When a laboring client shows signs of distress, the first step is to assess the situation

Doulas are calm anchors in a storm. When labor hits a rough patch, the first instinct isn’t to rush to a medical action or to jump between tasks. It’s to pause, observe, and understand what’s happening with the person you’re there to support. A guiding question you’ll hear in many doula trainings—and that you’ll rely on in the moment—is simple: what should you do first when distress shows up? The answer, in real life and in most training scenarios, is to assess the situation.

Assess first, act second. It sounds almost too tidy, but there’s a reason this step appears at the top of the response ladder. Distress in labor can have many roots—physical, emotional, environmental. Some signs are normal responses to intense contractions; others point to a need for extra support or medical attention. If you leap straight to “do something,” you risk misreading the moment and missing the root cause. By assessing, you buy time to tailor your support to what the client truly needs at that instant.

Let me explain what that assessment looks like in practice. It’s not an abstract checklist; it’s a careful, compassionate scan of body, mind, and surroundings. You’re looking for clues about pain, fear, fatigue, or discomfort, and you’re checking for anything that signals a red flag. The goal is to understand, not to judge or rush.

What does assessment actually entail?

• Observe the body and the room. Is the client tensing up, gripping the bed rails, or grimacing with every breath? Are contractions happening in a steady rhythm, or is there a sudden shift in pace? How’s the room set up—soft lighting, a comfortable surface, access to water and a sip of electrolyte-rich drink if that’s advised? Small environmental tweaks can make a big difference.

• Check in on emotions. Are they overwhelmed, anxious, angry, or exhausted? Do they feel supported by whoever is present? Emotional cues often reveal needs that comfort measures alone can’t address.

• Gather information from the client. Open-ended questions work well: “How are you feeling right now?” “What has helped during contractions before?” “What’s the most uncomfortable part of this moment?” If the client has a care team or a partner, you can also gently ask how they’re seeing the situation.

• Listen to the context. Are we dealing with a long, challenging labor, or is something acute happening that requires a different response? Are there medical updates from the midwife or nurse? Does the client have specific fears or preferences regarding interventions?

A few practical phrases can help you gather information without breaking the flow of support. For example:

• “Tell me how you’re feeling in this moment.”

• “What’s helping right now, and what isn’t?”

• “Would you like to try a different position or breathing pattern?”

• “Would you like me to check in with the nurse about how things are progressing?”

The key is to stay present with the client while you collect this information. Your presence itself is a powerful tool—the client often feels calmer simply because someone is consistently there, reading the room and responding with intention.

Comfort measures while you assess

While you’re taking in the signs and listening to the client, you can offer comfort that doesn’t jump ahead of the assessment. Comfort and assessment aren’t enemies; they’re teammates. The aim is to reduce distress without assuming a medical route immediately.

• Breathing and pacing. Guided breathing, a slow, steady rhythm, or even a gentle counting pattern can help diffuse tension. You might say, “Let’s try a slow breath in for four, out for six.” If the client has a preferred technique, you mirror that.

• Positioning and support. Sometimes changing positions eases the pressure—upright posture, side-lying, or hands-and-knees can relieve back pain and enhance comfort. Use pillows, a birthing ball, or towels to create cushions and support as needed.

• Hydration and nourishment. If allowed, small sips of water or electrolyte beverages and light snacks can help some people feel steadier. Check with the care team about what’s permitted in the moment.

• Touch and reassurance. Gentle counter-pressure on the lower back, a reassuring hand on the shoulder, or a short, calming touch can convey safety. The touch should be welcome and consented to; check in with a quick, “Is this okay?” before you proceed.

• Environment as a friend. Dimming lights, quiet background, and minimizing interruptions can lower arousal. A familiar scent or a soft playlist chosen by the client can also create a sense of control and calm.

Knowing when to escalate is part of the assessment, not a dramatic departure from your role. Not every moment of distress demands medical escalation, but some do. Here’s how to recognize the difference and what to do about it.

