What is a Doula?

I was reading the book  Ina May’s Guide to Childbirth when I first encountered the word “doula.”  Based on what I read, I would have told you that a doula is a woman who supports Mom through labor and delivery. 

The thing is that it’s a bit more than that.  These days doulas are professionally trained women (typically) who act as birth coaches and provide mental, emotional and physical support before, during and after birth.  These professionals have a whole host of experience working with various medical teams and navigating the delivery room. They can really help expecting mothers and fathers.

To be clear, most doulas are NOT medically trained, so they cannot administer medications, diagnose anything or offer medical expertise. They are, however, one of the best investments in your birth you will ever make!

DONA International (where most doulas train and are certified) actually likens doulas to travel guides through the new experience of becoming parents. But the best part of having a doula with you through this exciting time is that the experience will be uniquely tailored to your needs and desires.

The word doula itself is a Greek term meaning “female servant.”  And, historically speaking, women have been serving other women in childbirth for centuries.  Even in this day and age, it has been proven that assistance from another woman has a positive impact on the labor process.  

So you might be asking yourself: What EXACTLY is this woman going to do that my husband/sister/mom/friend can’t do?  

You know, I asked that same question before I looked further into what it would mean to have a doula by my side.

It’s not a matter of the doula being able to do something those people can’t do.  It’s that she is already experienced at supporting women through this process, so she can help you in ways your current circle just may not think of.

On top of that, your doula will work WITH your husband/sister/mom to trade off if they need or want a break.  She will even suggest options that others may not consider simply because they haven’t had the experience. 

Besides all that, the doula is focused on meeting your needs. If your husband suddenly discovers that he faints at the sight of blood, she’s not going to turn her attention to him (like some of the medical team will have to do). Instead, she will stay focused on you and making sure that you are being supported in every way.

Here are the ways a doula can make your pregnancy and birth experience so much better.

Answer all your questions and provide information about options

As a first-time mom, I had questions out the ying-yang. But my doctor only had 15 minutes to answer them all… Yeah, I never got past question #1 because I frequently freaked out around the medical staff to begin with. (I have issues with medical personnel. I’m sure they are great, caring and wonderful people, but I have some internal thing that stops me from trusting them. It’s not them, it’s me, and I’m working on that.)

In contrast, I not only felt comfortable talking to my doula but also expressing and sharing my fears, my freak-outs and my overwhelming frustration of not knowing what was going to happen. By talking with her, I got some really cool information about the stages of labor. Seriously, your doula is a wealth of information. ASK HER for all the info.

Share in your joys (and fears)

Your doula can help you work through anything, believe me. I self-identify as an abuse survivor. I had many, many triggers concerning childbirth and especially the thought of my medical team doing things to me without my permission. At only a few months pregnant, I was already coming unglued.

A doula can help you figure out what those fears are and how to handle them, which leads me to…

Recommend additional care providers to help you

Sometimes we mamas flip out over EVERY LITTLE THING — along with all the big things! I was no exception, but I also had a lot of hang-ups over stuff from my past that started to come out during my pregnancy (even though I thought I had dealt with all of them already).

My doula stepped up and suggested that midwifery care might be a better fit for me personally. She also recommended someone who helped me get over my fears of birth in general.

Help you know when it’s really go time

Your doula can help you recognize the signs of labor so you know what to ignore and when to call your medical team. If you have read my birth story, you know that it took a while for me to even acknowledge that I was IN labor. It helped that I had a doula standing there going “You just had 8 contractions in the last 20 minutes.” (Or something like that.)

Get you settled in at your birthing location

Whether you are planning to birth your little one at home, in a hospital or birth centre, a doula is a great person to help create a nurturing space.

At home it could be things like inflating and filling a birth pool. If you are headed to a hospital or birth centre, they can help you navigate to the correct room, turn on music or diffuse your favorite essential oils (if you want and the location permits). Basically, they are there to help you feel comfortable and secure in your birth space, which makes such a difference in your ability to handle the labor sensations.

Provide physical support

Movement during labor is correlated with shorter, less complicated labors. Your doula can suggest different ways to use movement and position changes to help you cope with contractions and rest in between. It could mean some walking around the halls or neighborhood and stopping to lean on your doula during contractions.

Some women also find it comfortable to sit on a birthing ball during waves of contractions, while an assistant provides support to keep the ball stationary.

If you have an epidural, a doula can help you change positions in the bed for better comfort and to help baby move down more easily.

Offer constant emotional support throughout labor

Birth is a natural and normal thing we women do. But when you’re immersed in this new and intense experience, hearing someone tell you “This is normal” and “You are doing great” can really help.

I have theorized many times that a key part of my ability to stay relaxed and have a positive birthing experience was that my doula (and midwife as well) spoke calmly and kept telling me how normal all the sensations were. If you have any anxiety, it is so soothing to hear a friendly voice telling you, “Okay, soon you might feel some pressure just a little lower. It’s totally normal and means you will get to meet your baby soon.”

