What is a Doula? A consumer’s guide to getting the help you need
What is a doula?
A doula is a labor support professional who “mothers the mother” during childbirth, as well as during pregnancy and in the early weeks postpartum. Birth doulas concentrate services prenatally and during labor and birth. Postpartum doulas provide in-home services to families after the baby is born, typically lasting from two weeks to three months, or longer in 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 provide evidence-based information, emotional support and comfort measures such as massage, hydrotherapy and enhanced relaxation. By the time the mother goes into labor, her doula has become a trusted guide. 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. For single mothers, the doula can serve as a primary support person so that the mother is never left alone in labor.
As non-medical care providers, doulas 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 the mother finds 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 may also be offering a service that families value, but she is operating outside of the scope of practice of the doula professional.
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
- Suggestions and support for positioning in labor
- Continuous support throughout labor and birth
- Troubleshooting for difficult births
- Promote informed decision making
- Facilitate communication with the woman’s 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 still 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 the value of a certified doula?
A certified doula has chosen to complete a certification process through a doula or childbirth association such as DONA International or a number of other organizations. All certification processes are not equal. At last count, there were 26 different doula certification agencies, many of them popping up in the last couple of years. Some offer 100 percent online programs, some require a two-day training to become both a birth and postpartum doula (as opposed to seven days through DONA), and some provide “certification” for simply completing the class. DONA is known for setting industry standards and is the oldest and most prestigious professional doula organization in the world.
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 required reading and (4) agreed to work within the Scope of Practice as defined by the certifying organization. The process guarantees that the doula has achieved a minimum level of training and experience is accountable to professional standards.
What do doulas charge for their services?
Because individual doulas are self-employed and set their own rates, there is no precise standard to determine how much one should expect to pay for doula services. Some doulas have a set fee, while others may use a sliding scale so that they can provide services to clients at a range of income levels. Expect doula rates to vary based on level of experience, certification status, additional services provided and geographic area.
In general, birth doulas charge from $600 to $1500 for a package of services. Keep in mind that this fee includes phone consultations, prenatal and postpartum visits, and continuous support at your birth.
Postpartum doulas generally charge from $20 to $35 per hour. Presumably, the more experienced and skilled doulas are the ones charging the higher fees, with less experienced doulas starting out at the lower end of the scale.
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. Women who receive doula support also have shorter labors, more positive childbirth experiences overall, and are more likely to breastfeed. Furthermore, infants born to women receiving doula support have higher one-minute and five-minute Apgar scores (a routine assessment of the newborn’s well-being immediately post-birth). Evidence for Doulas.
Postpartum doulas can have a strong positive impact on early parenting success. Evidence shows that women who use postpartum doulas have increased rates of breastfeeding, decreased rates of postpartum depression, 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 her partner. Doulas work alongside partners and/or other family members and show him/her/them how to best support the mother in labor. Doulas can enable partners to take needed breaks, provide reassurance and guidance for how to help the laboring mother, and facilitate communication with care providers.
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 babies less alert than normal, 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 vaginal 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.
How can I find a doula?
Center for the Childbearing Year maintains an online directory of service providers. The doulas listed there are, by no means, a comprehensive list of doulas practicing in the area, nor should listing on the site be interpreted as an endorsement of any one individual. If you are unable to identify a doula match on our site, then try the following websites:
If you live in Michigan and cannot afford to hire a doula, check out the nonprofit Southeast Michigan Doula Project. This website enables low-income families to find volunteer birth or postpartum doulas who provide services free of charge. Some bilingual doulas may be available through this website.
Tips on hiring a doula
- First, screen to see who is accepting clients around your due date.
- Ask how much the doula charges and what services are included in her fee.
- If the answers to the first two questions lead you to want to pursue the possibility of hiring this person, then you could ask for some time for a short phone interview.
- Ask about her level of experience, whether or not she has been formally trained as a doula, whether or not she is certified, and what her philosophy of care is (e.g., what are her thoughts and experience with breastfeeding?). You might want to know if she is a mother herself, what she thinks her biggest strength as a doula is, what she enjoys most about her work, etc. For a more extensive list of questions, see below.
