What is a doula?

A doula is a birth coach. They are trained to make you the most comfortable and knowledgeable you can be during your journey of pregnancy and birth. Typically they offer prenatal visits, attend your labor and birth as a continuous support person, and support you postpartum.

A doula is not medically trained, they support the physical, educational, emotional, and mental side of pregnancy, birth and postpartum. They will share what is normal and what to expect but will refer you to a medical professional if anything is concerning or medically related. 

What services do they provide?

Prenatal:

Generally a doula will have prenatal sessions with you to get to know you and understand your wants for birth.  They will assist you by: 

• giving information about what to expect

• helping educate you on evidence based practices

• providing coping techniques to practice

• sharing good resources

• answering questions

• assist with creating a birth plan if desired

A doula will learn your needs and accommodate accordingly.  Perhaps you’re scared of birth, she will work with you on overcoming that fear.  Maybe you need more understanding of the physiology of birth, she will explain the natural hormones you receive during birth to enhance your belief in managing. Possibly you want coping mechanisms during labor, she may teach you breathing techniques or ways to prepare your body and mind. 

Birth: 

During labor, a doula will stay with you providing support in any and all ways that will assist with an easier birthing experience physically, mentally and emotionally.  This includes: 

• applying techniques to keep you calm and comfortable 

• providing information

• supporting any other birthing partners to support you

• providing a barrier for mistreatment

By default, doulas provide a bit of a barrier for providers who may not have your best interest at heart (i.e., cutting an episiotomy without consent is an example).  Just by being there, the staff will know there is another person in the room who is aware of what is and is not happening and is well versed in a birthing person’s rights regarding consent. If a doctor is approaching you to cut an episiotomy without consent for example, your doula would notice and either say something to you so you speak up, or say something to the room so you gain the awareness about what is happening. There is an ongoing discussion over whether or not a doula’s role is to be an advocate but I believe in all cases a doula does their best to keep their birthing client safe, whether that is through advocacy or through informing you so you have the chance to speak up and are aware.  Each doula is slightly different but all will aim to protect you if it becomes necessary.

Postnatal:

A doula will visit you postnatally to help you with any number of different things.  Again they will assess your needs and provide services that are valuable to you and your family specifically.  It depends on the doula to what extent of services she provides, for example some may be willing to tidy your house, cook a meal, or entertain your kids if required while others may focus more on mothering the mother. Most postpartum doulas will be able to provide: 

• an informal screening for postpartum blues

• breastfeeding assistance with latch, pumping, storage questions, and basic breastfeeding help

• debrief the birth with you

• answer early baby care questions and coach you through things like bathing the baby

• listen to your emotional needs

• ease the transition into mothering a new baby though reassurance, resources, and encouragement

There are also many postpartum treatments that doula’s may be certified or have trained to provide that are more traditional such as: 

• belly binding

• closing the bones

• vaginal steaming

• traditional herbal teas

Though all birth doulas provide a bit of postpartum care, there are also postpartum doulas who will offer packages to assist for multiple visits after the birth. It may either be an hourly rate or specific services you may want to bundle. This varies depending on your needs and the flexibility of the doula’s schedule. Your birth doula may offer both doula services and can continue to provide postpartum care.  Typically a postpartum doula is utilized in the first 40 days after birth, to help ease the transition to life with a newborn.  They support the mother to find her way and give the extra boost, help, and confidence all new parents would benefit from. 

How are Doulas Trained?

Doulas get certified through any number of different trainers.  During the courses they will learn: 

• communication skills

• coping techniques for labor

• what it means to hold space (being compassionate and giving space for you to do and be whatever you need in that moment without judgement)

• physiology of non-medicated births

• pros and cons of medical interventions

• where to find good and reputable sources

• how to assess a birthing person’s needs, what to look for and appropriate ways to respond 

Doulas may also take additional training such as aromatherapy, prenatal yoga, hypnobirthing, or spinning babies.

 

Differences Between a Doula and a Midwife

A midwife is a medical professional.  They are responsible for checking vitals, ensuring the safety of the baby and mother, and performing any exams/IVs necessary.  A midwife is the foremost expert on physiological birth and is specifically trained to assist women with labor and birth while attending to any medical needs. 

A doula is a non-medical birth professional. They are responsible for supporting the mother emotionally, mentally, and physically. They stay by the birthing person’s side all through labor and birth attending to things like the environment (want music on?, diffuser?, lights down?), offer massages or hip squeezes, will walk or do exercise with the mother, make suggestions that may provide more comfort and so on.  They do not track any of the medical side of things like listening to heart tones or checking dilation.