Seriously, the only reason I think I noticed the “ring of fire” sensation at all was because I had heard so many other women talk about it. So I was waiting for it as a sign baby would be out soon, but even that didn’t bother me.

Soothe aching muscles and release tension

During labor a doula can use massage techniques or touch relaxation to target areas of tension and help you release and relax (as much as we are able to in birth).

The more relaxed you are, the less pain you are likely to experience.

Touch massage is great, but in labor I found counterpressure was amazingly better! OMG, you gotta try it! When I started feeling a lot of pressure in my lower back during contractions, my doula applied counterpressure which reduced the sensation and enabled me to ride out each wave more comfortably. I’m not sure how long that went on, but boy was I glad she was there! I don’t think the hubby or I would have figured that out on our own.

Enable your partner to focus and relax

Our partners are these totally amazing guys who offer support to us (or we negotiate for it, like I did 😉 ). But most of them are pretty nervous before labor that they won’t be enough or won’t know what to do or… Let’s just say there is a whole list of things dads worry about concerning childbirth, k?

The labor room can be overwhelming, and our partners do better when they don’t feel a huge pressure to provide everything we need. With a doula present, your partner is able to sit back and just be there with you in the moment. Or, in my case, run out and get some Gravol cause the midwife said I should try and sleep…

The point is that your man can step in as much (or as little) as he is comfortable. And your doula can also remind him to take breaks if he needs to without worrying that you’ll feel like you’ve been abandoned.

Affirm your choices and preferences

A good doula helps you make the best choices for yourself, even if they’re different from society’s current expectation of what birth should look like.

For instance, in my area, many women feel pressured to birth naturally, but they really don’t want to face labor without an epidural. A doula will assure you that your desires for the birthing experience are important and will provide you with information about epidurals so you can make your best decision.

We are not all the same mamma, and each birth is unique. A good doula will know and understand this.

The Different Types of Doulas

Did you know there are different kinds of doulas? This might sound confusing at first, but stick with me. There are four kinds of doulas who provide support in various ways from pregnancy through the postpartum time.

Antepartum Doulas

This is not one of the services I’ve used myself, but in my research, I found out that those of us with a high-risk pregnancy or who are put on bed rest can benefit from an antepartum doula for assistance with our emotional, physical and practical needs.

Birth Doulas (aka Labor Doulas)

These provide physical comfort or assistance during labor: massage, bringing water and snacks, maintaining or supporting a posture to help Mamma. They also give emotional support: company, encouragement or just speaking in a soothing voice to help Mamma stay calm. Also, they are usually capable of guiding/directing your other (nonmedical) birth companions in how they can best support you.

While many websites claim that a doula can advocate for you during labor, I’m not 100% certain this is true in all locations. Where I live, a doula has no legal authority to tell the doctors what I want or what I approve of, even if I’ve given her a signed contract detailing my wishes. But a doula absolutely can remind you and your other support people of your wishes, as decided and discussed before the birth. Those people (like your husband) may have the legal right to advocate for you.

Most birth doula-client relationships start months before the baby is due. This enables the doula and family to develop rapport so that the pregnant mamma feels free to ask questions and express fears or concerns. The birth doula can also work with the parents to design a plan for their ideal birth scenario.

This continuous care provided by doulas has been studied and found to improve birth outcomes. Many women also report more satisfying birth experiences.

Postpartum Doulas

Postpartum doulas offer educational, emotional and practical help in the home following the baby’s arrival for the first few weeks or months. They help new moms get off to a good start with breastfeeding/formula feeding, taking care of the little one, discovering a new balance with their partner, and handling all the new and often overwhelming emotions that many moms experience.

Please note that these doulas are usually NOT a babysitting service. They are there to support you as the mamma, and while that can include giving you a short break for some self-care, it is not their main focus.

I wish I’d had a doula’s help with figuring out a strategy for managing my household tasks so that I could feel more calm in the chaos that followed our baby’s arrival. Prior to baby, I didn’t have a system in place for managing my home, and after baby… Well, the house looked like a tornado hit it for about 3 months. By then, I think I had given up on getting it reasonable.

I’m not saying a postpartum doula will clean your house, but she can help you prioritize so you don’t feel totally overwhelmed. In this phase of your life, you’ve got so many new things to juggle, and you may feel like you need to continue doing all the old things too (trust me, that is NOT a recipe for success when you are healing after birthing your baby).

Full-Spectrum Doulas

I’ll be honest. I’m not entirely familiar with this type of doula, but my understanding is that they handle some of the more sensitive topics around pregnancy and childbirth like abortion, miscarriage, stillbirth, and family planning for couples who are not the traditional male + female match.

These doulas often self-identify as activists as well as service providers, emphasizing the human rights of their clients in the hopes of ending various stereotypes.

What Type of Doula is Right for You?

