Reasons to Hire a Doula + 14 Questions to Ask First

Benefits of a doula and reasons to hire one

If a doula were a drug, it would be unethical not to use it. ~ John H. Kennell, MD

I’ve had the privilege of serving as a doula dozens of times, for many different types of births, and each time I am still in awe of the strength of laboring moms and the beauty of birth. Certainly, labor isn’t often “easy” (thus the name), but there is a lot of evidence that the presence of a doula can shorten labor and improve birth outcomes.

This is not because of some magical power that doulas have, but just something that women have intuitively known forever- that having another supportive woman who has been through labor herself and who can help take some of the fear and uncertainty away, does wonders during labor.

What is a Doula?

The word “Doula” comes from the Greek word doule, meaning “handmaiden” or “woman who serves.” That is precisely the role of a doula for a laboring woman: to serve the laboring mother and help her have her desired birth outcome.

In essence, a doula is a massage therapist, friend, therapist, DJ, court jester or anything else a mother needs her to be in labor. She is a shoulder to cry on or an encouragement when the mother thinks she can’t go on. Most doulas go through a rigorous training program before assisting women in labor.

What Does a Doula Do?

A doula is trained in labor and childbirth and provides continuous support to a laboring mother. Her focus is tending to and helping the mom and supporting the relationship of the laboring couple. Doulas often support laboring women by:

  • Providing continuous emotional and physical support
  • Giving information if asked and helping the mother find resources to research her birth choices (before labor)
  • Using comfort measures like massage, suggesting different positions and helping with relaxation breathing
  • Accommodating the mother’s wishes for the birth environment (low light, soft music, etc) to the extent possible in the place of birth
  • Encouraging the mother to communicate with her doctor and to be informed about any procedures and interventions (a doula does NOT give medical advice or interfere with the doctor/mother relationship)
  • Supporting the father or birth partner in the best way to support the mother. A doula never replaces the very important role of the birth partner and a good doula will help the birth partner by suggesting ways that he can support the laboring mom and things that can improve their synergy in labor.

What Does a Doula NOT Do?

Doulas are not medical professionals and do not give medical advice. (If a doula ever tries to give you medical advice or directly suggests that you go against medical advice, this should be a red flag).

A doula will also not perform medical tasks like checking blood pressure, doing cervical exams or monitoring the baby’s heart rate. It is never the place of a doula to judge, condemn or go against a mother’s wishes. Doulas do not take over or come between the mother and her birth partner or doctor and should work with other birth attendants.

Unlike nurses and doctors, doulas also do not take shifts or leave during a labor. A doula is continuously with a laboring mother without leaving or sleeping (the longest labor that I supported as a doula was well over 24 hours). Also, unlike medical professionals, a doula does not have other patients or rounds so her single focus is on the mother.

Why a Doula?

Glad you asked… I wish I had before my first labor. I decided that I could “tough it out” and that “labor couldn’t be that bad.” I insisted that I didn’t want anyone besides my husband at my labor. We prepared with Lamaze classes and I read as many books as our public library had about natural pregnancy, labor and birth (68 in case you were wondering). I thought I was prepared.

I was not.

I was really, really, really not.

Here’s what I didn’t realize- when you try to “tough it out” through labor, it hurts more. Partner this with the fear of the unknown since it was my first labor, awful back labor and a horrendous on-call doctor and nursing staff, and I didn’t get the birth I wanted… not even close.

I also naively thought that my doctor and nurses would be there for continuous support, not realizing that while most labor and delivery nurses are wonderful and amazing people, they have many patients at once and doctors often only make an appearance as the head is crowning.

In hindsight, I wish I’d hired a doula and had someone there to answer my questions and give me support. A family member showed up to “help” but for me, this actually made labor more difficult because I was more guarded around this person (I confirmed this when that same person was there for my second birth and it was LONGER than my first). How I wish I’d had a doula.

