When I first became a birth doula, I understood that my primary role was to support moms during labor and birth. After all, birth doulas are passionate about birth and seek to facilitate the best possible birth experience for moms and their partners. Little did I know that this journey would lead me to doula-ing in various life situations, such as helping someone mourn the loss of a loved one, encouraging others to follow their dreams; basically, helping people who need help. Care and compassion, servanthood, teaching, and relational diplomacy, to name a few, are skills that doulas learn as they serve birthing families.
One of those life situations I have come to love is serving teen moms facing an unplanned pregnancy. When I first began providing care for teen moms, I fully expected to be serving girls with rebellious attitudes, who didn’t really care about the outcome of their births, and who probably wanted medication, etc. After all, the general stereotypical view of teens is that they are “me” focused, immature, rebellious, and prone to make dumb decisions. What I did not expect were young ladies from every walk of life, who fully realized and acknowledged their mistakes, eager to move on and make the best of their situations, and who were very concerned about the outcome of their babies’ births. They surprised me with the amount of research they did on their own. They did a lot of growing up during their pregnancies, shed a lot of tears, gave much thought about adoption, and mostly wanted someone to love them, encourage them, forgive them, and believe in them.
Often, there were family members who were disappointed or perhaps angry, trying to talk them into having an abortion or to give up their baby for adoption. This is understandable, as parents want the best for their children; it is often difficult for parents to accept that their child has to change life plans, such as decline a great scholarship because of a pregnancy at the most inconvenient and unexpected time, for instance. One thing that teen moms tend to have in common is that they have fears, just like adult first time moms. They are afraid that they won’t be good moms, afraid their parents will remain disappointed in them, afraid they’ve messed up their lives, afraid of facing very grown up circumstances alone.
Once the dust settles after the pregnancy is revealed, most of these young ladies begin to work out the details of becoming mothers. Usually, by the time I am contacted, they have made a decision to not have an abortion, but may not have yet decided whether to keep their baby or give it up for adoption. One of my roles is to help them figure that out for themselves, by providing them with information and being available to them to answer questions. So far, all of my teen moms have decided to keep their babies, but I know the day is coming when I will serve a young lady who decides to relinquish her baby to a new family. I foresee my role there to be as nonjudgmental as possible, and to help support her in her decision, as well as to provide emotional and informational support and resources.
When I meet with them for the first time, the first order of business is to get some history on their situation at home, make sure they are not using any substances, not drinking, or smoking, and are eating well. If one of their parents is in attendance, I also get a feel for how the relationship is. If things are touchy, then I know my doula role will be to remain as calm as possible for them, talk to parents alone, talk to the teen mom alone, try to help them both appreciate what the other is going through, as well as try to impart some excitement about becoming a mom or grandparent. I’ve learned to mostly provide as much encouragement and support as possible, as well as information and resources for them, without trying to influence their decisions or get in the middle of any family drama. That can be difficult sometimes!
My role at the birth is often to help teen moms know they are allowed to speak up for themselves, and that just because they are young does not mean they don’t have a voice. What I’ve witnessed is that oftentimes, medical personnel tend to treat them like children (partly, of course, because they still are), and don’t necessarily ask them what their wishes are, as they would for an adult mom. Sometimes, seeing they have a doula there causes providers to be a little more conscientious of the teen mother’s wishes. It is not uncommon for providers to prescribe all the routine interventions without really anticipating that they may want to avoid those things. It is always my goal to work respectfully with providers. We doulas are often witnesses to less than optimal care, which is very sad.
