What is a Doula? Everything You Need to Know

The word ‘doula’—which is derived from the Greek word for female slave—is now used to refer to what Britannica.com defines as ‘a non-medical assistant in prenatal care, labor and sometimes postnatal care.’ 

More exactly, birth doulas are trained professionals who provide continuous informational, emotional and physical support to birthing people and their famileis during pregnancy, birth, and the first days of parenthood. (Postpartum doulas, on the other hand, specialize in caring for families following the arrival of a new baby.)

History of ‘doula’

Originally coined in 1969 by a US anthropologist, the term doula was initially used to describe an experienced woman who helped mothers who’d just given birth with breastfeeding and newborn care. It was then expanded to mean a female companion who guided a birthing person during labor and childbirth. 

In 1986, the concept of doulas began gaining more widespread attention when a group of physicians who were studying maternal/newborn bonding discovered something unexpected. Women who had a supportive companion present throughout the birthing process had shorter labors with fewer complications than birthing individuals who received usual care. Since then, numerous studies have shown that continuous support for women during childbirth offers many benefits for birthing parents and their babies. 

Doula vs midwife: what’s the difference?

At this point, you might be thinking, isn’t this similar to what a midwife does? So what is the difference between a doula and a midwife? Here’s a brief explanation.

A midwife is a healthcare professional whose primary responsibility is protecting the physical health and safety of the birthing parent and baby during pregnancy, birth, and immediately afterward. Midwives also perform medical tasks, such as monitoring the baby’s heart rate during labor. 

By contrast, a doula does not provide medical care or medical advice. Instead, a doula’s main focus is the birthing person’s emotional wellbeing and physical comfort. A doula is a non-judgemental guide and advocate whose expertise can empower a birthing individual or couple to have the most positive childbirth experience possible. And that’s not just if you’re planning an unmedicated birth. A doula can provide a calming presence and explain what is happening during a Cesarean, for instance. If you choose an epidural, a doula can help you change positions to keep labor moving.

In short, the doula’s job is to guide you through labor and help you have the birth you and your partner want—whatever that means for you. 

What does a doula do?

But just what does that involve?

• Informational support and priority-setting. During pregnancy, a doula can provide prenatal education about labor and birth, and help you understand the options that are available at your place of birth. She (most doulas are women) will usually help a birthing person or couple decide what’s most important to them, whether that’s trying a certain non-drug strategy for managing pain, or having the baby placed on your chest immediately after birth. Using this information, you can create your birth plan. Typically, you can also contact your doula by phone, text, or email any time you have a question or concern.

• Expert guidance and labor support. Early in labor, a doula can track your progress and help you decide when it’s time to head to the hospital or birth center. As well, doulas can suggest strategies that may help reduce discomfort—such as moving into a different position—and provide hands-on comfort measures, like massage, applying warm or cold packs, or using counter pressure to ease back labor. While midwives and nurses know how to do these things, they may be occupied with other tasks. 

• Explanations and smoother communication. Another advantage of having a doula is that she can explain why certain things are happening, translate what your care providers are telling you, and advocate on your behalf. 

• Familiarity and emotional support. And since many different people–including nurses, lab technicians, medical students and other hospital staff—may pop in and out of the room while you’re in labor, your doula is a familiar face in a sea of strangers. 

Doulas may also act as a cheerleader, and bolster your confidence if you start feeling tired and discouraged. All of this can help you feel more relaxed and in control—which in turn reduces pain.

• Post-birth support. Doulas can support you in a variety of ways once your baby arrives. For example, if your baby needs to be taken away briefly for tests while you’re waiting for the placenta to be delivered, your partner can go along while the doula stays to support you. Your doula can also remind other members of your care team about your wishes—for example, having your partner hold the baby skin-to-skin. In the early postpartum period, doulas provide assistance with getting breastfeeding started (provided that’s what you choose).

Benefits of Having a Doula

• Lower chance of complications and better outcomes. According to the American College of Obstetricians and Gynecologists (ACOG), “published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula.” 
  
  One example: according to a large-scale review, this type of support for a birthing parent appeared to reduce the risk of a baby’s risk of a low five minute Apgar score by 38 percent. (The Apgar score is a system of evaluating a newborn’s physical condition shortly after delivery.) 
  
  In one study of low income women, those supported by doulas were much less likely to give birth to a baby with low birth weight, or experience a complication involving themselves or their babies. 
  
