Everything You Need To Know About A Doula

Meghan is a birth doula, postpartum doula, herbalist and breathwork teacher who is passionate about supporting the transition into motherhood. She lives with her husband in Boulder, Colorado and offers virtual doula support for expecting parents anywhere in the world. For more about her services and blog posts about all things holistic birth- visit her website www.birthandbeing.com.

I would say about half of the population knows what a doula is.  When I was on the West Coast, or in Colorado- where I live now- it’s a mainstream word.  And generally expected that everyone will hire one. Back home in the South, when I told my grandmother I was making a career change, she said  “a doula?!” “Do-what?”

But if you’re having a baby- or even thinking about having baby- you’ll want to know what a doula is.  We don’t just support home births, but hospital and cesarean births as well.  And the benefits of a doula are far reaching: we are there for the mother, the father, siblings and sometimes even the extended family.  We are there for labor and delivery process and are an important part of recovery during the postpartum period as well.  

Like a lot of care work, a doula’s role can be pretty open to interpretation.   Because of that I’d like to share a “who, what, when, where and why” guide to take you through everything you need to know about the benefits of a doula.  Hiring a doula is something you won’t regret, and you’ll understand why by the end of this article. 

Why Hire A Doula?

If we were to look back in our history, all over the world, everyone had a doula.  Whether it was your sister, mother, cousin, aunt, friend or another woman in the village, someone was there providing loving support while you birthed. In fact, the word doula means “woman-servant” in Greek.  And serve is what we do. 

The evolution of doula work as we know it today comes from the studies of two doctors in the 1960’s named John Kennel and Marshall Klaus. Their focus started with premature babies and how loving support, touch and care drastically improved their health outcomes.  But what these doctors learned in the process was that continuous loving support to birthing mothers drastically improved their outcomes too.  

After deciding to do a study of first time mothers’ in Guatemala receiving continuous labor support they found a 50% reduction in the cesarean rate, a 25% shorter labor, 60% lower request for epidurals and 40% reduction in the use of forceps. These are pretty profound statistics when it comes to illustrating the benefits of a doula (1).

Now that was a small study and limited in its scope, but what stands the test of time (and many more studies) is the harder-to-measure fact that women who had doulas felt more in control during their births and were far more likely to be satisfied with their births- regardless of what happened.

That’s because one of the most important  benefits of a doula can’t be quantified: emotional support.  Let’s imagine a scenario everyone of us has lived through at some point. Say two people come down with the flu.  Person one has a fever, chills, nausea, all the awful symptoms and it lasts for six days. They also have a loving partner or friend who sticks around for the whole thing and gives constant care.  They get back rubs, soup, tea, herbs, vitamin C, and their pillows fluffed and sheets changed.  

Person two has the exact same symptoms and the flu lasts five days.  However, they don’t have any of that emotional support. Someone might drop off a pot of soup at the door with some medicine from the drugstore, but otherwise they are suffering through the flu alone.  Same scenarios, slightly different outcomes, but the main difference? The presence of a loving support person. I guarantee that first person will look back and remember that year’s flu as less of a struggle, even though it lasted longer. Now do you understand the benefits of a doula? 

There is also science behind this, and it connects back to a hormone called oxytocin.  Oxytocin gets released in the body when we receive an extra long hug, touch our baby, breastfeed, or share a loving gaze with our partner. It is the love hormone and promotes those feel-good feelings.  It also happens to be the hormone that is released during labor to keep contractions progressing. Pitocin is a synthetic form of oxytocin that is often used in hospitals to induce labor, but unlike its natural form, pitocin creates much stronger and less manageable contractions. 

What this boils down to is the more someone is lovingly supported, touched, and doted upon during labor, the more oxytocin they naturally produce, which means they are likely to have more effective contractions and will feel better about the whole experience, even if it doesn’t go “as-planned.” This is one of the number one benefits of a doula. 

What is a Doula?

Besides emotional support, a doula is someone who provides continuous physical support as well as education to the birthing person and their partner.  That means decoding medical talk, offering massage, counter pressure and position changes. Doctors, midwives, and nurses are primarily concerned with making sure the mother and baby are safe and healthy from a medical standpoint,  while doulas focus on the well being of the whole family. We also make sure your birthing preferences are heard, because we work for you, not for a hospital. 

There is often a lot of confusion around what a doula is, especially when compared to midwives, so I feel like  this is an important moment to distinguish the differences between a midwife and doula. 

