First Breath to Last Breath - What a Doula Actually Does

We make partners look so good, like rock stars. We always say it's the mom that hires the doula the first time, and it's the dad that says, okay, call the doula when the second baby is on the way.

Health and wellness is confusing. There's a new trend every week. Everyone's got an opinion, and half the time you can't tell what's legit and what's just good marketing. And we get it. We're in it too.

Welcome to Dialed In Health. I'm Melissa Goodwin. Every episode we bring in the people who actually do this work. Providers, practitioners. The experts who see clients and patients every day. We ask the questions you'd ask if you were sitting across from them, so you can find the right people, make better decisions, and feel confident about what's out there.

You came into this world with a little help, and if you're lucky, you'll go out of the world with a little help, too. Today I'm sitting with Kelsie Thomas and Renée Forred, the owners of Transitions Doula Services right here in Sioux Falls. They support people at all vulnerable stages, including both ends of life - birth doulas, postpartum doulas, end of life doulas - from first breath to last breath.

So first of all, what is a doula? A doula is an emotional and physical support person. We're not medical professionals, so we can help fill in for families and help with all of the transitions.

How are doulas trained and certified? You know that a good doula is one that really brings information to the table, evidence based. We're both certified through Doulas of North America, DONA, which is an international certifying body which does require continuing education.

What are some questions you should ask to ensure that a doula might be a good fit for you? What are they going to bring to the table for you? What are you looking for in your support? That should be the first question they're asking you. And then to also just feel out the vibe and know if a person is right for you.

What does that support look like? A birth doula walks along with you in pregnancy, helping you through labor and birth. Postpartum doulas come in after baby is born and nurture the whole family, helping with education and resources. And then end of life doula is there supporting you and your family and loved ones as you're making decisions and navigating those end of life days.

My favorite question when I first meet people looking for birth support is: if you can wave a magic wand and have this birth go exactly the way you wanted it, tell me what that looks like. Then it helps me educate them on how a doula can help with that experience.

Doulas round out teams. We're not there to replace that care provider or your partner. We're looking for the gaps so that care providers coming up with that plan. But how can we see that plan through? What positions can we use to help?

When you think about people just googling things, you're spending so much time trying to find the right answer. And many of us maybe don't live with our extended tribe anymore. So we're all sort of on these little islands. Having somebody that steady, continuous, trusted, knows your story - it makes such a difference.

And having somebody that steady from their experience, right? What have we seen? What are the best ways to show up to the hospital at 2 a.m.? Do you go through the emergency room doors or do you just call? Just being able to help streamline and use your energy most efficiently.

And one thing - when you go to the hospital, there are OB nurses, but they might have a shift change in the middle of your delivery. You don't know what kind of day they may have had. So to have somebody that you can have in the room with you - and even if you have a partner, the partner doesn't always know what to do.

Especially for partners, bringing the creative brain to the table - oh, there's the cold washcloth in their hand or the ice chips - that then allows them to be the one to apply the washcloth, to give the ice chips. We make partners look so good.

And I didn't realize many times you're in the hospital room with them. It's not just for home births. The majority of births we serve are in the hospital setting. Everyone deserves a doula for those hospital births, epidurals, or C-sections.

C-sections or NICU clients - somebody can be with mom, somebody can be with baby. We can be helping navigate to make sure even that process can be as smooth as possible.

CLIENT STORY - JILL: My name is Jill, and I used the Transitions Doula Services. The birthing education I went through really sold me on having a doula as part of my birthing team. We chose to have a midwife, and with that, along with doula services, we had a successful VBAC birth. The midwife is more on the medical side, and the doula is more supportive and connecting with resources and breathing techniques and helping to remind you to release tension.

I was in labor for almost 24 hours. We were coming to the point where 24 hours is the time that my water had broken the day prior, so we were on a time clock. My doula reached out to Kelsie here at Transitions, who connected us with Nikki over at Leading Edge Chiropractic to get me in for an acupuncture session, as well as a chiropractic adjustment. That was like the final key piece sending me into full labor. Two hours after my adjustment, my waters broke. Three hours after that, our sweet baby boy was born.

Our first, we had a hospital birth without a doula. I definitely think a doula would have helped us navigate that process a lot better because a doula can help advocate what you want throughout your birth plan. Your husband is there to help you advocate, but that doula is that third person and may not be so emotionally involved in the labor process.

