In-Person Day 1 · 8:30 AM to 4:30 PM CST · YWCA Baton Rouge
Pain Management & Hands-On
Comfort Measures & Client Skills
Today you move from knowledge to practice. You will use your hands, your voice, your presence, and your judgment. All of it, all day.
Training Address
YWCA Empowerment Center
1690 North Blvd, Baton Rouge, LA 70802
By the End of Today, You Will Be Able To
- Explain the difference between pain and suffering in labor and describe the fear-tension-pain cycle
- Apply Gate Control Theory and the Neuromatrix Theory to understand how non-pharmacological support works
- Demonstrate nine evidence-based physical comfort measures, including adaptations for a client with an epidural
- Practice building rapport and establishing a collaborative team dynamic with clinical staff at the start of a birth
- Create a client character, develop her birth vision and birth plan, and play out her birth using the Birth Story Game
- Conduct a mock initial client interview using active listening, open-ended questioning, and SDOH screening
- Identify community resources for a hypothetical client based on her specific circumstances and location
Day at a Glance
| 8:30 AM | Welcome, Breakfast & Icebreaker | 30 min |
| 9:00 AM | Understanding Pain in Labor | 45 min |
| 9:45 AM | Hands-On Comfort Measures Lab | 75 min |
| 11:00 AM | Break | 15 min |
| 11:15 AM | Doula, Nurse and Client Role Play: Rapport & Team Building | 60 min |
| 12:15 PM | Build Your Client: Character, Birth Vision, Birth Plan & Birth Story Game (through lunch) | 90 min |
| 1:45 PM | The Initial Client Interview | 60 min |
| 2:45 PM | Break | 15 min |
| 3:00 PM | Community Resource Navigation | 45 min |
| 3:45 PM | Skill Check-Off, Debrief & Closing | 45 min |
8:30 AM · 30 Minutes
Welcome, Breakfast & Icebreaker
Settle in, grab breakfast, and get your name tag and binder. We will open with the "Stand Up If..." icebreaker to build energy and connection before diving into the day. Your instructor will cover housekeeping, review the agenda, and take a quick pulse check on any lingering questions from Nights 1 and 2.
9:00 AM · 45 Minutes
Understanding Pain in Labor: Theory, Suffering & the Doula's Role
Why Does Labor Hurt?
Labor pain is real, purposeful, and multi-layered. Understanding its sources helps you respond with intention rather than panic. Pain in labor comes from four main places:
- Uterine contractions: the powerful muscle squeezes that open the cervix
- Cervical dilation: stretch receptors fire as the cervix thins and opens
- Pressure on the pelvic floor and sacrum: especially intense as baby descends
- Tissue stretching: the vaginal walls, perineum, and surrounding fascia under pressure
Key Distinction: Pain vs. Suffering
Pain is a sensation, the physical signal the body is sending. Suffering is the meaning a person makes of that sensation. Two people can experience the same level of pain and have completely different experiences based on fear, support, environment, and expectation. As a doula, you cannot change the pain, but you can profoundly change the suffering. This is your leverage point.
The Fear-Tension-Pain Cycle
Dr. Grantly Dick-Read described what he observed in laboring women and named it simply: when a person is afraid, their muscles tense. When muscles are tense during contractions, pain is amplified. Amplified pain increases fear. The cycle feeds itself.
| Fear | → | Muscle Tension | → | Amplified Pain | → | More Fear |
Breaking this cycle is one of the doula's primary functions, through calm presence, informed reassurance, and physical techniques that interrupt the tension response. Your tone of voice, your body language, and the words you choose all speak directly to a laboring person's nervous system.
Two Theories That Explain Why Non-Pharmacological Support Works
Gate Control Theory, Melzack & Wall (1965)
The spinal cord contains a "gate" that can be opened or closed to pain signals traveling to the brain. When you flood the nervous system with competing non-painful sensory input, firm pressure, warmth, movement, touch, the gate closes partially or fully and less pain signal gets through. This is the physiological basis for counter-pressure on the sacrum, warm compresses, massage, TENS units, and hydrotherapy. You are not distracting the laboring person. You are changing what their spinal cord transmits.
Neuromatrix Theory, Melzack (1999)
Pain is not simply a signal the body sends. It is an output the brain produces based on all available information: physical sensation, emotional state, memory, expectation, and environment. This is why the same contraction can feel unbearable in a cold, bright, noisy hospital room and manageable in a dimly lit tub with your doula breathing next to you. The environment, the relationships, the words people say, all of it shapes the brain's pain output. You have the power to change that output without touching the body at all.
