What is a Doula?
Whenever I get asked the question, “what do you do?”, I know that I’m about to enter into a conversation — or potentially a monologue — rather than just giving a quick response. It would be so wonderful if people would understand what I do as quickly as they understood “I am a teacher”, or “a counselor”, or “an accountant.” But when I reply, “I’m a doula”, I begin to prepare myself to give my explanation.
Most people don’t know what a doula is so it never surprises me when the person I am speaking with looks perplexed and has no idea what I’ve just said. Let me say, I don’t mind giving an explanation because it gives me the opportunity to share my passion and educate someone on a service that they or a family member or friend might be interested in using. What does surprise me and excite me is when that person I am speaking with DOES know what a doula is. I love hearing their stories about how they heard about doula care, how their friend hired a doula, or how their family member is a doula. Unfortunately that only happens on rare occasions so I still find myself educating most people on what a doula actually is and what we do for families. You, our Mommy Chicks, may not know what a doula is. So, today, I wanted to take a few minutes to share with you the answers to some common questions. So let’s start from the very beginning. It’s a very good place to start. 😉
What is a doula?
The word “doula” — pronounced ‘doo-la’ — is an ancient Greek word meaning ‘woman servant, caregiver, or a woman who serves.’ More recently it is used to refer to a trained and experienced professional who provides continuous physical, emotional and informational support to the mother and her partner during pregnancy, labor, childbirth and their postpartum journey.
There are two main types of doulas, Birth Doulas and Postpartum Doulas. Birth Doulas are trained professionals that support women and their partners during pregnancy, childbirth, and immediately postpartum. Postpartum Doulas are trained professionals that support families during their transition into parenthood during the postpartum period (the first 12 weeks after birth).
The role of a doula has also evolved into other areas of life and there are now more specialities in doula care. There are:
- Antepartum Doulas support pregnant women who have been placed on bed-rest or who are in a high-risk or high-stress pregnancy situations.
- Bereavement Doulas provide emotional, physical, and informational support to women and families processing the loss of a child.
- Adoption Doulas build relationships with both the birth mother and the adopting or fostering family. Sometimes it’s just with the birth mother or the adopting or fostering family.
What does a doula do?
Birth Doulas normally offer to meet with each of their clients several times — two, three or four times — for prenatal visits to go over each couple’s wants and desires, as well as educating them on the options that are and will be available to them. This allows the doula to understand how to best support each family during their labor and birth.
At the birth, Birth Doulas bring an entire toolbox of ideas, tricks and techniques. Your doula may rub your back for several hours, or trade off with your partner in that role when his hands are aching and he needs to eat and rest. She may be the quiet, calm, reassuring voice whispering in your ear, or the firm, anchored voice that will help you get back on track when labor starts to feel intense and overwhelming. She can help you focus on natural ways to help your labor progress (if you want to have an unmedicated birth), or she can help you decide which medications you would want to use and when the best time it is during your labor to get them. Your doula can help straighten out a baby that’s slightly malpositioned in the pelvis and she can give you ideas on how to negotiate with the staff to achieve some important elements of your birth plan.
Birth Doulas offer a lot of support to the husband or partner, showing him and other loved ones how they can best help you, and reassure them about what’s normal. Your doula might offer a hand massage to help you rest and relax, and she can explain your options and help you brainstorm questions when you’re facing medical interventions for you or your baby. On occasion, doulas’ help and reassurance after the birth might be key to establishing your nursing relationship.
Every labor unfolds in it’s own unique way. A doula’s job is to bring her expertise in birth to the table and stay fully present and supportive, whatever your family’s needs and desires may be.
A Postpartum Doula’s role is so unique to every family. Essentially, she will come into your home, assess your needs, and jump in to help. Your doula’s role is to nurture you as you make the transition into life with your new baby. This could include help with breastfeeding, suggestions and information about baby care, and resources to help heal your own body postpartum. She is like a teacher, sharing evidence-based information and helping you integrate the baby into your family. She could help take over baby care for a little while so that you can have a shower or a nap. She can also show you how to use several different baby carriers, how to use your breast pump, suggest which diapers/diaper creams/baby detergent/etc. that you might want to try, and more. Postpartum Doulas can also do some light housekeeping, such as washing dishes or wiping down counters and doing baby’s laundry.
If you have older children, she can spend time playing or working with them to help them adjust to the big sibling role. She can also run errands for you and pick things up if you’re not able to drive yet or haven’t been able to get out of the house. Doulas come in with a keen sense of what new families typically need and then work with you to decide how she can best support you through the transition into parenthood.
What are the benefits of hiring a doula?
Numerous studies have documented the benefits of having a doula present during labor and postpartum. A Cochrane Review, Continuous Support for Women During Childbirth, showed a very high number of positive birth outcomes when a Birth Doula was present. With the support of a Birth Doula, 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. Here are some of the stats:
- Decreases the overall cesarean rate by 50%
- Decreases the length of labor by 25%
- Decreases the use of oxytocin by 40%
- Decreases the use of pain medication by 30%
- Decreases requests for an epidural by 60%
- Reduce the number of days newborns spent in the NICU (neo-natal infant care unit)
- Reduce the rates of postpartum depression
- Increase the rates of breastfeeding
- Increase the positive maternal assessments of maternal confidence and newborn health
Studies show that having a Postpartum Doula after childbirth results in:
- Greater satisfaction with postpartum period
- Quicker birth recovery
- More likely to eat healthier and sleep more
- More confidence in parenting and childcare
- Less stress and anxiety
- More positive opinion of baby
- More affectionate to baby
- Less incidence in postpartum mood disorders
- Higher breastfeeding success rate
These are awesome results! Who wouldn’t want to improve their chances of having a better overall experience during labor and bringing baby home?
