What is a Doula?
A doula is professional who offers guidance, support, and companionship for a woman during childbirth. Also sometimes called a birth doula or birthing coach, a doula stays with the mother through the entire birthing process. During that time, a doula provides non-medical assistance that may include helping the mother to relax, demonstrating pain management techniques like deep breathing, or holding her hand. Doulas also advocate on behalf of their clients and offer support to the father or other family members present.
Doulas are not medical personnel, but can play an important and complementary role in easing the childbirth experience for the mother, offering warmth and caring human presence. Many women find that working with a doula can help them feel more relaxed and safer while giving birth. The presence of a doula has been found to help the birthing process become healthier, shorter, and less dangerous to mother and child, as well as reduce the mother?s need to take pain medication. Mothers assisted by doulas are also less likely to need a C-section.
Some doulas also work with their clients during pregnancy and after the baby is born. Doulas can provide education on pregnancy, prenatal care, and what to expect once the baby arrives. They can also keep the mother company, as well as help with practical tasks like caring for the baby. This can be particularly useful for mothers who have been put on bed rest, or are experiencing postpartum depression.
While it is not required, doulas often go through training and receive certification. Doulas are usually women, but not always.
What does a doula do?
History and philosophy
Women going through childbirth have always needed support and companionship. Historically, this was provided by a woman's female relatives, who would stay with her during childbirth and assist her with the baby afterwards. This worked well for thousands of years in most cultures because it was normal for women to have large, extended families close by, able to help and give comfort.
However, over the last century, it has become much more common for women to give birth in hospitals, away from the home. At the same time, families have become more spread out and are often separated by geography. This means that women going through childbirth are often doing so in an unfamiliar and institutional environment, without the social support they might have had in centuries past. Even for women with larger families nearby, their relatives may be too busy working to offer enough help.
The doula profession has been developed as a result. Professional doulas can now take on the role that relatives used to play for mothers in childbirth. Their services have become increasingly popular with women and couples who want extra help and ease throughout the childbirth experience.
Studies have shown that working with a doula can provide significant benefits. One exhaustive assessment of existing research by Cochrane Reviews may have stated the obvious by finding that continuous emotional and practical support was helpful to all women going through labor. The review noted that receiving ongoing emotional support "increased the chance of a spontaneous vaginal birth, had no harm", and helped women feel "more satisfied"
The Cochrane study was not just assessing doulas, but emotional support of any kind. However, it found that while the presence of a woman's partner, friends, loved ones or relatives was helpful, the presence of a professional childbirth companion like a doula was more so. The review noted it was important for the doula to stay with the mother during the entire birthing process in order for her to experience the benefits.
Smaller studies and case reports have found that women essentially universally appreciate having a doula with them during childbirth.
Types of doula
The word doula usually means a professional companion for women during childbirth. However, over the past few decades, other variations on the role have been developed.
This is the most common type of doula. Birth doulas work with a mother to provide support during the birthing process. This includes emotional comfort, practical advice, assisting with tasks to benefit the mother, and helping her relax. Doulas also advocate for their clients in hospital settings and communicate on their behalf with the medical staff.
Antepartum or postpartum doula
Many birth doulas don't just provide help during the actual childbirth. Doulas can educate women on pregnancy and childbirth, give advice and guidance, as well offer practical and emotional support.
This can be especially helpful for women going through difficult pregnancies or who are confined to bed during their final weeks or months of pregnancy. Working with a doula during pregnancy also helps the expectant mother to build trust with the doula. This can help her feel more comfortable when she actually gives birth.
Doulas can also help once the baby is born. A doula can do everything from assisting the mother in taking care of the newborn. Some doulas work with their clients for up to several months after the birth.
People who work with the dying are sometimes referred to as death doulas. A death doula can provide companionship for someone in the final days of life, and be present with them through their experience of dying. The goal of the death doula is to help the dying person feel safe, heard and cared for. If the dying person is so inclined, many death doulas also offer spiritual care.
Death doulas often work with people receiving hospice care, or who otherwise know that they don't have long to live. They advocate for the people they work with, which can be useful when dealing with a hospice or nursing home. They can also provide education and planning suggestions for the dying and their families, as well as emotional and spiritual support to family members.
