New York governor Andrew Cuomo gained attention in April for driving initiatives to combat the horrific maternal mortality rate among black women in his state. A key element of this task force was for Medicaid to cover the use of doulas, or trained birth coaches.
What is a doula?
Doulas are professional birth coaches who provide emotional, informational, physical, and mental support to women during the prenatal, birth, and postpartum periods. Doulas do not provide medical care, but they are extraordinarily knowledgeable about childbirth. Their major role is to provide necessary support to the mother leading up to and during childbirth. There are also specific types of doulas, such as Antepartum Doulas, who assist women who are having a high-risk pregnancy or are on bed rest during pregnancy, and Postpartum Doulas, who assist women during the postpartum periods (1).
What doulas do during the prenatal period
Generally, doulas make themselves available to their clients during the prenatal period in the months leading up to birth. They will commonly meet with the soon-to-be mom and discuss any issues or concerns she is having, learn about her birthing preferences and questions, help to formulate her birth plan, and be available for phone calls or messages when things come up (1).
Doulas also provide evidence-based resources to help mothers make the many decisions that are involved in childbirth (2). These include what type of birth to pursue (medicated or unmedicated), whether to invite family members into the birthing room, how to labor, and others.
Doulas as birth partners
The term “birth partner” describes someone who is present during labor and delivery to offer support in any way they can to the mother. Birth partners are beneficial, but not everyone has one. One study found that while mothers expected their labor and delivery nurses to spend roughly 53% of their time offering labor support, those nurses actually spent more like 6-10% of their time doing it (3). Many other women choose to trust in their partner or another family member to support them through the process, but not everyone has that option. Furthermore, many partners aren’t familiar with the physical, emotional, or mental components of labor and birth, so they may become overwhelmed by the task of offering labor support.
The job of the Doula during delivery is to act as a highly knowledgeable and experienced birth partner. The doula stays close to the mother, responding to her needs and maintaining continuous, one-to-one support (3). Doulas assist with the labor process in any way they can and provide natural comforts and pain relief aids, such as massages, relaxation exercises, breathing techniques, alternative laboring positions, and others. Aside from the hands-on labor assistance that Doulas provide, they also help preserve the mental and emotional wellbeing of the mother. They do this by relaxing the mother, addressing any concerns she may have, and advocating for her (1). Doulas also support the family members and partners involved in the birth, encouraging them to be involved when they and the mother would like it and helping them understand what’s happening during the birth (2, 4, 5).
Doulas as advocates for mothers
Doulas also act as advocates for moms and pregnant women. Through understanding and valuing the mother’s goals, they aim to pursue a positive and safe birthing experience for the mother by keeping those goals at the forefront of the experience. They voice the mother’s goals to the medical professionals, advocate for her desires when she isn’t able to voice them, and comfort her if things aren’t going as planned. They stick by her side through whatever kind of delivery she has (1).
The role of a doula after childbirth
Directly following birth, Doulas offer assistance with feeding (breast or bottle), bonding, and helping the mother relax and enjoy her new baby (1). Commonly, after the mother returns home from the hospital with her baby, her doula will remain available for questions and concerns. She will also often visit the new baby and check in on the mother to make sure she is recovering well physically and mentally.
Postpartum doulas offer specific services beyond the main doula services. They will meet with the new mother and help with newborn care, recovery from a vaginal or cesarean delivery, household chores, and other tasks that help the mother settle into her new life (5).
What are the benefits of hiring a doula?
The American College of Obstetricians and Gynecologists has found that the assistance of a doula during childbirth has produces improved birth outcomes (6). One study showed that mothers who had doulas were two times less likely to experience birth complications, four times less likely to have a low birth weight baby, and significantly more likely to successfully breastfeed. Other studies have shown that women who had doulas experienced shorter labors, lower operative birth rates, babies with higher 5-minute Apgar scores, increased maternal satisfaction with the birthing process, and lower rates of anesthesia and analgesia use (4).
Who benefits from having a doula?
All women can benefit from having a doula to offer support, whether it be during the prenatal, the labor and delivery, or the postpartum periods. Researchers have found that the positive effects of having a doula have been greater in women from the following groups (3):
- Women who are primiparous (giving birth for the first time)
- Unmarried women
- Low income women
- Women giving birth without a partner
- Socially disadvantaged women
- Women experiencing cultural or language barriers
How to hire a doula
There are many ways to find a doula to hire in your area. Some include:
- DoulaMatch helps women find doulas that match their particular needs
- Find a Doula offers links to different doula resources in your area
- DONA International doula directory contains doulas who are certified through their DONA program, which covers 50 countries
What should I know about my doula?
Doulas usually provide free consults to pregnant mothers interested in using their services. It’s a good idea to learn certain information about your doula before signing on (1). Such details include:
- Services offered
- Availability near your due date
- Prenatal meeting options
- Experience with vaginal, cesarean, or VBAC deliveries
- General birth philosophy
- Views on important topics (medicated birth, delayed cord clamping, circumcision, breastfeeding, etc.)
- Having a Doula: Their Benefits and Purpose. (2017, July 22). Retrieved August 8, 2018, from http://americanpregnancy.org/labor-and-birth/having-a-doula/
- Benefits of a Doula. (n.d.). Retrieved from https://www.dona.org/what-is-a-doula/benefits-of-a-doula/
- Gruber K, Cupito S, Dobson C. Impact of doulas on healthy birth outcomes. The Journal of Perinatal Education. 2013;22(1):49–56. doi: 10.1891/1058-1243.22.1.49. [PMC free article] [PubMed]
- Sauls D. J. (2002). Effects of labor support on mothers, babies, and birth outcomes. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 31(6), 733–741 [PubMed]
- You Have a Doctor, So Why Get a Doula? (n.d.). Retrieved August 10, 2018, from https://www.parents.com/pregnancy/giving-birth/doula/do-you-need-a-doula/
- American College of Obstetricians and Gynecologists: Approaches for Ob-gyns and Maternity Care Providers to Limit Intervention During Labor and Birth in Low-Risk Pregnancies