All About Doulas

What is a doula?

A doula is a labor support professional who “mothers the mother” during childbirth, as well as during the prenatal and postpartum periods. Birth doulas provide support to pregnant women prenatally, through labor and birth, and in the early days postpartum. Postpartum doulas provide in-home services to families, typically lasting from three weeks to three months, or longer with special circumstances. Some doulas combine the birth and postpartum roles into a complete service package, thereby offering continuity of care throughout the childbearing year.

Doulas are non-medical care providers. Their role is limited to educational, emotional, physical, and logistical support. They do not provide clinical care such as taking blood pressure or checking dilation in labor, nor do they give medical advice. A “doula” who offers vaginal checks at home in early labor, for example, may be offering a service that you find desirable, however her role is more accurately described as “monitrice” (a clinical role which falls somewhere in between the doula and the midwife role). Postpartum doulas are not “baby nurses,” but a nurse may offer in-home care to postpartum families. Likewise, a “doula” who “prescribes” homeopathic or herbal treatments to support healing also may be offering a service that you value, but she is operating outside of the scope of practice of the doula professional.

All doulas provide information, emotional support, and comfort measures such as massage, hydrotherapy, and enhanced relaxation. Doulas enjoy providing attention to expectant parents and getting to know their clients prenatally. By the time you go into labor, your doula has become a trusted friend and mentor. During labor and birth, doulas feel privileged to be present and helping at such a sacred and joyful event. Postpartum doulas simply love hanging out with new moms and their babies! Your doula is there to support you in your choices and to provide concrete physical and logistical support. Doulas do not take the place of dads, partners, or other family members who want to help you. Their job is to facilitate everyone’s optimal participation at your birth, as well as to provide support to the entire family through the postpartum recovery and adjustment period. If you are a single mother, your doula can serve as your primary support person so that you are never left alone in labor.

A selection of services provided by birth doulas

Nutritional counseling
Tips for coping with discomforts of pregnancy
Preparation for birth
Assistance in creating a birth plan
Support at home in early labor
Comfort measures in labor
Massage
Suggestions and support for positioning in labor
Continuous support throughout labor and birth
Troubleshooting for difficult births
Facilitate communication and informed decision making with your health care providers
Support for dads and partners
Natural birth coach and advocate
Support for VBAC (Vaginal Birth After Cesarean)
Cesarean and post-cesarean support
Respect for the bond between mom and baby in those tender early hours
Encouragement and skilled support to breastfeed
Postpartum home visit(s)
Community resources and referrals

A selection of services provided by postpartum doulas

Breastfeeding support
Newborn care
Comfort measures and support for the mother’s physical recovery
Shopping, errands, meal preparation
Laundry, light cleaning, household organization (not housecleaning)
Sibling adjustment support (not babysitting or nanny services)
Depression screening and referrals
Education on infant topics
Community resources and referrals

Shifts worked by postpartum doulas vary. Some may do overnights, others may stick to the weekday hours when their children are in school, and so on. Expect a typical shift to be from three to four hours, though some doulas may work an eight-hour day. There are no rules – it is up to you and your doula. Typically, support is more concentrated in the first two weeks and then gradually the family weans off of doula support. However, in special circumstances such as multiples, preemies, babies with special needs, or moms suffering from postpartum depression, postpartum doulas may be involved over a longer period of time.

Before hiring a postpartum doula, consider whether or not you are really seeking a nanny for your other children or house cleaning help. If those are your primary motivations, then you should hire a nanny or house cleaner and will probably come out better financially by doing so. Another option may be to start out with a doula for the first couple of weeks while mom is recovering physically, adjusting emotionally, and may be in need of breastfeeding support, and then transition towards hiring a nanny later (say, in the case of twins or multiples).

What is a certified doula?

A certified doula is one has chosen to complete a certification process through a doula or childbirth association such as DONA International, Association of Labor Assistants and Childbirth Educators (ALACE), and others. While certification processes differ, certification generally means that a person has: (1) completed a proscribed training program, (2) documented a minimum level of hands-on experience with positive client evaluations, (3) completed reading requirements, (4) agreed to work within the Scope of Practice as defined by the certifying organization, and (5) paid her membership and certification processing fees. The process certainly guarantees a minimum level of training and experience for providing doula services. It is an effort to professionalize the traditional role of the female support person at birth and during postpartum.

Is certification important?

It depends upon who you ask. From the consumer perspective, good worth of mouth in the community, or a recommendation from a trusted friend trumps certification any day. Certification is no guarantee that your doula encompasses the personal qualities of patience, humor, compassion, integrity . . .

Some insurance companies may reimburse for doula services. Ask your doula if any of her clients have been successful in getting reimbursement or partial reimbursement for her services. As the doula profession grows, we expect increased success for insurance reimbursement and if/when this happens, it is likely that certification will be required.

What are the benefits of doula support?

There have now been several studies on the benefits of continuous labor support on labor and birth outcomes. Laboring women who are supported by doulas have lower c-section rates, lower instrumental delivery (forceps and vacuum extraction) rates, and are less likely to use epidurals or pain medication than women who do not have doula support. These women also have shorter labors, have more positive childbirth experiences overall, and are more likely to breastfeed. Furthermore, the newborns of these women have higher 1-minute and 5-minute Apgar scores.

Postpartum doulas can have a strong impact on early parenting success. The evidence shows that women who use a postpartum doula have increased rates of breastfeeding, decreased rates of postpartum depression, decreased incidence of maternal re-hospitalization for complications postpartum, a stronger bond with their newborns, greater self-confidence in their parenting abilities, and increased understanding of newborn care.

Is it appropriate to have a doula if my partner will be at the birth?

Yes! The doula’s role includes supporting the laboring woman and supporting her partner. Your doula should be able to work alongside your partner and/or other family members and show him/her/them how to best support you. If you and your partner have taken childbirth classes, the doula can remind you of techniques you learned in class and provide guidance through the physical and emotional challenges of labor support. Your doula can provide your partner with breaks, facilitate communication with your care providers, and, in short, be an excellent addition to your birth team.

Is a doula appropriate if I have an epidural?

Yes! Many women are unsure of whether they will want an epidural (or know they will want one) prior to going into labor. While you should ask your doula if she is comfortable working with women who choose a medicated birth, the role of the doula is not to critique your birth choices but rather to support you and ensure that your wishes are respected. A doula can improve your chances of having an unmedicated birth if that is what you prefer, but she should also be able to provide you with non-judgmental emotional and physical support in the context of a medicated birth. Women who choose to use an epidural during labor can especially benefit from a doula during the pushing stage, as this stage can take longer for medicated births due to the decreased physical sensations intrinsic to the use of epidurals. In addition, because the medications used often make mothers and babies drowsy, it is extremely helpful to have a doula during the immediate postpartum period so that she can support early breastfeeding efforts. Epidurals provide pain relief, not emotional support!

Is a doula appropriate if I am having a planned cesarean birth?

Yes! Although women having planned cesareans do not experience labor in the same way as women planning natural births, a doula can still be helpful to prepare you for the experience. Your doula can help you learn about the choices that you have in the context of a cesarean birth and can also provide emotional support before, during, and after the surgery. Because recovery from a cesarean often takes longer and is more complex than recovery from a vaginal birth, a doula can be an asset to parents during the postpartum period. A postpartum doula can help with newborn care, provide breastfeeding support, prepare meals, and help take care of your home while you recover from surgery.

Charlie’s Story

Read the story of one mother who received postpartum doula support from the Doulas Care program.

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