What Is a Doula?
July 8, 2021
When you got pregnant, you knew you were about to experience an expanded waistline—but did you know you were also going to expand your vocabulary? You’re likely hearing a host of unfamiliar terms as you consider your labor and delivery options, including the word “doula.”
No matter where you are in your pregnancy journey, it’s never too early to consider whether you’d want a doula to help you and your partner through childbirth and postpartum recovery. But what is a doula, exactly? And what does a doula do?
In this guide, we’re sharing everything you need to know about hiring a doula for childbirth and postpartum care. You’ll discover the benefits of having a doula present in the delivery room, learn about the training they receive and get tips on finding the right one to suit your needs. Ready to explore your options? Read on to get the lowdown on using a birth doula.
The term “doula” is derived from an ancient Greek word meaning “a woman who serves”—and this definition certainly applies today. To be clear, a doula is not a midwife or a physician, and doesn’t provide any medical care. So what is a doula? Here’s the gist of it: A doula is a trained birth coach who offers physical, emotional and educational support for the mom, during labor and sometimes in the postpartum period.
“Physicians, midwives and nurses all play their own important part in the clinical health of the mother and baby. Doulas complement this care by providing non-medical care,” explains Melissa Harley, a certified doula, doula trainer and public relations director for DONA International, a doula education and certification organization. “This includes emotional support, physical comfort measures, informational support and advocacy in the way of helping families get the answers to questions so they can make informed decisions about their care.”
There are three main types of doulas:
• Birth doula. The most common of the three, a birth doula guides you through labor and delivery. Often, they’ll meet with you a few weeks before you go into labor to talk through what childbirth is really like and discuss your options, wishes and fears. The doula may also come to your home when you’re in early labor to make you more comfortable as you work through contractions, continue helping you through labor at the hospital or birthing center and be a calm presence when your partner or whoever else is attending the birth gets (understandably) nervous.
• Postpartum doula. This type of doula focuses on providing support for Mom once baby is born, helping her manage the stresses of having a newborn. During home visits, a doula will share information about infant care, tend to the unique needs of a new mom and generally help parents feel more confident in their roles.
• Antepartum doula. An antepartum doula specializes in high-risk pregnancies. To help the mom-to-be cope with the added stress of complications, a doula can provide physical, emotional and educational support similar to what postpartum doulas offer, but before baby is born.
Doulas may not be medical professionals, but they still go through rigorous training. There are several doula certification programs, with DONA being one of the largest. “Our program begins with a hands-on workshop with a DONA-approved doula trainer, during which doulas will learn labor comfort techniques and communication skills, as well as about the role and scope of practice as a doula,” Harley explains. After completing the workshop, doulas must complete required readings and additional coursework—including childbirth education and breastfeeding education—as well as work directly with families to gain hands-on experience and, ultimately, be evaluated by clients and healthcare professionals.
There are other certification programs out there, including Childbirth International and the International Doula Institute, so ask your prospective doula where they completed their training, what their training involved and how many births they’ve attended before you hire them.
Doula vs. midwife
Some moms get confused about the difference between a doula vs. midwife. A midwife is a medical professional who can provide prenatal care throughout your pregnancy and deliver your baby, either in a hospital, birthing center or at your home. A doula simply offers an extra layer of service, working to ease your pain using labor comfort techniques and liaising with your midwife (or ob-gyn) and hospital nurses to help see you through childbirth safely.
If they don’t provide medical care, then what does a doula do? “I always tell clients that doula services stay above the waist,” says Rachel Nicks, a New York City-based doula. “We inform and empower women to make their own choices and help them achieve the birth they desire.” But how a doula goes about that can vary, so it’s helpful to have an initial phone conversation or in-person interview to discuss their offerings. Common doula services include:
• Pre-birth consultation. A doula will often meet with you a couple of times beforehand to review what to expect during childbirth, discuss your birth plan with you and answer any questions about labor and delivery.
• Assistance during birth. While a doula can’t perform medical services, they can guide you through the physical challenges of labor by moving you into optimal positions, giving you massages and leading breathing exercises, among other techniques, and stay with you until shortly after baby is born. Some even specialize in soothing services like reflexology, aromatherapy or music therapy. They can also serve as an advocate for you and work with your medical team to make your wishes known. Moreover, they can help explain what’s happening in a way that’s less clinical and more approachable.
• Breastfeeding support. Some doulas are also trained as breastfeeding counselors or lactation consultants and can offer advice, answer questions about nursing and help address any challenges you run into once baby is here. Ask about your doula’s certification.
• Text and email support. Every doula is different, but some provide on-demand phone, text and email consultation before and after delivery. Again, this is something you can ask about during your initial interview.
• Postpartum support. So much focus is placed on preparing for labor and delivery, but recovering from childbirth is another major challenge. A doula can visit you in your home after baby is born to offer assistance during this exhausting time, potentially performing light housework, preparing meals or just being a voice of support as you navigate the first few days as a parent.
Doula support during a c-section
Many women hire a doula to support them through their vaginal birth, but doulas can also be beneficial during a c-section. “A cesarean birth is equally as impactful to a family as a vaginal birth, and having a doula present can enhance that experience for all involved,” Harley says. “During a cesarean, a doula can help a family feel more prepared, understand their options and enhance communication with the medical team.”
That said, it’s important to clue your medical team into your plans for a doula: They can help you understand how a doula can and can’t help you in the delivery room, and alert you to any relevant policies. For example, some hospitals may only allow one other person in the operating room. “I had a doula and an unplanned c-section and had to make the last-minute decision between my husband or her,” says Annabelle, a mom of two. “I ended up choosing my husband but felt a bit cheated.” Knowing what limitations your doula may have to work with can prevent disappointment later on.
