Doula FAQ

A doula...

• Recognizes birth as a key life experience that the mother will remember all her life...

• Understands the physiology of birth and the emotional needs of a woman in labor...

• Assists the woman and her partner in preparing for and carrying out their plans for the birth...

• Stays by the side of the laboring woman throughout the entire labor...

• Provides emotional support, physical comfort measures, an objective viewpoint and assistance to the woman in getting the information she needs to make good decisions...

• Facilitates communication between the laboring woman, her partner and clinical careproviders...

• Perceives her role as one who nutures and protects the woman's memory of her birth experience.

What is a birth doula?
A birth doula is a person trained and experienced in childbirth who provides continuous physical, emotional and informational support to the mother before, during and just after childbirth.

Where does the word “doula” come from?
The word “doula” comes from ancient Greek, meaning “Woman’s servant.” Throughout history and in much of the world today, a cadre of women support a woman through labor and birth, giving back rubs and providing continuous emotional support. Like their historical counterparts, doulas know how to help a woman in labor feel better.

What effects does the presence of a doula have on birth outcomes?
Numerous clinical studies have found that a doula’s presence at birth:

Why should I hire a doula?
I believe every woman benefits from the special attention and continuity of care that a doula can give. Unlike L&D nurses, OBs, or midwives, who come and go and can even change shifts during your labor, a doula will not leave your side once she joins you.  Scientific studies repeatedly show that doulas can make a difference in the outcome of your birth. Here are a few examples taken from the book The Doula Book: How a Doula Can Help You Have a Shorter, Easier and Healthier Birth, by Klaus, Kennell, and Klaus:

What effects does the presence of a doula have on the mother?
When a doula is present during and after childbirth, women report greater satisfaction with their birth experience, make more positive assessments of their babies, have fewer cesareans and requests for medical intervention, and less postpartum depression.

What effects do the presence of doulas have on babies?
Studies have shown that babies born with doulas present tend to have shorter hospital stays with fewer admissions to special care nurseries, breastfeed more easily and have more affectionate mothers in the postpartum period.

What's the difference between a doula and a midwife?
Midwives provide clinical care, but doulas do not perform any medical tasks. We don't take blood pressure, monitor the baby's heartbeat, do vaginal exams or administer medication. A midwife replaces an OB, but a doula is an addition to a midwife or OB.  Most of us are from non-medical backgrounds, but we are highly trained in the mechanics of labor and in comfort techniques.  We may use massage, counter pressure, position changes, hot or cold packs, acupressure, aromatherapy and visualization to help you deal with the pain and discomfort of labor.

Does a doula replace nursing staff?
No. Doulas do not replace nurses or other medical staff. Doulas do not perform clinical or medical tasks such as taking blood pressure or temperature, monitoring fetal heart rate, doing vaginal examinations or providing postpartum clinical care. They are there to comfort and support the mother and to enhance communication between the mother and medical professionals.

Does a doula make decisions on my behalf?
A doula does not make decisions for clients or intervene in their clinical care. She provides informational and emotional support, while respecting a woman’s decisions.

My husbandwill be with me - isn't that enough?
We can never replace the support and encouragement of your husband or partner, but our experience has been that we help make the experience much more positive for them by offering suggestions as to how they can better assist you during labor. They may not feel physically what you're feeling, but they often feel anxiety and a sense of helplessness while watching you go through the birth process. Some men deal with this emotional upheaval by "checking out." They may sleep, watch a football game, or just seem to withdraw from you. We try to pull them back into the process by showing them how they can make you more comfortable and be there for you emotionally. There is a great article about this topic here: Dads and Doulas.

Will a doula make my partner feel unnecessary?
No, a doula is supportive to both the mother and her partner, and plays a crucial role in helping a partner become involved in the birth to the extent he/she feels comfortable.

Do you come to my home when I'm in labor?
Yes.  You may spend early labor at home with your doula or you might meet the doula at the hospital, if you prefer. If you do plan to stay at home in early labor, your doula can help make you comfortable and be an attentive companion. We can usually tell when you are entering active labor and will assist in the decision on when to go and the transition from home to hospital.

How do doulas practice?
Doulas practice in three ways: privately hired directly by clients, as hospital employees, and as volunteers in community or hospital programs.

What am I paying for in the doula's fee?
How much would you pay to cut your chances of cesarean and artificial induction (each) in half, reduce your chance of requesting an epidural by 60%, and cut the length of your labor by 25%? While some people think it's expensive, consider the service:  We agree to reserve the weeks around the mother's due date and are on call 24 hours during that time; we often stay up all night with women in labor and leave our families for extended periods; and we perform physically demanding tasks during labor such as massage and counter pressure and and often remain on our feet for hours at a time. The average amount of time we spend overall with a first-time mom is about 24-36 hours.

Are doulas covered by insurance?
Many women have received reimbursement by their insurance companies, and I can provide a form with the proper procedure codes that you may submit to your insurance company.  Doula fees can almost always be paid for tax-free with Flex accounts or HSAs. Birth options advocacy groups are working hard to secure reimbursement for doulas and we hope to see it become more commonplace in the future.

How do hospital staff regard the doula?
Luckily, many doctors in our area are very welcoming of doulas and even refer parents to doulas. Unfortunately there are some doctors and nurses who have misconceptions about our role. We do not make your choices for you or challenge a doctor when a decision has to be made, but apparently some people who call themselves doulas have done just that and have alienated doctors by their behavior. I am glad to provide information for you to give your doctor that outlines our standards of practice and our code of ethics. Often this clears up the misunderstanding, but some doctors are still wary. Please note when choosing a care provider: the doula-friendly practice is often the mother-friendly practice! Asking your doctor whether they welcome a doula can be an excellent litmus test for how supportive the doctor is of your choices and preferences.

What if I end up having a Cesarean?
When childbirth takes an unexpected turn, a doula will be there to help you navigate through what may be a very stressful time. If you  end up needing a cesarean, having had a doula's advocacy and support will allow you the confidence and peace of mind in knowing that every intervention along the way and the cesarean itself were necessary, well-considered points on your birth journey.  At least 50% of cesareans performed in the US are not necessary.  When you have a doula, there is no "if only we had.." or "we should have..." after the cesarean. The doula allows you to feel secure in the fact that this the way your baby had to arrive and supports you through the strong emotions that may accompany surgery. If are not allowed to go with you, we can use the time while you're in surgery to move your belongings to the postpartum area or we can stay with friends and family members and give them emotional support while they wait for news. We are allowed into recovery--that way the father stay be with the baby in the nursery/NICU (if necessary) and you won't be left alone. Some women hire doulas even when they are having a scheduled Cesarean because they know the value of having the prenatal and postpartum visits as well as someone to answer their questions and give emotional support before and after the birth.