What is a doula?

When I say that I’m a doula many people raise their eyebrows. What is a doula? How different it is from a midwife? What is the benefit of having a doula at my birth? What do doulas do? Do they replace husbands at birth? Do doulas attend birth at the hospital or only at home? And how do I choose the right doula for me? The list of questions seems endless. Are you puzzled about all of that? Let’s have a closer look at every question.

What is a doula?

The word “doula” comes from the ancient Greek meaning “a woman who serves”. Women have been serving others in childbirth for many centuries and have proven that support from another woman has a positive impact on the labor process. Nowadays, the word doula is used to refer to a trained professional who provides continuous physical, emotional and informational support to a woman and her partner before, during and right after birth (a birth doula); or who provides emotional and practical support during the postpartum period (a postpartum doula).

More on Birth Doulas:

The doula’s purpose is to help a woman and her partner have a safe, memorable, and empowering birthing experience. There are also numerous clinical studies that have proven multiple benefits of having a doula at birth.

How can it be beneficial to me to have a doula at the birth of my child?

Many studies from around the world have concluded that a doula’s support is more effective than hospital staff, friends or family. Doulas are trained in the art of birth support, and have a keen eye and intuition on what a laboring mother needs. She may do things, which a hospital midwife unfortunately does not always have time for (as much as she may want to). She may see things which your partner may not pick up on, or know how to deal with situations he may not know how to deal with.

Moreover, meta-analysis of several clinical studies¹ have found that continuous doula support at birth results in:

36% reduction in use of pain medications
71% reduction in use of artificial oxytocin (a drug that speeds up the labor)
an average of 1 hour and 38 minutes shorter labor

In addition the researchers concluded that a mother who does not use a doula is twice more likely to have a caesarean section or forceps delivery. Women who had doula support had 51% less c-sections and 57% less forceps delivery to be precise.

Another study² showed that women who had doula support in birth,

more often described their birth experience as good (82.5% as compared with 67.4% women without doula support)
more often felt labor had positive effect on them as a woman (58.0% as compared with 43.7% women without doula support)
more often perceived their bodies and themselves as strong (58.0% as compared with 41.0% women without doula support)

What does a doula do?

A doula may provide some or all of the following services, dependent on her training and skills. Often doulas are also qualified in other therapies too, so it always helps to ask!

Prenatal visits

Most of the time a doula will have 1 – 3 prenatal meetings with you, where she can do one or all of the following:

Birth education and preparation. While you can’t expect her services to be a substitute for prenatal classes, she may answer many of your questions and provide you with a scientific information, that may assist you in making important decisions.
De-briefing previous births if any, and help you process any leftover emotions or traumas.
Birth planning, including creating a written birth plan (birth preferences document)

During Birth

Massage and other comfort measures
Optimal fetal positioning
Suggest positions and changes to help ease pain and facilitate a smoother, more effective labor
Provide reassurance and encouragement
Talking through emotional blockages which may slow down labor
Keep your ‘environment’ going as in your plan – aromatherapy, music, candles etc
Photography and/or video of the birth itself, as well as those precious first moments as a family
Emotional and informational support in stressful situations for the whole family: When we’re stressed, we don’t make the best decisions. In hospital that may make your partner, mother or other, completely agreeable to what is being put on the table. They may feel uncertain or scared. A doula can help explain what’s happening with compassion and without judgment or medical jargon, so it is easier for everyone to understand. A doula can think clearly, see pros and cons of any situation and relay them to the couple to make their own decision.

Postpartum visits

Most of the time you will have at least one postnatal visit from a birth doula, postpartum doulas do multiple visits and support the family longer.

During postpartum visits, a woman has a chance to discuss her birth experience with her doula and process her emotions. This is especially helpful to the mother in case of a traumatic birth, and highly reduces her chances for a postpartum depression. A doula may offer evidence-based information on infant feeding, emotional and physical recovery from birth, infant soothing and coping skills for new parents and makes appropriate referrals when necessary.

How different is doula from midwife? Does she replace nurses or any other medical profession?

Doulas do not replace nurses or other medical staff. While doulas have good knowledge and awareness of the birth process, they 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. That is the job of the midwife or doctor. Doulas are there to comfort and support the mother and to enhance communication between the mother and medical professionals. Doulas help to realize the birth plan of the mother, keep her birth normal (if that is the wishes of the birthing mother), and is a valuable addition to the birth team.

Is a doula a replacement for my partner at birth?

No, a doula is supportive to both the mother and her partner, and plays an important role in helping a partner become involved in the birth to the extent both feel comfortable. A doula can give him tips on how he can comfort the mother more, if he feels a bit lost or it seems he has tried it all. In some cases a woman may prefer her doula just to serve her food and drinks, and take care of the ambiance or take photos while her husband to play the role of the main supporter at her birth. Sometimes in case the birth is very long and the main supporter needs rest, a doula may take his place. Sometimes a woman’s partner or her mother may need support for whatever reason. A doula may provide it as well, as long as the woman herself is taken care of as well. Though there are different variations on how doula may help you and your family at birth, she will never “take over” to deliberately replace any member of your family.

Do doulas attend birth at the hospital or only at home? What if I have an emergency?

Many people think that doulas only support at home birth or natural birth. In reality, while some doulas may have a preference for that type of birth, most of them will be there for you no matter what type of birth you will choose for yourself. Some doulas are privately hired directly by clients, some work as volunteers in community or hospital programs, and in some countries maybe employees of the hospitals. Either way, even if you plan for a most natural home birth, birth is unpredictable, and you shall expect doula’s support to continue in any scenario. Should a birth become complicated and require medical assistance, a doula will still remain by your side during the administration of the medications and help you deal with potential side effects.

If a mother faces a caesarean, and feels unprepared, disappointed, and lonely, a doula can be attentive to the mother at all times throughout the operation, letting her know what is going on throughout the procedure, giving her a light head or hands massage, and encouraging her. This can free the partner to attend to the baby and accompany the newborn to the nursery if there are complications. If the likelihood of c-section is known ahead of time, a doula can help you make such birth no less joyful and special event than natural birth.

How can I choose the right doula for me?

The key to choosing a doula is to find a person with whom you feel comfortable. Most doulas do not charge for an initial consultation, so take the time to interview as many as necessary until you find a good match.

Questions to Ask a Potential Doula:

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?

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For more details about my doula services, please check here.

If you live outside of Guatemala in some other country, I’m willing to provide you virtual support in the form of online consultations you can learn more about here.

I look forward to hearing from you soon,

Katerina

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References:

Scott, Berkpwotz, & Klaus: 1999, California. American Journal of Obstetrics and Gynecology 180, No. 5 (1999): 1054-1059
Gordon, Walton, McAdam, Derman, Gallitero, and Garrett, California, 1998. Obstetrics & Gynecology 93, No. 3 (1999): 422-26.
Gurevich, R. The Doula Advantage. New York: Three Rivers Press, 2003.