During that process, I had an amazing experience with my doula. She met me two sessions before the actual birthing process to go over things and make sure we were on the same page. She had no problems getting out of bed at 1 a.m. and meeting us. She was with us for 24 hours straight. She connected us with resources, guided my husband on providing counter pressure during contractions, and took amazing photos to document our story.

Our doula also met us about a week after the birth to sing over the birthing story and details, which helped my husband and I process things we really hadn't talked about. She really helped us remember what a great process it was for us.

Does Medicaid or insurance cover any of the services you provide? Yes. South Dakota Medicaid covers birth and postpartum doulas. Medicaid recipients can now access that care. Some insurances do cover doula support. Insurance companies in South Dakota are recognizing that there's actually cost savings when it comes to doula support because the outcomes and the research shows the outcomes are just better with that doula support.

Medicaid was approved just January 2025. So it's the insurance coverage is relatively new. You got to call and ask, and here are the codes that you can use.

CLIENT STORY - KRISTEN AND JOHN: My name is Kristen Nell, and I'm John Nell. We used Transitions Doula Services with our daughter Nora during her pregnancy. We had some pretty significant health issues that came up, and so navigating that, we were trying to figure out what's going to be the best for us to help bring us another level of support and comfort during the recovery time.

I was googling, as one does, thinking well, what can we do during this transition from pregnancy to motherhood? The term doula came up. We had an opportunity to have a postpartum doula, and I think that's the support we needed as first-time parents.

When we were leaving the hospital, they just hand you this baby and they're like, go home. I remember being really anxious having this baby. You're just supposed to take care of her, and even though they tell you how to bathe or hold her, there's a lot going on after birth. Sometimes when you get home, I'm like, what did they say?

Having that support and I have to say that I was never made to feel silly or stupid if I asked, like, so how do we bathe her? It was just that support that came alongside me, and it was like, you got this. What was wild is it's almost like there was this anticipation of needs.

I remember Renée would come in and she would be like, oh, I got Nora. And then she's like, you go lay down. When I would wake up and come out, Nora would be sleeping. Renée had washed the dishes, cut up carrots for later that afternoon. I was in awe of like, oh, those are things I did need to do, but I didn't know if I would ever have time to get to them.

For me, like as a dad, it was knowing that I can take care of other responsibilities and know that she still has extra support during this time. I will always remember it was Mother's Day. It was my first Mother's Day, and Ashlyn, our night doula, had made a handprint and footprint of Nora and left me a card. I remember opening it up and it was like, happy first Mother's Day. That was so unexpected, and it felt like they really became part of our family in this journey into motherhood.

In my mind, it's kind of like having a broken foot and needing a crutch. Sometimes we think we need to figure it all out by ourselves. But often when there's people around you willing to help, why not learn from the experience of others instead of always having to learn the hard way? Maybe we don't have to learn everything the hard way. Maybe a few things. But someone just to walk with you through this transition time in life.

END OF LIFE DOULA WORK: Let's flip a bit to some of the other work that you do. I have a written testimonial of one of your clients from the end of life work. This client had lost her father and realized her mother was as sick as she was, experiencing dementia-like symptoms. She wrote: "My mother's decline was so rapid, and through it all, Kelsie was there helping us understand the dying process and what needed to be done, especially helping me learn to handle the most unpleasant aspects while maintaining my mother's dignity and showing her love.

Kelsie helped me learn how to be strong for my mother and provide her with the little things that gave her pleasure during her life. She helped me see how I could share the wonderful, happy, sad, and silly moments that shaped our lives with her. On the day she passed, Kelsie ensured a calm house environment with Frank Sinatra playing, someone always by her side, and my sister cooking in the kitchen - something she loved to do. It was so peaceful and I knew she knew how very much she was loved. I would not have known how to provide her with that peace had it not been for Kelsie, making it something so natural and beautiful to be with her at the end."

The dying is a process for many people, and we don't really think of it that way culturally. Tell me a little bit about the end of life doula or the death doula and how is it different from something like hospice?

Different roles. A doula gets added to the team just like hospice. There's a medical provider overseeing care. We're not there to diagnose or make decisions for you. But I think that relationship piece that doulas bring to the table - just having that known relationship with that person, educating, trying to add information to the process that can help you, normalize what's happening - and also fill in with respite support.

Sometimes that DIY culture runs so strong that you're like, okay, I'm going to be the husband and the caretaker and the one doing laundry and dishes. But what if that husband just gets to be the husband and sit bedside because the dishes are already done?

