and local nonprofits. Afterward, she considered a career as a midwife or a nurse but didn’t want “to be medically responsible for anything.” When she learned about the role doulas play in the birth process, it seemed like a better career fit. Doulas are a type of health practitioner specializing in emotional and physical support of pregnant women through all of the stages of pregnancy, labor and post-partum.

After the home-birth of her son in Portland three years ago, she returned to Reno to offer her services through her company Bright Heart Birth Services, and the Reno Doula Project—a nonprofit offering doula services to low-income women. Reno News & Review sat down with Walton to chat about her experiences.

What falls within a doula’s scope of responsibility? And what kind of accreditation does it take to become a doula?

You can choose to be certified, but many people don’t. There are many certifying organizations. Some are done online, and some are done in person. The one I did was in person, and then I did, like, an internship, I guess, up in Portland. I highly recommend that people take an actual training to learn because learning the scope of practice is very important. We aren’t medical professionals. We don’t give medical advice. We can provide medical information, but we shouldn’t be telling people what they should and shouldn’t do. The idea of it is mostly support throughout pregnancy, birth and post-partum—and hopefully continuous support in that it’s somebody you know the whole time. A lot of what we do is helping people reframe what they’re going through as normal, and usually does not involve complications but also being able to help them make the decisions when complications do arise. We are really part of the birth team, and part of the mom-partner team as well. We aren’t looking to replace doctors. We aren’t looking to replace midwives. We aren’t looking to replace partners either.

Why has the doula’s role seemingly entered the public consciousness in recent years?

The actual term doula is an old term meaning “woman who serves,” but the actual job of a doula is a fairly new one. Midwives or nurses used to spend a lot more time with people in labor. And with the swing of medicalized labor, in hospital environments especially, about 70 percent of people had epidurals, so people are losing their skills at being able to support people through unmedicated birth—but also their staffing is done kind of expecting seven out of 10 patients to have an epidural and only need to be checked on every once in a while.

So a lot of pregnant women might go through their hospital experience potentially alone, or in the company of strangers—with the exception of maybe their partner—and that’s where a doula comes in?

Yes, and we get to know them in pregnancy, too, so we know what are the things that get them going, and what are the things they’re scared of, and what are the things that are really important to them in their birth, so we can try to protect that as much as possible. I see us as kind of being chaos coordinators. Husbands know their wives. Medical providers know the medical role of this, and we kind of know just how to fit all the puzzle pieces together.

What are some of the biggest misconceptions you battle against as a doula? Either on the parts of your clients or other medical staff?

From my clients, it’s that doulas are only for people who want an unmedicated birth or just a home birth, where it’s like doulas are only for hippie people, basically. I would say probably 75 percent of my clients would not describe themselves as, like, crunchy, hippie people. Most of them are choosing hospital birth. Many are choosing to have an epidural. We’re great for natural birth. You are more likely to have a natural birth in the event that you have a doula, but we aren’t just for that. From an outside perspective from providers or hospital staff, sometimes they think we’ve talked the patient into something when in reality that was completely their own doing. And our job is to support them even if we don’t agree with what they’re doing, too. Sometimes I can say, “These are the risks. These are the benefits.” But sometimes providers think we’re getting in the way, and we are the ones talking people into doing certain things.

What is your role when it comes to ensuring the safety and health of your clients?

In a home birth or at the hospital?

Either, I suppose.

A lot of stuff that’s done in a hospital is not necessarily coming from a place of evidence-based care. We definitely have shifted to a space where we are trying to avoid litigation and the place of just a “healthy mom, healthy baby” in a physical sense is their main priority, and the mental and emotional side of mom’s health definitely gets thrown aside sometimes. If they feel like they had a very traumatic birth, they aren’t going to be healthy. They’re going to have a harder time bonding with their babies, often, and some of them have a hard time going back to work. Some of them will never have sex with their partners again. It’s not necessarily healthy, but it’s just to avoid someone dying mostly. They may end up both being alive, but they might have to go through, like, surgeries and NICU stays because of it. And we don’t know when that will happen, but a lot of stuff is kind of not allowed to take it’s natural course, I think, partly out of fear of litigation and then another part out of convenience for staffing, vacations, you know? I get why it has swung that way, but also the kind of fear tactics that a lot of providers will use, where it makes mom’s feel like they can’t make the right the decision … that’s not really healthy, either. And I do see it sometimes, where the providers are very fear-based or control ‘I want to be the boss’ type of communication. It’s not good for people to be scared in labor.

What do you say to women who are considering a doula for the first time or are curious about contracting your services?

In interviews, we talk to them about the things that they think they would like more support on, the things that they might be scared about, and talk to them about how we can help meet those needs. And then in our first meetings after hire, we really try to get to know the people and ask them what’s a perfect birth for them—what do they see, themselves, as a perfect birth.

Is there a moment from your career that stood out as particularly gratifying or memorable?

I cannot even tell you how many they will say—the first time they look at their baby, they will look at their baby for a minute and then say, “We could not have done this without you.” And I don’t believe that, like, “Yes, you could absolutely do this without us—you have to.” Do we make it feel a little better, safer, happier? Absolutely.