A doula is a birth companion and labor support specialist who accompanies a woman before, during and after the birth of her baby. A doula provides emotional, physical and educational support to the expecting mom and her partner with the goal of achieving a positive and empowering birth experience. Doulas may be trained and certified in childbirth support and ideally will have many hours of experience supporting women and couples in a variety of childbirth scenarios and settings. She may also provide prenatal education, childbirth preparation, and post partum and lactation support.
A doula’s role is unique from medical staff such as nurses, doctors or midwives in that she is directly hired by the expecting mom and accompanies and supports her (and her partner) continuously during her labor, birth and the immediate post partum period. While a doula does not provide medical care or make decisions for a woman, a doula may offer information and strategies so a woman can better communicate with healthcare providers when making informed decisions on care options.
The most central thing a doula does is to be present and provide one-on-one support to the expecting mother (or couple) throughout labor, birth and the postpartum period. Typically a doula joins the laboring mom at her home, eventually accompanying her to her planned birth setting, and remaining with her through the birth process and the immediate post partum hour or two.
Most doula-client relationships begin a few months before the baby is due when a doula will meet at least once and possibly several times with an expecting mom and her partner to get to know her and her childbirth preferences and concerns. If desired, a doula can also help an expecting woman and her partner formalize a written list of birth intentions as part of her birth plans with her provider. As the birth day nears, an expecting woman may be in more frequent contact with her doula in preparation for the big day.
As a labor support specialist, a doula offers a variety of comfort measures and techniques such as relaxation, massage, and laboring positions to the laboring mom. When the birth plan includes the support of the father or another partner, the doula encourages and supports the couple as a laboring team.
In the immediate post partum hours, a doula remains available to help a mom with initiating breastfeeding, and supporting the couple as they settle in with their new baby.
In the days after birth, doulas may continue to provide breastfeeding support and newborn support at scheduled home visits and through communications.
A doula is unique in that she provides one-on-one support to a mom and her partner throughout labor. Attending healthcare providers such as nurses, doctors or midwives have many other responsibilities and will need to attend to other patients at the same time. They may transfer their care to the next provider when their shift ends, and typically spend limited time in the presence of the laboring mom. By contrast, a doula remains present with the mother as long as she is needed and is prepared and experienced with being continuously present for however long the birth may take.
Doulas help laboring moms physically, emotionally and clinically in measurable ways that reduce anxiety, boost confidence and reduce birth interventions. Women who have a doula attend their birth more often report a more positive birth experience (Hodnett et al, 2013).
Studies have shown that the presence of a continuous, one-on-one support by a trained labor support person/doula during childbirth results in clinically significant benefits to a mom and her birth outcome. The American College of Obstetricians and Gynecologists has stated that “one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula” (Caughy, Cahill et al, p. 189, 2014).
One of the most cited research reviews on the topic from 2013 included 15 different randomized controls involving over 15,000 women internationally.
According to the findings of the review, doula-supported women were:
much less likely to have a cesarean section (by 28%)
less likely to use synthetic oxytocin to speed up labor or need forceps or vaccum delivery
less likely to request pain medication
more likely to rate their birth experience positively
Outcomes were greater when the labor support person was neither part of hospital staff nor part of the laboring mother’s immediate social circle. That means the presence of independent, professional doulas can offer the greatest benefits (Hodnett et al, 2013; Simkin, 2012).
Doulas may have varying degrees of experience and training, and may or may not be certified. When interviewing any potential doula, ask about her credentials and experience to know what that doula has to offer.
Today, many women and their partners plan their births together with the partner actively participating. Fathers may attend some or all the doctor/midwife prenatal visits together with the expecting mother, with the intention to be present and participating at the birth of their baby. A doula’s role is to support the expecting couple together, helping both the mother and her partner throughout the pregnancy, birth and postpartum experience. The role of a doula is never to replace that of the partner, but rather to enhance and compliment the labor and birth experience for both. Some partners find it difficult to act as a labor coach and rely more heavily on the doula to fill that role. Other partners may want more guidance on how to emotionally support and coach mom during labor from the doula. A doula’s presence during childbirth can be a calming and positive way to encourage mom and her partner as a team.
Sometimes births don’t go as planned and interventions are needed for the safe delivery of a baby, including surgical interventions such as a cesarean section. A woman who had desired a vaginal delivery may feel conflicted or saddened by the change in the birth plan. She may also be separated from her partner for the procedure and the immediate recovery. A doula can be very helpful under such circumstances by continuing support before, during and after the delivery of the baby, and offering crucial post partum support so mom and baby can stay together in the recovery room for bonding, skin-on-skin time, and the initiation of breastfeeding. A professional doula can be a very valuable member of a birth team, especially if fathers or male family members are not allowed entry.
However a baby is born, a birth is still a joyful family event, the welcoming of a new little being (or beings!) to the world, and an important right of passage for a woman, and a birth should be honored as such. Doulas can help a woman and her partner regain and maintain the joy and wonder of such a special time, even when the circumstances may become highly medicalized.
Caughey, A. B., Cahill, A. G., Guise, JM, Rouse, D. J. (2014). Safe prevention of the primary cesarean delivery, American College of Obstetricians and Gynecologists and the Society for Maternal Fetal Medicine Consensus; American Journal of Obstetrics and Gynecology, March, 2014, 179-193. Retrieved from: http://www.ajog.org/article/S0002-9378(14)00055-6/pdf
Hodnett ED, Gates, S, Hofmeyer GJ, Sakala C, Weston J (2013). Continuous support for women during childbirth (review), Cochrane Database Syst Rev 2013; 7. DOI: 10.1002/14651858.CD003766.pub5.
Simkin P, (2012) The birth doula’s role in maternity care (position paper). DONA International. Retrieved from DONA website: https://www.dona.org