How a Doula’s Role Differs Based on Birth Location
One of the questions I get asked most often is whether the birth setting changes how I support my clients. The short answer? Absolutely. But not in the way you might think! Whether I'm supporting a family at home, in a birthing center, or in a hospital, my core role stays the same. I'm there to provide continuous physical, emotional, and informational support. But the way I show up? That definitely shifts based on where we are, and also what the parents-to-be’s preferences are.
How Birth Setting Shapes Doula Support
At a hospital birth, I'm often more focused on helping families navigate the institutional environment. This might mean explaining what different monitors are tracking, helping you understand your options when interventions are suggested, or simply ensuring you have privacy and quiet space amidst the bustle. I'm also more likely to bring extra comfort measures: a TENS unit, battery operated candles for ambiance (because hospital lighting is THE WORST), essential oils, my portable speaker for your birth playlist, etc. Hospitals are amazing for high-risk situations and immediate access to interventions, but they're not always designed for intimate, undisturbed birth, so part of my job is creating that nest within their walls. In a hospital, I will work with your birth partner to advocate for your wishes and ensure that your birth preferences are respected as much as possible.
At a birthing center, things feel more middle-ground. You've got that home-like atmosphere with the safety net of nearby medical backup if needed. My role here often involves less environmental setup (they usually have all the comfort tools!) and more focus on maximizing the beautiful space and helping you feel empowered to use everything available - the birth tub, the squat bar, the cozy bed. I'm also checking in about communication with your midwife team and making sure everyone's on the same page about your goals and birth plan.
At a home birth, I'm in your sacred space, and that changes everything. I'm typically bringing less stuff because you're already surrounded by your own things that you’ve prepared to labor with. But I'm also more hands-on with practical support—helping set up the birth pool, prepare food for you, protecting your space from well-meaning but overwhelming visitors, and working closely with your midwife as part of a tight-knit birth team. There's something incredibly powerful about supporting birth in someone's own home. The energy is different, and as a homebirth mama myself, I love supporting moms in their own homes!
The Real Talk About Home Birth: Pros and Cons
Listen, I love home birth. The intimacy, the autonomy, the primal power of birthing where you feel safest—it's incredible. But let's be honest about both the magic AND the realities.
The Pros:
Your space, your rules. Want to labor naked in your garden? Go for it. Want your other children present? Absolutely. Want to eat a full meal during labor? Dig in! (Try getting that in most hospitals…you won’t)
Undisturbed physiology. When you feel safe and private, your body can do its thing without the adrenaline spike that often comes with institutional settings.
Immediate postpartum bliss. You birth your baby and crawl into your own bed. No transferring, no hospital policies about who can visit, no fluorescent lights at 3 AM.
One-on-one midwifery care. Your midwife is there just for YOU, not managing multiple patients.
Lower intervention rates. Without immediate access to epidurals and continuous monitoring, there's less cascade of intervention (though this can also be a con if you want those options!).
The Cons:
Distance from emergency care. If something goes wrong quickly, transfer time matters. This is the biggest con, but shouldn’t be too much of a barrier for low risk pregnancies.
Limited pain medication options. If you decide mid-labor that you want an epidural, you're looking at a transfer. Good thing a homebirth midwife has so many tools in her belt to help you manage the sensations of labor though!
You're responsible for cleanup. That birth pool? The waterproof pads? The laundry? That's all you, mama (though your midwife will help immediately postpartum!).
Not covered by all insurance. Many families pay out of pocket for home birth midwifery care.
Requires low-risk status. Not everyone is a candidate (more on this in a sec).
Who Can't Have a Home Birth?