How is end of life doula training different? Training is unique to the individual. We've started to call it transitional care services because I do think it's when health care starts getting tougher to navigate. Maybe there is a diagnosis, but maybe it's managing a lot of hospital visits. Maybe family isn't around as readily. So just being extra ears in the room. I was trained through an international end of life doula association.

What do you do differently? Kelsie sees the details. She can see things coming a mile down the road and just centers everybody, whether it's birth or death. She is just so insightful for other people and loves to nurture people. She is the ultimate hostess, making sure everybody feels comfortable and setting the stage for centering on the person going through the end of life transition.

How do you stay composed during these emotional moments? It isn't about me. It's about this family or this person and figuring out what's at the surface for them. There's lots of personalities to navigate, and what emotional needs might be needed. You want to build that intimacy - offering whatever love languages somebody needs - whether it's physical touch or quality time or affirmations or gifts of service.

I'm not meant to be in every room. That's why we value our team approach so that many of us can step in if it's the right time. It's about figuring out the eyes on what that person might need.

Tell me about Cafe Mortel and why you do it. The Death Cafe is meant to be an open place to discuss, a safe place to have conversations, to find resources and support. Everybody should know what an advanced directive is. Everybody should plan their own funeral. An advanced directive helps with decision-making for your health and what you want done, and when.

What if you were just presented with options? This is what it could look like. This is what navigating funeral homes and the extra things your family will have to do for you after you leave. What if you just took the burden of them answering those decisions and you made them yourself?

We offer a welcoming space with good snacks and quality drinks. We've partnered with Breaks Coffee to provide some of that for those meetings.

Why is there such a surge of death doula education and need? I feel like there's a resurgence of community-based providers in answer to health care getting bigger and more localized. Being able to figure out resources directly in your community is really important. We're starting to see individuals take back their death and instead of it happening to them, making decisions and wanting to support where that is.

People are looking for more person-centered care, especially as our medical models and systems get bigger. You see a specialist for everything. Well, what about the patient? Having an end of life doula along for the ride consistently brings that focus back on the person.

MYTH BUSTERS:

Doulas are only for unmedicated births. No, no. Everyone deserves a doula. Everybody's best birth looks unique. My job as a birth doula is to hold space for their experience and their goals and wishes and help them pivot when they need to. If they want an epidural as soon as possible, let's get you as far as we can so it's the most effective. If they want a completely unmedicated birth, I'm going to bring the tools you need to help keep you comfortable.

Doulas are very expensive and only for the wealthy. Insurance is now starting to cover doula support. Medicaid is now covering doula support. HSA, FSA can be used. We are thrilled to be able to offer payment plans. Even if it is entirely out of pocket, we want to make it work for you.

My partner might feel replaced by the doula. We make partners look so good, like rock stars. It's the mom that hires the doula the first time, and it's the dad that says, okay, call the doula when the second baby is on the way. No partner should have to be the everything in a birth. And this is their experience, too. Being able to support the partner means the partner can better show up for mom.

A death doula or end of life doula is just for active dying. Building that relationship, when health care starts to get more difficult to manage - maybe driving's been compromised or hearing's compromised - and those health care visits are tougher, bringing somebody along sooner can help establish that relationship. Whenever you bring somebody to the team, you're always adding that extra support.

Talking about death makes it worse. It's uncomfortable. Talking about death makes it better. Empower families. Normalize it. There's no choice. You will die. We are all going to go through it. And how do you want to do it? When you start to think about your death, can you really, truly live too?

Death doulas and birth doulas are not real medical professionals. True, we're not medical professionals, but we know how to navigate medical systems and support you and your wishes and goals. We're non-medical, and I don't want to be medical. Those nurses and providers have really important jobs. I have the knowledge to help everybody find their place in the room and find what their goals and needs are and support them through that. Not medical, but a health care provider - just as equally important.

How do people learn more if they're doula curious or transitions in life curious? You can find us online at TransitionsDoulaServices.com. We also have a social media presence on Facebook and Instagram. Podcasts coming soon.

I think this is leading the way for more to be shared. There's just so much we can learn from our neighbors and lots of power that can happen in these very special moments.

Thank you for sharing your expertise, your knowledge, and your gifts with us today on Dialed In Health.

If you want to connect with Transitions Doula Services, you can click on the show notes below or follow them on social media. If someone came to mind while you were listening to this - if you thought, hey, my sister needs to hear this, or I should send this to my mom, or my buddy would get a lot out of this - please share it. Just hit the share button and send it their way.

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I'm Melissa Goodwin. The line is open.