Midwife 

• Licensed health-care professional
• Provides gynecological exams
• Delivers the baby 
• Can provide fetal monitoring, cut the cord and stitch up mom (if necessary)
• Takes the place of a doctor in the case of a home birth, birth center birth and even in some hospitals
• Is usually not present throughout the whole labor, but comes in during the active stage

Doula

• Certified but not licensed 
• Does not deliver the baby, monitor the baby, or provide any kind of physical exams
• Is not a health care professional but more of a birth coach
• Provides non-medical physical and emotional support 
• Does not take the place of a doctor, nurse or midwife, but works on behalf of the family 
• Provides support throughout the whole labor

While it is important to have a health-care professional present for your birth, there are things they often miss. And this is where I have to mention the general lapse in medical care during the postpartum period. Do you know how crazy it is to send someone home after having a baby without scheduling another official check-up for six weeks?

This is like asking mothers to run two marathons in a row (labor) and then sending them home to recover along with a brand new tiny person to care for.  They need to be awake every 2-3 hours to feed the baby, change the baby, burp the baby, and try to soothe the baby back to sleep just so they can get an hour of rest before doing it all over again.  No one is there to check up on the mother’s healing: physically or emotionally and it is very easy to become overwhelmed and completely depleted. This is where the medical model goes wrong. And this is where the benefits of a doula come in to make up for it. 

There are two different types of doulas, birth and postpartum doulas.  Then there are some people who do both, like me.  

Birth Doula

Birth doulas support a family prenatally to create a birth plan, learn comfort measures, and decode medical talk.  Birth doulas show up for that continuous care during labor and delivery, giving foot rubs, offering ice chips, talking through all the options, keeping things light, and helping with position changes so labor will progress.  Birth doulas should always include a postpartum visit as well. This is when they will check up on mom, process the birth story and make sure the family is feeling comfortable and set up for success in that first leg of the parenting journey.

Postpartum Doula

This type of doula will provide support in the first 1-3 months postpartum.  The benefits of a doula in the postpartum are having someone there to help with the baby, cook nourishing meals, troubleshoot breastfeeding issues, make sure mom is getting enough rest and being there to answer questions that are bound to arise.  Postpartum doulas also monitor and support the mother’s recovery and recognize when it might be time to see a medical or psychiatric professional. However from my experience, the biggest thing new mothers need is someone to listen to all their doubts, fears and emotions and say “you’re doing great.”   

When a woman feels genuinely cared for she is able to find the inner strength she needs to birth in an empowered way and after the birth, a well nurtured mother is better able to care for her baby too. If we want to change the world and create a society of healthy happy people, we need to help parents do their job better. This doesn’t mean telling them “how” to do it, but giving them the confidence and support to find their own way. One of the main benefits of a doula is the non-judgmental support we bring. 

When Should You Get a Doula?

As I said whether you’re having a home birth or a hospital birth, the benefits of a doula are huge.  So let’s break down how a doula could help you in either situation.  

Home Birth 

While your midwife is monitoring your medical care, your doula will be monitoring your emotions along with what’s happening in the room.  She will do her best to keep you grounded, happy, and optimistic through the tough parts. She will keep you well-fed and well-hydrated. She will take your dog for a walk if necessary, keep the birth space clear of clutter and mess, and hold down the fort if your partner needs a break to care for other children or run an errand.  

If labor is stalled your doula might go on a long walk with you, or help you get into positions that will facilitate labor.  Unlike the hospital, giving birth at home allows you the freedom to do most anything you want, even if that means sitting in your hot tub in the backyard. 

Another one of the benefits of a doula at a homebirth is the immediate postpartum time.  She can help you clean up the space, cook a delicious post birth meal, and establish breastfeeding, if that’s how you want to feed your baby. 

Home are some home birth tips to remember if this the direction you want to go:

• Make sure to research the different types of midwives.  There are three main certifications: CM, CNM, and LPM. This is a big topic, so dive in so you can make an educated choice on which type of midwife you want to hire. 
• Your midwife will usually help you figure out all the things you’ll need for the birth but there may be extra things to buy if you wish. Bigger items that could help are a birth tub, birth stool, or birth ball.
• Have your favorite snacks and drinks on hand. Never underestimate the power of your favorite chocolate or juice when things get tough! 
• If you like music and it helps you relax, make a birth playlist for your midwife or doula to play throughout. 
• Consider some aromatherapy candles or essential oils to help you through birth.  Rose is always a good choice for labor. Lavender and geranium will be relaxing, orange or bergamot will be uplifting and peppermint will help with nausea.  I find that once active labor gets going, you can’t go wrong with a mix of orange and peppermint. 

Hospital Birth

A hospital birth will be led by a medical team. There will be a doctor or a midwife, nurses, and other hospital employees going in and out. It can be pretty overwhelming to have all of these different people monitoring you and giving conflicting information.  A doula provides consistency and a steady presence throughout the whole process.  