This is where we get real about risk assessment. Home birth is beautifully safe for LOW-RISK pregnancies, but certain complications may mean you’ll need hospital-level care. It absolutely depends on the homebirth midwife and their experience with different complications (because some are VBAC or breech ‘experts’), but in general, you'd be ruled out for home birth if you have:
Previous cesarean birth (VBAC at home is controversial and not supported by most midwives)
Placenta previa or other placental complications
Certain pregnancy complications like preeclampsia or gestational diabetes requiring medication in/around labor
Expecting multiples (twins, triplets)
Breech presentation (though some experienced midwives will attend breech home births)
Significant health conditions like uncontrolled hypertension, blood clotting disorders, or heart conditions
Preterm labor (before 37 weeks)
Rh incompatibility issues
Baby measuring very large or very small for gestational age
Your midwife will do thorough screening throughout pregnancy, and sometimes things change - you might start as a great home birth candidate but develop a complication that means transferring care. That's not failure; that's responsive, safe care! Be open minded and trust your body and your team. (If you don’t trust your team, it’s time to find a new one!)
Let's Talk Numbers: Home Birth Safety Statistics
Okay, this is where things get nuanced, and I want to give you the most honest, evidence-based information I can. This is what the research says, but again, trusting yourself and your team is my biggest advice.
Yes, there is an increased risk of perinatal death with planned home birth compared to hospital birth, but we need to look at the actual numbers to understand what that means. According to large-scale studies, the absolute risk of perinatal death at planned home births attended by certified midwives is approximately 1-2 per 1,000 births, compared to about 0.5-1 per 1,000 for low-risk hospital births. So we're talking about a small increase in an already very small number - roughly double the risk, but going from 0.05% to 0.1-0.2%.
For low-risk women attended by certified midwives with a clear transfer plan, maternal mortality is actually very low and comparable to hospital birth. The key factors are: LOW-RISK STATUS, trained attendant, and proximity to hospital backup.
Here's what matters: informed consent. You deserve to know these statistics AND the context - that most perinatal deaths in any setting result from congenital abnormalities incompatible with life, not the location of birth itself. You also deserve to know that hospital birth comes with its own risks (higher intervention rates, infection exposure, etc.). Planned home births for low-risk pregnancies show significantly lower rates of medical interventions (cesarean, episiotomy, forceps, vacuum, etc.) and maternal complications (tears, hemorrhage, etc.) compared to hospital births.
This is a decision you make with full information and support from your healthcare provider. Not from me, not from your best friend, not from Instagram. From your qualified midwife or physician who knows YOUR specific situation.
Water Birth Safety: The Controversy
Oh, water birth. So soothing during labor, so controversial for actual delivery! Is it safe? The short answer is that laboring in water is widely accepted as safe and beneficial for pain relief. Actually birthing underwater is more debated.
Many midwives and birthing centers support water birth, and when done with appropriate protocols, research suggests it's generally safe for low-risk pregnancies. ACOG (American College of Obstetricians and Gynecologists), however, maintains that while laboring in water is fine, the safety of underwater delivery hasn't been sufficiently proven, which is why most hospitals require you to get out of the tub for the actual birth.
Why the concern? It comes down to baby's first breath - which brings me to one of the coolest physiological things about birth...
Baby's First Breath: The Science Behind the Magic
Here's where we dive into the beautiful intersection of physiology and trust!
What triggers baby's first breath?
While baby's in utero, they're getting oxygen from your placenta through the umbilical cord. Their lungs are filled with amniotic fluid, and they're making practice breathing movements, but they're not actually breathing air. When baby is born, several things happen almost simultaneously:
Temperature change: going from your warm body to cooler air
Pressure change : no more amniotic fluid surrounding them
Sensory stimulation: light, sound, touch, all the new sensations!
Chemical triggers: decreased oxygen and increased carbon dioxide in baby's blood signal the brain to initiate breathing
Chest compression during birth: helps squeeze fluid out of the lungs while descending through the birth canal. During vaginal birth, baby's chest gets compressed coming through the birth canal, which helps squeeze that amniotic fluid out of their lungs. Then when the chest re-expands after birth, air rushes in. This process is missed during cesarean deliveries, though so baby may have more fluid in their lungs.
The Dive Reflex Theory (Midwifery Model):
Here's where water birth proponents feel confident: babies have what's called a "dive reflex" or "laryngeal reflex." The theory is that when baby's face is submerged in water, their larynx closes, preventing them from inhaling water. Since baby has been in fluid their whole existence, they won't attempt to breathe until they hit air. This reflex supposedly prevents aspiration during underwater birth.
