The word doula comes from the Greek for "slave" or "to serve". And that is what a doula does: she serves you before and during the sacred, intense work of birthing your baby.
In most other cultures in the world, as in times past in our own culture, women are surrounded by supportive family/friends during birth. It is only with the movement of birth from home to the hospital and with the loosening of extended family ties that women came to birth in the isolated fashion that is the norm in our society's hospital births. Doulas offer laboring couples not only valuable support and information as they prepare for their birth, but also caring, personal labor support that is not offered by any other member of the birth team.
Doula provide valuable emotional and physical support for a laboring woman and her husband. Doulas offer laboring couples a bigger "bag of tricks" for coping with labor, as well as suggestions for alternatives to medical procedures and assistance in navigating hospital politics.
At homebirths and in birth centers, doulas complement the care and support given by a midwife. Because the midwife is responsible for your and your baby's physical well-being, it is important that she be well-rested and ready when birth is imminent. When labor is long, your midwife can catch a nap, knowing that you are being well cared for by your doula.
What benefits do doulas provide? What do the statistics say?
The original research on the benefits of doulas was actually conducted right here in Houston. That study showed the following benefits. The presence of family members has not been proven to provide the same benefits.
50% reduction in cesarean sections
Labor shortened by 25%
Use of Pitocin reduced by 40%
Pain medication use reduced by 30%
Forceps application reduced by 40%
Requests for epidurals reduced by 60%
(Kennell J, Klaus M, McGrath S, Robertson S, Hinkley C. Continuous emotional support during labor in a US hospital: a randomized controlled trial. JAMA 1991; 265(17):p. 2197-2201.)
The benefits a doula offers to mothers and babies extend beyond labor and birth. At six weeks postpartum, women who had a doula (as compared to women who did not have a doula):
had a higher incidence of breastfeeding,
were less anxious,
had higher self-esteem,
were less likely to be depressed,
reported more satisfaction with their partners (both groups reported similar satisfaction with their partners before their births),
regarded both themselves and their babies in a more positive light.
(For more information about doulas, see The Doula Book: How a Trained Labor Companion Can Help You Have a Shorter, Easier and Healthier Birth (Klaus, Kennell and Klaus))
What can a doula do for me for my hospital birth?
Doulas provide a variety of support to laboring couples who choose to birth in the hospital:
Guidance as you make plans for your birth
Emotional support as you progress through pregnancy
Advice on logistical planning for labor and birth
Labor with you at home until your labor becomes active and it is time to move to your birthing place (Not all doulas provide in-home labor support. Be sure to interview carefully.)
Personalized attention to your needs
Anticipating your needs as you progress through labor
Aid in navigating hospital politics, before and during your labor, to ensure your wishes are respected
Assistance with understanding "hospital speak" so you can make informed decisions
Tag team support with your partner, should you have a long labor, so you are not left alone (unless you choose to be alone)
Breaks for you husband, should labor be long
Positioning for comfort, to facilitate the descent of the baby and/or to correct baby's position, as necessary
Responsibility for logistical needs during labor
A calming, reassuring presence to remind you that YOU CAN when labor becomes tough and makes you feel like you can't
Remind both you and your partner that what you are doing is hard, but it is normal
Although many women expect that their nurse will provide labor support (if they are birthing in a hospital), the truth is that nurses often do not have the skills to provide labor support. Also, a nurse may be responsible for caring for several women in labor at the same time and will more than likely not have the time to devote to supporting you. Another important point to consider is that nurses do not work for you; they work for the hospital. If your interests or wishes are in conflict with those of the hospital, it is difficult for a nurse to take your side.
What can a doula do for me at a birth center or homebirth?
In addition to all that a doula does for you at a hospital birth, at homebirths and birth center births, doulas:
Remain with you throughout your labor, allowing your midwife to catch a nap so she'll be sharp and rested when baby is born
Be present with you, even if your midwife has another women in labor in the birthing room down the hall or at another home on the far side of town
Help your partner gather and pack your belongings to go home
Stay with you at the birth center until you released to go home
At homebirths, I stay until your birth room is straightened, you have eaten and you are all tucked in to go to sleep with your baby
Transport to the hospital with you, in the event transport is required
What about me?: Dads and Doulas
Dads are often fearful that a doula will push them out of their birth experience. A good doula gets Dad involved. Laboring women are often impatient. They are working hard and have little tolerance for the slightest discomfort or disturbance. Mom snaps at Dad, he backs off because he does not want to make it worse. A doula reassures him and helps him to re-engage, provides options for specific ways to support her and offers partners a break, when he needs it, from the intensity and duration of labor. Doulas are there to support your baby's father, to be his "handmaiden" as he supports you during the birth of your baby.