I was particularly appalled at one of these teen births, when the doctor got angry because the teen mother declined having her water broken. My role here was to put aside any opinions I had, and try to help her understand what the doctor wanted to do and why, and to facilitate communication. It is never a doula’s role to counsel a client to go against medical advice. Instead, it is to help clients get the information they need about procedures so they can make their own good decisions about their care and be active participants in the decision-making process. A teen expectant mom is perfectly capable of making good decisions when they are treated with respect and given choices about their care. Thankfully, in that scenario, the nurse advocated for the teen by telling the doctor that she clearly was refusing the procedure. The physician then abruptly threw the amniotomy kit into the trash and stormed out of the room, but not before making an uncalled for and nasty comment. Up to that point, that particular physician was talking to her in a demeaning way, treating her like a child, assuming that any treatment she suggested would go unchallenged, with no effort to find out what her wishes might be. After that dramatic episode, thankfully a new physician came in, one that was much kinder and more receptive to the kind of birth this particular teen client was hoping for.
Some of the unique needs of teen clients are: childbirth and parenting education, postpartum care, resources for completing high school from home, counseling against substance abuse, sexual promiscuity and STDs, information and resources for abusive situations, and mostly, a lot of nonjudgmental support, compassion, encouragement, and the belief that just because they are young does not mean that they aren’t amazing, strong, powerful women, fully capable of making the best out of a seemingly impossible and difficult situation.
Teen moms continue to amaze me with the amount of research they do and the enthusiasm they have for ensuring the best birth for their babies. I’ve learned that while their needs may be different, not to let their age interfere with how I approach serving them. While all moms need support and advocacy during childbirth, teen moms, especially, need someone to be on their side, someone who believes in them. It can make all the difference in the world in the outcome of their birth, and more importantly, give them a confident attitude toward mothering for years to come.
Care Net is a great resource for teens (as well as adult women) facing an unplanned pregnancy. They provide counseling, education, and many resources for supporting expectant teens. This link will help you find a Care Net Pregnancy Center near you: https://www.care-net.org/find-a-pregnancy-center.
The following is a sketch I wrote of an actual birth where I supported a teen mom. Some details have been left out or slightly changed, in order to protect the privacy of the family.
Setting: Hospital labor and delivery unit.
Characters: Sixteen year old teen mom, teen mom’s mom (Grandma), labor and delivery nurse (L&D Nurse), Doula, on call physician (OB Doc).
Phone Call from Teen mom: I think I’m in labor, or maybe I’m just being hopeful.
Doula: What’s going on?
Teen Mom: I keep having this tightening feeling in my belly. Hold on a minute (muffled sound of labor moans). Yeah, I just had another one.
Doula: How often?
Teen Mom: (muffled sound again) Um, sorry, that was another one. What did you say?
Doula: How often? Sounds like something good is happening there.
Teen Mom: Pretty often. Since this afternoon. I felt it last night, too, but it wasn’t too bad.
Doula: You may want to call the hospital. Is your mom there with you.
Teen Mom: (more moaning) Um, yes, but she’s not happy right now.
Doula: OK, may I speak with her?
Teen Mom: MOM!!!!
(sound of phone dropping, more moaning, indistinct conversation)
Doula: It sounds like your daughter is laboring quite well. Have you called the hospital?
Grandma: No, I think she’s being a drama queen. It’s still three weeks early. It’s late, and I have to work tomorrow.
Doula: I understand. Does your daughter want me to come to the house now?
(more indistinct conversation, arguing)
Grandma: OK, I’m going to take her in. I’ll probably leave once you get there. Can you call me to pick her up if it’s a false alarm?
Doula: Yes. You may want to call first so they can be expecting you.
Later, at the hospital:
L&D Nurse: How often are the pains?
Teen Mom: I don’t know (moaning)
Grandma: She’s been doing this all evening
L&D Nurse: Well that sounds promising. Let’s see what’s going on. Lie back and let me check and see what baby’s trying to tell us (Checks teen mom’s cervix).
Hmmmm…. you are about 5 to 6 centimeters and baby is very low.
Teen Mom: You mean I’m in labor for real?
L&D Nurse: Yes, sweetie, you’re going to have a baby. I’ll go let the doctor know that you need to be admitted. Since she is a minor, you’ll have to sign papers, Mom. Is dad in the picture?
