A doula is a professional who is trained to support a woman and her partner through pregnancy, birth, and postpartum. Generally, families interview several doulas to determine which is the best fit for their goals.
A birth doula meets with the family several times prenatally, offers continuous support during their birth, and provides one or more postpartum home visits. She is available to answer questions, listen to fears/concerns, and navigate the ups and downs of becoming a parent. She also connects families to resources such as postpartum support groups, lactation consultants, and educational classes.
A postpartum doula is trained to offer additional support to families during postpartum.
What does the research say?
We have excellent research on doulas. The research—which shows all benefit and no harm—prompted John H. Kennell, MD to write, “If a doula were a drug, it would be unethical not to use it.”
Cochrane reviewed the RCT studies we have on doulas, including more than 15,000
births, and found that women were more likely to give birth spontaneously without
cesarean/vacuum/forceps, were less likely to use pain medications, have shorter labors, and experience greater satisfaction. Moreover, their babies were less likely to have low 5-minute Apgars. Researchers found no adverse effects. They found the greatest benefit when the person providing continuous support was not part of the hospital staff and not part of the woman’s social network. In other words, when she was a trained professional working autonomously for the birthing woman.
With the continuous support of a trained birth doula, researchers saw:
- 31% decrease in the use of Pitocin
- 28% decrease in the risk of C-section
- 12% increase in the likelihood of a spontaneous vaginal birth
- 9% decrease in the use of any medications for pain relief
- 14% decrease in the risk of newborns being admitted to a special care nursery
- 34% decrease in the risk of being dissatisfied with the birth experience
But what does a birth doula actually do?
Do you remember that scene in “The Wedding Planner” when the character played by Jennifer Lopez pulls out unending tools and tricks to smooth out a bumpy wedding? Doulas are a bit like this. She offers everything from soothing words to lip balm. She wipes brows, holds emesis basins, offers comfort tools, feeds partners, and massages feet. Doulas are trained in techniques to help babies rotate or engage, to strengthen contractions, or to speed up labor. She helps you know when to leave for your birth place or call your midwife to come to your homebirth. And she helps you navigate informed consent, policies, and procedures.
But sometimes they do nothing. At least, they do nothing you can see. The key to doula
support is that it is continuous. When a woman and her partner have a continuous calm
presence, it boosts their confidence. So even if it looks like the doula is simply knitting in the corner, her peaceful and patient presence sends a message that all is well.
Sometimes women say, “But my mom or sister will be there.” Or, “My partner will be my
doula.” Partners, close friends, family members are not always the best doulas. Why? They’re emotionally caught up with the experience. They should be! Sometimes their faces can mirror their emotions. And the birthing mom can sense their fear or uncertainty. Policies and protocols change from year to year and hospital to hospital so inviting a friend or family member to act as “doula” isn’t adequate.
Best of all? She’s less expensive than an epidural and probably less expensive than the bill from that wedding planner. Doulas in my community charge a flat fee ranging from $700-$1000. Student doulas may be available for no or low cost.
What does a birth doula NOT do?
She does not replace the birth partner. She instead frees the partner to support the birthing woman without worries like when to go the birthplace, what is normal, etc.
A doula is not in charge of your decisions. She may advocate for you but she will center you as the voice.
She does not perform medical procedures. She does not take blood pressure, check a cervix, listen to the baby’s heartrate, or administer medications.
Finally, she does not work for anyone except the birthing woman. If the birthing woman
changes her mind about the way she wants to give birth, the doula continues to support her. Doula support is unconditional.
In the aftermath of birth, it should feel like the doula didn’t do anything. The doula’s goal is to fade into the background of the story because ultimately the desire of a doula is to
assist a woman in her strength and power give birth. Doulas believe that how a woman is made to feel during her birth matters. And they want her to feel strong and satisfied. That is a win for everyone.