Doulas – The Who, What, When, Where, Why and How

March 22, 2012 Guest Blogger 0 comments

Editor’s Note: In honor of World Doula Week, we are thrilled to bring you some thoughts from a longtime doula and Atlanta Birth Center supporter, Teresa Howard of Labor of Love Doula and Childbirth Services.

Wikipedia says Doula comes from Ancient Greek δούλη (doulē) meaning “female slave.” Greek labor supporters as well as various other global doulas call themselves labor companions or birthworkers. Anthropologist Dana Raphael used the term for experienced mothers assisting new mothers in breastfeeding and newborn care in Tender Gift: Breastfeeding (1973.) Marshall Klaus and John Kennell, who conducted clinical trials on the medical outcomes of doula-attended births, adopted the term to refer to labor support. But I want to share how a doula may be a useful team member to your birth and your journey as a new mom.

Who: Doulas may or may not be trained and certified. You could choose a friend to “act” as your doula; but realize she may not know all of the things a trained doula may know. Know that the doula you select needs to be able to fully support your birth ideals, not impose hers on you! Her experience is one element that may be important for her ability to guide you through your options. The feeling you have when you are with her is more important to many. “People don’t care how much you know until they know how much you care.” ― John C. Maxwell

What: Unlike your care provider and birth staff, a doula is there with the sole purpose of supporting you emotionally and physically. She is not there to give medical advice or to provide medical support. She represents you and your concerns. She does not speak for you since in doing so she would be disempowering you! But she is a great sounding board for your concerns and a great “birth guru” of position changes, pain coping techniques and ideas for your labor progression. A postpartum doula allows you to have a great transition as new parents. She is there to guide you in becoming parents. Baby soothing techniques, breastfeeding assistance, cooking meals, doing light housekeeping, organizing, and helping to care for you during your healing are her fortes.

When: A doula is usually hired in the last trimester before a baby is due. But actually, the sooner you hire a doula, the better because it allows the team to get to know each other and build a bond. Communication of ideals, concerns and thoughts over the months prior to the birth allow the doula to better know the couple and therefore better serve them in their pregnancies, labor, and birth.

Where: Where does the partner fit into this equation? Sometimes partners feel they will be in the back seat of support. Sometimes partners want to be in the back seat of support! A good doula allows the partner to feel supported and supports the partner in whatever role they feel good about. A past client’s partner said, “Her presence had a great calming effect on my wife, and it allowed me to handle the ‘business’ end of things knowing full well that my wife’s wishes and concerns were being cared for.”

Doulas support you where you plan to birth. So, know that she is there to fully support you and what you want. She does not have to agree or have done it the same way in order to be fully supportive of your ideals. Also where she lives is not as important as you may think since she is used to driving and going within her mileage range to attend a birth. Sometimes postpartum doulas do have a limit as to where they will be able to provide postpartum support.

Why: Dr. John Kennell, who has studied the impact doulas have on mothers, babies, and childbirth, says, “If a Doula were a drug, it would be malpractice not to use it.” There have been multiple studies done over the last few years that show these results:

  • Companionship in labor resulted in significantly less use of analgesia, and women were more likely to be breastfeeding at 6 weeks (51% versus 29%)
  • Continuous doula support reduced risk of cesarean (8% versus 18%), forceps deliveries, epidural anesthesia for spontaneous vaginal birth (7.8% versus 55.3%), oxytocin (Pitocin) use, duration of labor, prolonged infant hospitalization, and maternal fever.
  • Randomized controlled trial. Women who had doula support had reduced likelihood of cesarean section (7% vs. 17%) and oxytocin augmentation (2% vs. 13%), and fewer infants admitted to intensive care.
  • Compared perinatal effects of epidural anesthesia with continuous doula support. First time pregnant women with doula support had lower cesarean rates, less use of analgesia, less use of oxytocin, lower risk of maternal fever, and lower risk of assisted delivery (forceps or vacuum).
  • The presence of a doula shortened the duration of labor from an average 19.3 hours in the control group to 8.8 hours. Women with doula support also had lower risk of cesarean section or meconium staining.

How: You may want to ask your care provider about any doulas they have worked with for a recommendation. But if that care provider is attempting to make you have the birth of their choice instead of respecting yours, you may want to reconsider asking them. Ask your friends about their birth experiences and whether they used a doula. Referrals from friends are often a good choice. The internet is a great way to search your options as well. But call the prospective doulas, ask questions, meet with them and determine if this is someone you can be vulnerable with!

How can you afford a doula? Don’t let the cost of a doula be the reason you do not choose one. Often times payment plans, barters and even reduced fees for those who are trained but not really experienced can be found. Adding a doula to your birth team can certainly enhance your experience for both you and your partner. And often pretax medical plans and even some insurance plans are seeing the value of paying for the services of a doula!

I have been a doula for almost twenty years and attended over 500 births as a doula. I learn from every birth I attend. Sometimes midwives or doctors tell women they will not need a doula. The doctor often thinks the woman will choose a medicated birth and not need support. And some midwives tell the mom she will be with her during her labor. But if more than one woman is in labor, or she has been up all night at a birth and needs sleep, that just will not be happening. Often the partner is concerned that their role will be diminished but the photos I take make them look like the hero. And afterwards they are usually my biggest fan! I love being with couples in labor. It is the time I feel closest to God, watching the baby emerge, watching the parents become parents. I love the work I do… it is my calling!

Teresa Howard is our guest blogger. She is the owner of A Labor of Love Doula and Childbirth Services and an educator and doula. Visit her website at, the blog, and their Facebook page

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