Doulas Improve Birth Outcomes
Woman to woman support during labor reduces the chance of having a cesarean by 50%
The word doula is derived from ancient Greek, and it means a “woman caregiver of another woman.” Dana Raphael first used the term to mean someone who supports a breastfeeding mother in her 1973 book, The Tender Gift.
Today, the word doula signifies a woman, hired by the expectant mother and her partner, to “mother the mother.” Specifically, a doula is a trained professional who provides continuous physical, emotional and informational support to a mother during pregnancy, childbirth and the postpartum period. There are several doula specialities:
- Birth Doulas
- Postpartum Doulas
- Full-Spectrum Doulas
- Full-Circle Doulas
- Loss Doulas
A birth doula, as the name implies, helps a woman during pregnancy and throughout the process of labor and birth at home, in a birth center, or in a hospital. A postpartum doula helps after the birth. A full-spectrum doula works with preconception, pregnancy, childbirth, postpartum, miscarriage, abortion and infant loss. A full-circle doula works with pregnancy, childbirth and postpartum. A loss doula supports a family in the event of a miscarriage, stillbirth or infant loss.
A birth doula has probably witnessed many births and is very knowledgeable about how to cope with pain during labor. A doula is there just for you — she will be your best advocate and greatest source of comfort throughout your birth experience. A doula serves as the link between the physical, emotional, and spiritual parts of labor and birth. Among the services that birth doulas may provide are:
- Meeting with you before your due date to plan for the birth and to discuss any questions you might have. If you are nervous about any part of it, she will consider it her job to reassure you
- Giving you prenatal tips on exercise, nutrition, and relaxation techniques
- Helping you at home until it is time to send for the midwife or go to the birth center or hospital
- Transporting you and your partner to the birth center
- Attending you throughout your labor, from beginning to end. Half of all hospitals are short-staffed, and doctors, nurses, midwives — even friends and relatives — may come and go during the labor. Not your doula — she is there continuously as a calm, focused, and experienced presence
- Recognizing where you are in the labor process by observing your facial expressions and speech, as well as acting as your ally and communicating your needs to health care personnel
- Helping labor to progress more quickly if necessary
- Helping you to cope with pain using natural techniques such as massage and acupressure
- Explaining what is happening to you during each step of the birthing process and preparing you for what is to come
- Helping you breastfeed your newborn
- Explaining newborn tests
A postpartum doula is hired to care for the mother. She may change occasional diapers or give the baby a bath, if you need that kind of help (if you are recovering from a cesarean, for example), but her primary focus is to help you so that you can care for your new baby. Doulas range in experience and skills, but here is a short list of the basics you can expect from one:
- Emotional support and encouragement
- Help with baby care and breastfeeding
- Advice on self-care, nutrition and postpartum healing
- Screening calls and visitors
- Light housekeeping, laundry, meal preparation, and errands
- Help with older children (driving or entertaining them)
If your partner is taking time off, you may feel you don’t need the services of a doula. While this may be true, partners also need time to adapt to the new situation, and may not be experienced at caring for others while juggling the demands of a new baby.
It is best to line up the services of a doula ahead of time. However, if you realize that you need a doula during the postpartum period, don’t hesitate to call a doula service or ask a friend for a reference. Try to find a doula with skills that match your needs, for example, familiarity with vegetarian cooking or knowledge of your local community.
The benefits of doulas
The benefits of doulas have been well demonstrated in 27 randomized controlled trials in several countries, and the results reported in highly respected publications such as the New England Journal of Medicine and the Journal of the American Medical Association. Most of these trials noted that touch and words of encouragement were particularly effective tools used by doulas. Women reported more positive evaluations of the birth experience and felt more relaxed during labor when they received continuous woman-to-woman support. Here are some of the specific benefits of birth doulas:
- Reduce your labor time by 25%
- Reduce your chances of having a cesarean by 50%
- Reduce the likelihood that you will need medical interventions such as pitocin, forceps, or vacuum extraction by up to 40%
- Reduce the likelihood that you will ask for pain medication or an epidural by as much as 60%
- Increase your chance that labor will progress normally
- Increase the chances that you will feel satisfied with your birth experience
- Decrease the likelihood that you will experience postpartum depression
- Improve your bonding experience with your baby
- Help you to breastfeed with greater ease
Can my partner or best friend be my doula?
In some cases, friends or partners can be effective doulas. The problem is that, until you have occasion to see them in a birthing situation, neither you nor they will know if they can provide the support you need.
Additionally, partners need their own support during pregnancy and birth. No matter how much a partner loves you, he or she may end up feeling overwhelmed, squeamish, or exhausted by the experience. The very fact that partners love us so much might makes it impossible for them to relax and think objectively about what the current situation calls for. Plus, your partner or friend will most likely not have anywhere near the experience and knowledge of a competent doula.
Your partner, however, is still an essential part of the baby’s birth. In fact, it’s family and friends who can best appreciate a doula’s expertise, since she can guide them to be as effective as possible in helping the birthing mother.
How do I find a doula?
Ask your childbirth educator, midwife or doctor for a doula recommendation. Get a referral from a friend who has recently given birth and had a good experience with a doula. Call your local birth center and see who they recommend. Go to a La Leche League meeting or other parent meeting and ask members for suggestions. Search locally online and pay attention to the reviews.
A number of different organizations train and certify doulas as well as provide databases of certified doulas. If you choose a doula who has undergone such training, you can be assured that she has the knowledge and experience she should have in order to give you the help you need. Look for a training program with a reproductive justice perspective and a sliding scale for payment.