Just like at a home birth she helps with position changes and walks to keep things progressing, and will also monitor the emotional state of a mother and act as an advocate.  This is incredibly important in a hospital, where it’s easy to lose track of your birth plan and hand over all decision making to the doctors. Doulas won’t speak for you, but will remind you that you can request more information, take time to decide what’s best for you, and encourage you to use your voice.

A doula is still bringing all the drinks, offering massages, running out to the nurses station to get mom a snack, and giving Dad a break to get down to the cafeteria.  After the birth they will be there to take pictures, help with breastfeeding, pass news onto the extended family, place a to-go order from your favorite restaurant, and help you get settled into your postpartum recovery room. 

Here are some hospital birth tips….

• Do you feel comfortable with your health-care provider?  Because you can change up to weeks before you give birth!  Do a little research on your doctors. What are their stats when it comes to interventions, surgical birth and postpartum care?  
• Is the hospital mother and baby friendly?  This means they encourage at least one uninterrupted hour of bonding time after birth, called the golden hour.  This is hugely beneficial for the mother and baby, and while this is the standard of care at some hospitals, in others you really have to push for it.  Make sure to choose a hospital and care provider that aligns with your values, whatever they may be. 
• Bring warm socks with non-slip bottoms.  While laboring mothers are often hot and sweaty, hospitals can be really cold and the floors are slippery too. Having access to some good slipper socks is helpful!
• Bring your own comfort items like snacks, drinks, body products, clothing, sentimental objects or anything that will make the space feel more like home. 
• You can’t burn candles in the hospital, but you can bring a diffuser and any essential oils you’d like to help provide comfort. You can also bring the little electrical tea lights. Turning off the fluorescent overhead lights and keeping the room dim and calm is helpful for that oxytocin release I talked about earlier. 

Where to Look for your Doula?

So now that you know some benefits of a doula, how do you find one? Some of my clients find me through my website on a google search, others through word of mouth from past clients, and still others as referrals from massage therapists, acupuncturists, or health care professionals in my area. So ask your midwife or doctor or other holistic health professional if there is someone they recommend, or get cozy with a cup of tea on the internet until you find someone that really speaks to you. 

Another place to go is the DONA or CAPPA websites.  These are two of the more established groups that offer doula trainings and certifications. Once a doula is certified through either, they can be listed in the database.  Here’s the thing:  doulas aren’t yet licensed and so a doula doesn’t have to be certified to practice.  If you want to make sure that a doula has been well trained and is up to standard on their continuing education, ask for their certification info. 

Parenting forums on facebook are another great place to look. Hiring someone who comes well recommended by your community can help ease your mind, as they will become someone who gets very close to you and your family. 

Doulas may also carry liability insurance, CPR certifications or have other skills and training so if those things are important to you, just ask!  Ultimately there is a doula out there for everybody, which leads me to the question of what kind of doula do you want?

Who is Your Doula?

Now that you know what to expect from a doula and why you should hire one, how do you decide who your doula will be?  Finding a doula who matches your values is great, but most importantly, find a doula you feel comfortable with. Do you want a doula who is more like a mother or grandmother, or someone who is closer to your age, like a sister?  

Most doulas offer a free interview before you agree to hire them.  I always advise people to interview a few different doulas before making a decision.  When you find the right one, you’ll know it, and the benefits of a doula only increase the more comfortable you feel with her. Make sure she is easy to talk to, that you feel relaxed in her presence, and that she gives you quality, evidence based information (even if that means acknowledging when she doesn’t know an answer to your question.) I say “her”, but there are also a growing number of male doulas out there, so if you’d feel better with a male presence, see if there’s one in your area!   

I’m more of a holistic birth and postpartum doula, as I am a trained herbalist who also teaches breathwork. Clients who come my way are often interested in learning more about non-medical comfort measures, non-toxic lifestyle and holistic options for both mother and baby.  Speaking of, Elevays has a ton of amazing non-toxic baby things so be sure to check out their store while you’re here! 

Despite my holistic background I have also supported incredible families who chose epidurals, cesareans, and inductions for their births. The most important part of my job is to make sure parents feel well-informed about their choices and confident in their abilities to parent. So again, when choosing your doula, it ultimately boils down to whether they make you feel at ease. 

So is a doula worth it? The benefits of a doula in birth or postpartum usually far outweigh the financial investment.   And having the birth you want as well as being supported postpartum so you can heal and bond with your baby is crucial in setting you up for success as a parent- whatever that means to you. So give yourself that gift because when we choose to invest in our self-care, our children and our health, it gives other people permission to do that too. And our world could definitely use a little more of that! 

 

Sources:

1. Understanding Research (2019). “Playing the Doula Numbers Game.”  Retrieved from: http://www.understandingresearch.com/playing-the-doula-numbers-game