Overview
Studies show that birth doulas can promote better birth outcomes. Research shows that moms assisted by a doula during pregnancy and delivery can experience the following benefits: (1)(2)
- Lower odds of having a non-indicated C-section (cesarean delivery)
- Two times less likely to have a birth complication
- Four times less like to have a baby with a low birth weight
- They may be more likely to initiate and continue breastfeeding
Why are these moms’ birth experiences different from those who didn’t have doula care?
Researchers believe that the doula’s continuous support, communication, and encouragement throughout pregnancy might have helped increase these moms’ self-awareness in improving their pregnancy outcomes. (1)(2)
What’s A Doula?
A birth doula is a health care provider professionally trained to provide different types of support to a new mother through pregnancy, labor, and delivery.
Their main purpose is to help you have a safe and memorable birth experience.
Is A Doula For Me?
It’s estimated that around 6% of women in the US get doula support for childbirth. (2)
Although you aren’t required to have a doula, they can help provide continuous support, whether you’re planning a home birth without pain medication, going to the birth center, or planning on a hospital birth.
A doula can be a good choice if you want additional support and coaching in the delivery room.
They can guide you through the birthing process via pain relief and breathing techniques. They can help you remember what you learned during childbirth classes. It can be easy to forget these things amid contraction waves.
Are Birth Doulas Only Useful If You’re Planning An Unmedicated Birth?
No. Birth doulas can also provide support even if you’re planning on a medicated birth or a C-section at the hospital.
While they are usually trained to provide support with an unmedicated birth, they can also provide other forms of support, including physical and emotional. They can also be great allies and advocates to ensure our birthing desires are honored in medical settings.
Benefits Of Hiring A Doula
Studies show that birth doulas can lower the rate of C-sections and other medical interventions. (1)(2)
They can provide the following:
- Emotional support – provides comfort and reassurance
- Informational support – explains procedures or what happens during labor and postpartum
- Physical support – massage options
- Labor support – assistance with breathing and relaxation techniques
- Birth support – helps implement your birth plan
- Postpartum care support – postpartum doulas help nourish the mom back to recover, and some doulas assist in placenta processing
- Newborn care – Help you get into a routine with your little one
- Partner support – guidance and support for your partner and other family members
What Does A Doula Do? Work Process & Role
Prenatal & Birth
Your doula meets with you and your birth partner before your due date or anytime during the third trimester to:
- Discuss your birth plan
- Get to know each other
- Get answers to your questions
- Learn more about their exact role during labor
They can help you create your birth affirmation list or cards, birth plan, hospital bag checklist, and postpartum essentials checklist.
Birth doulas also provide supportive referrals to healthcare providers you might need during birth and the postpartum period (up to six weeks after childbirth). These can include an acupuncture provider, prenatal massage therapist, pelvic physical therapist, lactation consultant, etc.
Other topics to discuss with your doula:
- Labor positions
- Relaxation techniques
- Essential oils for labor and delivery
- Acupressure and massage
- Birthing desires
- Comfort measures
- COVID-19 measures
- Timing of umbilical cord clamping
- Cord blood banking (their thoughts)
- Placenta care
- Labor photography session (if you want)
- Service fees or special package options
During labor and delivery, your birth doula can provide continuous support and reassure you, especially when you need it the most.
Just be sure to give your midwife or doctor a heads up if you’re bringing a doula. It’s best if they’re on the same page to support you and your baby.
Childbirth Education
Your doula helps provide childbirth education and sometimes childbirth classes. They can also help promote natural birth (without medication).
Postpartum & Placenta Processing
Many doulas are also trained as lactation consultants, so they can also assist you with breastfeeding. This is important, especially to new moms, because improper latching increases your risk of having cracked and sore nipples.
Some doulas also offer placenta encapsulation services for moms who want to preserve or process their placenta. If they don’t offer placenta processing they often can refer you to someone who does.
Birth Tub Rentals
If you’re planning on water birth, ask your doula if they also offer birth tub rentals. Some also offer this service, so you wouldn’t need to buy your own tub.
Although you can also use regular inflatable tubs, some doulas have special birthing tubs with a heating system that helps maintain your desired temperature.
Limitations
It’s important to understand that your doula isn’t a medical professional, and they aren’t licensed to assist you with the actual birthing process. Instead, that role is reserved for your midwife or doctor.
Don’t plan on having your doula deliver your baby, especially in a high-risk pregnancy. However, they can provide emotional and physical support, especially for these difficult pregnancies.
Is A Doula The Same As A Midwife?
Midwives need to have a license either as a CM (certified midwife) or CNM (certified nurse-midwife) that they can get after completing their tertiary education in midwifery.
Doulas don’t need to be certified (but many have certifications) or complete tertiary education. However, they don’t perform any medical procedures and aren’t allowed to prescribe medications.
During labor and delivery, their roles are clearly spelled out:
- Your doula offers moral support for you (can also include your family members)
- Your OB/GYN or midwife oversees your medical care and delivers your new baby
Challenges: What Do Doctors Think Of Doulas?
Not all medical professionals support doula care. (3)
Be sure to ask the hospital’s policies on whether you can bring a doula as part of your birth team. Some hospitals might limit the team to your family members only, while others might even provide you with a referral for one.
Is A Birth Doula Worth It?
Childbirth is a physically and emotionally exhausting experience. Having a birth doula to support them through this motherhood milestone is priceless for some moms.
Considering the many benefits you get from hiring one, the right birth doula can be worth your money.
