What does a labor & birth doula do and why would I want one at my child’s birth?

Simply put, doulas are support people for pregnancy, birth, and beyond. They provide practical, emotional, physical, spiritual and informational support, as necessary, to the family that is about to welcome a child. They help create and maintain a safe space for the process of birth to unfold. They help to normalize what can often be challenging new terrain, both for first-time parents and families welcoming another little one into their lives. Each birth is different and each person has unique needs when giving birth. Doulas understand this and meet people where they are at. A doula’s goal is not to push an agenda, but to empower their clients to have the birth they envision, and to offer all support possible along the way to help make it happen.

There are many evidence-based benefits to doula care! Doulas have enjoyed some time in the spotlight in recent years due to the emergence of a demand for non-medicalized birth. People want to have agency and support for their choices in birth, not to feel railroaded through a medical procedure. Doulas exist to provide families with information and support so they can make informed decisions from a grounded place. We live in a region where there are many hospitals that want to support choice in the birth room, which is wonderful! And yet, there is still a need and a place for doulas.

• Evidence Based Birth, a phenomenal resource on scientific studies regarding birth, states that people “who received continuous support were more likely to have spontaneous vaginal births and less likely to have any pain medication, epidurals, negative feelings about childbirth, vacuum or forceps-assisted births, and C-sections.” (Source) When this support was provided by a doula SPECIFICALLY, it was found that there was a:
  • 31% decrease in the use of Pitocin
  • 28% decrease in the risk of C-section
  • 12% increase in the likelihood of a spontaneous vaginal birth
  • 9% decrease in the use of any medications for pain relief
  • 14% decrease in the risk of newborns being admitted to a special care nursery
  • 34% decrease in the risk of being dissatisfied with the birth experience

• A recent NPR article from January of 2016 explains a study published by the journal Birth which produced findings that show a decreased chance for an unwanted Cesarean birth when using doula care. The study aims to statistically show the benefits of doula care and the need for doulas to be covered by Medicaid, so that low-income and disadvantaged families could also benefit from doula care.

• A Cochrane study found that “supportive care,” which they describe as “emotional support, comfort measures, information and advocacy,” “may enhance physiologic labour processes as well as women’s feelings of control and competence, and thus reduce the need for obstetric intervention.” The researchers concluded that “continuous support from a person who is present solely to provide support, is not a member of the woman’s social network, is experienced in providing labour support, and has at least a modest amount of training, appears to be most beneficial” and recommended that all women should have such support.

• This study in The Journal for Perinatal Education found that “communication with and encouragement from a doula throughout the pregnancy may have increased the mother’s self-efficacy regarding her ability to impact her own pregnancy outcomes.” The researchers also state that “with the support of doulas, many women are able to forego epidurals, avoid cesarean births, and have less stressful births.”

What about for a homebirth?

Yes, there is a place for doulas at homebirths as well! A doula’s role may shift somewhat for a homebirth as opposed to a hospital birth, but the ultimate goal is the same: to maximize the potential for a spontaneous birth with minimal intervention and contribute to an environment that is conducive, safe and optimal for birth. As with hospital births, doulas do this through caring, compassionate, nonjudgmental support: emotional, physical, spiritual, informational; as needed.  Doulas at homebirths work with midwives and other support people to create an energetic atmosphere that enables the person giving birth to go within themselves and focus on the task of birthing, knowing that all things around them are taken care of, and most importantly, so are they. As with hospital births, doulas at homebirths also attend to the laboring person and their partners’ needs for food, water, and basic care, and helps empower them, alongside their midwife, to be able to make informed decisions when a situation arises. A doula comes to the home to help with labor support before the midwife arrives and helps the client normalize the labor experience. A homebirth doula helps the client determine when to call the midwife.

What does a postpartum doula do?

A labor doula naturally transitions from caring for the parent(s) during birth to caring for the new family once the baby arrives. A doula’s warm care and support eases worry and stress during the delicate, wonderful time of family bonding that takes place after birth. A postpartum doula melds gently into that environment to offer needed help and care to everyone, including baby (or babies!).

Postpartum doulas are also wonderful for families who adopt or have surrogate births, and can help facilitate family bonding and normalize the newborn experience. Postpartum care is a wonderful gift to receive from family and friends who want to support a new family but don’t have time or don’t know how!

Here are just some of the many things a postpartum doula can help with:

• Breastfeeding counseling/help with latching and feeding positions
• Assistance with and evidence-based information for formula feeding, if needed
• Helping new parents learn to soothe their baby
• Helping new parents understand their baby’s cues and communication
• Hands-on education on caring for a new infant, including swaddling, bathing, and babywearing
• Assisting with meal trains and organizing offers of help from loved ones
• Support with nursery set-up
• Help with cleaning and preparing of bottles
• Resources and referrals based on family’s needs (lactation consultants, massage, chiropractor, acupuncture, craniosacral therapy, etc.)
• Emotional support, support with processing the birth and screening for postpartum depression
• Help with sleeping strategies
• Care for baby when new parents need to nap, shower, meditate, get time to themselves
• Care for the postpartum clients as they recover from birth, especially those who’ve had Cesarean births
• Light housekeeping and errands
• Preparing meals and snacks as needed

What if I can’t afford a doula?

Everyone deserves support for labor and birth — it is not a luxury. Doulas fill the gaps in the medical system and provide crucial services for birthgivers, babies, and families. The value of a doula cannot be overstated. Unfortunately, until doulas are covered by medical insurance, they can be a costly service and many families can be unable to access them. Some doulas, like myself, offer services on a sliding scale whenever possible in order to work with some families who want doula care, but can’t afford it. The benefits greatly outweigh the costs of doula care, and doulas charge a very fair amount based on the quantity and quality of time they devote to their clients. If cost is an issue for you, consider asking friends and family to donate to a doula fund for your baby shower instead of getting you non-essential items! There are also volunteer doulas available to those who need them through Birthways in Berkeley and SF General Hospital.