Doulas 101: What Is a Doula?

For centuries, women have been using doulas (a Greek word that means "a woman who serves") to help them with aspects of childbirth. Today, doulas are professionally trained birth coaches who "mother the expectant mother," says Latham Thomas, a maternity lifestyle expect and labor support doula in New York City and founder of Mama Glow (mamaglow.com).

There are a few types of doulas: birth doulas, postpartum doulas, and antepartum doulas. A birth doula provides assistance to another woman before and during labor and childbirth; a postpartum doula provides assistance to new parents after their baby is born (though some doulas offer both services). Antepartum doulas help women who are having high-risk or difficult pregnancies -- such as those on bed rest. Most pregnant women, especially those giving birth for the first time, opt to hire a birth doula, who "offers prenatal education and emotional support, and she advocates for the mother," Thomas explains. "She is not a medical professional, but she is well trained and well primed in the protocol for childbirth whether at home, in the hospital or at a birth center. She is a liaison between the medical practitioners and the expectant mother."

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What Are the Benefits of Having a Doula?

A doctor is focused on keeping the baby safe and sound, but a doula is focused only on the mom. "The biggest benefit of having a doula is that you have a woman trained and experienced with labor and birth... whose sole job is to support you," explains Ami Burns, a childbirth educator and doula in Chicago and the founder of Birth Talk (birthtalk.com). "A doula doesn't also have to do anything medical or check on other patients like a doctor might. She is there for you and your needs." You might be thinking, "My partner will be by my side; he'll tend to me," but keep in mind that the birth experience can be extremely emotional and surreal for him, too. He might not even know how to help you (without driving you crazy!). That's where the doula steps in. "The doula provides reassurance to the partner when everything is going smoothly, and helps facilitate communication between the mother and her partner when it's not," Burns says. "Doulas can also tag team with the partner to provide labor support to the mom so that the partner gets to rest when he needs to." A doula understands the importance of the birth experience, so she aims to help make sure those memories are as positive as possible.

Another benefit: According to a 1999 study in the Journal of Women's Health and Gender Based Medicine, doulas help reduce medical risks. Women who have doulas present at birth tend to have shorter labors with fewer complications and less of a need for caesareans, Pitocin (a drug which induces labor), and other medical interventions, such as pain medication or an epidural.

What Are a Doula's Responsibilities?

Doulas can provide many different services, so find out exactly what you should expect when you meet with various candidates. In general, "birth doulas complete the birth team, which can include the doctor, nurse, doula, midwife, partner, and additional friends and family, by providing hands-on support and comfort measures for labor and delivery," Thomas says. "They help educate you about birth options, get you comfortable and confident with your body, and teach you and your partner techniques for a smoother labor." As birth guides, the support doulas offer depends "on each individual woman's needs and desires," says Sunday Tortelli, president of DONA and a birth doula in Cleveland. For instance, one woman might want to hear soft music and experience guided imagery to help her relax; another woman might want to smell certain scents, such as vanilla or lavender.

Postpartum doulas have a different role -- they enter the picture after a woman has already delivered her baby and they can stay for any length of time, from a few hours here or there during the first week to every day for three months or more. "Their primary goal is continuing to... make sure the mother is well fed, healing, adjusting to motherhood, and bonding with her baby," Thomas says. Keep in mind that the postpartum doula is not a nanny or a nurse. First and foremost, she is a resource who provides up-to-date information about how to care for a newborn and who reminds the mom about the importance of self-care, too. In a nutshell, a doula's role is to take care of you and help you transition into your new role as a mother, from helping you stay calm during labor to easing birth pain with various techniques to making sure you're nourished and hydrated after the baby is home so you'll have enough energy to take care of him. Talk to doulas you're considering about what they're willing and able to do for you (some will even do the dishes so you can spend time with your newborn!).

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How Can You Find a Doula?

The best way to find a birth or postpartum doula is by checking with organizations that train and certify doulas such as DONA International (dona.org), CAPPA (cappa.net) Birthworks (birthworks.org), and Childbirth International (childbirthinternational.com). Call your doctor or your childbirth educator to see if there are recommended doulas, and ask friends and other moms, as well as your childbirth educator, for other recommendations in your area. In rare instances, hospitals and birth centers may offer a doula program. It's worth asking.

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What Should You Look for in a Doula?

When choosing a doula, it's important to meet candidates in person. Make sure the doula is certified -- ask for her credentials or check with DONA to see if the doula is part of their database. "The most important thing a mom can do when choosing a doula is to trust her gut feeling," Burns says. "The doula will be her support during one of the most intimate, life-changing events, so she needs to be sure that the doula will respect her wishes." You might want to choose a doula who will work well with the rest of your birth team. "Ideally, continuous labor support is provided by individuals who have formal education in maternal care and who also [have] mutual awareness and mutual trust with the nurses and physicians on the mothers care team," says James Byrne, M.D., chair of obstetrics and gynecology at Santa Clara Valley medical center in San Jose.

Ask prospective doulas questions about their experience level (including any special training or certifications), their availability to answer your questions before labor and after delivery, their ability to help you achieve a successful birth, and what their backup arrangements are if they can't make the birth for any reason. Thomas recommends asking the questions to make sure the doula you hire is the right fit for you and your family.

• What inspired you to enter this field of work?
• What certifications do you hold?
• How long have you been a doula and how many births have you attended?
• What types of births have you attended -- home, hospital, birth center?
• How do I get in touch with you when labor begins? Are you always on call? When and where will you join me?
• If you are unavailable when I go into labor, do you have backups?
• What is your philosophy on childbirth? (Make sure your birth preferences are compatible with the doula's practices and beliefs.)
• What techniques will you use to help me move through labor?
• How long will you stay with me after labor?
• What happens if I need a C-section?
• Do you provide postpartum services? Do you have experience helping nursing mothers?
• What's your fee and refund policy? What does it cover?

Ultimately, remember that "doulas are support coaches; they are not supposed to impose their views on your birth," Thomas says. "Their job is to carry out your vision to the best of their ability, given the circumstances that arise, and help make it a day to remember. It's a celebration, after all."

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