Grandma: No, he doesn’t want to be here. Figures I wouldn’t get any sleep tonight. Oh well. Why do babies get born at night?
L&D Nurse: Let me get her admitted, and then we’ll see what we can do for the pain.
Teen Mom: I don’t want to take pain stuff. I am doing a natural birth.
L&D Nurse: That’s wonderful! I love supporting moms having a natural birth!
Grandma: Ha! I said I was having you natural. I ended up begging for an epidural! You don’t have to suffer.
Doula: (to Grandma) Lot’s of women do ask for epidurals. Did you have anyone supporting you in your wishes?
Grandma: No, not really. Everyone kept dangling temptation in my face, and no one really believed I could do it.
Teen Mom: (lots of moaning) Can you do some doula stuff and help me?
Doula: Sure, honey. You’re doing great! Where are you feeling it the most?
Teen Mom: In my lower back. (begins shaking uncontrollably) Why is this happening?
Doula: Oh, it’s just a natural response to all the hard work your body is doing, and all the different hormones being released. It’s very normal, and it helps things along, too.
Teen Mom: Oh okay. I remember reading something about that.
Doula: I’m going to slide my hand under your back and try applying a little pressure. When they’ve finished monitoring your baby, we’ll try a better position. How does this feel”
Teen Mom: Oooohhhh, that helps sooooo much! (moaning)
Doula: You are doing so well for a first time mom. You did a great job laboring at home first! Nice deep breath in, blow it away. There now.
Grandma: Is there anything I can do?
Doula: Sure, would you mind getting a cold wet washcloth for her forehead? They are in that drawer over there.
Grandma: I wish somebody helped me like this when I was having her.
Doula: Yes, a little support can make such a difference. You are being such a good support for your daughter.
Grandma: Well, I just wish she didn’t have to go through this.
A little later, after nurse takes medical history, and finishes monitoring and admission process
L&D Nurse: OK, sweetie, let’s get you off of those monitors so we can get you out of that bed.
Teen Mom: (Moaning, and a little less than enthusiastic) Yay…
L&D Nurse: It will help a lot! It always hurts more lying in the bed.
Grandma: Can she have water?
L&D Nurse: Hospital policy is ice chips only, or popsicles. I won’t notice if she happens to have water in her cup, too.
(Mom goes to find ice)
OB Doc pops in:
So, I am going to rupture your membranes, to get things going. Get back on the bed, lie on your back and drop your knees to the side.
Teen Mom, with big wide eyes as she sees the doctor open the amniotomy kit: What’s that for?
OB Doc: This is to rupture your membranes. It won’t hurt. It will only help your labor progress more quickly. You don’t want to be doing this all night, do you?
Teen Mom doesn’t say anything. Her eyes are big, and she is clearly scared.
Doula: Do you know what rupturing your membranes means? It means she wants to break your water bag.
Teen Mom shakes her head no, but doctor proceeds to put on gloves and pull out equipment.
L&D Nurse: You look uncomfortable with this. Do you want the doctor to break your water?
Teen Mom: No.
OB Doc: It’s not going to hurt. It will only help.
L&D Nurse: She clearly said, “No.”
Doctor stands abruptly, throws her gloves and the amniotomy kit into the trash, and storms out of the room.
Doula: You have the right to say no to anything you feel uncomfortable with. You can also ask questions, until you fully understand what the purpose is of any procedure suggested.
L&D Nurse: Phew, she sure did storm out of here like a bat out of the wind. Yes, honey, you can say no to anything. But you have to speak up.
Grandma, who was asked to wait outside the room during the procedure, comes in:
Teen Mom: The doctor wanted to break my water. But we didn’t let her.
Grandma: She looked angry!
OB Nurse: Oh don’t worry about it. She’ll get over it.