  In fact, there’s good evidence that doula care is especially helpful for pregnant  people who belong to groups that are at a higher risk of problems during pregnancy and birth. This includes women who are low-income, racialized, or receive Medicaid. Based on this research, more and more states are funding doula care to address the extreme racial gap in the health of non-white mothers and babies in the US. (For example, compared to white women, Black mothers are almost three times more likely to experience a life-threatening birth complication, and 50 percent more likely to have a premature baby.)

• Lower likelihood of interventions. Other research has linked doula support with a significantly lower use of Cesarean section, a greater likelihood of spontaneous vaginal birth (not requiring assistance with forceps or vacuum), and decreased use of pain medication.

• Greater satisfaction. Several studies have found that birthing individuals who are supported by a doula give their birth experiences a higher rating than those who don’t receive doula care. 

• Reduced chance of depression. Some evidence suggests that doula care may reduce the chance of a birthing parent developing symptoms of postpartum depression.

How to Find and Hire a Doula

Once you decide you want to hire a doula, how can you go about finding suitable candidates? 

You’ll probably have more choices available if you live in an area with a hospital that provides obstetric care—which is something many rural communities lack. That said, here are some tips to help with your search. 

Resources for finding a doula

• Your immediate community. Ask friends and family members if they know anyone who’s hired a doula. Other possible sources of referrals include your midwife, family physician or obstetrician; hospital or birth center; or, if you’re taking childbirth classes, your childbirth educator. 
• Birth, parenting and professional organizations. You may also want to contact your local La Leche League chapter or any regional doula or midwifery associations in your area. Some of the latter have websites featuring searchable directories. So do the following: National Black Doulas Association, DoulaMatch (US and Canada), Doula UK, Find My Doula (UK).
• Doula-training and certifying organizations. If it’s important to you to have a certified doula (who has completed a training program, and met a certain set of standards) you can search the directories of organizations that certify doulas. (You can read more about the specific certification requirements of each of them here.) These include: DONA International, ICEA (The International Childbirth Education Association), CAPPA (Childbirth and Postpartum Professional Association), and toLabor.

Questions to ask when selecting a doula

Of course, finding a doula is just the first step. An initial meeting can help you get a sense of whether a candidate you’re considering might be a good fit. To spark that get-to-know you conversation, here are a few possible questions. (You can find more suggestions here, too.)

Background

• Are you certified, and if so, by which organization?
• How many births have you attended in total, and in the past year?
• Have you attended births at my planned birth location?
• What techniques will you use to help me through labor?

Logistics

• At what point in labor will you join me/us?
• Will you stay for the entire labor and birth?
• Do you have any other clients with a due date near mine?
• What are your back-up arrangements if you’re not available?

Fees and services

• What is your fee, and what services does it include? (How much does a doula cost? Read more here.)

Other Frequently Asked Questions About Doulas

• Can doulas work alongside midwives and obstetricians? Absolutely! Unlike midwives and obstetricians, doulas don’t have medical responsibilities. A doula is a ‘bonus’ person whose sole focus is supporting the birthing parent and their partner emotionally and physically during labor and birth.

• Can doulas attend a home birth? Certainly. In addition to the same type of encouragement and hands-on pain relief techniques they provide in a hospital or birth center, doulas can lend an extra pair of hands for a variety of tasks, from setting up supplies to taking photos. 

• How does having a doula impact the partner’s role? Your doula and partner aren’t interchangeable. They have complementary roles. Your partner is an expert on you—your likes and dislikes, and what makes you anxious, for instance. A doula is an expert on what happens during labor, birth, and immediately afterward. That means a doula can provide emotional support and reassurance to the partner as well as the birthing person. Plus, the presence of a doula can take pressure off the partner. The doula and partner can work as a team—for example, with the former demonstrating how to perform a specific technique, or staying with the birthing parent while the partner takes a break to eat, or rest.

• How soon should I hire a doula? In general, you probably don’t want to wait any later than the end of your second trimester, so you have enough time to get to know one another.

• What happens if a doula is not available during the birth? This is definitely a question to ask when you’re interviewing prospective doulas. Does the doula have a back-up arrangement with a colleague? If so, can you meet that individual? 

Overall, a doula can help reduce stress and anxiety for a birthing individual and their partner, ensure they have the information they need to make informed choices, and increase their chance of having a positive birth experience. 

If you’re a doula, you, too, need support—albeit of a different kind—so you can spend more time and energy doing the work you love. 

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