Have you heard about doulas and are wondering what all the fuss is about? Are you curious about what they do and how they can contribute to your birthing experience?
I wasn’t convinced about the usefulness of a doula when I had my first child, but shortly afterward, I watched a friend go through her first pregnancy with the help of a doula. And I was impressed. It was like she had a helpful expert in her corner.
The doula never seemed too busy to answer questions like doctors sometimes do. And she was a soothing ally for my friend when she most needed it — on delivery day.
This guide will answer all the questions you may have about doulas and should help you determine if it’s something you want for your own pregnancy.
What Is a Doula?
They are commonly thought of as birth coaches to help women through the difficult childbirth experience and the aftermath.
Support Where Needed
Although doulas don’t usually have formal obstetric training, they are often certified — some of the classes they take can take up to a year to finish. Some people mistakenly believe that doulas are only used for home births, but they can also be used in the hospital setting.
While doulas can perform a lot of duties to help support a woman through this challenging but exciting time of her life, there are some things she can’t do.
Doulas shouldn’t give you medical advice. If a sticky situation comes up during delivery that requires you to make a medical decision, your doula shouldn’t offer any advice about it (source). They don’t have the medical training to make decisions like that when it comes to your health, so you and your partner, along with your medical doctor, will be responsible for any decisions.
Unlike midwives, they can’t give medications to you either — they aren’t allowed to administer them because they don’t have the medical training (source).
A doula is not allowed to deliver a baby. They also can’t do other medical procedures like checking on your cervix dilation, breaking your water, or checking the strength and rate of your baby’s heartbeat.
For physical support, doulas can offer women ideas as to different positions and relaxation techniques they can try in the later stages of pregnancy and delivery to find some relief from the constant discomfort and pain they’ll be facing.
They also can give hands-on relief by using methods like gentle touches, counter pressure, and by instructing moms-to-be about their breathing techniques. They can also show a woman’s partner how to be there emotionally and physically during birth and the postpartum period.
Emotionally, your doula will act as a cheerleader of sorts by letting you know you can do this and that you’re doing fine.
The Benefits of Doulas
Plus, women sometimes feel better about their overall experience of becoming a mom when they have the support of a doula.
Here are 10 tangible benefits of employing a doula.
- Some studies have shown there is a 28-percent decrease in the risk of Cesarean section when doulas are used. The largest effects recorded were as high as 39-percent (source).
- Hiring a doula also appears to lead to shorter labors, which is something no woman would argue with.
- It also can cut down on the amount of anesthesia used and how long it is used for.
- With doulas, there are fewer births where forceps or vacuums are needed to assist with deliveries.
- Babies have higher APGAR scores when doulas are involved. APGAR tests measure heart rate, respiration, muscle tone, reflex response, and color.
- Women leave their birthing experience with more positive memories and a better feeling than they often do without doulas.
- Women who use doulas tend to be as much as 60 percent less likely to ask for an epidural (source).
- Those who enlist the help of a doula can be as much as 40 percent less likely to need Pitocin to start labor or speed it up. Pitocin is a synthetic form of oxytocin, which has been known to cause injuries in babies through oxygen deprivation (source).
- Doulas can also help women cut down on the use of pain medications of any kind.
- No matter what, childbirth isn’t going to feel like a day at the spa, but the hands-on methods employed by a doula can hit just the right muscles and spasms to help relax you as much as possible.
Reasons to Hire a Doula
With so many benefits, it can be easy to see why you might want to consider using a doula. But here are 10 more specific situations where it makes a lot of sense:
1. You’re Delivering Alone
If you’re without a partner and about to embark on this parenting journey all by yourself, you might want a doula at your side. That’s especially true if you don’t have a mother, sister, or best friend who will be involved and there with you in the delivery room.
Having a baby is difficult physically and emotionally, but it’s even harder when you feel you don’t have the support you need. Everyone needs someone in their corner at a time like that and a doula might be your best bet.
2. She’ll Be Like Your Shadow
You’ll have your team of doctors and nurses circulating in and out of your room while you’re in the hospital, but a doula is there to stay with you. She’s in it for the whole duration and you are her only focus, unlike doctors and nurses who have other patients.
If you want someone to be by your side the whole time who knows how to help you without you having to bark out demands, a doula is a good choice.