The midwifery model holds that as long as baby remains completely submerged until brought to the surface (no partial emergence), they won't gasp underwater because they haven't yet experienced the triggers for breathing.
The Medical Model Concerns:
The medical establishment isn't entirely convinced. Their concerns include:
The dive reflex isn't foolproof and can be overridden, especially if baby is in distress
If baby is stressed during labor (low oxygen, for example), they might gasp before being brought to the surface
Water temperature matters—too cool or too warm can affect baby's response
There's not enough long-term, large-scale data on outcomes
So... if baby can't aspirate in water, why do some babies aspirate during labor and delivery?
GREAT question! This is the heart of the controversy. Babies CAN and DO sometimes aspirate—but usually it's not birth water they're aspirating. More commonly, it's meconium (baby's first poop) mixed with amniotic fluid BEFORE birth if baby becomes stressed in utero. This happens in the womb, not during a water birth delivery.
When aspiration happens specifically related to water birth, it's often in situations where:
Baby was already compromised/in distress
Baby was partially lifted out and then re-submerged (breaking the dive reflex)
Water temperature wasn't properly maintained
The birth was attended by someone without proper training
The real risk isn't so much "water birth is dangerous" as "water birth needs specific protocols and trained attendants."
My take? (And remember, I'm not your midwife!) If you want a water birth, choose a provider experienced with them who follows strict safety protocols: proper water temperature (97-100°F), keeping baby fully submerged until brought directly to surface, immediate monitoring once baby emerges, and knowing when to get OUT of the water if complications arise.
Home Birth Supplies: Who Brings What?
If you're planning a home birth, you'll need to prepare supplies because not everything will be provided for you like in a hospital. Who brings what depends on your provider, but in general, here's a typical breakdown:
What PARENTS usually provide:
Birth pool (if using one) and hose to fill it - this is a great affordable one on Amazon
Waterproof mattress covers and old sheets/towels you don't mind ruining
Disposable underpad sheets (get the good ones; some are even HSA/FSA eligible)
Receiving blankets for baby
Nightlight or soft lighting
Snacks and drinks for everyone (yes, feed your birth team!)
Plastic trash bags
Olive oil, vitamin E oil, or coconut oil for perineal support
Your comfort items: birth ball, music, essential oils, etc.
Check out In His Hands for birth supplies
What your MIDWIFE typically brings:
Medical supplies: doppler, blood pressure cuff, oxygen
Emergency medications (Pitocin, etc.)
Newborn resuscitation equipment
IV supplies if needed
Instruments for repair if you tear
Sterile gloves, clamps, scissors
Weighing scale for baby
Newborn exam supplies
What I bring as your DOULA:
My doula bag with comfort measures: essential oils, massage tools, rice sock, LED candles, birth comb, TENS unit, etc.
Rebozo for positioning
Extra supplies (just in case): straws, honey sticks, hair ties, chapstick, etc.
My experience, calm presence, and unwavering support!
Bottom line? Every birth setting has its place, its benefits, and its challenges. Whether you're birthing at home, in a birthing center, or in a hospital, what matters most is that YOU feel supported, informed, and empowered to make decisions that align with your values and your specific situation.
Want to chat more about your birth setting options? Reach out! I love helping families think through these big decisions. And if you're local to southern New Hampshire and looking for doula support wherever you're planning to birth, I'd be honored to be part of your team. As always, this information is educational and doesn't replace personalized care from your midwife or physician. Every pregnancy is unique, and you deserve individualized support!
Resources:
https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/04/planned-home-birth
https://pmc.ncbi.nlm.nih.gov/articles/PMC5465453/
https://pmc.ncbi.nlm.nih.gov/articles/PMC2742137/
https://americanpregnancy.org/healthy-pregnancy/labor-and-birth/water-births/
https://evidencebasedbirth.com/waterbirth/
https://prezi.com/vva74meo3nob/transient-tachypnea-of-the-newborn/