Escalation: red flags that might require medical input

There’s a fine line between comfort-focused support and situations that call for more hands-on medical involvement. You’re not a medical professional, but you’re a frontline observer who helps the team respond safely.

• Persistent or escalating distress despite comfort measures. If breathing remains rapid, the client remains tense, or pain intensifies in a way that seems unmanageable with comfort, it’s a clear signal to involve the care team.

• Changes in fetal status. Any concerning signs from fetal monitoring or reports from the nurse or doctor should prompt timely communication with the team. Your role is to relay the client’s experience and any changes you’re observing.

• New symptoms or complications. Bleeding, signs of dehydration, dizziness, or sudden swelling require escalation and professional evaluation.

• Client requests or preferences. If the client expresses a desire for more medical input or changes in the care plan, support those preferences by liaising with the birth team and updating them on the client’s status.

The point isn’t to create panic but to ensure safety. When in doubt, ask the care team for guidance. A simple, “Would you like me to check in with the nurse now?” can keep everyone aligned and reduce delays in care.

A couple of real-world illustrations

Scenario A: Back labor with rising anxiety

A client in active labor is dealing with persistent back pain. She starts to tremble, her breath shortens, and tears leak at the edges of her eyes. You stay, you breathe with her, and you offer a few positions—the hands-and-knees, then a side-lying with a pelvic tilt. You check in: “What’s most uncomfortable right now?” She answers with a request for slower breaths and a quieter room. You adjust the lights and sounds, offer a warm compress for the back, and call out to the nurse to confirm hydration status. After a few minutes, her breathing settles, and the anxiety eases. The distress isn’t gone, but it’s better contained, and you’ve provided a clear path back toward calm.

Scenario B: Early signs that things may be shifting

Mid-contractions, the client suddenly stiffens, voice tight, and the monitor shows a shift in pattern. You pause the internal autopilot and assess: “Is this a single moment of stress or a signal of something more?” You check in with the client and her partner, confirm her emotional state, and confirm with the nurse about signs to watch. You maintain presence, adjust the room to quieter settings, and prepare to relay the situation to the medical team with precise, concise notes. The team confirms a plan of action, and you step into a supportive, collaborative role—neither bypassing medical input nor burying the moment under fear.

A handy, quick-start checklist for quick reference

• Assess first: body, breath, emotion, environment.

• Check in with the client using open-ended questions.

• Offer comfort measures suited to the moment and client’s preferences.

• Monitor for signs that distress is changing in a way that requires medical input.

• Communicate clearly with the care team; relay the client’s experience and concerns.

• Maintain a calm, steady presence; your steadiness is a resource in itself.

A note on tone and role

As a doula, you’re not there to medicalize the birth or to perform procedures you’re not trained for. You’re there to read the room with empathy, to support the client’s choices, and to help them navigate distress with a toolkit that respects their autonomy. The first step—assessing the situation—keeps you grounded. It prevents impulse from outpacing judgment and ensures your actions are aligned with the client’s needs and the care plan.

If you’re building a practice that serves families well, this approach matters. It’s a practical philosophy you’ll carry into every birth: pause, observe, respond with intention, and escalate when the signs point that care beyond comfort is needed. The moment you learn to separate reflex from reason, you’ll be a steadier presence for your clients, their partners, and the professional team surrounding them.

Closing thoughts

Distress in labor can feel overwhelming, both for the person in labor and for the people who want to help. The one step that anchors everything is the simple act of assessment. It’s your compass, your first line of action, and the fairest way to respond—giving space for the body to do its work, while you honor the emotional journey unfolding in the room.

If you’re practicing as a doula, keep this approach close. Let it shape your days with clients, shape your conversations with care teams, and shape the quiet confidence you bring into every birth. After all, the most powerful tools you bring aren’t just techniques or checklists—they’re presence, patience, and a steady, thoughtful approach to distress that respects the experience at hand. And that, in the end, makes all the difference between fear and the sense of safe, supported birth.