Interview with the OB: Dr. Dunham on her Experience with Doulas

One of the most remarkable and treasured aspects of our job is the relationships that we get to form with some truly extraordinary people. Usually the relationship begins with a few names, some contact information, and whatever else the sender wishes to put on her contact form. Our e-mail dings, Ashley and I quickly glance at the calendar to see when we can squeeze in a consult.

The day that Dr. Dunham contacted us was a busy one. It also happened to be Evangeline's first day back from maternity leave. We met her little family that night and instantly connected. Her due date was coming up quickly, so we set out to plan her prenatal care. 

Fast forward to a few weeks ago. We reached out to Dr. Dunham about interviewing her about her experience, and she set the location, which appropriately was Sushi Masa. The location was appropriate because about a quarter of Dr. Dunham's labor was spent gushing over sushi, ramen, and various other foods. Dr. Dunham's first prenatal visit, she introduced Evangeline to Sky's Pizza. Evangeline has been obsessed ever since. Sometimes doulas are there to just keep you company and talk about the things that make you happy in order to make you feel comfortable and relaxed. Evangeline's love of food was more than matched by Jun and Caitlin's, and she was more than happy to help pass the time by dreaming of broths. 

Evangeline Schepper, doula, holding baby

After catching up with Caitlin and passing baby Yoshi back and forth, soaking in his sweet, chunky youth, and engorging in all you can eat sushi, we spoke with Dr. Dunham about her birth experience: 

I loved the story you told me about how you got hooked as an OB. Could you tell it?

It was a start of a new life, for this young woman it was her first baby, I just watched her life transform in an instant. I watched her go from being just a woman to a mom, seeing how her face changed as soon as she saw her baby.

To be there and to be apart of that magical moment was so inspiring to me and I was on cloud nine afterwards, suddenly all of the exhaustion just melted away, and I didn’t care that my make-up was running and I was sweating and I barely knew my name; I didn’t care I hadn’t slept or that I was so stressed. I was just so happy to be apart of that process. I knew in that instant that I could never go back, I could never walk away from that.

Did that have something to do with why you pursued your own vbac?

Absolutely, from a medical standpoint, I knew that the safest way to have a baby is vaginally, and that is true in virtually all situations, even with a prior uterine incision. The safest way, for mom and baby is to have a successful VBAC. So it’s umm...I feel as though that I am always encouraging my patients to try for a VBAC but I felt like I needed to walk that road myself, so I can tell my patients that I went through that. Also for my own personal safety, I knew if I wanted more children in the future, I know the risk associated with c-sections increases with more surgeries you have….if there were any complications that would potentially last beyond my reproductive time. C-section is a very safe surgery, but it is not without consequence and as a physician, I understand that very well.

Do you find that other doctors see where you were coming from?

Some of them did. Of course my fellow residents did and some of the faculty did; unfortunately, VBAC isn’t always the most convenient thing for the provider. I was very lucky that I had supportive colleagues and a supportive physician

How did your being an OB impact your own personal decisions?

It’s almost impossible to separate the physician in me from the mom in me. I knew I wanted to try, and I wanted to have the experience of a vaginal birth. I think being an OB helped me to understand the risks better but more importantly, it helped me to understand the benefits better. When I speak with my patients about trying for a VBAC, many of them are reluctant to try and a lot of them don’t understand why it’s more beneficial. So it helped me to understand how to help these moms become aware of the benefits.

How did you hear about doulas?

In medical school, a group of lay midwives came and gave a talk to the students and invited us to come to the birth center and meet them and their doulas. I thought to myself, that was a really good idea. For a lot of moms, it’s really nice to feel taken care of, and for dads and other support people, they may feel sort of helpless--they might know how to be there emotionally but they are in an alien environment as well, so to have a doula who is there to support mom and family is fantastic. As a medical professional, I know that doulas reduce the burden on nurses.

What were you looking for in doulas?

I knew that what i was going to need was emotional and physical support. I adore my husband, but I knew for him to be in a strange environment, possibly up all night, it was going to be hard on him. I specifically looked for doulas who connected with us who knew us and enabled us to really focus on the process and we wanted to find a doula who really wanted to make sure that what happened was what we wanted and to be a part of our birth experience. We really like that there were two of you, so you wouldn’t be exhausted if you were coming off of another birth. As a doctor, I know how exhausting it can be to work more than 24 hours.

