By Ali Weatherford

DOULA is an ancient Greek word that means female slave or servant. Yikes, right?!?!

Some more modern interpretations of the word accept the meaning as woman caregiver. In modern times, being a doula is a profession. A doula is a birth companion.

Birth doulas are hired to provide CONTINUOUS labor support. Postpartum doulas offer support AFTER your birth during the recovery period. Some doulas do both. They are called Full Spectrum Doulas. A lot of modern day doulas might actually consider themselves female servants in the most literal way. They are there to serve the woman. Most people don’t hire a doula or have even heard of a doula, but they do provide an essential service.

What Doulas are NOT

Doulas are not medical practitioners. A doula should not do any medical procedures or even offer medical advice. A doula also can not speak for you. A doula can find out a lot about you and understand your preferences and plans for your birth, but they can not step in and make medical care decisions on your behalf. A doula can offer you general information about birth related procedures and topics and offer you resources and referrals, but really should not make recommendations about your healthcare.

Doulas are also not babysitters or nannies. A doula is trained to support the pregnant, laboring, or postpartum woman. They are the doulas’ focus. A pregnant, laboring, or postpartum person needs plenty of support, and most often they don’t get enough. Babies are adorable, but they have parents AND other caregivers.

How Doulas SERVE

A doula knows a lot about pregnancy, labor, birth, postpartum recovery, and possibly even about baby care. They learn some of this from books and training, but they also know this from having the experience of being with other people on this journey. It’s usually a very deep and personal understanding.

Doulas usually feel called to the profession. Most doulas don’t do it for the money or the glory because there isn’t much of either! Most doulas are completely awed by and obsessed with pregnancy and birth. It’s a fascination that might have been sparked by their own birth experience or that of a loved one, or they might have been born with their passion!

The spark is usually fanned and fueled by a deep desire to help. Doulas understand what a special and complicated time pregnancy and birth and new parenting are in a person’s life, and they feel compelled and honored to help and participate in some way. Doulas also understand that the modern birth experience is often cold, disconnected and scary. They want people to feel nurtured, safe, and informed so that they can experience the joy in the process and the outcome.

Birth doulas help by:

  • Being a touchpoint during pregnancy. A doula will listen and offer answers or referrals or moral support when you have issues or questions.
  • Providing education. Some doulas will offer some childbirth preparation as part of their services.
  • Making a birth plan. Some doulas will encourage you to make a birth plan and even help guide you through the process.
  • Being on-call and showing up for labor and birth. Your doula will stay available for the time around your due date and make sure to answer your call when it’s time! They might come to your home or meet you at your hospital or birth center depending on the situation.
  • Providing physical support for labor by offering touch or massage or help you get into more comfortable positions. They will encourage you to breathe effectively and stay well hydrated. They can make recommendations for how to position or move your body so your labor continues smoothly and with less pain.
  • Providing emotional support. Labor and birth can be hard. A doula usually knows the right things to say and do at the right times to keep you feeling motivated and calm. They can help you understand that what you are experiencing is normal and that everything is OK.
  • Being an advocate. A doula can not speak for you, but a doula can remind you and your care team about your birth preferences. If a problem comes up, a doula can’t make a decision for you, but they might be able to offer you information so that you can make a decision for yourself. A doula can be very observant about what is happening, and can bring your attention to anything that you might need to know about. “It looks like they’re about to cut the cord. Didn’t you say your partner wanted to do that?” A doula can help your partner to advocate for you when necessary. Your partner or family member can often speak for you when needed, and a doula can help them if they don’t remember some of your birth preferences or need more information. They can help you AND your partner know what questions to ask and how to advocate for yourselves.
  • Facilitating communication. During your prenatal care, a doula can help you know what to ask about during your visits with your doctor or midwife. A doula can help you make respectful requests of your caregivers when needed. They can help partners communicate more effectively with each other so you can stay on the same page and set up healthy expectations.
  • Helping your partner know how to best support you.
  • Supporting your partner by giving them time and ideas for rest and rejuvenation. When your partner stays healthy, they can continue to offer good support for you.

