The word doula is a Greek word meaning women’s servant. Women have been serving other women in childbirth for many centuries and have proven that support from another woman has a positive impact on the labor process.
My husband (partner) is my left hand and my doula is my right. - from Doulas Making a Difference
What is a doula?
A doula is a professional trained in childbirth who provides emotional, physical and informational support to the mother who is expecting, is experiencing labor, or has recently given birth. The doula’s purpose is to help women have a safe, memorable and empowering birthing experience.
Most often the term doula refers to the birth doula, or labor support companion. However, there are also antepartum doulas and postpartum doulas. Most of the following information relates to the labor doula. Doulas can also be referred to as labor companions, labor support specialists, labor support professionals, birth assistants or labor assistants.
What does a doula do?
Most doula-client relationships begin a few months before the baby is due. During this period, they develop a relationship where the mother feels free to ask questions, express her fears and concerns, and takes an active role in creating a birth plan. Most doulas make themselves available to the mother by phone in order to respond to her questions or explain any developments that might arise during the course of the pregnancy. Doulas do not provide any type of medical care. However, they are knowledgeable in many medical aspects of labor and delivery. Consequently, they can help their clients gain a better understanding of the procedures and possible complications of late pregnancy or delivery.
During delivery, doulas are in constant and close proximity to the mother. They have the ability to provide comfort with pain relief techniques that include breathing techniques, relaxation techniques, massage, and laboring positions. Doulas also encourage participation from the partner and offer reassurance. A doula acts as an advocate for the mother, encouraging and helping her fulfill specific desires that she might have for her birth. The goal of a doula is to help the mother experience a positive and safe birth, whether an un-medicated birth or cesarean.
After the birth, many labor doulas will spend some time helping mothers begin the breastfeeding process and encouraging bonding between the new baby and other family members.
What are the benefits of having a doula?
Numerous studies have documented the benefits of having a doula present during labor. A recent Cochrane Review, Continuous Support for Women During Childbirth, showed a very high number of positive birth outcomes when a doula was present. With the support of a doula, women were less likely to have pain relief medications administered, less likely to have a cesarean birth, and reported having a more positive childbirth experience1.
Other studies have shown that having a doula as a member of the birth team decreases the overall cesarean rate by 50%, the length of labor by 25%, the use of oxytocin by 40% and requests for an epidural by 60%2.
Doulas often use the power of touch and massage to reduce stress and anxiety during labor. According to physicians Marshal Klaus and John Kennell, massage helps stimulate the production of natural oxytocin. The pituitary gland secretes natural oxytocin to the bloodstream, causing uterine contractions, and to the brain, resulting in a feelings of well being, drowsiness and higher pain threshold. By contrast, because synthetic IV oxytocin cannot cross into both the blood stream and the brain, it increases contractions without the positive psychological benefits of natural oxytocin.
What about the father’s role when using a doula?
The role of the doula is never to take the place of husbands or partners in labor, but to compliment and enhance their experience. Today, more husbands are an active role in the birth process. However, some partners prefer to enjoy the delivery without having to stand in as the labor coach. By having a doula as a part of the birth team, a father is free to do whatever he chooses. Doulas can encourage the father to use comfort measures and can step in if he wants a break. Having a doula allows the father to support his partner emotionally during labor and birth and to also enjoy the experience without the added pressure of trying to remember everything he learned in childbirth class!
Are doulas only useful if planning an un-medicated birth?
The presence of a doula can be beneficial no matter what type of birth you are planning. Many women report needing fewer interventions when they have a doula. But be aware that the primary role of the doula is to help mothers have a safe and pleasant birth–not to help them choose the type of birth. For women who have decided to have a medicated birth, the doula will provide emotional support, informational support and comfort measures through labor and the administration of medications. Doulas work alongside medicated mothers to help them deal with possible side effects and other needs where medication might be inadquate, because even with medication, there is likely to be some degree of discomfort.
For a mother facing a cesarean, a doula can be helpful by providing constant support and encouragement. Often a cesarean results from an unexpected situation leaving mothers feeling unprepared, disappointed and lonely. A doula can be attentive to mothers at all times throughout the cesarean, letting them know what is going on throughout the procedure. This can free the partner to attend to the baby and accompany the newborn to the nursery if there are complications.
What about other types of doulas?
There are three types of doulas: the Antepartum Doula, the Labor Doula and the Postpartum Doula:
Antepartum Doulas provide help and support to a mother who has been put on bed rest or is experiencing a high risk-pregnancy. They provide informational, emotional, physical and practical support in circumstances that are often stressful, confusing and emotionally draining.
Postpartum Doulas provide help and support in the first weeks after becoming a mother. They provide informational support about feeding and caring for the baby. They provide physical support by cleaning, cooking meals and filling in when a new mother needs a break. They provide emotional support by encouraging a mother during those times when she might be feeling overwhelmed.
Some doulas have training in more than one area and are able to serve as more than one type of doula.
Finding a Doula:
The most important thing in choosing a doula is to find a person with whom you feel comfortable and who gives you confidence. Most doulas do not charge for an initial consultation and interview, so take the time to interview as many as necessary until you one that meets your needs. Find a Doula Here.
Questions to Ask a Potential Doula:
- What training have you had?
- What services do you provide?
- What are your fees?
- Are you available for my due date?
- What made you become a doula?
- What is your philosophy regarding childbirth?
- Would you be available to meet with me before the birth to discuss my birth plan?
- What happens if for some reason you are not available at the time of my birth?
Your Next Steps:
- Find a Doula in your area
- Talk to friends and family members who have used a doula
- Read more about Doulas
- Mothering the Mother: How a Doula can help you have a shorter, easier and healthier Birth by Marshall H. Klaus, Phyllis H. Klaus, and John Kennell.
- The Doula Book by Marshall H. Klaus, John Kennell, and Phyllis H. Klaus.
- The Doula Advantage by Rachel Gurevich.
- Contact DONA International (DONA)
- Contact Childbirth and Postpartum Professional Association (CAPPA)
You can also call the American Pregnancy Association at: 1-800-672-2296 for a list of doula referrals in your area.
You may find the following books helpful.
- Mothering the Mother
- Marshall H. Klaus
- The Doula Book
- Marshall H. Klaus
- The Birth Partner
- Penny Simkin
Your purchase supports the American Pregnancy Association.
Compiled using information from the following sources:
1Hodnett ED. Gates S Hofmeyr GJ. Sakala C. Continuous Support for Women During Childbirth. Cochrane Database of Systematic Reviews.(3) CD003766, 2003.
2Klaus, M., Kennell, J., Klaus, P. Mothering the Mother.: Addison-Wesley Publishing Company, 1993.
Childbirth Connection, http://www.childbirthconnection.org/