Turns out, I would have had a better chance statistically of getting the birth I wanted if I’d had a doula.

Benefits of a DoulaIn fact, a Cochrane review published in 2012 found that in labors with the continuous presence of a doula, laboring mothers experience:

  • Reduced use of pitocin
  • Decreased rate of interventions during labor
  • Less need for pain medication and less requests for epidural
  • Higher satisfaction with birth outcomes
  • Much lower c-section rate
  • Higher chance of a spontaneous vaginal birth
  • Shorter labors

The American Journal of Managed Care reported in 2014 that:

Doula-supported women had lower odds of cesarean compared without doula support and those who desired but did not have doula support (AOR = 0.41, CI, 0.18-0.96; and AOR = 0.31, CI, 0.13-0.74). The odds of nonindicated cesarean were 80-90% lower among doula-supported women (AOR= 0.17, CI, 0.07-0.39; and AOR= 0.11, CI, 0.03-0.36). (source)

The Cochrane review also compared doula support to other types of labor support, including support by hospital staff, support of a friend or relative, or partner support and found that doula supported mothers had the best outcomes. This is not to discount the very important role of family and birth partners, but to show that doulas can provide additional help to a laboring mother.

Other studies have shown that the best outcomes occur when a woman is supported by a doula, along with a supportive hospital staff and birth partner (source).

Benefits of a Doula: From the Moms

I’ve found that best reasons and encouragements to have a doula come from other moms who have experience with doulas:

I wish I would have hired one for the birth of my first child, who ended up being born by cesarean after “failure to progress”. At the time, I thought I was prepared since I had taken a childbirth class. The second time around I educated myself, switched to a provider with a lower cesarean rate, hired a doula and had a beautiful vbac birth in the hospital. Having a doula made a huge difference. She told me what to expect, helped me get into positions that would encourage the baby to be in position, she kept me calm and relaxed. I would not have had the birth I did if it wasn’t for her. – Laurie

I had a doula for my second birth! She was amazing at helping with pain relief. She kept me relax. So my husband was able to focus on being with me and comforting me in a way only a husband can. But my doula definitely made it a beautiful and empowering experience. -Megan

Can’t say enough about their value! So helpful in many ways, supportive, advocates, and it’s nice to have clear mind around when you and your husband aren’t thinking straight! -Beth

I had a doula the second time around and wouldn’t have had it any other way. My goal was to have a drug-free birth and that is what I accomplished. She helped me with my labor at home, then went to the hospital when I was nearly ready to push and delivered my beautiful baby girl! -Laura

I had a doula and I was able to give birth to my daughter naturally. Based on how my labor progressed (s-l-o-w) and the way my daughter was positioned (sunny-side up), I believe I would have ended up with a C-section. In the moment, it really helped to have someone encouraging me to try one more thing before getting an epidural. It was a really, really hard labor, but it was worth it. Super alert baby and took to the breast like a champ. That was my goal. -Lesley

Great resource for myself and my husband. It was our first baby, and we found ours through a local midwife. She was dedicated, took the time to get to know us, and our vision for our birth. She met with our OB ahead of time and really helped by being another person of support during the final month of pregnancy, birth, and the time after.

Highly recommend, especially if like in our case, it’s your first, and you don’t have any family you want to be there. Hooray for Great Doula’s! – Kristine

And so many more

Interview Your Doula: Questions to Ask

Many women benefit from having a doula, even if planning to have an epidural or other medications. Doulas can be helpful in a hospital setting, at a home birth, a birth center or any other birth scenario but it is important to make sure that a prospective doula is a good fit for everyone involved.

Most doulas will have an initial meeting with a couple to answer questions and see if it is a good fit and several follow up meetings before delivery.