Postpartum doulas help by:

  • Offering some information and referrals (if needed) about baby care and feeding.
  • Providing some baby care when you need to shower or get some self-care time.
  • Helping you eat well.
  • Helping you get plenty of rest.
  • Doing light housework.
  • Teaching you about your body changes and how to manage your recovery.
  • Providing emotional support and comfort when things feel very hard and overwhelming.
  • Offering information and referrals about complications that might come up during postpartum recovery including mental health issues.
  • Being a touchpoint during your postpartum recovery. They can help you understand that what you are experiencing is probably normal and will pass. You are OK.

The Benefits of Doula Care for Birth and Beyond

Most people who have had doula care understand the benefits. I have very rarely heard someone say that they regret hiring a doula. Most people say the opposite. They can’t imagine having done it WITHOUT their doula.

Some people give birth without a doula first, then get a doula with a subsequent pregnancy. Most of these people say they wouldn’t do it again without a doula. It’s easy to hear THAT doulas are helpful, but HOW doulas are helpful is a lot harder to understand. Most people can’t really articulate WHY their doula was so important, just that she was essential. I also can’t tell you exactly why my favorite shoes are so helpful. I don’t know what it is about the design or features of these shoes that make them so special to me. I just know that when I don’t wear them, life is worse. My feet hurt. My ankles hurt. I’m just not as comfortable or energetic when I wear other shoes. A doula is sort of like having a really good shoe. Maybe it doesn’t sound all that glamorous, but it’s life-changing!

There is very clear and legitimate research showing that doulas actually make a very measurable difference in birth outcomes.

Research shows that doula care can:

  • Significantly lower the risk of having a cesarean birth.
  • Lower the risk for postpartum depression and other postpartum mood disorders.
  • Lower the use of epidural medication.
  • Make it more likely that people rate the birth experience as good.
  • Increase the chance that people feel they coped well with labor.
  • Make it more likely that people report that “labor had a very positive effect on their feelings as women.”
  • Help people have improved perceptions of their bodies’ strength and performance.
  • Increase breastfeeding success rates.

This is a HUGE and very significant list of benefits, and the word is spreading. Doula care is not universal, but it’s there! Many cities have a thriving doula community and there are plenty of doulas to contact and interview and hire. In other places, there are only a few. Doula care is usually not very expensive when you consider the amount of time a doula spends with you. Also, consider the fact that they have to reserve about a 2-week window around your due date to be on call for your birth.

Even so, doula care might not be in everyone’s budget. While doula care is not currently covered by most insurance plans, some are coming around. It seems like a no-brainer that insurance companies would want to cover a service that can have such a huge and lasting impact on maternal health.

Currently, Tricare covers doula services, and there are a few others. Rhode Island passed legislation REQUIRING doula coverage for both Medicaid AND private insurance providers. Nine states including Oregon, Minnesota, New Jersey, Florida, Maryland, Nevada, Michigan, D.C., and Virginia currently reimburse Medicaid clients for doula services. At least 17 other states are planning to implement something similar for Medicaid reimbursement. Five states are considering a Medicaid sponsored doula program. There is a pilot program in Texas that includes Austin through G.A.L.S., which is covering the cost of doula services for Medicaid clients. There are programs like G.A.L.S. Austin or Black Mamas ATX which provide low-cost or no-cost doula services for those who can’t afford to hire a doula out of pocket.

Another option to make doula care more affordable for you would be to hire a doula-in-training. To become fully certified, most doula certification programs require a student doula to attend at least three births. This means that the doula has taken the classes and done the reading and fulfilled other requirements, but now they have to get out there! They will probably need the clients and medical staff attending the birth to submit a short evaluation about the care they received. It can be hard for doulas to get invited to births before they’re actively working, so most doulas-in-training offer a very reduced rate for their certification births.

Doulamatch.net is a nationwide doula directory where you can see many of the doulas in your local area. The doulas can show that they have a certification. Doulas-in-training are easy to spot, because they lack a certificate verification and have no or limited experience. In my hometown of Austin, TX, the Central Texas Doula Association is another great way to find a doula.

If you do not have access to doula care for lack of availability, budget, or any other reason, your partner or another family member or friend can step in. Doulas are shown to offer the most benefits, but continuous labor support of any kind is beneficial. I would recommend getting some education about how to support someone through labor, so that your partner can provide the best support possible. We have a class for that! Birthing Partner Prep: The Manual For Labor and Birth Support. Another great resource is a book called The Birth Partner by Penny Simkin.

Resources

Our articles are not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment.

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