3. Your Partner Might Like the Help
Let’s face it. Men sometimes aren’t much use during childbirth, even when they really want to be. They feel helpless, confused, and overwhelmed by what’s happening, and they often don’t know what to do to comfort you or make you feel better.
If you want to show some pity to your out-of-his-element partner, a doula can do that. It takes some of the pressure off of them because the doula can let them know exactly what you need from them. That can bring you two closer during childbirth instead of driving a wedge between you.
4. They Aren’t As Expensive As You Think
Doulas, especially the best ones who have a lot of experience and references can cost a fair amount of money at a time when you’re already probably strapped for cash. You’ll have hospital bills flooding in and all that baby gear and necessities to purchase.
But it is important to remember that working with an experienced Doula should be seen as an investment and not an expense. Doulas have been shown to reduce the risk of birthing complications, cut down on the amount of pain medications required, and improve the overall birthing experience for women. That’s money well spent in my opinion.
5. They Can Give You Solid Information
While doulas aren’t able to tell you what medical decisions you should make, they can give you the information you’ll need to make an informed decision. If you’re having contractions, they can help describe ways to tell if they are true contractions or the real deal. That kind of information is invaluable to a new mom-to-be.
Doulas are also familiar with the different kinds of procedures and steps that occur during childbirth. They can keep you informed about what is happening and what your doctor or nurse is doing.
6. You Can Ask for What You Need
Some women are too timid during delivery to ask for what they need from their partner, especially if the guy isn’t exactly the greatest at taking orders.
With a doula, women can ask for exactly what they need — if they want someone to work the kinks out of their lower back with a massage or you need someone to convey to the medical staff any problems you’re having, your doula will have your back. It’s like having your best friend in the delivery room — she’ll always have your back no matter what.
Sometimes patients and their family members are intimidated by the healthcare staff and do not feel comfortable in asking all the questions they would like to. A doula can be a bridge to that and can act as the patient’s advocate making sure all the patient’s concerns are tended to.
Editor's Note:Dr. Njoud Jweihan, MD
7. They Give You Post-Partum Help
So you and your partner are on the way home from the hospital after having your baby. Now what? You’re on your own if you don’t have a doula.
That can be scary. Your husband might be terrified and unsure of himself. And you will be extremely sore, full of hormones, and possibly even be nursing a surgical wound.
In short, you may find yourself needing back-up. Your doula can provide that. She can give you an extra set of hands around the house, doing whatever it is you need support with — grabbing you snacks and checking out your breastfeeding latch.
It’s like having a caregiver for you. It may feel a little extravagant at first but enjoy it. You’ve worked hard and you’re entitled to some pampering.
8. Labor Can Be Harder Than You Think
Giving birth has earned a legendary reputation over the years for being one of the most enduring experiences a woman will go through. But some women still underestimate just how tough it will be. Or they think they can handle pain better than other women do.
During labor though, all bets are off. It can be incredibly difficult, especially if labor draws out longer than usual (source).
Doulas can help get you through what might feel like the longest day of your life. Methods they use include aromatherapy, massage, music, and mantras. And that can be more than worth the money you’ll pay for their services.
9. You Want To Use Less Medications
Since studies do show women who use doulas need less pain medication during delivery, if you’re hoping to use as little medication as possible, you might want to hire a doula. Some medications cross the placenta too — I was dangerously close to requesting one of those medications with my first child because the pain was so intense. A doula would have really come in handy at that point.
A doula doesn’t guarantee you won’t need medicine, but it will give you your best bet of reducing the amount you’ll need.
10. You’re Worried About a Cesarean Section
Doulas can help lessen the risk of having a C-section. For some women, that may be enough to warrant hiring one. No one wants to run the risk of having a C-section if they don’t need to.
It is difficult to have a C-section instead of having a vaginal birth because you have to recover from an operation as well as giving birth. That makes things even trickier.
Doulas can also be present during the c-section if you are having local anesthesia for encouragement.
How To Find a Doula
The best way to find a doula is by word of mouth. Check with your friends who are moms or any mom groups you’ve joined.
They’ll be able to tell you if they have worked with a doula they’d recommend. They can also steer you away from doulas they haven’t had a great experience with too.