I can’t answer this one for you. What I can say is that, in my experience, many doulas offer multiple services and will tailor those services to your specific needs. So, for instance, when I contracted with our doulas for the birth of our first child, I didn’t realize it at the time, but that also included postpartum support during the newborn period.

We worked with 3 doulas. During my pregnancy, one of them was always available to come with me to appointments with my medical support team. It’s thanks to my doulas that I chose to work with a midwife as my practitioner. They saw something in me that screamed at them that I needed a different kind of medical care.

I’ve noticed that there are more doulas who provide birth support than solely ante- or postpartum care, but many doulas offer both. It’s important to ask up front what will be included in your service agreement (at the very least, read the contract and ask questions if something isn’t clear). And make sure you “click” with your doula on a personal level.

Doulas and Your Medical Team

As mentioned above, a doula is not a medical professional, so she cannot take measurements or do any other clinical tasks. However, she can help you understand how to communicate with your medical team.

A doula’s primary purpose to support you mentally, emotionally and physically.

Doulas and Your Family

Sometimes we hear stories (often funny later) about Dad passing out in the delivery room. Either the sight of blood makes him go weak in the knees or the stress of seeing you deal with so much work/pain is too stressful and his brain just “nopes” out. I’m told some doulas will spot this in advance and send Dad out for a breather, but that’s not the main reason I had our doula there.

A doula does not diminish the role that your family members will play at your birth. Rather, she enhances their ability to participate in the ways that you want them to.

A doula can step in when your other support person needs a break. She can even lead the whole coaching process so Dad can just be there with you for emotional support. (I recommend this; it’s effectively what we did.)

When you are still at home, your doula can do things like tracking your contraction time and spacing so you know when you should head to the hospital (if that is where you choose to birth) or to bring out and set up the birth pool if you are doing a water birth at home.

In our case, my husband was out late the night before, enjoying some last-minute fishing. So when I went into labor and didn’t believe it was the real thing, the doula helped us by
1) convincing me I was in labor
2) allowing the hubby to get some sleep while she kept me company
3) directing him on how to support me through the process because he had never done it before and had NO CLUE WHAT WOULD HELP.

You can read my birth story here if you would like more details.

The Benefits of Having a Doula

A doula is amazingly helpful and supportive to have with you on birthing day. She can positively affect so many aspects of your experience. Here are some of the benefits that other women (and myself) have commented on about having a doula.

  • Studies show that women who use a doula have shorter labors and are less likely to require medical interventions like C-sections; they also request less pain medication.
  • Doulas can help you have a more positive childbirth experience, no matter how you choose to deliver.
  • Moms who use doulas after birth may have an increased success rate with breastfeeding.
  • Doulas can take over coaching Mamma when Dad needs a break or completely free up Dad to be Mamma’s emotional support (rather than trying to remember all the instructions from that birthing class).
  • Doulas can help give physical relief of some pain through touch massage, provide physical stability for various laboring positions, and use other techniques that may interest Mamma.
  • Doulas can help reduce Mamma’s stress and anxiety before, during and after birth. They can also offer educational materials and answer questions before the big day arrives. (You can also ask during labor, but I doubt you will want to read any materials at that time.)

How to Find the Right Doula for you

The biggest key to finding the best doula for you is connecting with someone that you trust and feel comfortable with. Most doulas don’t charge for an initial meeting, so take the time to interview as many as you need to find a good match. I think I interviewed 10 before committing to one. Like 24 hours after we found out we were pregnant again, we had already hired her for our current pregnancy because we adore her so much. (Seriously, lady — if you are reading this, you are the awesomest!!!!!)

Ask your doula these questions to get to know her and learn about her background:

  • What training have you had?
  • What services do you provide?
  • What are your fees?
  • Are you available for my due date?
  • What made you decide to become a doula?
  • What is your philosophy regarding childbirth?
  • Would you be available to meet with me before the birth to discuss my birth plan?
  • What happens if for some reason you are not available at the time I give birth?
  • What happens if for some reason I don’t tell you in time that I’m in labor?
  • How much notice do you need to arrive at my home/hospital/birth centre?

As important as the answers to these questions are, you also need to trust your gut! With our doula, I knew within 15 minutes that she would be in the delivery room with us. She was part of a team of 3, and I just knew I would end up getting her.

All the others I had talked to previously left me feeling a tad uncomfortable or like something wasn’t clicking. You want that connection as soon as possible since it will help you get the answers and information you need to make your best choices for this pregnancy.

To find a good doula where you live, start by asking friends and family who they have used (if any). I would also recommend contacting DONA International for a list of doulas in your area.

P.S. — As wonderful as blogs like this are for providing helpful information, books can go into greater depth. I highly recommend that you pick up a book or two and learn more about how a doula can benefit you and your family.

Do you know what a Doula is?  Despite their growing popularity among labouring women this birth support role is often mysterious and misunderstood.  Here is what you really need to know.