Important questions to ask when considering a doula:

  1. What is your training? If certified, through what organization?
  2. Are you available around my due date?
  3. How many other clients do you have around this time?
  4. What is your philosophy about birth and how do you most often support women in labor?
  5. How many births have you attended?
  6. Have you attended births at my birth location and what were experiences there?
  7. Do you have experience with my caregiver?
  8. Do you have a backup doula and will I meet her?
  9. At what point in labor do you meet up with us?
  10. How do we contact you during labor? Are you always on call?
  11. What coping techniques do you find most helpful?
  12. What are your fees?
  13. Why did you become a doula?
  14. Have you given birth yourself? Did you have a doula? What were your birth experiences?

It is also really important to connect with your doula and feel like you can trust her. She will be with you during one of the most intimate and vulnerable times in your life, so your comfort with her is vital.

How to Find a Doula?

If possible, I recommend talking to friends who have used doulas and getting recommendations. This will help you get an idea of the doula’s experience and personality before meeting with her and make the process easier.

There are also websites, like DONA International, that have a “Find a Doula” feature to let you search for birth and postpartum doulas in your area. This is the organization I trained with and I know many other wonderful DONA doulas.

A Note on Cost…

The cost of a doula varies greatly depending on where you live. Doulas who are working toward certification may offer discounted or free rates, while some celebrity doulas cost thousands of dollars. In general, the rate seems to be $400-800 in my area. In some areas, insurance will cover this, but often it does not.

When insurance does not cover the cost of a doula, it can seem like a tremendous expense, but the presence of a doula can help avoid costly interventions and often helps improve the birth experience. If there is one thing I’ve learned through my five pregnancies, it is that birth experiences stay with you for a very long time and can impact you deeply. I wish I had prioritized protecting my birth experience more with earlier births.

Also, when all costs are taken into account, the average doula only makes $10-15 an hour for her time in prenatal meetings, labor support, and follow up. I personally volunteer as a doula for friends and women with a need for labor support (single parents, husband deployed, financial need, etc), and many doulas are willing to barter, accept payment plans or work with a couple on cost.

Have you had a doula? What was your experience?

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Reader Comments

  1. Katie,

    You are so amazing. Thank you THANK YOU so much for writing this. This is so inspiring. I am currently infertile because I am so sick (hormonal imbalance, candida, NAFLD, and testing for more) but because of sites like yours that offer so much help, I KNOW I will heal, I KNOW I will have my children, and I have been praying that I would get a good doula so when the time is right, my kids have a healthy start and not a sick start in a hospital with no clue what they are doing to me. Now I have the information I need to find a good one.

    I don’t know how to thank you for all the help you’ve given to us all. From your recipes, to your advice, I will pray for you and your family that you are healthy, happy and thrive and continue to be extremely successful in what you do. For all the things you’ve contributed to REAL health, you deserve recognition. You are a blessing and a gift. Truly.

    I really appreciate you, admire you, respect you, and love you – because YOU HAVE made the world a better place.

    Sincerely,

    Lisa Beaulieu in Canada

  2. I never had a doula, but I delivered with midwives each time–they tend to stick around more than the doctors and nurses it seems. Mine were with me the entire time once I reached 5cm. And I made sure that anyone who might make me feel uncomfortable was not allowed in the room. This meant that my mom was not allowed in, which was hard for her, but since I was the one in labor, I figured that what I say goes.

  3. I must say I’ve had 6 children and never a doula. But my first 5 were born at home with amazing midwives. They were accompanied by at least one person and a doula wasn’t needed at all as home birth midwives are with you, for you every minute. BUT…#6 was born in the birthing center of the local hospital with midwives and boy a doula to deal with the medical staff alone would’ve been so helpful. I would love to be a doula someday, and Katie I bet you are an amazing one!!! I think they are absolutely under appreciated and hope this article will raise awareness. You cannot under estimate the support you will need in labor, especially if you are on someone else’s turf, rather than the comfort of your own home.

  4. All my births were with midwives at home. Wonderful! But i think doulas are invaluable as well!
    Have you ever written on the Bradley Method of natural childbirth? That is what we used and I found it SO HELPFUL!! I used every bit of it. My mom didn’t like Lamaze, so I went searching for another way, and that was such a blessing. I was able to relax, let my body work. My midwives and my husband just had to support.

