What Is a Doula?

The word doula is derived from Greek and meant a servant (a woman) who attended to other women. The meaning has changed slightly to now mean a woman who assists another woman and her family achieve the type of birth that they desire. Usually a doula meets with the pregnant woman two or three times before the birth so that they can establish a relationship and so that the doula can learn what the woman's desires and wishes are for her birth -- like laboring at home, no interventions, changing positions during labor, massage, holding baby and nursing before baby is taken, etc. Every woman is different in their desires and vision of their birth, and, of course, things can happen that are unexpected, so it is important to play out all scenarios. The main "work" that a doula does comes when the woman goes into labor. The doulas job is to totally support the laboring woman, providing comfort measures, and also to support the mother's partner in fulfilling his role as a support person, as much as he feels comfortable. A doula is knowledgeable of different laboring positions, relaxation techniques, and the general physiology of birth, so that the mother's experience during labor will be improved and she will usually have a shorter labor and pushing stage. Usually a doula will stay with the family for one or two hours after the birth, to make sure everyone is settled and that breastfeeding has been established. Two post-partum visits in the home are arranged in order to check in on mom, to see how she is adjusting, and to also debrief the birth with her.

Doulas are not medical personnel. I am not trained to deliver a baby or do vaginal exams. My job is to work with the medical team (nurses, doctors, midwives) to help the mother achieve the birth she desires. I am also not there to replace the mother's partner. I know some women who have spouses that really want to be intimately involved in all aspects of the labor and delivery, desiring to be the mother's primary labor coach. That's great. The doula would then be there in a secondary capacity, maybe providing suggestions for laboring positions, providing refreshment, helping to keep mother comfortable, and allowing the partner to take breaks as needed. Some men feel very overwhelmed by the whole experience, and wouldn't even know where to start. Seeing their spouse in pain can be very stressful for some men, and the doula is there to assume a primary role, including the partner to the degree that he desires to be. All of these things would be discussed ahead of time.

Doulas are not just for women who desire an unmedicated birth. Some women may go into a birth knowing they want an epidural, others may not be sure. Just because a mother receives an epidural, doesn't mean that she doesn't need encouragement and support. She may still need an advocate or her spouse may need his own support. A lot of first-time moms aren't sure what to expect, so it is nice to have someone there to support in every type of scenario. Some women even hire doulas when they have a planned cesarean, simply because there is a lot going on at the birth, and usually mother and baby are separated for a short while, causing the partner some conflict about who to stay with. Doulas can be there to continue their support of the mother, when the father goes with the baby, and assist in breastfeeding, immediately after mother and baby are reunited.

The cost of a doula varies by where you live and is usually based on cost of living. When I initially looked at hiring my own doula, I didn't think that there was any way that we could afford it, but we went ahead and did just because I had been feeling so much anxiety. Afterwards, my husband said that he would gladly have paid double the price, just because of how wonderful our doula was and how instrumental she was in helping both of us through the process. Please read Charlie's Birth Story if you would like to learn more about how my doula assisted me during my labor and delivery.

Statistically, doulas are proven to reduce cesarean rates by 50%, epidurals by 60%, the use of Pitocin by 40%, the need for a forceps or suction delivery by 30%, and women who use a doula have been shown to have a labor that is 25% shorter than women who don't (this was taken from the book Mothering the Mother). Those are pretty good statistics. If you are interested in finding a doula in your area, check out DONA's (Doulas of North America) website. They have a listing of all certified doulas by state and then city.