When we were expecting our first baby, I had never heard of a doula. I had this romantic notion that it would be my husband and me, working together in perfect harmony to birth our baby. I remember telling him to remember a hundred different things for labor: what to do for back labor, how often I should empty my bladder, which positions help baby descend, who should be allowed in our labor room. The baby day came and we knew, in mere minutes, that we were in WAY over our heads. We were casually prepared, but when things got a little off-track, we were lost and had no one to whom we could turn for help. Yada, yada, yada: we had TWO doulas for our second birth and neither of us has ever, for a minute, regretted that decision.
My husband tells me that men do not talk about labor. Ever. Author John Eldridge says that men talk about concrete. By the time a woman becomes pregnant, she has most probably attended baby showers or had a pregnant friend, cousin, aunt or coworker with whom she has had many conversations about labor. Women talk about pregnancy, labor and birth. Men don't. Most of our husbands take a bit of time to "catch up" to the pregnancy of their partners. Your husband is, more than likely, three months less pregnant than you are. You're five months and he's only at eight weeks thinking "Wow. We're going to have a baby." You're eight months, entering panic mode over preparations, and he's just at five months thinking "Yeah, we're going to have a baby. We should maybe start making some plans, here." Looking back, I can see that asking my man, a man who had never even discussed labor, to be the sole support of a laboring woman might have been asking a bit much.
Having a doula at your birth to care for you, frees up your husband to be what you will need him to be: present and loving and, simply, your husband. He is having a baby, too, and the support a doula gives allows him to better care for you and himself.
At what point in my pregnancy should I hire a doula?
Some people wish to hire me before they are pregnant. (But it is hard to commit to being at a birth if we don't even know yet when the baby will be coming: months from now? Years?) In a few rare instances, I have been hired when a woman was already in labor.
Some things to consider:
You get more work out of a doula the sooner you hire her. Hiring a doula in early pregnancy will give you access to her skills and knowledge when selecting your caregiver, choosing a birth place, selecting a childbirth class and for answering all the little questions and concerns that come up during pregnancy.
Consider the doula's availability, experience and popularity. I have had months completely booked six months out. Other months, I have no births at all. I limit my practice to four births per month, in most cases. Contact more experienced doulas sooner than you would a less seasoned doula.
The longer you work with your doula, the more comfortable you and your partner will be with her. She will also be more familiar with your particular wants and needs.
Do doulas work only with women planning unmedicated or natural births?
I do not limit my practice in this way, though there are doulas who prefer not to work with women who plan to get an epidural. Most women who come to me are planning an unmedicated birth. I want you to make the decisions that are right for you.
Some women fear that if they hire a doula and later choose to get an epidural, they will feel that they have failed or that their doula will be disappointed in them. My only goal is that you make good decisions for yourself, not out of fear, not out of panic, but out of a solid understanding of the benefits and risks of any procedure you choose.
I firmly believe that there is nothing that can be done to or for you in a hospital that might not, at some point, in someone's labor, be necessary (with the notable exception of episiotomy; there are very few reasons that anyone should be cutting your vagina). The truth is that many women receive many interventions that are not necessary. My goal is that you see interventions as tools. You purchase those tools you need to have the kind of birth you want and leave those you do not want or need.
Will you labor with me at home?
I will labor with you at home unless you and your caregiver have agreed that you should be in the birth center or hospital earlier for medical reasons. Many care providers recommend that you stay home until your are in active labor.
How were you trained?
When I began birth work, I wished to be able to provide monitrice services to the women I served, so I chose to apprentice with one of the most experienced doula/monitrices in the country, as well as the most respected midwife in our community, for my initial training. I believe that the personalized quality of training I received from these women far exceeds any offered by a doula certifying organization.
After practicing for just shy of 18 years and attending over 340 births, I chose to certify as a doula through CAPPA (Childbirth and Postpartum Professional Association) and received my certification in March of 2017. I chose to certify for several reasons. My family life has evolved to a point where I can begin to expand my practice and I wanted to be a doula trainer. I am opposed to certification offered by individuals and much prefer tested curriculums developed with the input of multiple professionals. I wish to be associated with an organization that sets and maintains high standards and I believe that CAPPA does that. Also, the profession of doula is changing and the day is coming when training and credentialing will become standardized. I see this as a good thing, one that will elevate our status as professional members of the birth team and create opportunities for insurance coverage. The doula industry is young, but growing rapidly and I much desire to be part of keeping standards for practice and training at the level I believe birthing families deserve.
Copyright 2013 and after. Debbie Hull. All rights reserved.