The Three R's, Penny Simkin
Penny Simkin identified three organizing principles observed in people who coped well in labor without medication:
| Relaxation | Releasing held tension in the body, the jaw, the shoulders, the hands. A body scan between contractions helps reset the nervous system. Coach it: "Let your jaw go soft. Drop your shoulders. Open your hands." |
| Rhythm | Breathing, rocking, vocalizing, swaying. Rhythm is the doula's single most powerful tool. When a laboring person loses their rhythm, they begin to panic. Get in front of the contraction with them: "With me. Breathe with me. In through the nose..." |
| Ritual | A repeated sequence that becomes a coping anchor across contractions, the same words, the same touch, the same breath pattern each time. The nervous system learns the ritual means you are safe, you can do this. |
Doula Script: Coaching Through a Contraction
"Here it comes. You know what to do. Breathe in through your nose ... and out through your mouth ... just like that. Soften your jaw. You're doing it. This one is already halfway. One more breath. There it goes. You did that one. Rest now."
Notice: no medical decisions, no promises, no diagnosing. Just presence, breath, and rhythm.
Group Activity: "Pain or Suffering?" Scenario Sort (10 min)
You will receive a set of cards, each describing a birth scenario. In small groups, sort the cards into three categories: Pain Alone, Suffering, or Both. Be ready to explain your reasoning. The goal is to start noticing the difference between a physical sensation and the experience someone makes of it.
9:45 AM · 75 Minutes
Hands-On Comfort Measures Lab
This is a hands-on rotation lab. You will move through nine stations with a partner, spending approximately 8 minutes at each. Your instructor will demo each technique before stations open. Wear comfortable clothes you can move around in. You will be on the floor, standing, leaning, and lifting.
| Station 1 | Touch & Massage: counter-pressure, hip squeeze, effleurage |
| Station 2 | Positioning & Movement: hands-and-knees, standing lunge, supported squat |
| Station 3 | Birth Ball Work: circles, rocking, leaning; when and how to introduce the ball |
| Station 4 | Rebozo Techniques: sifting standing and side-lying, belly sling, teaching the birth partner |
| Station 5 | Water & Temperature Therapy: shower technique, warm compress, cold pack placement |
| Station 6 | Breathing, Visualization & Vocalization: exhale anchor, imagery scripts, sounding vs. holding |
| Station 7 | Acupressure Points: SP6, BL67, pericardium 8; when to use and how to explain to clients |
| Station 8 | Sensory Environment: lighting, sound, aromatherapy; creating a supportive space within hospital constraints |
| Station 9 | Epidural Adaptations: peanut ball, position changes every 30 min, emotional presence for medicated clients |
Initial your skills checklist as you complete each station. You will demonstrate two techniques for instructor sign-off at the end of the day.
11:00 AM · 15 min
Break. Stretch, hydrate, use the restroom. We resume promptly at 11:15.
11:15 AM · 60 Minutes
Doula, Nurse and Client Role Play: Rapport & Team Building
One Scene, Many Relationships
The scene is the same every rotation: a client is in labor at the hospital, you have just arrived as the doula, and the nurse enters the room. What changes each round is who is in that room, what kind of mom this is, what kind of nurse walks in, and what energy you bring as the doula.
We are not practicing scenario problem-solving today. We are practicing the very first moments: the introduction, the eye contact, the way you enter a room, how you make a client feel seen and a nurse feel like a colleague rather than an obstacle. Rapport in a birth room is not built over time. You have about 90 seconds.
Rotation Cards: Draw One from Each Pile
| The Client | The Nurse | The Doula Approach |
|---|---|---|
| Anxious first-timer, partner stuck in the parking garage | Warm and collaborative, genuinely glad you're there | Calm and grounding, low voice, slow movements |
| Experienced mom who knows what she wants and does not want to be managed | Busy, stretched thin, skeptical of doulas in her room | High-energy and enthusiastic, has to read the room fast |
| Teen mom, quiet, hasn't told her family she has a doula | Professional but territorial, this is her patient, her room | Gentle and deferential, earning trust without shrinking |
| Mom with a prior traumatic birth, jumpy, easily startled | New nurse, nervous themselves, looking to you for cues | Experienced and grounded, leads with steadiness |
What You Are Practicing
- How you introduce yourself to both the nurse and the client in the same breath
- How you physically enter and claim your space without challenging the clinical team
- How you make eye contact with a scared client while also acknowledging the nurse
- How to establish your role clearly and warmly: "I'm here to support [client]. I'll follow your lead and stay out of your way."
- How to read the room in the first 60 seconds and adjust your energy accordingly
Full group debrief (15 min) to close: What landed? What felt awkward? When did you feel the room shift?
