Wednesday, August 14, 2013

Childbirth Choices Series Part III: Do I Need a Doula?

This is the third in my Childbirth Choices Series, geared toward newly pregnant or planning-to-be pregnant couples with the goal of educating women and their partners about the many options they have when it comes to their prenatal and maternity care, including choosing a care provider, choosing where and how to give birth, and information about labor, delivery, and the immediate postpartum time. This is not meant to replace or substitute for a childbirth education class. Rather, it is intended to get women thinking about their options and making informed choices when it comes to their care throughout pregnancy and labor and delivery.

More articles in this series:
Part I: I've Just Found out I'm Pregnant; Now What?
Part II: Meeting Your Care Provider
Part IV: What Will Happen at My Prenatal Appointments?
Part V: It's almost Time to Have a Baby!
Part VI: Labor and Delivery
Sometime reasonably early in your pregnancy, perhaps in the first part of the second trimester, you'll want to start thinking about who will be there at your birth. For many women, it's a no-brainer: the father of the baby should attend the birth. For others, the father may not be present, there may be no "father" in a parenting sense, or the father may not be able to attend due to circumstances out of his control, such as being deployed with the military. In other cases, the pregnant woman's partner may simply feel inadequate to be fully supportive or may be unwilling to try. Other partners may simply feel that having someone else there who knows what labor and childbirth should look like may be helpful.

That's where a "doula" comes in.

Realistically, it's only in the past maybe 40 years that the father of the baby has been expected to be anywhere near the birthing room. Birth, historically, has been the domain of women. A laboring woman's mother, older sisters, aunts, or other women in her life who have been through childbirth would traditionally attend her, as would a trained midwife, typically. Even when male doctors started attending births, fathers waited outside. Today, most fathers desire to be in the birthing room, supporting the mother of their child and meeting their new baby right away, and most new mothers want the father to be there.

In all cases, there is no question that a woman was never expected to get through labor alone. 

The word "doula" comes from the Greek meaning "a woman who serves." Today, the term doula generally refers specifically to a woman (or occasionally a man) who attends a woman during her labor, providing physical and emotional support, helping her understand the birth process and what's happening to her, assisting her in communicating with her partner and her care providers, and helping her to make informed decisions throughout the labor and delivery process. The term doula is a professional title for someone who has been trained in this arena, but in terms of the more casual use of the word, a doula is anyone a woman chooses to be there to support her as she labors. 

It is important to remember that a doula is not a medical provider. A doula does not check vital signs, administer medications, check cervical dilation, or make recommendations or medical decisions on behalf of the mother, and she does not deliver the baby. A doula is a support person who understands the birth process and can help the laboring woman manage pain using non-medical techniques such as breathing and relaxation. Some doulas have specific training in areas such as massage, aromatherapy, or acupressure that she can use to offer other types of relief as a woman labors. A doula's primary role is to provide information and emotional and physical assistance. A doula is in constant attendance and is there solely for the sake of the mother.

Why Might You Want a Professional Doula?

While anyone can technically act as a "doula," such as your mother, sister, or best friend, a professional doula will have specific training in how to support a woman in labor. She will have knowledge and an understanding of the birth process. She will be a steady presence, someone who has seen birth and knows what's going on who can offer perspective, information, and help the mother make informed decisions when presented with choices by her care provider. She can help the mother and her partner develop a birth plan or decide on birth preferences and come up with alternatives in case of unexpected events. A professional doula, more than anything else, will be a source of reassurance and strength during this exciting and frightening event and will act as a mother's advocate in the medical setting, and she will be able to be with the laboring mother at all times, while the medical personnel are generally in and out over the hours. A doula can also support the laboring woman at home and help her decide when it is time to go to the hospital, enabling her to spend more time in the comfort of her home and not set off in a panic to the hospital the moment the first contraction hits.

Professional doulas have specific training and are required to attend several births before receiving their doula certification. Doulas are certified by DONA International and may use the initials CD(DONA) after their names. See for more information about DONA and how doulas are trained and certified.