- An enthusiastic but inexperienced doula with whom you feel a warm rapport may be preferable to a more experienced doula with whom you feel uncomfortable, for any reason. Trust your instincts. This is all about getting your needs met.
- As you move through this process, you will likely have narrowed down your selection to one or two people with whom both you and your partner (if any) should meet in person and interview.
- Ask for and check references. The most useless doula in the world is the one who is unreliable (if she doesn’t answer her phone when you are in labor, who cares how skillful or “nice” she is?). Doulas who have created good word-of-mouth about their services are likely to endeavor to ensure that you too are a satisfied customer.
- Check credentials. If the doula claims to be certified, you should be able to verify her claim by checking with her certifying agency.
- Does the doula have an agenda (my way or the highway)? If so, is her agenda congruent with yours? Try to think of a few questions before the interview that are designed to get at the answers most important to you. Have your partner articulate any questions or concerns he/she may have as well. In the end, make sure you hire someone who can provide non-judgmental support for you and your family. You don’t want to have to hide your diet pop cans or your four-year-old’s toy gun collection when your doula comes to your home, nor apologize for a medicated birth if those are your choices. (I’m having a hard time letting the diet pop statement stand, because it’s SO bad for you, but I hope that makes my point about non-judgmental support … I would not be the doula for you if you wanted me to bring you your diet pop in labor or, at least, I would be very challenged in this regard.)
- In the case of hiring a postpartum doula, many couples find themselves in a rather urgent frame of mind (“Can you start today?”). Consider starting with a one-week commitment from your doula with the possibility of extending beyond that time frame. If integrating a stranger into your home proves more stressful than helpful, you may have chosen the wrong doula.
Sample questions to ask a prospective doula
The best way to choose your doula is to consider the fact that the doula will be present at your birth or providing in-home support at a time when you may feel especially open and vulnerable. Ask yourself with whom you (and your partner) feel the most comfortable. Just what are you looking for? What helps you when you are feeling stressed? Information, humor, kindness, massage, a flexible attitude, a good listener? Are you looking for a mother figure or more of a big sister? The personality and beliefs of your doula may well be more important than any other factor. If you choose to interview one or more doulas, it can be helpful to ask the following questions. In the final decision, trust your gut. A less experienced, uncertified doula may resonate better with you than the most experienced doula in town.
- How long have you been in practice as a doula? How many families have you served?
- What training have you completed to prepare you for this role? Are you certified?
- What is your philosophy about your doula work and its purpose?
- Are you a mother yourself? (This may or may not be important to you. Doulas who are not mothers themselves may have more time to focus on you and your needs, while doulas who are mothers themselves certainly will bring an added dimension of understanding to their care. On the other hand, experienced mothers may be more opinionated about the “right” way to do things, based upon their own beliefs and experiences. Look for someone capable of flexible, non-judgmental support or, if she has an agenda, make sure it’s the same as yours!)
- Do you have experience with other clients whose situations are similar to mine (first-time mothers, natural/medicated birth, same hospital, home births, older mothers, single mothers, VBAC moms, etc.)?
- How much do you charge? Under what circumstances would I receive a refund?
- What is included in your fee (prenatal/postnatal visits, phone support)?
- Do you work with a backup doula?
- Do you have any references from families with whom you have worked?
Additional questions for birth doulas
- How certain are you that you will be able to attend my birth? Do you have any other commitments during that time period?
- How do you picture yourself supporting me and my partner during the birth?
- Do you provide labor support at home in early labor for women planning hospital deliveries?
- Do you only work as a birth doula or can we also hire you for postpartum work if needed?
Additional questions for postpartum doulas
- Are you available for overnight help, weekend help, daytime help, etc.?
- How much experience do you have providing breastfeeding support?
- What services do you provide or exclude? (For example, some doulas may be willing to do some sibling care, scrub out a bath tub, or walk the dog, while others may not. Really think through what it is that you need and then ask questions to determine if the doula can meet your needs. In some cases, parents might be better off hiring a babysitter or nanny if their concerns revolve around balancing the needs of a two-year-old and newborn twins.)
- Do you have any add-on services (such as bringing meals, massage, etc.)?