Advancements in technology, industry, and business have brought about many changes within the last century. Society has likewise evolved both for better or for worse. Among these evolutions has been a big shift in the standard process of childbirth. Back in the day it was fairly normal to live near extended family and close friends, so it was very natural to have many of them support a woman during labor and delivery. As we have changed over time, it is now more common to live far away from family and delivering in the hospital has become the norm. A side effect from these changes is that mothers have lost the standard support team of women around them while they labor. A possible replacement for this lack of support is to hire a doula. Despite the myriad of positive benefits of a professional doula, only a small percentage of people utilize them. Many newly pregnant people often wonder if a doula is a worthy investment.
Benefits of having a doula
Many studies have been conducted that show the positive effects of doula support, although currently only about 6% of people use one. These benefits include, but are not limited to: decreased labor time; and a lower rate of epidurals, c-sections, pitocin administration, and instrumental assistance during delivery. Those who hire a doula also tend to have a much more positive view of their experience. When they feel safe and protected, they let go of fear (which interferes with progression). Stress levels decrease, and natural oxytocin levels rise, thus encouraging labor advancement. After babies are born, they are more likely to have higher apgar scores (Hodnett, Gates, Hofmeyr, Sakala, & Weston, 2013), and there is an earlier initiation of breastfeeding as well.
Do I need a doula?
There are many known benefits of doula support during labor, but do you really need one?
The large majority of people deliver babies in a hospital and are left to the care and attention of a medical team. A staff may be concerned and aware of a birthing person’s physical and emotional needs, but they are often distracted by their duties as part of hospital procedure and policy. A nurse, midwife, and doctor all have their own specific tasks to complete—monitoring the baby’s vitals, reading charts and logs, making sure mom is hydrated, and has good stats, etc. They are preoccupied with the safety of mother and baby and are also overseeing a large number of other laboring people at the same time. They will be in and out of the room constantly, and even monitoring birthing people from machines in the hall. Think of all that is going through the minds of these healthcare workers during delivery.
Making sure baby’s position is optimal, providing perineal support, trying to prevent tearing, coaching mom how to push, monitoring baby and mother’s vitals, assisting the baby when it emerges, making sure the baby is breathing, checking apgar scores, cleaning things up, performing sutures, baby care, delivering the placenta, avoiding hemorrhaging, and keeping things sterile. They have so much going on mentally and physically that although they may be sympathetic to the birthing person’s needs, they cannot be too preoccupied with them. Plus they have other patients simultaneously.
A Doula’s Purpose
Conversely a doula’s primary purpose is to provide emotional, physical, and informational support for the mother for the entire duration of labor, and afterward. A doula will be solely focused on you and at your side continually. But what if you have a partner, sister, mother or friend with you? It is highly recommended to have support from people you love and trust. Yet keep in mind that your support group is not always specifically trained in how to care for a laboring person, no matter how much they love you, whereas a doula is. In order to become a certified doula, a candidate must meet many qualifications. DONA International, “the international leader in evidence-based doula training, certification, and continuing education,” requires that a doula meet the following criteria:
- have a minimum of 28 hours of labor support time logged
- read several required textbooks on labor and birth
- attend at least 3 births and be evaluated by a doctor, nurse or midwife, and the mother.
This knowledge and skill set put into practice is truly invaluable in knowing intuitively how to support a laboring mother.
Doula Services Prior to Delivery
A doula will usually meet with a client about two times prior to your birth. During these meetings, they will get to know you a bit, get a feel for what your birth vision and preferences are, and help with a birth plan. They can address any concerns and fears you have about birth, and offer educational materials to review. They will learn about your personality and what calms you, as well as what gives you a boost when you are tired, and how you best anticipate needing support.
A good doula will also be well connected to the birth community for additional support and education. This can be a great resource for those wanting to gain more childbirth education and to get involved with other moms and resources in the area.
Doulas Stay With You the Whole Time
The best thing about doulas is that they are usually available as early as you’d like them in the process, even from the first few contractions. They can come to your home and be with you while you labor there, then transfer with you to the hospital. One of the main advantages to hiring a doula is that you meet them and know them before you go into labor, whereas your nurse and perhaps the doctor on call at a hospital can be complete strangers. Having your doula with you can help you feel more at ease when you arrive. Another advantage is they will stay right with you whereas doctors and nurses, and sometimes even partners will be in and out throughout the process.