- The Yiya Vi Kagindi Full Spectrum Community Doula Training was created by Tewa Women United (TWU), a multicultural and multiracial support group for women of the Pueblos of Northern New Mexico. This one-of-a-kind doula training has a social justice framework and indigenous foundation. It’s an extensive training that encompasses seven weekends over the course of a year. In exchange for training, doulas attend three births in the local community. For more information, email Alma Rivera.
- Doulas of North America (DONA) was founded by esteemed childbirth educator, Penny Simkin, and was the first US program to certify doulas. DONA offers both birth and postpartum doula certification. Requirements include attendance at a 14-hour training course; training in childbirth education, midwifery, and breastfeeding; three client evaluations; and documentation of three birth experiences.
- Shafia Monroe, founder of The International Center for Traditional Childbearing (ICTC) offers a Full Circle Doula Training Intensive that includes cultural awareness and sensitivity, infant mortality prevention, high risk pregnancies, medical terminology, prenatal support, labor and birth management, postpartum and breastfeeding support, nutrition, relaxation techniques, HIPPA, lead prevention, professional business development, and traditional and spiritual birthing practices.
- Birthworks certification program includes attendance at a three-day intensive workshop, co-faciliatation of a doula workshop, attendance at 15 births, two client evaluations, and tours of two birthing facilities.
- International Childbirth Education Association, Inc. (ICEA) offers training for birth doulas, and postpartum doulas. Both face-to-face and online courses are available.
- Childbirth and Postpartum Professional Association (CAPPA) is an international certification organization for doulas, childbirth educators and lactation educators. They offer Labor Doula and Postpartum Doula training.
- Birthing from Within has a doula training program based on the book of the same name by Pam England, CNM. This five to seven day in-person training focuses on personal growth, understanding and hands-on skills to support families throughout pregnancy and birth. Online doula training is also available.
- Ancient Song Full Spectrum Doula Services focuses on women of color, low income areas, undocumented persons and families who want to make informed decisions about their care. They incorporate an intersectional lens that encompasses reproductive and birth justice framework into their trainings. The organization serves the New York City and New Jersey area. Ancient Song offers a three-day Full Spectrum Labor Doula training and a seven week Full Spectrum Doula Labor and Postpartum training. All trainings are virtual at this time.
- Health Connect One serves communities that have been historically marginalized and inadequately served. The organization trains Community-Based Doulas who provide culturally-sensitive pregnancy and childbirth education, early linkage to health care and other services, labor coaching, breastfeeding promotion and counseling, and parenting education that encourages parental attachment. The Community-Based Doula Program Model succeeds because doulas are of and from the same community as their clients and are able to bridge language and cultural barriers for optimal health and well-being. Based in Chicago, Illinois, Health Connect One is the only home visiting program model in the US in which a home visitor is present at the birth.
- The Prison Birth Project in Holyoke, Massachusetts partnered with the local women’s jail in Chicopee, Massachusetts in 2017 to offer childbirth education and full-spectrum doula support, within a reproductive justice framework, to incarcerated people who are pregnant. The co-founders, Lisa Andrews and Marianne Bullock, understood that incarcerated women are not offered the full spectrum of reproductive options, healthcare, and support available to women on the outside because of the social, economic, and political oppression that accompanies the carceral system. The organization also raises awareness of the experiences of incarcerated parents and worked on the passage and implementation of Massachusetts’ 2014 anti-shackling policy.
- Radical Doula has a list of local volunteer doula programs state by state.
Questions to ask a prospective doula
In interviewing a potential doula, the following list of questions might come in handy. Remember, your doula should be someone you like, since she will be with you during one of the most intense experiences you will ever have.
- Are you certified? By what organization? What kind of training have you had?
- How long have you been in practice as a doula? How many births have you attended?
- What care providers have you worked with? How many homebirths have you attended? In what hospitals and birth centers have you attended births?
- Tell me about some of the births you’ve attended.
- What is your philosophy about childbirth? How do you support women and their partners throughout labor?
- May I meet with you to discuss our birth plans and the role you will play in supporting me?
- May I call you with questions or concerns before and after the birth? How do I contact you in an emergency?
- Do you work with one or more backup doulas (for times when you are not available)? May I meet them?
- When do you join women in labor? Would you come to our home or meet us at the birth center or hospital?
- Can you drive us to the birth center or hospital if necessary?
- Will you meet with us after the birth to review the labor and answer questions?
- What is your fee? Is any part of your fee refundable if, for some unexpected reason, you do not attend the birth?
- Can you provide references?
Childbirth is not the time to tough it out. The research is overwhelming: we do better when we have companionship and support. Choose a midwife who can provide this and/or look for a doula to complement your maternity care. And, don’t forget the often overlooked postpartum period. You may need more help then than during the birth. Be kind to yourself.
Here’s a helpful infographic, “Doulas: 17 Science-Backed Benefits” from Neve Spicer at We the Parents.
About Peggy O’Mara. I am an independent journalist who was the editor and publisher of Mothering magazine for over 30 years. My books include Having a Baby Naturally, Natural Family Living, The Way Back Home, and A Quiet Place. I have conducted workshops at Omega Institute, Esalen, La Leche League, Hollyhock, and Bioneers. I am the mother of four and grandmother of three. Sign up for my free newsletter with my latest posts on parenting, social justice, and healthy living.