What Does a Doula Do?
If you’ve done any research about childbirth, or even talked to other moms with new babies, chances are you’ve come across the term doula. You may have heard women say things like, “My doula saved my life!” or “I couldn’t have gotten through labor and delivery without my doula.” But just what is the role of this mythical “doo-la” person? What does a doula do? Do you really need one?
In this article, we’ll look at the doula’s role, some statistics about labor support, coping techniques for women in labor, and how to make the decision about whether you should hire a doula for your birth.
What is a doula?
Many moms compare a doula to a wedding planner when trying to explain why they chose to hire one. Consider for a moment the differences between the wedding officiant and the wedding planner.
Most officiants help you with putting together your wedding ceremony, and they may also offer support and counseling as you and your fiancée prepare to begin your married life together. An officiant isn’t going to help you select vendors, coordinate the logistics of the big day, or step in with a creative solution when your florist doesn’t show up.
Your wedding planner, on the other hand, is your go-to person for all of the logistical aspects of your wedding. She probably isn’t an expert in holy matrimony, but she knows which bands offer the best entertainment for your budget, and she’s there to save the day when your maid of honor can’t figure out how to work the bustle on your train.
In many ways, the officiant vs. planner distinction is a good metaphor for the difference between a doctor or midwife and a doula. Your doctor or midwife has extensive medical training in labor, delivery, and neonatal care. She’s going to make sure that your baby’s entrance into the world follows medical standards of care, and she’s equipped to deal with any medical emergencies that may arise. She may also have several other patients in labor at the same time as you.
Depending on the medical practice, you may meet your doctor for the first time on your baby’s birth day. A doula, on the other hand, will be getting to know you, your pregnancy, and your wishes well before labor day.
If you hire a doula, you’ll meet with her throughout your pregnancy, and she will be well-acquainted with your needs and preferences in advance of your delivery, as well as those of your partner. A good doula feels like a trusted friend, offering calmness and a voice of reason during your labor and birth.
Many people say your wedding day pales in comparison to the day your first child is born; likewise, a wedding planner’s duties fall short in approximating the role of a doula in childbirth. Many brides choose to forego a wedding planning, thinking they’ll save a bundle of cash doing it all themselves. When it comes to giving birth, however, doing it all yourself is quite a different proposition. But before we get into the reasons why it’s much harder to DIY your birth, let’s take a closer look at a doula’s role so you can confidently answer the “what does a doula do” question.
What does doula mean?
Doula comes from the greek word doulē, meaning female helper or maidservant. You can find a variety of definitions for doula, ranging from the short:
“A woman who is trained to assist another woman during childbirth” (Google Definition)
To the more in-depth and inclusive:
“A companion who supports a birthing person during labor and birth. Birth doulas are trained to provide continuous, one-on-one care, as well as information, physical support, and emotional support to birthing persons and their partners,” (Morton, 33).
While the earliest usage of the modern definition dates back to 1960s, labor support provided by a well-trusted, educated, and empathetic woman has been a constant in many cultures for centuries. Doulas continue to grow in popularity, and several recent studies have provided hard data showing the benefits that have long been recognized anecdotally by women all over the world.
What does science say about doulas?
A Cochrane review, originally published in 2012 and later revised in 2017, included more than 15,000 participants and looked at the role of continuous labor support (Bohren et al.). The study lists the following substantial positive effects for the birthing person:
- 25% decrease in the risk of Cesarean; the largest effect was seen with a doula (39% decrease)*
- 8% increase in the likelihood of a spontaneous vaginal birth; the largest effect was seen with a doula (15% increase)*
- 10% decrease in the use of any medications for pain relief; the type of person providing continuous support did not make a difference
- Shorter labors by 41 minutes on average; there is no data on whether the type of person providing continuous support makes a difference
- 38% decrease in the baby’s risk of a low five minute Apgar score; there is no data on whether the type of person providing continuous support makes a difference
- 31% decrease in the risk of being dissatisfied with the birth experience; mothers’ risk of being dissatisfied with the birth experience was reduced with continuous support provided by a doula or someone in their social network (family or friend), but not hospital staff
For more details about the Cochrane review, we highly recommend that you check out the evidence for doulas over at Evidence Based Birth. These numbers alone should get you thinking about the impact a doula could have on your birth experience, not to mention the relatively low cost of adding so many benefits to your support team.
