What Is a Doula?
Although the role of a doula is one that has existed throughout history in every culture, the term “doula” how it is used today has only been around for a few decades. The word doula comes from the Greek work doulos, meaning “slave” or “servant.” Although some doulas prefer different titles because of this meaning, I think this origin encompasses the sacrifice and heart that this profession demands. We come with no agenda, only a desire to serve and nurture.
Traditionally, a doula is any companion that cares for a new family throughout pregnancy, birth, and/or the postpartum period - a relative, close friend, or community member. Doulas as birth professionals who receive training and credentials is relatively new to the last few decades. As people learn more about the benefits of having a doula and desire having additional support for navigating the perinatal period, the use of doulas is on the rise, jumping from 3% of people utilizing a doula in 2006 to 9% in 2018.
How Is a Doula Different From a Midwife?
Although doulas and midwives have unique roles as birth workers, the two are commonly conflated. While midwives receive medical training and are licensed to diagnose, treat, and examine people through pregnancy, birth, and postpartum, doulas provide non-clinical support. Doulas can receive training and credentials from a variety of certifying organizations (although this is not required, so it’s important to ask your potential doula what their certifications are if this is important to you), but they do not prescribe medications, perform examinations, or provide medical advice or treatment. Because midwives treat a number of patients, they are not typically present for the entire length of labor (and families may meet the midwife delivering their baby only a couple of times, if at all, before the birth); doulas are able to provide continuous support throughout pregnancy and for the duration of the labor and birth. They may be the only person in addition to your partner who provides this continued care.
What Do Doulas Do?
The work of a doula is about companionship and support. This looks different for each family, so doulas individualize their support to best serve their clients and support their vision for the birth. The list below includes some things I typically do for families to care for them, but I try to keep this quote from Dr. Dana Raphael at the forefront of my mind: “Whatever the doula does, however, is less important than the fact that she is there.”
During pregnancy, doulas…
develop a trusting relationship with families so they feel confident that they will have continuous, safe support once labor begins
learn about the family’s desires surrounding the birth experience so they can support this vision for birth
discuss hesitations and fears about the labor and birth, providing encouragement, information, or just a compassionate ear
guide families through the different options and situations that may arise during the course of the labor and provide evidence-based information when desired
provide techniques and resources for preparing for labor, such as breathing and relaxation strategies, comfort measures, etc. and instruct the partner on how to support the person in labor
During labor and birth, doulas…
join the family in-person at their birthing location and provide continuous emotional and hands-on support for the length of the labor
guide the partner in supporting the laboring person to the extent they want to be involved
do basic tasks, like filling water bottles, finding snacks, etc. to care for the family and free up the partner to be fully present and involved
help families think through the benefits and drawbacks of the options that present themselves throughout labor so that they can feel confident and informed in their decision making
provide hands-on support to minimize pain and discomfort, such as massage and counter-pressure
recommend position changes to optimize baby’s position, encourage cervical change, and increase comfort
provide verbal encouragement to the laboring person and their partner, especially during times of intensity or doubt
During the postpartum period, doulas…
check in on the physical recovery of parents, as well as the emotional adjustment to life with a newborn
observe and provide feedback and resources on infant feeding, if desired
refer out to other birth workers and professionals in the community, such as lactation consultants, chiropractors, mental health professionals, and pelvic floor physical therapists, depending on the new parents’ needs and unique situation
invite parents to share about their experience during the labor and listen, validate, and encourage
instill confidence in the new parents and support the decisions that they are making for their family
“Whatever the doula does, however, is less important than the fact that she is there.”
The Evidence on Doulas
Doulas do not guarantee certain birth outcomes. Our job is to support you in navigating the birth however it unfolds and to make sure you feel heard, seen, and supported throughout the entire process; however, the evidence shows undeniable benefits to having an additional support person.
A Cochrane Review found doulas provide a…
39% decrease in risk for Cesarean
15% increase in the likelihood of a spontaneous vaginal birth
10% decrease in the use of any medications for pain relief
38% decrease in the baby’s risk of a low five-minute Apgar score
31% decrease in the risk of being dissatisfied with the birth experience
reduction in labor by 41 minutes on average (this is very significant to the person in labor!)
There is a lot more that can be said about doulas and their role. There are even differing opinions within the doula community on what our scope of practice really includes. There are barriers to people being able to access a doula. I hope to cover these topics through future posts.
