What is a Doula?
There are many modern names for a doula, (pronounced 'doo-la',) including labor coach, birth assistant, and birth attendant. The roots of the word itself stems from a Greek word meaning "woman servant or caregiver." Doulas are trained to provide emotional, physical and educational support for the mother during all parts of the birth, and are considered by many to be indispensable to women wanting to have a positive birth experience. Besides providing continuous support for the mother during labor, doulas may also provide pre and post natal assistance, along with many other roles relating to birth.
There are so many things that doulas are, that first it is easier to describe what doulas are not; Doulas are not medical health providers.
While doulas will have a familiarity with birth specific medical procedures, their primary focus is of the emotional well being of the mother and baby, and they do not replace midwives or doctors in the birthing room. Doulas are not there to replace the partner. Doulas do not judge or push their personal agendas on births. Doulas are at births for the sole purpose of making your birth the best experience it can be for you!
Studies show that women whose births were attended by doulas were more likely to have spontaneous vaginal births and less likely to have any pain medication, epidurals, negative feelings about childbirth, vacuum or forceps-assisted birth, and cesarean birth. Also, labor time was decreased by 40 minutes and their babies were less likely to have low Apgar scores at birth. Furthermore feelings of satisfaction with the birth experience were greatly increased.
A doula may take on a different role for difference women, depending on their specific needs. Most Birth Doulas will provide the following services during and before labor:
Birth Consultant: A doula will help you prepare you for all the different ways your birth may progress, and will help you to sort out your preferences for various interventions, pain relief options, emergency situations, and more. She will help you create a unique and clear “birth plan,” stating your personal preferences for your birth. Many women go into the labor room uninformed of the many options they have, and may become overwhelmed and confused during the intensity of labor. Sorting all of the details out before your birth begins means that you will feel much more in control during your birth itself.
Birth Advocate: Your doula wants you to have the birth you want! She will work with you, your partner, your midwife or doctor, and anyone else involved in the birth so that your birth can run as smoothly as possible. The nuances of being your birth advocate may range from gently asking your loud sister to please talk on her cell phone outside, to reminding the hospital staff: “Please refrain from speaking to the mother during contractions” and “No, she does not want an epidural now, please stop offering. We will let you know if we change our mind. Thank you!” Your doula will do everything in her power to gently (or sometimes firmly) keep everyone in your birth support party reminded of their roles. The role of Birth Advocate will vary greatly from the home to the hospital.
Birth Team Unifier: Your doctor or midwife is there to make sure you are medically and physically sound; your partner is there to support you and experience this transition with you, and your friends and family are there to support as well. Everyone in your team has various roles to fill, and a doula will help each of them support you in the best way possible. Imagine your doula as an “event planner” of sorts for your birth: making sure all the details are taken care of so you can focus on your journey.
Labor Coach: Supporting the mother through labor is its own job! A good doula knows various labor positions, pain relief methods, as well as visualization techniques to keep the mother’s strength up. It can be easier to lose sight of both the end result of birth (the baby!) and of appreciating and honoring the process. When it gets rough, a doula will help you keep your journey in perspective. Having continuous support by a knowledgeable and loving companion is proven to greatly improve the labor experience. Just like a sports coach or trainer, she will keep you focused and inspired during the long and intense birth process.
Physical Labor Support: The doula’s job is physical as well as mental. Holding up a laboring mother is no easy task! She, along with your partner and/or midwife, will guide you through various labor positions, massage you, rub you, comb your hair, and do everything to support your physical comfort.
Birth Assistant: Doulas can also act as you and your partner’s personal assistant during birth. Births can be long laborious processes, and not everything stalls just because you are in labor! Although we stress multiple times that doulas are there to provide continuous labor support, in some situations a doula may be more valuable helping out in other ways. For example you may ask your doula in some cases walk your dog, water your plants, or keep the lighting in your birth room at the same hue as the sun rises or sets. She may become good friends with your mother on the phone as she calls her hourly to keep her informed of your progress. She may spend an hour away from you as she helps your toddler daughter get ready for bed and fall asleep. A good doula has no ego, and knows that there is no task beneath her if having it done brings you a sense of calmness.
Birth Cheerleader: Your doula’s role may simply to be your biggest cheerleader during your birth. Nothing you can do can phase her. She will hold your hand as your body convulses and wipe up vomit, urine, or defecations without blinking. You can scream, cry, laugh, and curse, and she will still tell you you are a champion. She is your biggest fan, and she will cheer you on until the milky end.
Many doulas have additional areas of expertise, and may also offer services such as the following:
Postpartum Doula: The fourth trimester can be the most difficult for new parents, and many doulas specialize in this period. Your postpartum doula may be the same as your birth doula, or may be a different woman. She can help you with newborn care, family adjustment, breastfeeding, meal preparation, education, companionship and more. Many birth doulas will include these services in their birth packages, make sure to inquire.