What does a doula do?
A doula’s job is often multi-faceted and customized to the specific needs, worries, and priorities of the couple she is supporting. Because of this, it’s hard to touch on everything a doula can provide, but most everything falls into one of the following four categories:
- Educational support
- Mental support
- Emotional support
- Physical support
We’re going to look at each of these categories in detail below.
Have you ever heard the saying, “Evidence-based information thoroughly explained by an unbiased third party is power?” Probably not, but it does sum up the way a doula provides educational support to her clients.
Many parents find themselves bombarded with friendly advice, doctor recommendations, medical policies, facility routines, and more information than they could possibly want. The problem is, no one takes the time to fully explain all of these aspects of pregnancy, labor, birth, and postpartum. What’s normal? What’s a necessity and what’s superfluous?
These tests, decisions, and seemingly concrete hospital routines are all things that doulas know inside and out.
It’s part of a doula’s job to help you feel more confident about the process as your pregnancy advances.
You have a lot of options available to you for everything from your birth facility and providers, to your tests, birth preferences, and overall birth environment. Perhaps you have heard it said that if you don’t know your options, you don’t have any. Your doula is able to explain them all. Furthermore, having conversations and discussing possible interventions beforehand allows the birthing mother to keep her power should that topic or decision come up during labor.
When you’re faced with a decision without being educated, you’re much more likely to allow someone else to decide for you. Many times, this type of situation leaves mothers feeling as though birth happened to them, instead of something in which they were active participants. Often, we see this small-but-monumental shift become the difference between feeling empowered and associating birth with trauma. Know better, do better!
Most birth professionals would agree that much of birth—perhaps 95% of it—is mindset. Our bodies follow our minds. This is known as psycho-physical association. When we build our mindset on fear and doubt, our bodies tense up, and our fight, flight, or freeze mode is set to ON. Being in that state doesn’t help you push out a human—in fact, it can actively hinder your efforts. Alternatively, when you work to reframe your mind regarding birth and build a foundation based on positivity and confidence, your body responds appropriately. Labor can move quicker, is often easier, and we find that birth can be great.
Doulas know you’re being fed horror stories by everyone from your grandmother to random people in Target (how rude!), and it’s hard to not let those experiences affect you. Your birth team should be the first place you find encouragement, positivity, and unwavering support. Doulas can help you reframe doubts, and they can also dispel myths, misinformation, or fears that might affect your overall mindset. Birth is transformational. Working during prenatal meetings to shift your mindset might be one of the most important benefits a doula can have on you and your birth experience.
“When you change the way you view birth, the way you birth will change.” – Marie F. Mongan
Pregnancy emotions, usually exacerbated by hormones, can take a seemingly sane person and reduce her to a puddle of tears and snot because she ran out of chocolate chip ice cream. While not an exaggeration by any means, it can be quite comical (maybe when you’re NOT pregnant!) and has certainly happened to the best of us. While your doula will most likely understand why that’s devastating, she’s especially equipped to help you with the more serious emotional aspects of this journey.
It’s completely normal to possess a greater degree of vulnerability to anxiety, worry, and stress. As you get closer to your birth, it’s completely normal for self-doubting questions to start running through your mind:
- Will I be a good mom?
- Why haven’t I gone into labor?
- Can my body do this?
- Is something wrong?
Doulas act as a neutral emotional outlet. They can discuss and provide suggestions and solutions for working through triggers from past trauma and current doubts and anxieties for both you and your birth partner. They have often completed additional training that allows them to connect with a variety of individuals, regardless of their backgrounds. A vital aspect of unbiased support is no judgement; a doula gives you shoulder to cry on, along with a steady voice of reason and encouragement.
When needed, doulas also have access to a vast network of mental health professionals who specialize in prenatal and postpartum woes. Together, they can help you through especially tough emotions so pregnancy and birth can be an exciting time in your life, not one you dread. The experience of giving birth never leaves you, but what usually stands out the most is how you felt. Were you supported and affirmed in those moments of emotional distress or conflict? Empathetic care goes a long way to make you feel strong and able, despite the heavy emotions or availability of ice cream.