After a couple of hours of doula and grandma taking turns supporting the teen mom, a sweet bond has formed between mom and daughter. The doula had taken Grandma aside and given her a little pep talk about how wonderful it is to be a grandmother, and had given her praise at the wonderful support she was giving her daughter, which helped Grandma’s attitude to change. The teen Mom felt safe and protected, and as a result, her labor progressed rather quickly.
Teen Mom: (Moaning very deeply, with little grunts on the end) I feel like I need to use the bathroom.
Doula: I thought that was a little grunt I heard. Do you feel like you have to push?
Teen Mom: Maybe. I don’t know. I just feel like I have to poop.
Grandma: Here, I’ll help you get to the bathroom. It might help things along.
Doula: Yes, that’s right. There’s no rush, here. I’ll let the nurse know while your mom helps you.
OB Nurse comes in: Ooooooh that looks very promising! That pressure you’re feeling is probably baby. Let me check and see what’s going on.
Teen Mom: I think my water just broke! Either that, or I sure did pee a lot!
OB Nurse: It’s probably your water Let’s get you back into the bed to see what’s going on. Maybe baby is trying to tell us something. (Checking cervix) Hmmmm, you are…. do you want to know?
Teen Mom: Yes, have I made any progress?
OB Nurse: You are complete, with a little bit of a lip. Hands and knees might really help get rid of that. Doula, can you help her try that while I let the doctor know?
Doula: (grinning) Sure!
Grandma: Does that mean she’s getting close?
Doula: Yes. That means she’s almost ten centimeters, and there’s just a little bit of cervix left that needs to disappear (Lots of moaning in the background).
Grandma: Wow! You really did it! I can’t believe it! I’m so proud of you!
Teen Mom: Oh my God! I think I’m pushing. I can’t help it!
Doula: That’s ok. Just let your body do what it needs to do. They will be in here in a minute. Let’s try that hands and knees position the nurse suggested.
Doula and mom help her to get on her hands and knees. A new doctor walks in. She is very excited to see mom laboring on her hands and knees.
OB Doc: That is a great position! Let me see if that lip of cervix is gone. You can just stay like that, if you want. When I heard this brave young lady was doing a natural birth, I just had to steal her. (Chuckling). Well, well, let’s see. Oh my! Baby is right there! You can bear down as you feel the need to. I’m not in a hurry. Are you ready to meet your little… is it a boy or a girl? Or are you being surprised?
Grandma: It’s a girl.
After a few minutes of pushing, the teen mom is holding her beautiful red headed baby girl in her arms, skin to skin in between her breasts. She saw the “Breast Crawl” video, and wants to try letting her baby do that. After about thirty minutes, her baby self-attaches and is succesfully suckling at her breast. Doula and Grandma are by her side, admiring and encouraging her.
Grandma: That is the most amazing thing I have ever witnessed! I wanted to breastfeed, but the doctors told me I couldn’t. The nurse said I was too young to breastfeed, and that I wouldn’t want my baby to get too attached, since I had to return to school. My mother didn’t breastfeed me, either, and she always felt that it was kind of substandard and dirty.
Doula: That’s so sad. It sounds like you didn’t have much support.
Grandma: I didn’t. But I’m not going to let that happen to her! She’s going to have my full support! I am so proud of you sweetie! You really did it!
This grandmother ended up staying with her daughter all night long, and she called out of work the next day! Every time I watched her lovingly support her daughter, I had to push back the tears in my eyes. The growing bond between these two was the most beautiful thing to witness, as they were transformed into mother and grandmother. The support was beautiful, and in my heart I knew that it would continue beyond the birth.
About a year later, I bumped into them at the grocery store. We chatted and I learned that things were going very well. Baby was still breastfeeding, my client had completed her GED and was doing online college courses, as well as working part time in the evenings. Grandma was watching the baby while her daughter was at work, and was beaming with pride. That encounter left me with a renewed sense of the importance of support for birthing women and their families, no matter what the age.