Getting an abortion can be deeply emotional, as well as scary. An abortion doula provides a service similar to a birthing doula by supporting the client through the experience. The doula sits with the client during the abortion, helping her relax, listening and offering empathy. Abortion doulas can also provide practical education and advice on abortion.
What's the difference between a doula and a midwife?
Both doulas and midwives support women during pregnancy. There is some overlap between the two roles. Both build relationships with expectant mothers, educate them in pregnancy, prenatal and postnatal care, and offer emotional support during the birthing process.
However, midwives are medical professionals and specifically provide medical care, including delivering babies and conducting prenatal or postnatal health exams. Doulas offer companionship and practical guidance before, during and after childbirth. However, doulas cannot offer medical services and do not deliver babies by themselves.
During the birthing process, the two roles can be complementary - with the midwife focused on delivering the baby, the doula can provide additional support such as holding the mother's hand and instructing her on proper breathing techniques.
What are the benefits of working with a doula?
The benefits of working with a doula can include:
Having supportive companionship during childbirth can help reduce the pains of labor. Studies have found that women who work with a doula are less likely to need pain medication during labor. The comforting presence of the doula can essentially serve as a treatment for birthing pain.
When labor becomes intense, a doula may simply hold her client's hand. Physical touch from someone we trust is actually critical to our sense of well-being; it can help relieve emotional and physical pain, lower our stress, and just give us a sense that everything is okay. This can be especially helpful during labor.
A more human birth experience
Over the past century, childbirth has gone from typically happening in the home, to occurring most often in the hospital. As a result, it has increasingly come to be viewed as a medical event, rather than as part of the natural cycle of life. The doctors and nurses overseeing the birthing process are trained to see women specifically as patients.
A doula can help bring back the human element of the experience. The doula isn't there to treat you, but to be with you, person to person. This can help make childbirth feel less overwhelming and more relaxing. Many women who work with doulas comment that they find their presence remarkably reassuring, providing calm in the midst of chaos.
Even the best doctors often don't have enough time to connect with their patients. Doulas do: they get to know you before you go into labor, help you come up with a birthing plan, and offer attentive, personal care once childbirth begins. The doula can also advocate on your behalf with hospital staff, helping to ensure you get what you need. The doctor may be attending to several patients at once, but the doula is completely focused on you.
Decreased chance of Cesarean section
Studies have found that the presence of a doula makes it more likely that a woman will give birth vaginally, rather than by C-section. This may be because the doula helps her to feel more relaxed, facilitating a natural birth. Research has also found that women working with a doula are also less likely to need an instrumental delivery (forceps).
Midwife-led births are also less likely to result in C-sections. It has been suggested that midwife training, which emphasizes that childbirth is a natural event, not a medical one, makes midwives more likely to wait for a natural birth to occur. It could also be that a doula has a similar effect on the medical team she is working with.
Support from a woman experienced in childbirth
In one study of women who worked with (female) doulas while giving birth, many noted that they felt intuitively comforted by being with another woman who had experience with childbirth. The presence of a doula was more calming than a male doctor or partner, as women were more likely to believe the doula when she reassured them during labor pains. Participants commented that working with a doula helped them feel connected to the idea that "ages of women have been doing this", which they found sustaining.
Support for the father
Doulas don't just help the mother. Studies have found that fathers often appreciate the presence of the doula in the birthing room. Childbirth can be stressful for the father as well as the mother, and a doula can offer him reassurance. The doula can also help take some of the pressure off the father by providing an additional source of emotional and physical support to the mother.
Many women also appreciate knowing that their partners receive help.
Because doulas are not medical professionals, the medical aspects of childbirth are outside of their professional scope of practice. In other words, doulas do not offer medical care of any kind. To ensure a safe pregnancy and birthing experience, experts strongly suggest also working with a midwife or doctor.
How much do Doulas cost?
Dina Roth Port
Continuous Support for Women during Childbirth
Hodnett, Ellen D., Simon Gates, G. Justus Hofmeyr, and Carol Sakala.
Cochrane Database of Systematic Reviews, 2012
Women's Perceptions of Their Doula Support.
Koumouitzes-Douvia, Jodi, and Catherine A. Carr.
The Journal of Perinatal Education, 2006