Support and comfort measures for the laboring woman are often covered in childbirth classes and pregnancy books, but there’s a big difference between being able to move between labor positions in a classroom and knowing what to do in the heat of the moment. Many women describe the sensation of going into lala land during labor, particularly as they approach and navigate transition. The same goes for your partner—it can be very difficult for even the calmest, most rational partners to keep their cool while watching the birthing mother in action.
Doulas, on the other hand, are trained in a wide variety of labor positions and comfort measures, and they’ve experienced a variety of births. As an objective observer during your labor, a doula can look at what’s happening and suggest alternatives to help you release pain and tension, encourage the baby into an optimal position, and ultimately move your labor along.
Your doula will also be familiar with your birth plan and wishes. She is there to advocate for you, but she’s also less likely to have emotion clouding her abilities to make decisions. That is, if you’re struggling through a phase of labor, your partner is most likely going to be struggling along with you, while your doula will have a clearer view of what’s going on and whether it’s advisable to deviate from your birth plan. You ultimately have the final say on all decisions, but it’s often difficult to make clear decisions when you’re the one going through labor.
Another critical aspect of physical support is that your doula is dedicated to you throughout your entire labor, birth, and postpartum time—unlike your nurses, doctors, and/or midwives, a doula isn’t attending to other patients or coming up on a shift break. Because of this, she has a holistic view of what’s been happening and can provide physical support that’s tailored appropriately. She also won’t leave your side, unless you ask her to do so. A doula also provides partner support, whether that’s giving your partner a break to rest or eat, or simply supporting him as he supports you.
Your doula isn’t a substitute for a trained medical professional—your doctors and/or midwives. She is, however, a powerful addition to your birth team.
Do I really need a doula?
Can you push out a baby without having a doula? Totally! Women do it every day. Your body has the ability to complete this task, and whether you choose to have a doula alongside you is a personal choice.
That said, there are so many compelling reasons to hire a doula for your birth. You’re preparing for an experience that will change your mind, body, chemical makeup, reasons for living, family, and finances for the rest of your life. Your world will never be the same. A doula will help to ensure that you’re heard, supported, and seen by your medical team.
The evidence we shared above is just the tip of the iceberg when you begin talking with moms about their experiences with doula-assisted childbirth. It doesn’t matter if you want the most natural, unassisted, mystical birth possible or the exact opposite end of the spectrum. A doula will help to ensure that you have the best possible experience and outcomes aligned with your wishes and circumstances.
It’s not uncommon for a partner or family member to tell you, “You don’t need to spend all that money on a doula—I’ll be there!” While this person probably has the best intentions, it’s really up to you to build your best possible support team. Will your partner, friend, or family member be able to give you objective support: educational, mental, emotional, and physical? Who will be with you if your partner needs to leave during your labor? Who can you text at 3 am to ask about symptoms? Doulas are used to (and professionally trained for) these types of situations, along with so many others.
One of the most common concerns is that a doula just isn’t in the budget. We completely understand. There are so many costs coming your way when you’re pregnant, particularly if you’re having your first baby, and these just keep piling up as your children grow. That being said, consider how your birth experience and outcomes fit into the priorities in the rest of your budget. You can also find some creative ways of covering the cost here. (Link blog post on how to pay for doula.)
At the beginning of this article, we compared a doula’s role to a wedding planner, whereas your doctor or midwife is like the wedding officiant. No, you don’t need a wedding planner for your wedding, but you’re probably going to have less stress and more fun overall by hiring one. Let’s look at the doula’s role from the perspective of another major life event: climbing Mt. Everest.
Even if you aren’t at all into climbing, you’ve probably heard of the sherpas that guide even the most expert climbers up the mountain. The sherpas are the elites—they live in the tough mountain climate, are acclimated to the elevations, and know how to complete the climb in the safest way possible. They go up and down mountains all day long.
A doula is your birth sherpa. She’s supported countless other women on their birth journeys and offers you an overflowing fountain of wisdom while honoring the spirit of your unique birth.
Birth matters. We make it simple.
Let us help you on your journey!