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.
In 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
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:
- What is your training? If certified, through what organization?
- Are you available around my due date?
- How many other clients do you have around this time?
- What is your philosophy about birth and how do you most often support women in labor?
- How many births have you attended?
- Have you attended births at my birth location and what were experiences there?
- Do you have experience with my caregiver?
- Do you have a backup doula and will I meet her?
- At what point in labor do you meet up with us?
- How do we contact you during labor? Are you always on call?
- What coping techniques do you find most helpful?
- What are your fees?
- Why did you become a doula?
- 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?