While hiring a doula is by no means necessary, there are many benefits to having one by your side. Childbirth is a momentous event that can be both physically and emotionally challenging, so having someone with you throughout the experience who can not only be your cheerleader, but also help your labor progress successfully and ease your pain is a definite boon. “We have no family nearby, and my husband felt that he (and I) could use someone else there at labor and delivery who knew what they were doing,” Sarah, a mom of a 2-year-old, says of her decision to hire a doula. “She had us do some real thinking about how we wanted labor and delivery to go, which was super-empowering and helpful.”
The upsides of working with a doula have been well-documented, and extend to both Mom and baby. “When combined together, research shows that quality healthcare and labor support by a professional doula has the ability to improve health outcomes and reduce risks for mothers and babies,” Harley says. Below, some of the key benefits of having a doula:
• Nonstop support throughout childbirth. Your midwife or ob-gyn won’t be by your side for the entirety of your labor, but a doula will be. “Doulas can provide a continuous presence, while medical providers are often more limited with their time with patients or juggling multiple patients at one time,” Harley explains. What’s more, they can tag-team with your partner. Having a doula in the room allows your plus-one to get rest, food and fresh air as needed.
• Less need for labor medications. Women who work with a doula are 60 percent less likely to request an epidural, according to the American Pregnancy Association. (Of course, using a doula shouldn’t preclude you from getting pain medication if you want it.) The use of Pitocin, a drug often used to induce labor, also drops by 40 percent.
• Shorter labor. Research shows that support from a doula can help shorten the duration of labor by more than half an hour, according to the American College of Obstetricians and Gynecologists (ACOG).
• Lower risk of c-section and other interventions. A study found that the presence of a doula lowers women’s odds of having a c-section by nearly 60 percent, and their chances of undergoing a c-section for non-medical reasons by 80 to 90 percent. Labor tools like forceps and vacuums were also less likely to be used during delivery.
• Better outcomes for baby. Research shows that moms who work with a doula are less likely to have a baby with a low 5-minute Apgar score, a test performed on newborns to evaluate their muscle tone, pulse, respiration and more to determine whether baby needs immediate medical care after delivery.
• More positive birth experience. One-on-one support from a doula has been proven to increase the level of women’s overall satisfaction with their childbirth experience.
So how can you find a qualified doula? Word of mouth is a great way: ask your mom friends, Facebook message groups or your midwife or ob-gyn for referrals. You can also head to the DONA International website and search for a doula near you through their online database.
It’s smart to begin your search for a doula in your second trimester; you’ll want ample time to research and interview potential candidates, and then schedule your pre-birth visits without feeling too rushed. But if you decide late in your third trimester that you’d like a doula, you haven’t missed the boat. “I’ve been hired a week before a woman was due to give birth, so it’s never too late,” Nicks says.
When interviewing a prospective doula, consider the candidate’s credentials, level of experience and scope of included services, says Angelia Leipelt, a doula trainer with Dignity Health Methodist Hospital of Sacramento. Some doulas may offer unlimited text support, while others may specify a set number of check-ins in their service package. Some doulas may come to your house as soon as contractions start, and others may meet you at the hospital. Ask how long they typically stay with you after birth, and if a postpartum visit is included in the initial fee.
It’s also important to ask a doula how many clients they take on each month, and what their backup plan is if they’re with another client or have another emergency when you go into labor. In general, doulas plan their calendars out so they aren’t on call for women with the same due dates to minimize the chance of conflict, Leipelt says, but most will set up a secondary doula who can step in and support your labor in their place, just in case. You may be able to interview the backup doula as well.
Last but not least, look for a doula who you and your partner personally click with. “This is an intimate time for families, and it’s important to find someone that helps you feel more comfortable and empowered in your choices and decision-making abilities,” Harley says.
The cost of doula services varies greatly—from several hundred to several thousand dollars—depending on the doula’s level of experience and services. And unfortunately, doula support isn’t generally covered under insurance. But don’t hesitate to discuss your budget with prospective candidates; some apprentice doulas may be willing to negotiate a discount in exchange for the experience. “I think one of the misconceptions we see is that having a doula is a luxury afforded only to some families,” Harley says. Finding a doula in your price range may take a little legwork, but it can definitely be doable.
Deciding to hire a birth doula is a personal choice. Ultimately, you need to weigh your options and consider what’s best for you, your partner and your growing family.
If you’re feeling especially nervous or anxious about your upcoming delivery, you might want an extra person in your corner. Talk to your partner; they also may appreciate having the calming presence of a birth doula. The wonderful truth is that doulas are pros at offering support to all family members, and they can help everyone feel more at ease and empowered during what can be a stressful and sometimes scary experience.
Also consider whether you think you’ll want help relaying your birth plan to your medical team. Your doula will act as your cheerleader and champion for you as you make decisions about pain management, procedures and more. They are great advocates, so if you have trouble standing up for yourself—or would prefer to have someone else take a more vocal role in your childbirth experience—getting a doula might be the right choice. Plus, while they don’t perform medical procedures, doulas are very knowledgeable and can help you understand interventions that might otherwise sound intimidating
Even if you don’t hire a doula for baby’s actual birth, you can still opt to get one for everything that follows. Postpartum doulas are great at supporting new moms in the early recovery period, while also helping them adjust to their new normal.
Doulas provide physical and emotional support and encouragement for moms-to-be and their partners; they can help make childbirth and the transition into parenthood feel less daunting. Still, using a doula isn’t for everyone. It’s your decision, so do your due diligence and choose what feels right for you—after all, it’s your experience. You do you.
About the experts:
Angelia Leipelt is a doula trainer with Dignity Health Methodist Hospital of Sacramento.
Rachel Nicks is a New York City-based doula and fitness instructor.
Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.