How Much Does A Doula Cost?
Birth doula costs vary depending on your location and their level of experience, services offered, or work hours.
For example, the average doula rate in the Bay Area, San Francisco, is $40 per hour for a single baby and $50 for twins. But the rate can go up to $50 and $60 per hour, respectively, for an overnight shift (usually begins at 7 PM).
Most doulas will require a 50% down payment and certain minimum service hours, especially for overnight shifts.
Some doulas charge by the hour, and many offer special birth packages.
For example, some doulas in New York charge around $2,500 for a birth package (includes two prenatal appointments, support throughout labor and delivery, and one postpartum visit). Additional postpartum services can cost around $50 per hour.
Private childbirth education classes can cost around $350 (four hours) in New York. The rate can be lower in other states.
Be sure to ask your doula for their service fees and other charges.
Why Are Doulas So Expensive?
Doula training can be expensive. For example, one school in San Francisco charges $825 for a 37-hour birth doula training. That’s excluding the fees trainees might need to pay for certifications. They also have a separate fee for postpartum doula training.
Most doulas own their businesses, so they also have to shoulder the overhead expenses. The costs of running a private business or practice can be expensive, especially the taxes, liability insurance, certifications, website fees, etc.
They need to set their rates in this way for a sustainable practice.
But it’s not just about their expenses. Here are some of the things that you’re paying for when hiring a doula:
- Their time
- Their skills
- Their experience
- Their brain and listening ear
- Your peace of mind
Guide To Hiring A Doula: How Can You Find The Right One For You?
What Qualities Should A Doula Have?
Be sure to ask your birth doula about their qualifications and other relevant information, including the following:
- Training
- Certification status
- Experience
- Availability
- Services or packages offered
- Fees
These are also factors to consider:
- Your personal instinct or desire about having this doula in your home
- Conversational compatibility (after your first meeting)
Find someone else if you feel that you might not get along well with this doula.
Your birth doula should be someone that you’re comfortable being with and can support you throughout your birthing experience. You don’t want to be clashing with them, especially during the difficult moments of labor.
Training & Certification
DONA International is a non-profit organization that certifies doulas, promising to carry out its mission professionally. Its non-profit status also makes DONA one of the world’s leading doula organizations.
So, you might want to choose a DONA-certified doula. You can use the search feature on their website (dona.org) to find the right one for you.
Some Questions To Ask Your Doula
- What’s your philosophy about childbirth?
- What support can you provide if I need induction or a C-section?
- How many births have you attended?
- What are your training and certifications?
- What services do you provide?
- How much are your services?
- Do you have special packages?
- What books do you recommend?
- What’s your refund policy?
- Who is your backup?
- Do you have references?
Other Types Of Doulas
Fertility Doulas
They help during the conception process, especially if you undergo IVF (in vitro fertilization) or other procedures. They can be especially beneficial for couples trying to get pregnant.
Antepartum & Full-spectrum Doulas
They provide support for the following:
- Infertility
- From the antepartum period (before childbirth) to postpartum
- Miscarriage and preterm loss
- Stillbirth
- Abortion
Postpartum Doula Services
Postpartum doulas assist in postpartum care, including some of these responsibilities:
- Physical support
- Emotional support
- Informational support
- Newborn care (feeding, burping, bathing, etc.)
- Breastfeeding or bottle-feeding support
Their primary role is to provide care and support for new parents, so they can get a much-needed rest after having a new baby. These doulas can also have the following roles:
- Meal and snack preparation
- Some errands
- Light housework (dishes, laundry, tidying up, etc.)
- Older sibling or pet care
- Nighttime feeding and diaper changes
Community-based Doulas
Medicaid rarely covers birth doula services, but the average doula service can cost around $1,200 per birth. So, many low-income families are unable to get their services.
Some non-profit organizations and local government units organized programs to create community-based doulas to assist low-income moms.
There are also some private doulas who offer discounted rates and special payment terms for low-income, single, or teen moms.
Prison Doulas
In some places, prison doula support is provided for pregnant incarcerated women. However, the practice isn’t widespread, mostly due to the lack of funding and support. (4)
FAQs
What’s Your Birth Partner’s Role If You Get A Doula?
Hiring a birth doula isn’t meant to replace your birth partner’s role in childbirth. Your birth partner can be your spouse, partner, parent, family member, friend, etc.
The birth doula and your birth partner can complement each other and work as a team to help you during labor.
For partners who actively want to participate in the labor process, your doula can assist them in finding the massage points and doing the relaxation or breathing exercises you practiced during your birth education classes.
Can You Be A Doula Without Having A Baby?
Yes. You don’t have to be a mom to be a doula. However, some moms might prefer having another mom as their doula.
Having a doula certification can increase your chances of getting clients even if you haven’t experienced childbirth.
Resources To Know More About Doulas
- Rachel Gurevich’s “The Doula Advantage”
- Lindsey Bliss’ “The Doula’s Guide to Empowering Your Birth”
- “The Doula Book” by Phyllis H. Klaus, John H. Kennell, and Marshall H. Klaus
- “You Are So Love” by Jill Maggofin
REFERENCES
(1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3647727/
(2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5538578/
(3) https://pretermbirthca.ucsf.edu/sites/g/files/tkssra2851/f/wysiwyg/Neel%20-%202018%20-%20Hospital-based%20maternity%20care%20practitioners_%20perceptions%20of%20doulas.pdf
(4) https://onlinelibrary.wiley.com/doi/10.1111/j.0737-1209.2005.22108.x
