What is a Doula? And What Do They Do?

What is a doula?

A doula is a professionally trained support worker who provides emotional, physical, and educational support during pregnancy, birth, postpartum, and even pregnancy loss.

• They help with questions you (and/or your partner if you have one) may have on all aspects of pregnancy and as you plan for birth, and act as an advocate for both you and your supporter during labor.

A doula is familiar with the hospital settings and protocols, and acts as a bridge between you and the team attending your birth. A doula provides continuous support, which can be very helpful in what may feel like an intimidating or overwhelming situation.

Why do people choose to have doulas?

Doulas are there to advocate for you throughout your pregnancy. Many find that doulas offer a wealth of information and peace of mind during an overwhelming time.

• Recent research shows that the presence of a doula has a positive impact on labor and delivery outcomes, quantified both in terms of emotional experience and in terms of the physical toll and recovery. Statistics show that with a doula present there is a 25%-53% decrease in cesarean delivery, and one study found that those who received doula care during labor and birth were 57.5% less likely to experience postpartum depression and anxiety.

But What Does A Doula Actually Do?:

• Doulas can provide emotional support. They are a person to whom you can voice your preferences and help you write a personalized birth plan, which sketches out your desires for how you plan to give birth.
• Doulas can serve as your advocate and assist in facilitating communication between you and your care provider or other medical staff.
• They can provide you with information on interventions like induction, an external version for breech birth, options for pain management during labor, and help you understand birth procedures and discuss your options.
• A doula can reassure and encourage you from the onset of labor through labor and birth. They can talk through coping techniques like breathing, apply a TENS machine to help cope with pain, or offer suggestions for labor positions as your labor progresses.
• Although doulas cannot perform medical procedures, they can be hands-on and offer physical support during labor, like providing counterpressure to help ease pain during contractions, massage to aid relaxation or help shift labor positions.
• Doulas can also help your supporter by providing them with guidance, information, and ways to support and advocate for their partners and themselves during labor. 

Are there different kinds of doulas?

Yes. Birth doulas specifically provide pregnancy, birth, and immediate postpartum support, while postpartum doulas offer support in the weeks after birth and typically help with breastfeeding if desired, along with helping new parents adjust to life with their newborn. While you don’t need to be certified to offer doula services, there are many certification courses which provide training.

Do doulas actually make a difference?

There is overwhelming evidence that shows that that do. Here's what some of the research shows:

• Births where there is support from a doula are shown to have 25% to 53% lower rates of cesarean delivery
• There is about a 10% decrease in the use of medications for pain relief in labor
• There has been shown to be a whopping 38% decrease in low Apgar scores, which is a post-birth assessment administered immediately after birth to measure the newborn's health scale on a range of 1-10. 69% of people who use doulas report a positive labor and birth experience
• On average, labor is about 41 minutes shorter
• The rate of preterm delivery decreases by about 22%
• And of patients who had postpartum doula care, 89% were breastfeeding at six weeks postpartum, compared to 40% without a doula

Is a doula right for me?

Whether you hire a doula depends on many factors, including birth preferences, the resources available in your healthcare setting, your budget, and how comfortable you are navigating the healthcare system. The impact of doulas on birth outcomes is undeniably strong, but ultimately, it comes down to the level of support you seek during pregnancy and the birthing process.

• If you’re hoping for an unmedicated birth you may benefit from doula support, as they can help navigate the suggestions of interventions from hospital staff.
• If you could use some assistance in advocating for yourself, a doula can be helpful.

How much does it cost to have a doula

Doulas vary in education levels, expertise, and experience, so their prices also vary. You can typically expect to spend between $800 to $3,000 or more for a prenatal and birth doula, which isn’t usually covered by insurance. Some states and health plans may allow you to use health savings and flexible spending accounts to cover doula fees, though, and some states will cover doula services under Medicaid.

Postpartum doulas may charge hourly or offer packages of time that cover everything from overnight infant care to household tasks such as laundry and cooking.

How do I find a doula?

It’s important to match with someone who aligns with your needs and shares the same perspective on pregnancy and birth. It’s a very intimate relationship, and you should feel comfortable asking every single question that you have and feel confident that the person you hire will be your ultimate advocate during a very vulnerable, emotional time.

To find a doula, check with your healthcare provider, hospital, or birth center for recommendations, and ask friends or family if they have any suggestions.

• When selecting a doula, discuss your and their views on different types of births (including birth with an epidural, pain management, and c-sections), and breastfeeding/pumping/formula, to ensure you’re aligned.
• It’s important to find someone who can support your opinions and decisions. A doula can help you and your partner feel safe, comfortable, and empowered no matter how your birth plays out.

Other important questions to ask a prospective doula:

• What’s your availability leading up to (and after) my due date?
• What kind of training and certifications do you have?
• How long have you been a doula?
• How many births have you attended?
• What type of support do you offer throughout the term of your service agreement?
• What type and frequency of communication are you open to?
• Can we communicate between prenatal meetings via text, email, or phone?
• What’s your backup doula policy if you’re attending another birth when I go into labor or have a scheduled induction or cesarean section? 

What if I can't afford a doula?

Cost is a significant barrier to access to doula care. Some hospitals and birth centers, as well as some doula organizations, have volunteer doula programs that provide a doula during labor and birth, free of charge, to help address health disparities and improve birth outcomes. Ask your healthcare provider if this is an option in your care setting. Additionally, some doulas who are new to the profession may be looking to voluntarily support clients to gain experience and referrals.