Why consider hiring a doula?

1) They inform you. Having the right information about pregnancy and birth ensures you are empowered to make informed decisions for your pregnancy and birth.  Prenatally, a doula will spend time with you to fill any gaps in your knowledge.  Together you will think through scenarios and understand your preferences. A doula will ensure you have the information necessary to navigate birth and all the many decisions that come with.

2) They put your mind at ease. Many times, all a woman needs during labor is to hear that what is happening is normal and that she is doing a great job.  That can be enough to get the mom through the next contraction and on to a happy delivery. It sounds simple, but when considering the science behind hormones, it makes more sense.  If you get tense because suddenly it feels overwhelming, having someone by your side saying “you’re doing wonderfully, this is all quite normal” and who coaches you through will help you to stop being as tense. Reducing tension aids the process to continue on more comfortably.  At a time when you may feel quite vulnerable, having someone there who knows birth and is familiar with you can keep you more at ease.  

3) Focused on you. All of a doula’s attention is on helping you achieve an empowering experience. Anyone would do  better at any task with the right encouragement and support.  Doulas are trained specifically in how to make you the most comfortable and how to help you have the most positive birth experience possible.  Their focus will be entirely on you and helping any other birth partners support you effectively. 

4) The evidence of effectiveness. The evidence behind having a doula present at the labor and birth supports all the following claims (as of 2020 from evidencebasedbirth.com): 

• up to 39% decrease in the risk of C-section*

• 15% increase in the likelihood of a spontaneous vaginal birth*

• 10% decrease in the use of any medications for pain relief

• 38% decrease in the baby’s risk of a low five minute Apgar score

• 31% decrease in the risk of being dissatisfied with the birth experience*

• Shorter labors by 41 minutes on average

The above results were obtained from looking at studies that reviewed having a non-medical support person present all throughout labor and birth.  The starred items indicate results were better with a doula specifically than with all other types of continuous support.  

What to Look For in a Doula?

A doula makes up part of your birth team.  You want the full team to gel and be comfortable with each other.  If you know your parenting partner is also attending the birth, they should also be interviewing doulas with you.  The doula makes up your birth team, it is most important that you get along and feel comfortable with this person.  Next, you can determine what you are looking for in a doula and interview ones who seem to fit that criteria.  Things to consider: 

• Comfortable with their personality?

• Familiar with spinning babies?

• Provides a lot of information for decision making?

• Knows many different techniques to keep you comfortable?

• Someone excellent with directing your other support person?

• Someone who is a calm mothering figure? Or someone who makes you laugh? 

• Has additional training/services you can avail?

• What’s included in their package?

• Has a back-up doula in case they are unavailable?

Are They Covered by Insurance?

More and more options are popping up in the United States for insurance reimbursement for doula care.  It’s worth asking your insurance provider if there is coverage.  Sometimes HSA or FSA (Health Savings Account or Flexible Spending Account) funds can be spent on doula services, other times private insurance companies will reimburse the client.  Medicaid has programs in Oregon, Minnesota, Indiana and New Jersey for doula reimbursement. 

Final Points

Doulas are gaining in popularity for good reasons. Their service is filling gaps.  In the olden days, women used to birth surrounded by the women in their communities and fully understood how birth looked and what could be expected. Today, society mainly only shows us screaming and fear and the beautiful side of birth is a little known secret. A doula brings out the beauty, they are the community of support in one person; they are humanizing the birth experience again.  The presence and use of doulas is helping to shift our communities’ perceptions, one birth at a time.  I dream of the day when all women know their innate power, abilities, and strength.  For no other time than birth is such a physical and otherworldly experience possible. A doula is the protector and steward of bringing out the best possible experience for you and your baby. 

About the Author

Yasmin loves the beauty and power of birth and wishes for every mother to experience the journey as an empowering one.  Her favorite moments as a birth doula and breastfeeding counsellor are when mothers recognize and embrace their own strength.  She is passionate about birth rights for women and believes the more information a mother has and the more involved she can be in the decision making around birth, the more positive her experience will be.  

Yasmin is a pioneer in change and is working on making birth centers a reality in the UAE, to shift the mindset around birth to one of empowerment instead of fear.  She is co-author and co-editor of the book “Birthing with Heart: the Birth of a Mother” available on amazon.

She can be contacted through DeltaStrengthDoula.com and RiseBirthCenter.com.

Sources:

Dekker, R. “Evidence on: Doulas.” Evidence Based Birth®, 12 Aug. 2019, evidencebasedbirth.com/the-evidence-for-doulas/.