Why Might You Not Want a Professional Doula?

Not everyone has a doula at her birth, and not everyone wants one. You may feel that you know enough about the birth process, or you trust that your partner or another family member or friend will be sufficient support that you don't want or need to seek out a professional. For many, there are also financial considerations. While most women who have had a doula at their birth will tell you it is money well spent, a professional doula typically charges anywhere from $700 to over $1,000, depending on her services, experience, and your region, and this is generally not covered by insurance. Finally, some women or their partners are uncomfortable with the idea of having essentially a stranger attending such an intimate experience in their lives, or they feel that one more person in the room will be one more too many.

I should note that if finances are the main reason you are not considering hiring a doula, you can often find doulas who are willing to work with you on a payment plan, as well as doulas-in-training who may be willing to negotiate a reduced fee. There are some doulas who donate their services on occasion, depending on the circumstances, and there are some hospitals (a few) that may have a volunteer doula program where doulas will attend your birth at no additional cost to you. The disadvantage to this last option is that you wouldn't get to meet her in advance and become comfortable with her. Please remember that for a professional doula, attending births is her job as well as her passion, and she will be spending many, many hours with you as you labor, often through the night, both at home and in the hospital or birth center, and it is not fair to expect her to do it for free.

If your major concern is the idea of having a stranger with you, keep in mind that you will meet with your doula a few times before you go into labor, and you should only choose someone that you feel comfortable with. Your care provider and the nurses who attend you (if you deliver in a hospital) will also be relative "strangers" as well, if you think about it.

Many women do not hire a doula either because they don't know it's an option that exists or because it seems too "hippie" and nontraditional. Women who choose to have a doula attend their birth are still a small percentage of all birthing women, but the number is growing. Studies have shown that women who have a doula with them at their birth report more positive feelings about their births, shorter labors, and healthier outcomes for mother and baby. 

Thoughts from Two Professional Doulas

I interviewed two professional doulas to get their perspective on what their role is. Jenna Anderson and Jessica McGuire are San Diego-area doulas who were kind enough to participate in the writing of this article. 

Jenna and Jessica were both inspired to become doulas after the births of their first babies. Jenna did not have a doula in attendance, but after the long labor she realized how helpful it would have been to have another support person as she labored, especially so that she wouldn't have been left alone through so much of the labor process. She decided that she would like to become a doula to provide that kind of support to other laboring women. Jessica did have a doula with her at her first birth. Though she found her birth to be quite traumatic, she reports that her doula was very encouraging and reassuring as labor progressed. She remembers a line from More Business of Being Born that said that doulas are natural born teachers and realized that this was her calling.

I asked Jenna and Jessica to describe, in their own words, what a professional doula does. They both responded that their role is to provide information, support, encouragement, reassurance, and advice to the laboring woman and her partner. Jessica stressed that her advice should never be unsolicited and both Jenna and Jessica stated that they adjust their role and how hands-on they are based on the needs of the individual woman they are with. 

I then asked what they are not supposed to do. Both mentioned that they specifically cannot and do not speak for the mother, nor can they provide any clinical or medical services such as cervical checks or fetal heart monitoring. They both again stressed that their role is support, information, and reassurance.

Jenna and Jessica described some of the methods they use to help a woman relax and cope with contractions. They may use essential oils, massage, hot water bottles at specific points on the body, and they may suggest different positions and movements and, of course, offer verbal encouragement and emotional support. Jessica also mentioned that she has received certification in the use of a TENS unit to help with pain management.

Jenna's website is and Jessica can be found at

I acted as a doula at the birth of my friend's second child a few years ago. You can read my account of that incredible event here.

More articles in this series:
Part I: I've Just Found out I'm Pregnant; Now What?
Part II: Meeting Your Care Provider
Part IV: What Will Happen at My Prenatal Appointments?
Part V: It's almost Time to Have a Baby!
Part VI: Labor and Delivery

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