Thinking about hiring a doula? Here's the How and Why of Doula Care
Here’s the low-down on Doulas and how to hire one that’s right for you.
That Double Hip Squeeze is the bomb-diggity during labor. photo cred: Meredith Rowe
“Evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support provided by support personnel, such as a doula, is associated with improved outcomes for women in labor.”
The fact that you are reading this says that you are curious about hiring a birth doula! But you may also be wondering how to go about doing that. It’s good to be Doula-curious and I hope that you get some answers to your questions here! Let’s take a look at the Who, What, When, Why, and How of hiring a doula. And don’t worry, if you are wondering what questions to ask, we are going to help you with a guide to hiring a doula
Who is a doula?
A doula is a non-clinical support person who walks alongside of you during your pregnancy, labor and birth. They are trained in the process of childbirth but may not necessarily have given birth themselves. Usually, they are female but there are a growing number of male doulas (A man-doula? Or, a dudoula?). A doula may have a medical background or training but in the capacity of a birth doula, they do not play a medical role. Many have been drawn to the work because of passion to work with women or from their own birth experience - good or bad. The important thing is that they should not let their own birth experience influence your birth experience (but that’s another blog for another day).
What does a doula do?:
Physical - Emotional - Informational- Advocacy*
They provide informational, emotional and physical support during your pregnancy, labor, birth, and postpartum period. They are The 411 of Birth and, importantly, their primary responsibility is to YOU and your family. They can help you find a care provider who will listen and provide the care you are looking for. The doulas are one of the few people in a community who actually have 10’s if not 100’s of births under their belts with many of the different care providers and birth venues in town. Yes, a labor nurse also works with different care providers in her hospital but, unlike a doula who is in and out of all of the hospitals in town, usually nurses have worked at one or two of the hospitals in the city. A doula is a connector: your doula can help you find an OB, Nurse-Midwife, Professional Midwife, Chiropractor, Acupuncturist, Massage Therapist, Physical Therapist, Prenatal Fitness classes, Childbirth education, Postpartum Recovery Fitness classes, Certified Lactation Counselors (CLC), Mental Health therapist, and more.
During your labor, your doula will provide continuous labor support. She will help you navigate the different stages of labor, often starting with early labor at your home. Often in the early phase of labor, this support is provided through text and phone calls. At some point, when you are ready, your doula will continue to support you at your home birth, birth center, or hospital venue - depending on your desire. Your doula will assist you with comfort measures, breathing and relaxation, movement patterns and positioning, and provide encouragement, reminders, and guidance. Depending on your and your partner’s desires, your doula can teach and guide your partner in the ways to best be of support to you so that the three of you are working as a team.
After your birth, your doula will visit you at home at least one time for your postpartum visit where she may do a variety of things from debriefing your birth to helping with nursing (if she is a CLC) to showing you how to bathe your baby to helping you to learn to swaddle your baby.
What doesn't a doula do?
A doula does not provide medical care or opinions or diagnose conditions. Your doula does not do vaginal exams or listen to your baby’s heartbeat. Your doula does not make decisions for you but they should remind you of your birth preferences and your goals and advocate for your wishes. Your doula does not take the role of the birth partner. Your doula leaves her own opinions and her own personal birth experiences at her home.
*As your advocate, she does not speak for you, but helps you to speak for yourself and your loved one.
Emotional support is so important…especially during transition. photo cred: Dallas Arthur Photography
WHen should we hire a doula?
You can hire a doula at anytime. Even before you are pregnant! Most people hire their doula in the first or second trimester but don’t wait too long to make contact because most experienced full-time doulas are booking 8 months out on their calendar. True! Honestly, the best time to call is right after you have:
Dipped your stick
Told your significant other
Told the family… THEN, call the doula to see if they have availability on their calendar. The earlier you hire, the more value you get out of your investment because your relationship starts as soon as the contract is signed. Most experienced doulas are booking 7-8 months out. No Kidding!
Why should we hire one?
