How a doula can help with childbirth

What is a doula?

A doula, specifically a birth doula, is a trained labor and birth assistant who helps pregnant women before, during, and in the immediate hours after labor and delivery. Doulas provide emotional support, as well as assistance with other non-medical aspects of your care.

A doula can share guidance that will help you make informed decisions about your birth options. And while they’ll never make any decisions on your behalf, a doula can also serve as a liaison between you and the rest of your birth team, communicating your birth plan and your wishes.

Postpartum doulas differ from birth doulas in that they provide support after you've given birth, usually by visiting you at home to help with breastfeeding, preparing healthy meals, and more.

The word “doula” comes from ancient Greek language meaning “a woman who serves.” Today, women, men, and nonbinary doulas continue to serve moms during childbirth. Estimates reveal that around 6 to 15 percent of moms opt to have a doula during labor and delivery. The choice often comes down to your personal preference, your finances, and whether or not you have other sources of support that will be with you during childbirth.

What does a doula do?

Though it might seem like a birth doula only starts helping you once you go into labor, their services typically begin during pregnancy – so they can help you prepare for birth – and last through the delivery until hours or days after.

Typically, a doula handles the following:

• Answers your questions about what to expect and eases your fears before labor
• Provides resources that you may find helpful during and after your pregnancy
• Helps you develop a birth plan, and advocates for the type of birth you're hoping to have
• Prepares your space and mind for the arrival of your baby
• Suggests various birthing positions during labor, and helps you with breathing through contractions by assisting and providing encouraging words and massage
• Explains what's happening during labor
• Encourages you to communicate your wants and needs to your healthcare providers, including your OB or midwife and your labor and delivery nurses
• Assists you immediately after you give birth, providing information on newborn care and breastfeeding guidance

A postpartum doula can offer you support in your first few weeks after childbirth, giving you information and guidance on how to care for, feed, and bathe your baby. They'll help you as you heal from your birth, and offer you information on care options for you and your baby. Postpartum doulas generally provide these services during the day, but you can also hire a postpartum night doula to help you care for your baby overnight so you can get extra rest.

It’s possible for you to hire one doula to help with both the birth and postpartum care, though they can also be two separate people if you choose that route. One potential benefit of having the same doula is that they're aware of what happened during your birth as a firsthand witness, and thus might be able to better tailor their postpartum advice to you and your experience.

What's the difference between a midwife and a doula?

A midwife is a medical professional who can do almost everything an OB can, aside from performing a c-section, but a doula is not a medical professional.

Doulas don't have medical training, but professional training and certification programs do exist for birth doulas and postpartum doulas through organizations including DONA International, Opens a new windowCAPPAOpens a new window (Childbirth and Postpartum Professional Association), ICEAOpens a new window (The International Childbirth Education Association), and Childbirth InternationalOpens a new window. Community doulas – doulas funded by county or private dollars to assist moms who may not be able to otherwise afford care – are trained through community-based doula training organizations. 

Certification programs vary, but birth doulas typically attend workshops on working as a doula, childbirth, and breastfeeding. (Postpartum doulas have different coursework and requirements focusing on postpartum needs.) Aspiring doulas may need to write essays, provide doula services to several clients, and provide written references before earning their certification.

Certification isn't required for most doulas, and it's up to you whether you want your doula to have it. (Many doulas who aren't certified by any particular entity are still able to provide excellent assistance and care.) It is smart, however, to find out how many births your doula has attended – the more the better – and ask about your potential doula's training and experience.  

What are the benefits of a doula?

It's impossible to predict or control how your labor and birth will go: Will you connect with your labor and delivery nurse, and will they have time for you? How will you react to the pain? Will you be able to stick to your birth plan even if you end up having to be induced? Will you have a swift delivery or a long, drawn-out one? And if you have a partner who will be present for your birth, how will they hold up under the pressure?

Faced with these uncertainties, many women find enormous reassurance in having a doula by their side. Research has found that women who have continuous one-on-one support during labor tend to use pain medication less often, have slightly shorter labors, and are less likely to have a c-section or a forceps or vacuum-assisted delivery. In fact, if you're serious about trying to have a natural, unmedicated birth, a doula may be your best ally.

Women who have continuous support are also more likely to report being satisfied with their birth experience. One theory is that moms who have this support produce lower levels of stress hormones during labor than women left alone or attended by inexperienced assistants.

How much does a doula cost?

A birth doula charges anywhere from several hundred to a couple thousand dollars for their services, depending on where you live – doulas tend to cost more in bigger cities, for example. Some health insurance plans will cover part or all of the cost, and some doulas are willing to work on a sliding scale based on your ability to pay. Community doulas are usually free to the client. A few pioneering hospitals even provide doulas to laboring patients who want them. 

Some doulas charge by the hour, while most have a flat rate for their services. Also, some might offer you various packages, with just hospital support during the birth, or with more comprehensive support in the days and weeks before or after.

You can ask your doula if they provide text or call support during the early hours of labor, and if that’s an additional fee, as that time frame can last days for some moms. It can be helpful to have this service to better understand what you're feeling, to get help on timing contractions, and to know when to go to the hospital or to request medical help if you're having a home birth.

How do I know if I should hire a doula?

If you’re seeing a midwife in a low-volume hospital practice or you're planning to give birth at a birth center or at home, you’re likely to have more continuous one-on-one support from your midwife. If you have your baby at a hospital, it's likely to be a different story – and hiring a doula may be a great way to make sure an experienced birth assisant will be with you throughout labor.

In a typical hospital setting, OBs and some midwives don't stay in the room with you continuously during labor. Labor and delivery nurses often have to split their time among several patients, and can come and go according to their shifts.

There are many reasons you may choose to hire a doula, if you're able, such as:

• You're giving birth without a partner and want a support system in the room
• You prefer not to invite family in the room as your support system
• You're hoping to have an unmedicated birth and want support with navigating pain
• You find it difficult or anxiety-inducing to communicate with hospital staff, especially if it involves asking for alternative options or reasoning behind why a healthcare provider is recommending something. A birth doula can be your advocate.
• You want to be able to discuss the birth with someone afterward who has witnessed it, and can help you mentally debrief and process what happened. This can be especially helpful if you've had a traumatic or difficult birth experience in the past.
• You want additional advocacy if you feel distrustful of medical systems
• You're a woman of color who believes it will help to have a doula of color with you. There is a black maternal health crisis in the U.S., and research has shown that implicit bias can affect your care. Having a doula present can help you learn about how this affects your birth, and can empower you to have a louder voice when it comes to your care.

How to find a doula

Organizations like DONA InternationalOpens a new window, CAPPAOpens a new window, and the National Black Doulas AssociationOpens a new window can help you find a reputable doula near you through referral locators on their websites, and you can always ask your childbirth class instructor, midwife, OB, or family and friends for their referrals.

If you're looking for a doula, plan to start interviewing them early, in your second trimester, as many book up months in advance. If you find a doula that seems to be full around your due date, ask to be added to their wait list, as their others clients’ needs may change at any time. That said, you may not realize you want a doula until later in your pregnancy; if that's the case, don’t be afraid to still try to find one, even if you're well into your third trimester.

It's not a bad idea to interview a few doulas before deciding which one you'd like to hire. Because your birth doula will be by your side during one of the biggest moments of your life, it's especially important that you feel comfortable and the relationship is a good fit.

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Video: What is a doula?

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