What Is a Doula? What Do They Do?

Former New York Governor Andrew Cuomo gained attention in April 2018 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 period.

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 soon-to-be parents and discuss any concerns they have, learn about their birthing preferences, help to formulate their birth plan, and be available for phone calls or messages when further questions or concerns arise.

Doulas also provide evidence-based resources to help parents make the many decisions involved in childbirth. These can 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 closer to 6-10% of their time supporting the patient. Some choose to trust in their partner or another family member to support them through the process, but not everyone has that option, and partners may not be familiar with the physical, emotional, or mental components of labor and birth and may become overwhelmed.

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 their needs and maintaining continuous, one-to-one support. Doulas assist with the labor process in any way they can and provide non-medical comfort and pain relief aid, such as massages, relaxation exercises, breathing techniques, and alternative laboring positions. Doulas also help to preserve the mental and emotional wellbeing of the mother by keeping the patient relaxed, addressing concerns, and advocating for them. Doulas can also support 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.

Doulas as advocates for mothers

Doulas also act as advocates for patients. Through an existing relationship with the mother, they aim to pursue a positive and safe birthing experience by keeping the mother’s goals at the forefront of the experience. They voice the mother’s wishes to the medical professionals, advocate for them when they aren’t able to, and comfort them if things aren’t going as planned. Doulas stick by the mother’s side through whatever kind of delivery they have.

The role of a doula after childbirth

Directly following birth, Doulas offer assistance with feeding (breast or bottle), bonding, and allowing the mother time to relax and enjoy her new baby. Commonly, after the mother returns home from the hospital with her baby, the 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 the patient 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 their new life.

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. 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.

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 period. Researchers have found that the positive effects of having a doula have been greater in women from the following groups:

Women who are 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 people interested in using their services. It’s a good idea to learn certain information about your doula before making a decision.

Important details to consider may include:

Costs
Services offered
Availability near your due date
Prenatal meeting options
Training
Experience with vaginal, cesarean, or VBAC deliveries
General birth philosophy
Views on important topics (medicated birth, delayed cord clamping, circumcision, breastfeeding, etc.)