So. Many. Reasons and you will have your own ideas, too. Hiring a doula will help you stay calm and in control during your birth so that you can best advocate for yourself. This has a positive flow of benefits. Let’s take a look at what the Studies say about the benefits of having a doula:
Improved overall birth experience by BOTH parents, doula positive experience (McGrath & Kennell 2008)
Enhances and strengthens mother- infant bonding, significantly reduced medical intervention (Pascali-Bonaro et al. 2004)
Decreased rate of instrumental birth, use of analgesia, shorter labor, better APGAR scores (Bohren et al. 2017)
Huge reduction in Cesarean Birth especially when having a medical induction (McGrath & Kennell 2008)
Psychosocial affect of doulas improves breastfeeding at one month after birth (Langer et al. 1998)
More likely to have a spontaneous vaginal birth, decreased use of medication, shorter labors, reduced instrument and cesarean birth (Hodnett et al. 2013)
Improved birth experience, reduced fear, bridges the communication gap between health care professionals and patients, facilitates non-pharmacological pain relief (Bohren et al. 2019)
How do I find a great doula?
Ask you friends who they used and ask your care provider for recommendations. Then, go to the doula’s website to see what service they provide and read the testimonials. See if you know anyone who has used that doula and then get the scoop on them. Be careful of believing what you read on social media…some of the groups are “owned” by a doula but “look” community based, so you won’t get an accurate referral base from there. Then contact them and meet with them - virtually or in person. Some doulas will meet with you for free, others (like myself) have a consultation fee that can be applied to your doula services when you contract with them. Be okay with that. They are giving you their time and expertise. It is a very valuable commodity and well worth the consultation fee.
If you are wondering what should I ask the doula during the interview… Usually the doula will send you a client intake the might bring up questions. I usually start off with "Tell me what you dream birth looks like" and we go from there. Other things that may be of interest: How long have you been a doula? What is your experience? Why are you a doula? Are you current with your certifications? What certifications do you have? What is your fee (that will vary depending on experience)? Who is your back up? Have you worked with my care provider? And so on...
Common questions:
Some of the movements with an epidural and peanut ball
I am planning to have an epidural, do I need a doula? In my opinion, THIS is when the physical work of a doula really begins and YES, a doula is really helpful. When an epidural is in place, I am moving my mommas about every 45 mins to mimic the movements of an unmedicated laboring mom. I am placing a peanut ball to open the pelvis appropriately, or moving the bed so that she is sitting up right, or even helping her over on her hands and knees. And yes, an epidural mom can labor and even birth on hands and knees!
Your partner might ask, “Why do I need a doula if she has me?” My answer is pretty simple: YOU, the birth partner, know HER. I, the doula, know LABOR & BIRTH. Together, WE make an awesome SUPPORT TEAM! With a doula present, your partner can focus on the experience of becoming a parent alongside of you instead of trying to remember “all of the things”. It really helps them to be able to be fully present and not checking their “do this now” list. And, I can tell you that more than once during labor, your partner will give me a look that says, “Uh… Is that normal? Is that okay?” and I can give him 2 thumbs up or say, “well, let me check on that for you”.
By the way, have your partner check out this Blog for tips on how to best help you in labor!
I am having a cesarean birth, is it “worth the investment” for a doula? Remember that the your doula is able to help you far before you get to the day of your cesarean. In fact, one of the things that I do as a doula is to help my cesarean families find a care provider who will honor their wishes for Family Centered Cesareans. Depending on your care provider and hospital policy, your doula can go in to the OR with you for your cesarean birth (as long as it is not under general anesthesia). This is super helpful because your doula will help you stay calm during your spinal, stay calm and relaxed during the cesarean and (again depending on your hospital policy) help baby get latched, take pictures, be with your partner during the waiting times, and so much more. As one of my clients said, “having you there was essential, not just for my wife, but for me!”
“Having you there was essential, not just for my wife, but for me!”
4. How much does a doula cost? Doula fees vary widely and are usually based on your doula’s experience. If your doula has 800 births worth of experience, they are likely to be more expensive than a doula with 10 births. You may also be able to use your FSA and HSA card but you will need to ask for a Letter of Medical Necessity (LMN) from your care provider. Most doulas will ask you to sign a contract and pay a 50% retainer to lock in their services. Expect to pay anywhere from a few hundred dollars to several thousand.
5. I have a midwife, won’t she support me during my labor? At a home birth, your doula often arrives hours before your midwife and stays later, too. This may be dependent on your midwife, of course, but in general, I find this to be true. At the hospital, your midwife will come and go as she will have other patients in labor at the same time. Doula’s provide continuous labor support and that often starts at your home and finishes at the hospital.