    • May I second that about the Bradley method!! It is far more educational than Lamaze, IMHO. We have been told at all 6 of our births that we do amazing and I KNOW the Bradley training is what made the difference. You cannot under estimate the training and prep for the father, Bradley method empowers him to be an active part and support the mother through the ups and downs. When that baby is born he KNOWS he was a part of that! If anybody lives in the Phoenix Arizona area, Carol Denny is an amazing midwife and Tona Bailey was our Bradley teacher. They are amazing. I have been told I am very tough by my OB after my miscarriage and D&C, but I’m not! It’s just that I’ve learned how to handle pain from the Bradley method, and I apply it to all areas of my life.
      Ok, I’m stepping off my soap box now 😉

  5. I was lucky, I didn’t have to hire a doula because my mom is oneBut I’m the kind of person who would rather give birth alone in the woods haha. I didn’t want anyone touching me. She did have some good suggestions, and I think my husband was glad to have some support 😉

  6. Another question I would add to that list would be: what are your recommended hospitals? Not all of us who use doulas will give birth at home and they would know which hospitals in the area are more midwife/doula friendly — this makes it easier on you, then, your birth plan wishes, etc!

    I had a doula with my daughter and I’m so glad I did even though I was the small percent that did have to get a c section after nearly 30 hours. I had 3 different doulas “decline” me without reason, and the doula I ended up choosing told me it was because I had chosen a hospital that was not midwife/doula friendly and it makes it so difficult for them (granted the doulas should have told me that!) so I changed hospitals and it was better on everyone. I’d have her again in a heartbeat!

    • I’m not sure how long it’s been since your last birth, but I think hospitals are making a movement towards a more supportive, natural approach. I only had my babies 1.5 years apart, but it was night and day! I had planned out of hospital births for both, but unfortunately had to be transferred each time. With my son they just wanted to strap me to the bed with monitors and try to talk me into pain medication. I don’t think they liked my noises haha.
      With my second they asked me right away if I wanted a natural birth, and when I said yes they said they wouldn’t offer pain medication unless I asked. They also let me use an intermittent portable monitor so I could be walking around and in the shower. Then they automatically delayed cord clamping and did skin to skin for an hour straight as soon as she was born. I didn’t even have an IV, and it was an induction!

  7. i want to have one more baby. Baby number 4. I really want a doula to help me have a natural drug free birth. with my third baby I ended up getting a bit of pitocin and one dose of pain med in my IV. I was really sad I gave in because my husband kept telling me the baby needed to come out because I wasn’t dilating. Long story short he was getting scared and didn’t want to put baby at risk. It had been 17hrs water ruptured and no contractions. I want to have at least one natural birth.

  8. I’m about to have my second child and I decided to hire a doula this time! Seeing this post reaffirmed the decision. Yes, it is another expense but I REALLY want to have a wonderful natural birth, and my experience with my first showed that my husband and I alone really don’t have the tools to achieve that especially in intense situations (I’m right with you on the HORRIBLE back labor). Although I’ve already hired a doula, it was great to see that much of what I asked went along with what you suggest 🙂 Thank you!

  9. From one doula to another, thank you for the support! I have been reading your blog for quite some time now and I love to read your posts related to pregnancy and birth. Being a birth worker is a challenging and rewarding career and definitely beats the 9 to 5.

  10. Our doula was THE most important factor is achieving a natural birth.

    At first I though having midwives would render a doula obsolete. I was very worried that it was an unnecessary cost. However, my labor started on a Friday eventing and didn’t result in our son’s birth until Monday afternoon. Being able to call the doula and describe the labor as it advanced, being able to leave the decision of when to call the midwives to her, and then having her presence a full 12 hours before the midwives came was essential. Giving birth was ridiculously difficult and a great doula made the difference. In the end, the cost was worth it.