If you happen to be friends with a nurse who works on a maternity ward, she’ll likely have some names to give you when it comes to good, reliable doulas. She’ll have seen them in action so her advice will be invaluable.
If you don’t know any women who have used doulas, there are other ways to find them. You can search the DONA International database for a certified doula (source). They have a membership of over 5,000 doulas.
Some moms have also had success with checking Craigslist to find doulas. But with Craigslist, you need to be careful and check any references thoroughly.
Before you choose the first doula who shows any interest in the job, you need to think about what you want. It can be tempting to fill the position quickly because it’s just one more thing you want to check off your list. With so many balls in the air to juggle, it can feel comforting to line up things so you can move along on your to-do list.
There are a number of things you need to consider before choosing your doula.
- If you like her: This may seem like a strange thing to consider, but your doula is going to see you at your worst and in some compromising positions. You’re already going to be super aggravated and in pain, so it’s best if you don’t hire someone you already feel like throat punching. If you don’t feel an immediate sense that you like the doula you’re talking to, you’ll like her even less in the delivery room.
- Does she feel comforting to you: Your doula is going to catch you at a time when you feel frantic, worried, and writhing in pain. So you want her to have a soothing effect on you. If she feels a little too rigid or high strung while you’re interviewing her, you’ll want to find someone else.
- Do you want someone with a firmer hand: Are you the type of person who wants someone to motivate you with some tough love? If you do, make sure your doula isn’t too much of the earth-mama type that she can’t get firm with you when you need it.
- Who your partner will be comfortable with: While ultimately, the decision about who to hire as your doula should belong to you, your partner will probably want to have some say. You should consider their feelings too. But only to a point — after all it’s your body and your responsibility to bring that life into this world so you need all the support you can.
- The fee she charges: While money should never be the determining factor, it’s a reality most of us have to deal with. We don’t often have deep pockets, especially when we’re expecting because there are so many other places we must spend money. So your doula’s fee is a big consideration for you.
- Any special talents the doula may have: If you want someone who can really help your back spasms because she’s good with a massage technique, you might want to consider asking your doula candidates if they have any special talents.
- References: Even if you love a potential doula’s personality, you should still check on her references. You should never trust her word alone or any certification she has. What you really need to know is the satisfaction level of those who have worked with her in the past.
- Would you be comfortable with a male doula: Although there aren’t many in the profession, male doulas do exist. Whether you’d be comfortable with someone who can’t really understand how you’ll feel during childbirth is a matter of personal preference.
- Do you have any challenges in your pregnancy you want her to have experience with: If you are having multiples, you are obviously going to want someone who can give you peace of mind about how you’re doing in the delivery room (source). You’ll also want someone who can give you breastfeeding tips when you have two babies to feed.
What Questions to Ask
Here is a list of questions you may want to consider asking your doula.
- What is your background and experience?
- How much do you charge?
- How many clients do you take a month?
- Will you be available at all times, or do you use a back-up doula?
- Is it possible for me to meet your back-up?
- What ways can I contact you — through text, calling, or emails?
- If you have an emergency and can’t come to the birth, will you refund my money?
- Will you see me before birth or will the delivery room be our first get-together?
- Are you comfortable with home births in case I go that route?
- Will you be available for the postpartum period?
- Have you been in any deliveries that have had complications?
- Do you have much experience with C-sections?
- Can I call you anytime — day or night?
- Will you be able to help me with breastfeeding form and issues?
- Do you have a specific philosophy?
- What do you think your best quality as a doula is?
- How many births have you attended?
The Big Day
- Will you be in the delivery room until I’m holding my baby?
- What if my labor lasts 24 hours or longer — will you stay?
- Will you work with my partner to address any concerns they have?
- How do you help clients with their pain management?
- Will you be comforting or try to take charge of the situation during delivery?
- What do you typically do to offer support to a mom during childbirth?
- Have you attended home births?
Frequently Asked Questions
Doulas can seem like a foreign concept to some women, especially those who don’t quite understand exactly what they do. Here’s a breakdown of some common questions you may have.
Let’s look at what each one can bring to the table.
- Antepartum doulas: This type is able to give you prenatal services, including information you’ll need before childbirth. They might help with massage, breathing techniques, and ways to relax. They can help you make meals, which is great if you are on bedrest, and they can give you moral support. They are especially helpful if you are having a high-risk pregnancy or uncertainties that are causing stress and anxiety.