12:15 PM · Through Lunch and Into the Afternoon
Build Your Client: Character, Birth Vision, Birth Plan & Birth Story Game
For the rest of the afternoon, everything you do, the interview, the resource search, grows from one person you are going to create right now. She is not a scenario card. She is a full human being. The more real you make her, the more useful all of this practice will be.
Step 1: Build the Person (15 min)
Work individually. Give your client a name and a life. You can use a famous person, a fictional character, or someone entirely made up. Go deep on the questions that feel most alive to you:
- Who is she? Name, age, where does she live?
- Is this her first baby, or has she been here before? If before, how did that go?
- What does her support system look like: partner, family, friends, or is she doing this alone?
- What is her relationship with her provider? Does she feel heard by them?
- What are her hopes for this birth? What is she most afraid of?
- What does her day-to-day life look like: work, housing, stress, stability?
- What cultural, spiritual, or personal values shape how she thinks about birth and her body?
Step 2: Complete the Birth Vision Guide (through lunch)
Using the MHN Birth Vision Guide provided on paper, complete the vision for your character. This is not a birth plan yet. It is a values and preferences exploration. What does she want her birth to feel like? What does she want to avoid? What matters most if things go differently than planned? Grab your lunch and keep building. Some of the best creative thinking happens when you are not staring at a blank page.
Step 3: Draft the Birth Plan (20 min, after lunch)
Now you are going to draft the document that will represent your character's voice in the birth room when things move fast. Before you write, remember the BRAIN framework your client will use when facing any recommendation from her care team.
| B | Benefits | What are the benefits of this recommendation for me and my baby? |
| R | Risks | What are the risks, and how likely are they? |
| A | Alternatives | Are there other options we haven't discussed? |
| I | Intuition | What does my gut say? Does this feel right for my family? |
| N | Nothing / Next Steps | What happens if we wait, or choose to do nothing for now? |
Doula Language for BRAIN Support
- "Have you asked your provider about the alternatives?"
- "You don't have to decide right now. It's okay to ask for a few minutes."
- "What does your gut tell you?"
- "Whatever you decide, I'm right here with you."
Choose the format that best fits who your client is. Consider her literacy level, her hospital, her relationship with her provider, and what she told you matters most.
| Visual Birth Map | One-page, icon-based, accessible to all literacy levels. Images communicate faster than words in a busy labor room. |
| Bullet-Point List by Stage | Organized by phase: check-in, active labor, pushing, birth, postpartum. Easy for staff to scan quickly. |
| Letter of Intention | Personal and narrative. Opens with who the client is, not just what she wants. Particularly effective for clients who have experienced trauma or whose preferences may be dismissed without context. |
Step 4: Play the Birth Story Game (45 min)
You have built your client. You have drafted her birth plan. Now you are going to live through her birth, whatever happens. The Birth Story Game uses dice to determine what unfolds at each stage. Your job as the doula is to respond to whatever life hands you, with support, presence, and your full skill set.
How to Play
- Single D6 rolls (Rolls 2, 7, 8, 9): Roll one die. Result is 1 to 6.
- Double D6 rolls (Rolls 1, 3, 4, 5, 6, 10): Roll both dice and add them. Result is 2 to 12.
Share your birth vision briefly with the group, then one person rolls for each stage while the doula responds to each scenario with supportive strategies, just as they would in a real birth. The full scenario tables are on your printed game cards. Adapt and support through all ten rolls.
| Roll | What It Determines | Doula Focus |
|---|---|---|
| Roll 1 | Maternal Physical Health | Understand the medical picture and what it means for your support role |
| Roll 2 | Maternal Psychosocial Profile | These factors often shape care more than the medical picture. Ask open questions, follow her lead |
| Roll 3 | Baby's Prenatal Condition | What is the baby's picture heading into labor and how does it shape the birth plan? |
| Roll 4 | How Labor Begins | Set the opening tone: spontaneous, induced, prodromal, or precipitous |
| Roll 5 | Labor Progression and Interventions | Navigate stalls, fetal distress, epidural requests, and nurse conflict |
| Roll 6 | Birth Outcome | Support whatever arrives, from a peaceful birth to emergency cesarean to stillbirth |
| Roll 7 | Support Person Dynamics | Your job is to support the whole room, not just the birthing person |
| Roll 8 | Doula Challenge Card | A wild-card interpersonal or situational challenge: language barriers, hostile nurses, decision pressure |
| Roll 9 | Newborn Transition | Protect the golden hour, advocate for skin-to-skin, help parents process what just happened |
| Roll 10 | Postpartum Recovery | Navigate recovery, breastfeeding challenges, NICU stays, mood concerns, and the follow-up visit |
Debrief After Play
What rolls surprised you? Where did the birth plan you drafted need to flex? What moments made you reach for techniques from the lab? Did anything make you want to cross a scope line? Bring your character, her plan, and what happened to her birth into the interview practice next.