Grief Counselors: Some doulas have taken special classes and certifications to be able to provide special support for mothers dealing with loss. Many of these doulas have experienced loss themselves, and want to support others going through what they experienced.
Nutritionist/Herbalist: Some doulas may specialize in nutrition or herbalism and will be able to advise you about what foods and herbs can best benefit you during and after your pregnancy. She can recommend certain food and/or herbal combinations to combat various ailments, both physical and emotional, that can arise during pregnancy and after birth. Nutritionists vary immensely from USDA trained to holistically inclined.
Reiki/Energy Workers: Some doulas have additional training in energy field work such as reiki, crystal healing, sound healing, aromatherapy etc. Be warned that during the birth process some things you think you like (sounds and smells) may repulse you without reason! Some of these therapies may be more beneficial before the birth.
Massage Therapists: While all doulas should be comfortable with intimate touch and pressure points, it is common to find doulas that are also trained and licensed massage therapists. Many of these doulas will offer a series of massages as part of their prenatal and/or postnatal care packages. Receiving intimate touch from your doula prior to the birth can be a wonderful way to bond with her, and for her to learn how you prefer to be touched (or not to be!).
-Abortion Doulas: There has been a rising trend of abortion doulas, doulas that support you emotionally during a planned abortion. Abortions can be mentally and spiritually crushing, even if the choice is made with great deliberation, and there are women who honor that and want to help you deal with the decision in a healthy and informed matter.
-Birth Photographers: At the very least your doula will be able to help snap a few photos of you (with consent of course) with your partner and belly, during labor, and with your baby after the birth. However many doulas go above and have the camera equipment and know-how to create beautiful maternity and newborn family portraits as well.
-Lactation Consultants: All doulas have specialties, and many doulas are lactation specialists. Some babies are able to latch on instantaneously, and some can cause great turmoil in their difficulty to breastfeed. If you are planning on having your birth doula also take on postpartum doula role, then finding out about her lactation experience should be a given.
-Placenta Experts: Love it or hate it, we believe that all women should be able to consume their placenta if they choose, and having someone to safely prepare it for them is important. Many doulas offer placenta preparation packages on top of their birth packages, and have experience in the various ways placentas can be consumed. Often they are prepared, dehydrated and crushed into a powder, so that it can be taken in gel caps.
-Midwife/RNs: Some doulas come from a medical background and are able to fill various roles in the birth room. Sometimes midwives will work in pairs, so they can alter roles as medical provider and doula. Some midwives will have an apprentice who will take on the role of doula. Never assume that a doctor, RN, or MD has doula training and agrees with doula-principles, but there are always exceptions, and depends on your circumstances.
-Friend/Mother: Studies show that having ANY continuous labor support by another female results in higher overall satisfaction and less interventions with the birth, and that these figures are consequently increased with a women trained in birth. What this means is that having a professional doulal is always recommended, there is no reason why a close friend or relative that has a natural propensity towards you, and shows a strong desire to support you in labor.
DONA (Doulas of North America) explains how doulas fit into the birth team: “Women have complex needs during childbirth. In addition to the safety of modern obstetrical care, and the love and companionship provided by their partners, women need consistent, continuous reassurance, comfort, encouragement and respect. They need individualised care based on their circumstances and preferences. The role of the birth doula encompasses the non-clinical aspects of care during childbirth.”
Doulas are trained and experienced in childbirth and are usually mothers themselves. They have a good knowledge and awareness of female physiology, but a doula does not support the mother in a medical role – that is the job of the midwife or doctor. She works on keeping birth normal and empowering, and should the birth become complicated and require medical assistance, a doula will still remain by your side and help in any way she can. She will not make the decisions for those she supports, but she assists them through the decision making process and provides balanced information so the couple can make their own choices.
Many women consider doulas to be a must for those giving birth in a hospital, due to the over-medicalisation of birth – unnecessary inductions have skyrocketed and are partly to blame for the 1 in 3 Australian babies now born by caesarean section. In Australia, some hospitals have caesarean section rates as high as 50% and higher. This is a terribly high statistic, well above World Health Organisation recommendations, which makes us amongst the highest in the world. Given the long term emotional and physical effects this can have on the mother, her partner and baby, a doula to me is like an ‘insurance policy’ – which can help protect you from a disempowering, disappointing experience or unnecessary procedures and intervention. With a doula, you know that someone is always on YOUR team, holding the space for you and your family. She works for you and has your best interests at heart, unlike hospital staff who have to abide by policies, which are not always best for a birthing woman, but best to avoid legal issues and to keep things running as a business.
A doula works in birth centres, private and public hospitals and at homebirth in conjunction with midwives – but never as the sole carer at birth. Birthing without a midwife or doctor present is known as free-birthing however it is always recommended to birth with a qualified midwife or doctor.