  11. I’m due with our third in October and we are prayerfully planning our first homebirth! I appreciate all your posts on natural childbirth.

    I would actually love to BE a doula! I’ve done research on doula training programs and it sounds like something I would love to do.

    I’m a stay-at-home (new homeschooling) mom to a four-year-old, a two-year-old, and our soon to be newborn. I love being at home with our children.

    So I’m just wondering, with your five children, how do you find childcare for the times that you are working as a doula? I don’t have a babysitter for my children, and it seems complicated – and expensive – to find someone who could watch my little ones at a moment’s notice, random times during the month.

    Thanks for your advice and tips.

  12. Hello Katie,

    Congratualtions on your pregnancy!!!! I am so happy for you!! And not to be selfish with your exciting time, it comes at a perfect time for me. I am also pregnant – first time – and have so many questions… As an experienced mother and doula, I am hoping you can help me cope with a few things.

    1- I would like to use a doula more than anything. My husband does not feel it is necessary. He is an incredible man – a traditionalist and a care taker. We have had some lengthy conversations about all of the benefits, and he feels equipt to do everything a doula would do just from reading. He feels hurt that I would question his abilities to care for me. So, that being said, I am hoping you can share some tips / tricks / techniques that I can share with him to help me be as calm and happy as possible through a natural childbirth. (I would benefit from breathing and meditation tequniques. I am a yoga teacher and love breath work! – My husband doesn’t ‘get it’ and I know I will need this. He would benefit from any position change instruction and massage / pressure point techniques).

    2- My midwife has recommended a great birth class that encompasses patterned-pace breathing, partner coaching / Bradly Method, position coaching and hypnobirthing… however, this is basically a crash course and am wondering if you could recommend some reading or other tools to learn a little more on these methods – reading that is easily understood and easy to follow.

    3- Lastly – baby books. I dispise the baby books. I have gotten through half of 1 book and I am 22 weeks in the game. My husband has gotten through 4 or 5 and know way more than I do about what is going on with me (I can’t help but laugh). Any good ones that you have liked? I am open to reading things that would apply to pregnancy as well as birth and caring for your infant / getting on a scheddule etc.

    So sorry this is so lengthy – I am so tickled that you are expecting, and am SO looking forward to all of the emails / blogs etc of helpful mommy hints – and baby products to make at home. Oh, one more thing – any good info on breast feeding / lactation and pumping you have found?

    Thanks a million for all of your blogs/recipes etc. I love reading them and bringing more natural health to my family.

    Namaste,
    Aubrey

  13. Question for everyone out there: Are there any major or compelling reasons not to hire 2 doulas? My husband and I are considering this because there is a good chance he will be out of town for work when I go into labor and we want to make sure I have as much support as I need (we also opted out of Bradley coaching for this reason… Don’t want my coach to be MIA). I just don’t want to commit an industry faux pas or upset my doula(s). I don’t want it to look like I am suggesting that either one, for example, is not competent. My best choices right now are an intern (free through my birth center) and an independent, certified, and experienced doula who is costly. We like both ladies, and would like to work with both if possible. Any thoughts or advice?

  14. Hi Wellness Mama! I am nearing the end of the first trimester of my first pregnancy, and am almost certain I want to hire a doula. At what point in my pregnancy should I reach out to potential doulas and begin interviewing? To complicate matters, I am moving to a new state two months before my due date, so would not be able to meet in person much before that point anyway.

  15. I couldn’t agree more! I thought I could do it alone, have a natural, unmedicated labor but I was so wrong. I thought the books I read, and the hypnobirthing exercises would be enough to guide me through but turns out it’s not that easy. It was my first pregnancy, I was so scared of the unknown and I caved and opted for an epidural. I still had a great experience but it was not how I imagined. So yes, hire a doula! Especially if you are thinking about having a natural, unmedicated birth.