1:45 PM · 60 Minutes
The Initial Client Interview: Listening, Assessing & Building Trust
The Art of the First Meeting
The initial interview is not an intake form. It is the beginning of a relationship. Everything that happens in that first meeting, how you enter the space, how you listen, what you notice, what you choose not to ask yet, tells your client whether they can trust you with the hardest day of their life.
| Active Listening | Focus entirely on what is being said, not on formulating your response. Put down the clipboard. Let silences breathe. Reflect back: "It sounds like you felt really unsupported at that last appointment." |
| Body Language | Open posture, eye contact, leaning slightly forward. Presence before words. Your body communicates safety before you say anything. |
| Open-Ended Questions | "Tell me about your pregnancy so far." invites a story. "Is everything okay?" closes the door. Always prefer the open door. |
| Silence as a Tool | Holding space without filling it. What comes after a pause is often the most important thing a client will say. |
What to Cover in the Initial Meeting
- Birth history: previous births, experiences, what they want to be different this time
- Hopes and fears: what they are looking forward to, what keeps them up at night
- Support system: who will be in the room, who is at home, who is reliable
- Medical history and provider relationship: do they feel heard by their OB or midwife?
- Hospital preferences: delayed cord clamping, skin-to-skin, environment requests
- SDOH screening: housing, transportation, food security, insurance, gently, as part of the whole picture
- Cultural and spiritual preferences: what matters to this family that we need to honor?
- What they want from a doula: clarify expectations early, align on what your role will look like
SDOH: Why It Belongs in Your First Conversation
Social Determinants of Health are the non-medical factors that shape how a person experiences pregnancy and birth, where they live, whether they have reliable transportation, what they will eat this week, whether they feel safe at home. For the populations MHN serves, these factors often have more impact on birth outcomes than any clinical decision made in the hospital. Screening for SDOH is not prying. It is how you find out where the real work is.
Pairs Practice: Interview Your Character (25 min)
Find a partner. One of you plays the doula; the other plays the client using the character they built, fully in character, not reading off a card. The doula uses the MHN Pre-Birth Packet to guide the conversation while practicing active listening, open-ended questions, and SDOH awareness. Then switch. Debrief together, then share out as a full group: What did you notice? What felt uncomfortable? Where did you want to jump in and fix something?
2:45 PM · 15 min
Break. Last one before closing. We resume at 3:00 PM.
3:00 PM · 45 Minutes
Community Resource Navigation
Knowing Your Community Is a Clinical Skill
When you can connect a client to the right resource at the right moment, you change what is possible for that family. The categories below are your map. Your job is to know what is available in your client's community, not just near the hospital, but wherever she actually lives.
| Category | What to Look For |
|---|---|
| Food Security | WIC, food banks, SNAP enrollment support, hospital social work referral |
| Housing | Emergency housing programs, domestic violence shelter pathways, housing navigators |
| Transportation | Medicaid NEMT, Uber Health, community car programs, church networks |
| Mental Health | PSI Warmline (1-800-944-4773), community counselors, sliding-scale therapy, peer support |
| Peer Support | Centering Pregnancy groups, Black mamas circles, breastfeeding peer support, MHN community |
| Financial & Insurance | Medicaid enrollment, hospital financial counselors, community health clinics, sliding-scale care |
Activity: Resource Map for Your Client (20 min plus share-out)
Find a new partner, someone different from your interview partner. You are keeping the same client. Based on what you learned in the interview, identify as many real resources as you can for her. The key word is real: actual organizations, actual phone numbers, actual programs. Search in her community, wherever your character lives is where you are looking.
A few pairs will share out: What did your client need most? What did you find? Were there gaps? Those gaps are worth naming out loud. Everything you find goes into your Resource Guide.
3:45 PM · 45 Minutes
Skill Check-Off, Debrief & Closing
We close the day in two parts. First, comfort measure skill check-offs: each student demonstrates two techniques from the lab for instructor sign-off. Then an instructor-led debrief: What clicked today? What still feels uncertain? What was harder than you expected? We will close with a preview of Day 2, postpartum changes, breastfeeding basics, newborn skills lab, mental health, and ICEA certification pathways.
Mary's Hands Network · ICEA Certified Birth Doula Hybrid Training Program
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