Doulas Support Your Partner Too
Doulas are also valuable resources for birth partners. A doula does not replace a partner’s support; rather assists both parties. They can allow the partner the main role of offering words of encouragement and emotional support while providing some physical support, and vice versa. They can offer suggestions of what a partner can do to help you. They can also support the partner should they start to feel anxious or overtired. In one recent study, it was recorded that on average, doulas touched the laboring person 95 percent of the time, as compared with less than 20 percent by male partners. This in no way discredits the helpfulness of a partner, but rather sheds light on the fact that a doula and a partner may have different primary roles. In the end, your doula will be able to read signals from you and your partner of what their needs are in the moment.
A doula’s job is to be there for the birthing person and to encourage a safe and satisfying birth experience. They provides three kinds of support—informational, physical, and emotional.
Physical Support from a Doula
A doula draws upon their knowledge of many different labor positions and offers suggestions to the laboring person to help ease discomfort and keep labor progressing. They can offer massage or counter pressure, adjust your temperature with blankets or cool washcloths and fans. They can help to implement breathing and relaxation techniques, and will offer verbal reassurances. A doula can offer ice chips, drinks, and food if the hospital allows it. They remember things you might not think of like to use the bathroom frequently. A doula knows your preferences and will guard the atmosphere so it remains as calm and peaceful as possible. This is invaluable, especially when the birthing person is focused and does not want to be bothered with details.
Doulas Offer Informational Support
A well-trained doula will be aware of the hospital policies where you are delivering, and will know what kinds of things are allowed and/or prohibited. They can offer advice and information if the birthing person has concerns or questions. A doula can be a liaison between the staff’s medical jargon and the procedures that are happening. Should unexpected complications arise, a doula can offer extra information, advice and encouragement for big decisions.
Emotional Support from Your Doula
Should some unexpected things arise during the course of the labor, a doula can offer emotional support and encouragement, especially if a c-section or epidural is ordered. They can help to ease fears and guilt and allow you to process your potential anxiety or confusion.
Keep in mind that a doula is not only valuable for those planning an unmedicated birth, but for all kinds of deliveries. Birth can be an unpredictable event. Even if you plan on getting an epidural or having a planned cesarean section, a doula can offer tremendous emotional guidance during the process. They can help to aid in your comfort level both physically and mentally. They can be aware of the details that are happening while you are “in the zone.” If a lot of information is being thrown at you all at once, and you may already be overwhelmed—it can be hard to process and remember what is being said. A doula can be a valuable second set of eyes and ears to absorb information and help answer your questions.
Postpartum Doula Services
Many doulas will offer care for postpartum as well and charge an hourly rate. Their tasks can range anywhere from breastfeeding support, emotional support, physical care and healing, to cleaning, cooking meals, or taking care of the baby so you can rest. They will usually offer services up to a certain amount of time (like 4 hours), and some will even offer to sleep over and help with night feedings for an extra fee. The postpartum period can be a difficult time, especially for brand new parents, and the aid of a doula can be very valuable, so it’s something to consider. Even knowing the option is available can put one’s mind at ease.
An Example of a Positive Doula Experience
Elaine Stillerman of Massage Today tells of her positive experience with a doula.
“I called Ilana when I became pregnant. She came to my home to interview me and my husband about our hopes for the big day. Ilana took copious notes in the attempt to get to learn my likes, dislikes and what would be most helpful during labor. She gave us a realistic list of items I would need to make my labor more comfortable. Since then, I have provided my clients with that invaluable list and offer it in my textbook.
When the day came, Ilana had just returned from another birth she had stayed at for 13 hours. She had been home for two hours when I called. “Don’t worry,” she said, “I’m on mommy time.” My water broke and I went into active labor within minutes. The contractions were coming one after the other. She asked to hear a contraction. Did this mean put the phone on my abdomen? Or did she want to hear the sounds I was making? By this time, all rational thought was out the window. “What?” I asked. “Let me hear a contraction,” she repeated. Mine were silent. “I’ll meet you at the hospital.”