With being so knowledgeable what was the experience like?

What I really appreciated were the things that are not covered during medical school such as chiropractic care, pre-labor exercises, positions...we don’t learn about that stuff even though it’s so important.

What are some profound moments from your birth?

Gosh there were so many. Eventually I had to throw in the towel but being able to make that decision myself, it helped me to be at peace with what had happened. To be able to make that call myself, really changed around how I felt about my experience. Being on the patient side was really interesting. I have a lot of patients who are very nervous about going through a foley bulb induction for instance and before I couldn’t really advise them about it. Having gone through it myself, the foley bulb actually wasn’t that big of a deal. Something comical about sitting up in bed, hooked to monitors, and IVs, and here we were talking about our favorite food. It was silly almost, it was a fond memory, that I have. I had a good time, not that you would ever think that, they don’t call labor that because it’s easy. I just felt comfortable physically and emotionally relaxed.

Do you feel that a doula is worth the investment?

Absolutely! I would absolutely do it again. Having the extra hands, the extra support and having the extra knowledge I got from working with you all was just so critical--changed the experience from something that I was afraid of to something that I could handle. A lot of my friends and colleagues were surprised. Some professionals have different opinions about doulas or have had unpleasant experiences or have perceived conflict with doulas. Once I was able to tell them about my experience, I think it may have changed their opinions a little bit, and I hope they will reconsider their views in the future.

What is one thing that you would like to let other expectant moms know?

Part of being a mom is learning how to let go. You learn how to let go of always having your hair perfect or always having your house clean. You learn to let go of your body while you’re pregnant and you suddenly see changes in your body that may not be expected or wanted. You learn to let go for the sake of your baby, for the sake of your child. The same is for pregnancy and birth. We all want to make decisions about how our birth is going to go. But learning to expect the unexpected and being ready to take whatever happens and be ready for it. So surround yourself with people who can help you roll with the punches as it were, to help you be prepared for whatever comes and to not even know that it's coming but to be prepared emotionally to cope with the unexpected.

Do you think having doulas helped with that?

Sure, because I knew that I was going to have lots of people behind me that were experienced in childbirth. I mean I’m an OB and I experience childbirth every day and I have less discomfort than most but other moms are not as comfortable around childbirth. Having other experienced hands and voices who are their specifically to support them would make it easier to deal with the complications of labor or if there is more pain that she can deal with or doing more than she believes she is capable of. Helping her stay focus on the process and not give into the fear or the uncertainty.

What would you like other OBs to know about doulas?

That a good relationship with a doula will make your life easier. If your patient is well-supported and happy, your nurses are not run off their feet because they have extra help. Your patient is happy and able to cope with the process. It’s going to make it that much easier for you to have a therapeutic relationship with your patient. A helpful and supportive doula makes the process easier for everyone.

Dr. Dunham holding baby in Pensacola, FL

So tell me about having a cesarean, and how having a doula could help change things?

Certainly the prep for a cesarean was a little scary so getting over the discomfort of the end stages of labor, the disappointment of not having a successful vbac, the exhaustion of having labored for over 24 hours. Having the help from my doula was invaluable to me. And then in the recovery room and suddenly being handed my baby and trying to establish that first bond and get started with breastfeeding. I had such a struggle breastfeeding my first born, but having someone there to help me start the process was really nice for me and helped me to feel more confident that I was going to move forward and successfully breastfeed my baby.

It’s just been so pleasant to work with you and something that I’ve really enjoyed. We can speak together as professionals with the same goal and my experience was different from what it might have been. It’s so heartwarming to have had you guys there to support me, it was such a good experience for me. I’m just so thankful for you.

Unfortunately, Pensacola doesn't get to keep Dr. Dunham. She is off to the Mayo Clinic in Minnesota. Ashley and I will sorely miss the Dunham-Sato's after they leave. 

Ashley Barnes and Evangeline Schepper interview Dr. Dunham about her experience with doulas