My husband/partner/mom/friend is going to be my support person in labor. Do I still need a Birth Doula?
I know that dads are sometimes nervous that a Birth Doula might take over their role and that they’ll be “shut out” of the labor process. That is not the case at all! Dads and doulas actually compliment each other in labor.
A doula is kind of like a tour guide in a foreign country or a coach to a team. Your tour guide doesn’t take away from your trip, she enhances it for both of you. And how are you supposed to win a game if you have never played the game before? (Assuming your husband hasn’t coached you or any other women in labor.) Your coach can help lead you to victory! The same is true of a doula. She can help you both navigate the healthcare system and understand the process of labor and birth.
Doulas often find themselves reassuring dads/partners about the normal sights and sounds of labor, which can be disconcerting to even the best prepared support person. Doulas show dads particular techniques to help the laboring woman, based on exactly what is happening in her body at that moment. Experiencing back labor? “We might try this counter-pressure technique, let me show you exactly where to put your hands.” Relaxing in the bath? “How about gently pouring water over her belly with each contraction, like this.” Mom is laboring in the bathroom? “Here, let me get the birth ball so she can lean forward into your chest to rest between contractions.”
During labor, moms usually retreat into their own private “laborland.” Doulas often find themselves bonding with the dad during the birth as they work together to figure out the best way to support the laboring woman. This is why dads/partners are generally so happy to have another “birth partner” with them for the journey!
As for friends and family members, they can also make wonderful labor support people, but their role is distinctly different than a doula. Doulas bring specialized training in birth and labor support. She has seen many births in various settings and she can help familiarize you with what to expect at each stage. She doesn’t have the same emotional attachments as your family, so it’s easier for her to separate herself from your choices.
A doula is there to support you in whatever kind of birth you want, whatever that looks like for you. You don’t have to worry about what a doula might say or do in any given situation, like you may with some friends or family members. She’s there for your unconditional support and can support your friends and family, too, just as she supports dads and partners in the birth space.
I’m getting an epidural. Do I still need a doula?
Doulas come to your birth with an open mind and an open heart. She is not there to carry out some agenda; she’s there to help you have the best birth possible, whatever that looks like for you. She’ll talk in-depth during your prenatal meetings to learn more about what kind of birth you envision, and she’ll put all of her energy toward helping you get there. And if you get into labor and for whatever reason plans change, a doula can actually help you cope with the unexpected turn of events.
There is a lot a doula can do if you opt for pain medication, including position changes and other tricks to help your baby descend. She can also help you cope with the physical side effects of medication, to continue making your journey as comfortable as possible.
I also hate to say it, but sometimes pain medication doesn’t work as expected, but mom’s movements and coping tools are suddenly limited with those medications — a doula will get you through it.
What if I need to have a C-section. Do I still need a doula?
There are so many things a doula can do to help make a cesarean birth the most loving, family-centered experience possible. For example, she can be with you before the surgery, to help with relaxation and assist you in brainstorming questions for your health care team. She can help advocate for some of the things you might want during the surgery. For example, working with surgeons and anesthesiologists to allow skin-to-skin contact on the operating table, while the surgeon is finishing the operation. This is so much more family-centered than taking the baby to the nursery or to the recovery room to wait for you, and we have found that it significantly decreases birth trauma for the mother. But it’s often something that requires some advocacy with the staff—a doula can help with those negotiations.
Doulas are sometimes allowed to stay with you and your partner in the operating room during the surgery, although this is always a case-by-case decision by your surgeon and anesthesiologist. If a doula is allowed in the OR, she can help explain what is happening during the surgery and show your husband or partner some physical comfort measures that may help you deal with the sensations of surgery. Sometimes a baby needs to go to the nursery or the NICU after a cesarean birth, in which case the dad or partner generally goes with the baby, and the doula will stay by your side. This helps mothers to not feel so alone as the surgery is finished and recovery begins, and it helps partners to not feel so torn between mom and baby.
In most cases, though, the baby will go with the mom to a recovery area, where a doula can help you establish nursing and skin-to-skin bonding. And finally, if the cesarean was unexpected, a doula will offer a compassionate, listening ear to help you process the birth. She can also connect you with resources.
I will have help from my family after the baby is born. Do I still need a Postpartum Doula?
Your husband/partner, family members and friends can offer wonderful support in the days and weeks postpartum! Some of their skills may spill over into the postpartum doula realm, and others are quite different. Postpartum Doulas are great listeners, and they can support you in forming your own parenting philosophies, based on solid research-based information. Postpartum Doulas are an objective source of information and support who can help both you and your husband or partner adjust to life with this new little person. Many family members and friends have found that with a Postpartum Doula’s help, they are actually more involved in caring for mom and baby because they learn exactly how to be most supportive.
It can also be overwhelming for others to care for a new mom and baby, and Postpartum Doulas can help share that nurturing role. For dads and partners, she can help them know how to help and reassure them about what is normal for babies and postpartum mothers. Siblings have a big adjustment too, and a Postpartum Doula can help ease that transition by spending time playing, talking about their new role, and helping the parents with tips on how to interact and entertain older children during the intense weeks when mom is healing and a newborn needs so much attention.
Postpartum Doulas can also help new families recognize the symptoms of imbalance, and connect them with resources for help. They are good listeners so they may lend an empathetic ear to the new mom, or help to take care of other household responsibilities while she is focusing on getting well. There is also some evidence that using a Postpartum Doula can help reduce the chance of developing postpartum depression.
Overall, a doula believes in ‘mothering the mother’. She has the experience and training to support women during these different times in their lives to make their experiences during pregnancy, birth, and motherhood the best that it can be.