What Is a Doula?
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? Read on to learn what services birth and postpartum doulas offer, and how to choose the right doula for you.
To be clear, a doula is not a midwife or a physician, and doesn’t provide any medical care. Instead, a doula is a trained birth coach who offers physical, emotional and educational support for the mom, either during labor or the postpartum period.
“Physicians, midwives and nurses all play their own important part in the clinical health of the mother and baby. Doulas compliment 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, she’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 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, she can 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, she 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 she completed her training, what her training involved and how many births she has attended before you hire her.
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.
“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 her 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, she 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. She can also serve as an advocate for you and work with your medical team to make your wishes known.
• 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.
• 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. 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 2014 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. 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 she typically stays 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 she takes on each month, and what her backup plan is if she’s with another client or has 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 her 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.
How much does a doula cost?
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.
Updated January 2018
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