Everything You Wanted to Know About Birth Doulas

15 Min Read

While more and more women are utilizing the valuable support of birth doulas, many are still unsure what a birth doula actually does. To put it simply, they supply physiological and psychological support before, during and sometimes after childbirth. They act as the birthing mother’s right-hand woman (or man), helping to make the experience happy and as stress-free as possible. Doulas are not medically trained, and do not administer medicine or perform clinical or medical tasks, but their presence can still be incredibly beneficial to the mom, baby, and birth companion.

Each birth doula will slightly differ in their offerings, but following are the typical answers to queries about birth doulas.

Does a doula take the place of my birth companion? Absolutely not, a doula just offers additional support. They are there to guide you and your companion through techniques for pain relief and emotional comfort, while also supporting your birth companion in staying fed and rested. Often, the guidance a doula provides allows you and your companion to engage in more quality bonding.

What’s the difference between a midwife and doula? A certified midwife is a trained medical professional who went through years of training to have the expertise to safely deliver a baby. They are typically able to provide almost all the same care as an obstetrician, with the exception of a c-section. While many midwives also provide emotional support, their main role is to keep the mother and baby safe before, during and after birth. Birth doulas on the other hand have no medical training and are not required to go through any type of certification. Their sole responsibility is to provide emotional and physiological support.

How often will I see my birth doula? Many birth doulas have two or three prenatal appointments with women and their partner during pregnancy. These appointments typically last about an hour and might consist of the doula helping you create birth preferences, pack your hospital bag, prepare the birthing space (in the case of a home birth), discuss a plan for when you go into labor, and anything else you and your doula think would provide support and strengthen your bond with one another.

Most doulas also offer continuous phone support, allowing you to contact them anytime about questions, or a need for emotional guidance. Birth doulas are also on-call for the two weeks before and after your due date, hopefully ensuring that they’re available to provide support at a moment’s notice when you go into labor. The doula will then be with you through the entirety of birth, only leaving after it’s confirmed that you and baby are doing well.

Many doulas also offer at least one appointment after you’ve brought baby home to process the birth experience, and answer any questions you have about recovery or baby care.

What’s the difference between a birth doula and a postpartum doula? A birth doula provides support during pregnancy and childbirth, while a postpartum doula helps you in the first few weeks, or even months, of the baby’s life. Postpartum doulas often provide emotional support and breast-feeding assistance, perform household chores, and offer any other (nonmedical) support your family needs. Your birth doula may offer postpartum services as well.

What are the specific tasks a birth doula performs? While each doula is a bit different in how she provides support, these are the tasks you can typically expect them to perform.

Provides continuous emotional support: helping to reduce fears and anxieties, and bolster confidence and a sense of empowerment.
Provides information about birthing terminology, and offers an explanation of various interventions the care provider might be suggesting. However, birth doulas do not give medical advice, that is the job of the birthing person’s midwife or doctor.
Offers pregnancy and birthing massage.
Acts as a buffer in “harsher” birthing environments.
Facilitates bonding between you and your companion.
Offers aromatherapy.
Offers acupressure.
Provides visualization prompts.
Leads you through breathing techniques.
Provides assistance with various relaxation techniques, such as hypnotherapy.
Advocates for you and your birthing preferences.
Sets up the birthing tub.
Assists with various birthing positions.
Serves as photographer and videographer.
Offers breastfeeding support.
Provides infant care training.
Prepares food.
Offers postpartum clean-up.

Is a birth doula worth the money? Absolutely. A good birth doula can reduce fear of childbirth, minimize your chance of receiving unwanted interventions, and can significantly enhance your overall birth experience. They do this by providing an amazing combination or tender care, empathy, objectivity, and knowledge, creating a birth environment that makes you feel safe and fully supported.

The peer-reviewed Cochrane Database of Systematic Reviews published an article on the benefits of having the continuous support of a doula during childbirth.1 The authors merged the results of 22 trials that included more than 15,000 thousand women.

Women who received continuous support during birth were more likely to have a spontaneous vaginal birth and were less likely to have medical interventions such as epidurals, forceps-assisted birth, induction medication, and cesarean sections.
The women who received this support had labors that were about 40-minutes shorter, on average, than the deliveries of women without continuous support.
These babies were more likely to have higher Apgar scores (a quick test done on babies a few minutes after birth to summarize their health) than babies whose mamas did not have continuous support.
When a doula was the individual providing the continuous support, the following results were found:

* 31% decrease in the use of synthetic oxytocin (Pitocin)
* 28% decrease in the likelihood of a C-section
* 12% increase in chance of spontaneous vaginal birth
* 9% decrease in use of pain medication
* 14% decrease in chance of infant being admitted to the NICU
* 34% decrease in chance of the mother being dissatisfied with her birth experience

How do I find the right doula? When selecting a birth doula, ask for referrals from local moms. Then, create a list of questions to ask prospective doulas, as they will help you get a good sense of whether or not the relationship would be a good fit. Here are some questions to get you started.

What’s your birth philosophy?
Where were you trained?
How many births have you attended?
Where do you usually attend births?
Do you provide a backup doula? Will I be able to meet them?
Will I be charged more if the backup is called to attend my birth?
When do you go on-call for my birth?
Will you work with women who are due around the same time as me
What will you do if we go into labor at the same time?
How do you typically support a woman during birth?
How soon can you be available when I go into labor?
Will you stay with me for my entire birth? Regardless of how long it takes?

Will a birth doula push their beliefs on me? A quality doula will put her views of birth aside and support you in whatever type of birth you’re hoping to have. For example, if you’ve decided you want an epidural, your doula should not try talking you out of that decision, regardless of their personal beliefs. Unless you specifically ask them to share their thoughts on a certain aspect of birth, they should keep their opinions to themselves.

Can doulas attend births in hospitals and birth centers? Doulas are allowed to attend births in all locations. The only exception is a cesarean birth, as the woman is typically only allowed to have one companion in the operating room. If the woman doesn’t have a companion, the doula can be with her during the surgery. As a doula, I’ve supported moms having c-sections by posting-up in the waiting room in case I’m needed. In some situations, the birth companion had to be with the baby in the NICU, and I would support the mom in the OR as she received sutures. I also provide care after the mom and baby are in the recovery room.

How much does a doula cost? The rates doulas charge often range from a couple hundred dollars to more than a thousand, depending on how much experience a doula has, and where they work. For example, a doula with years of experience who works in a city will likely charge more than a new doula in a more rural area. In addition, doulas specializing in certain areas, such as massage or hypnotherapy, might have higher rates because of their additional training. However, many doulas provide sliding scales, so it’s worth asking if they can work within your budget. It’s also worth asking your insurance company if they cover doula support. Many do not, but it is sometimes covered (or at least partially covered) under the umbrella of “out of network” services.

While many mothers can feel overwhelmed by the flood of to-dos during pregnancy, and wonder if they have the bandwidth to search for a doula, most find that this effort more than pays off. Because, at the end of the search, they often have an invaluable advocate dedicated to helping them have the birth of their dreams. And the sense of security this advocacy provides allows women to relax into their pregnancy and birth experience, confident they’ll be supported mentally, physically, and emotionally. All in all, if you're curious, hiring a doula is well worth your time and money, as they help you claim your right to an empowered, well-informed, and nurturing birth experience.

References

1Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. “Continuous support for women during childbirth.” Cochrane Database of Systematic Reviews. 2017, Issue 7. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub6.