What is a doula?
A birth doula is a trained and experienced professional who provides physical, emotional and informational support to the mother and her partner before, during and after birth;
A postpartum doula provides emotional, educational and practical support after birth, during the postpartum period.
Time and again, studies have shown that when doulas attend birth, labors are shorter with fewer complications, babies are healthier and the breastfeeding relationship is stronger.
What do doulas do?
According to DONA, the oldest and largest doula association in the world, a birth doula:
- Recognizes birth as a key experience the mother will remember all her life
- Understands the physiology of birth and the emotional needs of a woman in labor
- Assists the woman in preparing for and carrying out her plans for birth
- Stays with the woman throughout the labor
- Allows the woman’s partner to participate at his/her comfort level
- Provides emotional support, physical comfort measures and an objective viewpoint, as well as helping the woman get the information she needs to make informed decisions
- Facilitates communication between the laboring woman, her partner and her clinical care providers
- Perceives her role as nurturing and protecting the woman’s memory of the birth experience
- Allows the woman’s partner to participate at his/her comfort level
As a birth doula, I accompany women in labor to help ensure a safe and satisfying birth experience whether you birth at home, at a birth center or at a hospital. I draw on my training, knowledge and experience to provide emotional support, physical comfort and, as needed, communication with the other members of your birth team to make sure that you have the information that you need to make informed decisions in labor. I can provide reassurance and perspective to you and your partner, make suggestions for labor progress, and help with relaxation, massage, positioning and other techniques for comfort. I am independent and self-employed. As your doula, I work for you, not your care provider or hospital.
As a doula, I have certain expectations of my clients too: I like for them to have taken some childbirth classes (preferably mine, as that gives us 20 hours of contact time and we get to know each other better); I like honesty when it comes to hopes, fears, concerns and wishes relating to the birth; and I encourage women to keep as many options open to them as possible by working on their health through great diet, exercise and relaxation.
What do doulas not do?
As your doula:
• I do not perform clinical tasks such as blood pressure checks, fetal heart checks, or vaginal exams. I am there to provide physical support, emotional comfort, and advocacy.
• I do not make decisions for you. I will help you get the information necessary for you to make your own informed decisions.
• I do not speak to your care providers on your behalf. I will discuss concerns with you and suggest options, but you and your partner must speak on your behalf to any care providers concerning your care decisions.
• I do not guarantee any particular birth outcome.
Benefits of having a doula
Numerous clinical studies have found that a doula’s presence at birth tends to result in shorter labors with fewer complications, reduces the need for pitocin, forceps or vacuum extraction, reduces the chance of caesarean birth, reduces the mother’s request for pain medication and/or epidurals and results in more positive maternal assessments of the birth experience.
Let me repeat that last one because I think it is so important:
A doula’s presence leads to more positive maternal assessments of the birth experience.
Optimal preparation for birth and a good support team are essential keys to a positive birth. Many births go beautifully as hoped and a doula’s help supporting mom and her partner brings a more relaxed and comforting feel to the experience. I think it’s also important to understand that a woman – and her partner – can have a positive and empowered birth experience even if things do not go as planned. Most birth-related anger, hurt or even trauma has more to do with how a woman feels she was treated than with how her birth experience happened physically. She may absolutely be (very) disappointed if she had to go with Plan B or even Plan C, but most women can accept it if they feel it truly was in the best interest of their own health and that of their baby. However, if they feel they were rushed, pressured or bullied into a situation, or were told untruths or felt downright insulted, this can have a tremendously damaging effect on the birth memory, which in some cases can spill over into the crucial mother-baby relationship. The presence and support of a doula may help to prevent this and allow moms and their partners to have a more satisfying birth experience.
If a doula were a drug, it would be unethical not to use it.
~ John H. Kennell, MD
Of course, there is always an element of risk in any childbirth situation. Clients need to be aware that the doula cannot guarantee how labor may unfold and cannot be held responsible for negative outcomes resulting from the rare but very real and sometimes serious or fatal complications that can occur during pregnancy, labor or birth.
Midwife or doula: What’s the difference?
Sometimes people ask me if I’m a midwife, and or ask me to explain the difference between a doula and a midwife and how the two work together and complement one another. If you have a midwife, do you really need a doula?
A midwife is a skilled, trained and licensed health care provider. She has gone through years of studies and training to care for all aspects of a pregnant woman’s health and to ensure she and her baby have the safest and healthiest outcome possible. Her primary focus is the clinical care of her patients, and she does that with compassion and kindness. She bears an enormous responsibility for the safety and well-being of mom and baby.
A doula, on the other hand, offers physical, emotional and informational help, but no clinical care – as a doula, I do not even take blood pressure readings, much less perform cervical exams, catch babies or offer any medical advice. A doula does not practice medicine or midwifery. Some doula training programs are just two days long plus some required reading and a few birth reviews. So the difference in training and in focus is very significant.
As a doula, I am there to support you from whenever you need me in labor. Your midwife would typically like to see you when you are in active labor. So it is not unusual for me to be called to a birth and spend hours at someone’s home with them while they labor before we transfer to the birth center or hospital. I’ve been with clients anywhere from half an hour to 24+ hours before they give birth – each birth is unique. While most women do not need to call the doula at the first contraction, the doula may still spend more time with a mom in labor than the midwife does. It also makes the midwife’s job a bit easier to know her client and her partner have continuous one-on-one support, and everyone wants a well-rested midwife – she will be the one to handle any complications, if they arise, make any repairs, if necessary, and of course monitor the clinical aspects of both mom and baby throughout labor and birth.
What do doula services include?
The services offered may vary from doula to doula, and some offer different packages at different prices. Services can be discussed according to your needs, but for birth doula clients I typically include:
- one or two prenatal appointments (your choice) at your home
- being on call for you from 37 to 42 weeks
- support throughout labor and immediately after the birth
- one postpartum home visit between 3 and 7 days after birth
- optional free second postpartum appointment as needed
- unlimited phone and/or email support
Did you hire a birth doula for your labor?