6. What happens if the doula can’t make it to my birth? A good question to ask is WHO IS YOUR BACK UP DOULA (BUD)? You want to make sure that your doula’s BUD is just as experienced as the doula that you hired. They don’t have to have similar personalities or styles but they should be on the same page as far as how they provide doula services. Doulas should have a well-oiled BUD system in place. You also want to know how the finances of a BUD are handled (usually the doulas handle this between themselves). In my group, we serve as a sounding board for each other and are able to provide a wide range of services for our clients. We like to say that our clients get “9 doulas with 140 years of experience for the price of one”. Ha!
North Florida Doula Group - we serve as each other’s BUD. photo cred: Beloved Bits
did you have a doula?
We would love to hear about your experience! Please share in the comments!
If you are looking for a doula in the Knoxville, Tennessee area , feel free to reach out to Emily.
Other Free downloads for You!
Pregnant? Check out this blog. Postpartum? Check out this blog!
Sources:
Bohren, M. A., Hofmeyr, G. J., Sakala, C., Fukuzawa, R. K., & Cuthbert, A. (2017). Continuous support for women during childbirth. The Cochrane database of systematic reviews, 7(7), CD003766. https://doi.org/10.1002/14651858.CD003766.pub6
Bohren, M. A., Berger, B. O., Munthe-Kaas, H., & Tunçalp, Ö. (2019). Perceptions and experiences of labour companionship: a qualitative evidence synthesis. The Cochrane database of systematic reviews, 3(3), CD012449. https://doi.org/10.1002/14651858.CD012449.pub2
Campbell DA, Lake MF, Falk M, Backstrand JR. A randomized control trial of continuous support in labor by a lay doula. J Obstet Gynecol Neonatal Nurs 2006;35:456–64.
ChildbirthConnection.org
Dahlen HG. It is time to consider labour companionship as a human rights issue. Evid Based Nurs. 2020 Jul;23(3):78. doi: 10.1136/ebnurs-2019-103127. Epub 2019 Sep 12. PMID: 31515238.
DONA International www.dona.org
The Evidence for Doula, https://evidencebasedbirth.com/the-evidence-for-doulas
Hodnett, E. D., Gates, S., Hofmeyr, G. J., & Sakala, C. (2013). Continuous support for women during childbirth. The Cochrane database of systematic reviews, 7, CD003766. https://doi.org/10.1002/14651858.CD003766.pub5
Hofmeyr, G. J., Nikodem, V. C., Wolman, W. L., Chalmers, B. E., & Kramer, T. (1991). Companionship to modify the clinical birth environment: effects on progress and perceptions of labour, and breastfeeding. British journal of obstetrics and gynaecology, 98(8), 756–764. https://doi.org/10.1111/j.1471-0528.1991.tb13479.x
Kennell J, Klaus M, McGrath S, Robertson S, Hinkley C. Continuous emotional support during labor in a US hospital. A randomized controlled trial. JAMA 1991;265:2197–201.
Kobayashi, S., Hanada, N., Matsuzaki, M., Takehara, K., Ota, E., Sasaki, H., Nagata, C., & Mori, R. (2017). Assessment and support during early labour for improving birth outcomes. The Cochrane database of systematic reviews, 4(4), CD011516. https://doi.org/10.1002/14651858.CD011516.pub2
Kozhimannil KB, Hardeman RR, Attanasio LB, Blauer-Peterson C, O'Brien M. Doula care, birth outcomes, and costs among Medicaid beneficiaries. Am J Public Health 2013;103:e113–21.
Langer, A., Campero, L., Garcia, C., & Reynoso, S. (1998). Effects of psychosocial support during labour and childbirth on breastfeeding, medical interventions, and mothers' wellbeing in a Mexican public hospital: a randomised clinical trial. British journal of obstetrics and gynaecology, 105(10), 1056–1063. https://doi.org/10.1111/j.1471-0528.1998.tb09936.x
McGrath, S. K., & Kennell, J. H. (2008). A randomized controlled trial of continuous labor support for middle-class couples: effect on cesarean delivery rates. Birth (Berkeley, Calif.), 35(2), 92–97. https://doi.org/10.1111/j.1523-536X.2008.00221.x
Pascali-Bonaro, D., & Kroeger, M. (2004). Continuous female companionship during childbirth: a crucial resource in times of stress or calm. Journal of midwifery & women's health, 49(4 Suppl 1), 19–27. https://doi.org/10.1016/j.jmwh.2004.04.017