- Birth doulas: As the name implies, these doulas can give you support during childbirth — the support will be both for you and your partner. They’ll help with relaxation methods and coax you into different positions that may help with the pain. In addition to physical and emotional support, they can help you get the hang of breastfeeding during your hospital stay. Birth doulas usually will meet with you a few times before birth as well.
- Postpartum doulas: These doulas will help you with your postpartum needs, including breastfeeding questions and getting some much-needed sleep. If you’re suffering from postpartum sadness, it will be good to have her around too.
Just because there are different types of doulas, it doesn’t mean your doula won’t offer more than one type of service. She can be a birth doula who also gives postpartum care, although it will likely cost more if she is offering both services.
A doula isn’t meant to replace a father’s role — whether it is in the prenatal period, the delivery room, or in the week following delivery. The doula will work hard to include your partner as much as he wants to. And if you have a partner who isn’t too interested in being there throughout the process, your doula can help fill in the cracks so you have all the support you need.
Many fathers appreciate having a doula to help with childbirth. It takes some of the pressure off of them when they’re unsure what they should be doing to help their partner. And they’ll be relieved their partner has someone on her side who knows exactly what needs to be done.
Every doula might be a little different on this rule, so you’ll want to check with her. But if you have a birth doula, she’ll want to be notified when you start having contractions. If it is the middle of the night, your doula may want you to determine if you are having true contractions before calling.
You should also keep her posted after every doctor appointment you have in the last month. And if the doctor checks your cervix, you should call your doula to let them know how far you are dilated.
The fee for a doula varies greatly, depending upon experience levels, services provided, and even the location you live in. Bigger cities are typically more expensive for hiring doulas, just as they are more expensive for a lot of things.
If you catch a rural doula who doesn’t have much experience and is trying to get a client base, you may be able to find one for as little as $300, but you should be prepared to hear fees up to $2,500 (source).
Usually, doulas aren’t covered by insurance plans because they are seen as a non-medical aid for childbirth. But some insurance plans do cover doulas or at least a portion of their services. Sometimes you can pay the doula and get a detailed receipt to send to your insurance company for reimbursement. Your best bet is contacting your insurance company to find out — it doesn’t hurt to ask.
Doulas don’t need to be certified. But if you’re looking to hire one, it’s a good idea to choose one who has been certified. Certification programs will vary, depending upon which organization is backing the doula.
Finding a certified doula will give you more confidence that a doula understands their role and how to best help you.
Postpartum doulas help moms with all the tasks they need to do with their new baby but don’t always feel up to doing.
A doula can help for the first couple days or may be employed for weeks until the mom feels like she has a handle on what she has to do and has recovered enough to do it by herself. They can help with things like making your meals or snacks, caring for your baby, helping with breastfeeding techniques, and helping you manage your emotions which can sometimes be all over the map as you shed those pregnancy hormones.
If you have other children, she can also help take care of them and help them bond with the new baby. And a postpartum doula can do some light housekeeping so your house doesn’t fall apart as you recover and you can spend more time with your baby. If you have many children and taking care of them after delivery is your biggest challenge there is what is called a sibling doula who can take care of all your children’s needs.
Doulas can help with breastfeeding in many ways. First of all, she can give you information about breastfeeding and its benefits, which may help you decide to feed your baby with breast milk instead of formula.
They can help you understand what a proper latch looks like, find comfortable positions that will help you pursue breastfeeding, and teach you how to tell if your baby is drinking enough milk. They might help set up breastfeeding areas throughout your house, so you’ll have what you need no matter which room you’re breastfeeding in.
Your doula will also stress the importance of eating frequent snacks and drinking enough water to help your body adjust to the rigors of breastfeeding. She will also be able to address any concerns you have and give you the reassurance that while breastfeeding isn’t always easy, it is beneficial. Studies show that women who have a doula for support experience higher rates of lactogenesis or production of breast milk in the first 72 hours after birth.
If you don’t have enough support during your childbirth journey, you might want to consider finding a doula so you don’t feel like you’re tackling this all on your own.
Did you use a doula? If so, would you recommend it? What was your experience like?