Once there, she directed my husband to get a different nurse and a private room for me. She disappeared for a few minutes and came back with a pile of waterproof pads and clean gowns. She opened her bag of goodies and asked if I was hungry or thirsty. And she held me. She massaged me. She danced with me. When the pains got intense, she took my face in her hands and said, “Give me the pain. Give it to me.” And the pains lessened.
When I felt I was losing strength, she told me to relax my feet and let Mother Earth’s power help me. She stayed by my side for 19 hours, encouraging me, honoring my efforts and nurturing me. And when my son was born, she told me how magnificent I had been. A week later, Ilana came to my home for a visit, bringing lunch, gifts, pictures and my birth story. We shared a life-affirming experience and I wasn’t going to let her out of my life since she had been such an important part of it.”
If this sounds like an experience you’d like to have, it is worth looking into hiring a doula.
How to find a doula
There are a few resources to help with finding the right doula for your specific needs. You’ll want to read reviews, choose several options, and then interview them to get a feel for the right fit for your personality. Here are some places to look.
- Dona.org – Doulas of North America
- Cappa.net– Childbirth and Postpartum Professional Association
- Alace.org– Association of Labor Assistants and Childbirth Educators
- Birthcenters.org– National Association of Childbearing Centers
- Doulamatch.com– online database of certified doulas, where you can search by state, years of experience, and price.
Doctor or Midwife Office- many offices have a list of doulas in the area or that they have personally worked with before. This is a great sign that the office is mother-centered and practices evidence based birth!
Hospital—Similarly, some hospitals have doulas on staff full time that they offer to laboring mothers.
Doula Education and Services for the Black Community
- Sista Midwife Productions (https://www.sistamidwife.com/): Doula training and education for Black community. Follow on instagram @sistamidwife and facebook
- National Black Doula Association (https://www.blackdoulas.org/): Overall mission is to help fight the Black Maternal Mortality rate in the U.S. and beyond, through education empowerment. Provides a professional business directory and resource for Black Doulas & Trainers in the childbirth industry.
- Sese Doula Services (https://www.sesedoulaservices.com/): Doula services in Bronx, NY. Follow on instagram @sese_doula
- The Black Doula Project: Providing free doulas to Black parents in DC and Baltimore. Donate here. Follow on instagram @blackdoulaproject
- Why maternal outcomes are worse for Black women and what doulas are doing about it: (nyc lens) video
- Radical Doula (https://radicaldoula.com/): Where social justice and birth activism meet. Follow on facebook
What does a doula cost?
A doula’s services can range anywhere from about $300-$1800. They will usually charge a down payment upfront and then collect the rest after delivery. Many doulas are willing to work with you on price if you are not able to afford their fee. Some believe that everyone has a right to have the support they need. Don’t rule someone out just because their fee is high. Check with them first and see if it is flexible, or if they would accept a payment plan. Some insurance companies are now helping to cover the cost of doulas as well, so check there to see if you qualify.
Having a baby is in itself a monumental accomplishment. A doula can provide the additional physical, emotional, and informational support a mother needs to navigate labor and delivery more easily. Your birth experience is one of the most significant experiences you will have in life. Consider enlisting the aid of a doula to make it the most positive experience you can.
- Bolbol-Haghighi N, Masoumi S, Kazemi, F. “Effect of Continued Support of Midwifery Students in Labour on the Childbirth and Labour Consequences: A Randomized Controlled Clinical Trial.” Journal of Clinical and Diagnostic Research. 10. 9 (2016):QC14-QC17. Effect of Continued Support of Midwifery Students in Labour on the Childbirth and Labour Consequences: A Randomized Controlled Clinical Trial-PubMed-NCBI. Feb. 2017. https://www.ncbi.nlm.nih.gov/pubmed/27790526
- Stillerman, Elaine. “In Honor of a Doula.” Massage Today. Dec. 2008. Massage Today Digital Issue. Web. Feb. 2017. http://www.massagetoday.com/mpacms/mt/article.php?t=38&id=13902
This guest post was written by Austyn Smith.