The doula is a professional trained in childbirth who provides emotional, physical, and educational support to a mother who is expecting, is experiencing labor, or has recently given birth. Their 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 in which the mother feels free to ask questions, express her fears and concerns, and take an active role in creating a birth plan. Doulas may provide information about perineal massage and other techniques that can help to reduce stress and trauma often experienced during childbirth.
Most doulas make themselves available to the mother by phone in order to respond to her questions or address any concerns that might arise during the course of the pregnancy. Understand they do not provide any type of medical care. However, they are knowledgeable about many medical aspects of labor and delivery.
As such, they can help their clients gain a better understanding of the procedures and possible complications in 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 including 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 she might have for her birth. The goal of a doula is to help the mother experience a positive and safe birth, whether an unmedicated birth or a cesarean.
After birth, many labor doulas will help new 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 their support, women were less likely to have pain-relief medications administered and less likely to have a cesarean birth. Women also reported having a more positive childbirth experience.1
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 feelings of well-being and drowsiness, along with a higher pain threshold).
Historically it was thought that intravenous oxytocin does not cross from the bloodstream into the brain in substantial amounts and, therefore, does not provide the same psychological benefits as natural oxytocin. However, more recent studies indicate that oxytocin administered nasally and/or intravenously may cross from the bloodstream into the brain. Nonetheless, doulas can help mothers experience the benefits of oxytocin naturally without the use of medication.
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 rather to complement and enhance their experience. Today, more husbands play 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. They can encourage the father to use comfort techniques 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 unmedicated 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 one. 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, informational, and physical support through labor and the administration of medications. Doulas work alongside medicated mothers to help them deal with potential side effects. Doulas may also help with other needs where medication may be inadequate 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 a mother feeling unprepared, disappointed, and lonely. A doula can be attentive to the mother at all times throughout the cesarean, letting her 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?
Antepartum doulas provide 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 support in the first weeks after birth. 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 when she feels 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 key to choosing a doula is to find a person with whom you feel comfortable. Most do not charge for an initial consultation, so take the time to interview as many as necessary until you find a good match.
Questions to Ask:
- What training have you had?
- What services do you provide?
- What are your fees?
- Are you available for my due date?
- What made you decide to 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 I give birth?
Want to Know More?
- 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)
Compiled using information from the following sources:
1. Childbirth Connection
2. Hodnett ED. Gates S Hofmeyr GJ. Sakala C. Continuous Support for Women During Childbirth. Cochrane Database of Systematic Reviews. CD003766, (2003).
3. Klaus, M., Kennell, J., Klaus, P. Mothering the Mother.: Addison-Wesley Publishing Company, (1993).
4. Viero, C., Shibuya, I., Kitamura, N., Verkhratsky, A., Fujihara, H., Katoh, A., Dayanithi, G. (2010).
5. Oxytocin: Crossing the bridge between basic science and pharmacotherapy. CNS Neuroscience & Therapeutics, 16.