What is a Doula and Do You Need One? Here’s What You Need to Know

Using a doula has been an emerging trend among mothers. Like lotus births and placenta encapsulation, it can be hard to tell if they are another fad or if there is any scientific truth backing these practices. However, unlike lotus births and popping placenta pills, which carry infection risks and no scientifically-backed benefits, social support can be beneficial for the mental well-being of mothers-to-be. Doulas can serve as a source of social support during pregnancy, and to better understand the scope of their benefit, we recently interviewed Shannon Padlog, a doula based in the San Francisco Bay Area. Based on our conversation with her, this post will answer:

  • What can a doula do, and what are they not able to do?
  • Why should I use one?
  • How are they different from OB/GYNs and midwives?
  • Is there any scientific merit to using a doula?

What is a doula?

A doula provides continuous labor support to the mother, no matter what decisions the mother makes or how she gives birth. The word “doula” actually comes from ancient Greek and means “Woman’s Servant.” According to Shannon, “Doulas often act as a bridge in communication between medical staff and families, helping both parties understand the goals and priorities of everyone in the room.”

What are the services doulas are allowed to do?

According to Shannon, here are what doulascan and cannot do::

A doula can…

A doula cannot…

  • Provide continuous emotional and physical support
  • Give medical advice because they are not medical professionals
  • Give information if asked and help a mother find resources to research her birth choices
  • Disrupt or interfere with the doctor-mother relationship
  • Perform comfort measures like massage, suggesting different positions and helping with relaxation breathing
  • Replace the important role of the birth partner
  • Accommodate the mother’s wishes for the birth environment (low light, soft music, etc.) to the extent possible in the place of birth
  • Provide clinical services, such as checking vital signs or performing exams, because it is outside of our training and practice.

 

  • Encourage the mother to communicate with her doctor or midwife to be informed about any procedures and interventions
  • Provide prenatal services, such as monitoring the baby’s heart rate, development, etc.
  • Support the father or birth partner in the best way to support the mother.
  • Judge, condemn, or go against a mother’s wishes.

 

Why would a woman choose a doula in the first place?

As exciting as it can be to meet your baby, pregnancy and giving birth can be filled with uncertainty and distress. From trying to distinguish Braxton Hickscontractions from early stages of labor to wondering about the safety of prenatal vitamins, and pregnancy workouts, many mothers-to-be understandably have a lot questions. According to Shannon, a doula helps to take a lot of the mystery out of birth. She says, “They [doulas] can answer questions in real-time (yes, even in the middle of the night!), make suggestions for what to do, explain why something is happening, and just generally normalize an experience that is extremely novel, new and sometimes overwhelming and anxiety producing.”

This can be particularly supportive during labor as doulas are experienced in helping with changing positions, vocalizations to help alleviate distress, rhythmic movement, guided relaxation with breathing and/or visualization, and specialized massage for labor.

Doulas can also support women by helping them gain information about different pregnancy and birth practices, so women can make decisions from a place of confidence and knowledge versus fear and lack of information.

One of the most valuable reasons to choose a doula is that they offer continuous emotional support. This comes in the form of verbal encouragement and reassurance, a constant physical presence, and full trust in the mother’s power and ability to birth.

Does a doula guarantee a better birth outcome?

There are a few clinical trials that have been done to evaluate whether a doula results in a better labor experience or delivery success. One clinical trial of 600 low-income women found that a doula significantly reduced vaginal delivery time from an average 11.7 to 10.4 hours although it had no effect on the likelihood of using an epidural or having a C-section delivery. Also, there was a slight but significant increase in APGAR scores among babies delivered when the doula was present (99%) versus no doula present (97%). Interestingly, the doulas in this study were “lay doulas,” meaning they only received two 2-hour sessions of training before they assisted women 1. Another study of almost 500 women similarly found that female friends or relatives given lay doula training increased a sense of social support in mothers during delivery 2.

The bottom line? A doula doesn’t guarantee a smoother or less complicated birth, but social support is extremely important during pregnancy and labor. Whether that support comes from a doula or somewhere else, a strong social support system is always a good idea.

Is there a difference between a doula and a midwife?

Doulas are NOT the same as midwives. Midwives are medical care providers and their role is more similar to an obstetrician (OB), though their training and areas of expertise are different. According to Shannon, “Doulas are a great addition to midwifery care, but their roles don’t actually overlap. Many families seek out midwifery care instead of seeing an OB/GYN in their pregnancy. Midwives support their patients in hospitals, at home or birth centers, whether they are planning to birth in a hospital, home or birth center.”

If I have a doula, do I still need an OB/GYN?

Yes, they work as part of your team, but are not a replacement for either an OB/GYN or midwife.

What is the working relationship between a doula and an OB/GYN?

They are both part of the team supporting the birthing family. Doulas often help to bridge communication between the medical staff and the family.

What kind of training does a doula need to have?

Doulas are not a certified or licensed profession, so there is no agency that qualifies a doula. They are trained via local and national organizations, such as the Doulas of North America. Some organizations include a certification program that involves workshop attendance, assigned reading, attendance and supporting a certain number of deliveries, and receiving recommendations from mothers, family members, and health care providers.

Are doulas covered by insurance?

Here is what Shannon had to say: “As of now, doulas are not generally covered by insurance, though many organizations are pushing to get coverage since we know that doulas can drastically lower health care costs with the support they provide prenatally and during birth! Many families I have supported have been able to use HSA or FSA funds for doula services. I have had a handful of families get some reimbursement for doula support after being persistent in contacting their insurance provider.”

When should I get a doula?

Shannon recommends getting a doula as soon as you want one, and it’s never too late to ask. She says, “Hiring a doula earlier gives you more time to get to know one another and families have more selection since many doulas book up months in advance. Your doula is a great buddy throughout the pregnancy journey and many of the families we work with enjoy having a non-medical support person to ask questions throughout the pregnancy.”

What do I look for in choosing my doula?

Here’s what Shannon suggests for choosing a doula: “I often tell families the most important decision-making factor is the connection you feel. Interviewing doulas is kind of like going on a first date! You want to walk away having that gut feeling that you feel comfortable with one another, can communicate openly and honestly, and that your decisions will be respected. Some families also want to know about specific training or philosophy that will help guide their decision. Chatting with doulas on the phone and then meeting in person with 2-3 that is usually a great way to find the perfect match.”

How often do you meet with your doula during pregnancy?

It depends on each doula’s practice, but most women meet them two – four times.

Will a doula see me after I give birth?

Again, it depends on the doula’s practice, but typically 1-2 times.

Shannon says: “No matter what your preferences are, a doula can help support you and your team through the experience. They offer non-judgmental support and continuity of care that fills a big gap in our current maternity care system. In essence, a doula is a massage therapist, friend, therapist, DJ, court jester, or anything else a mother needs her to be in labor. She is a shoulder to cry on or an encouragement when the mother thinks she can’t go on. What I hear most often after families give birth is ’How does anyone do this without a doula?’”

You can learn more about Shannon’s services at:

Collective Hearts Birth Services

Community. Education. Equity. Dignity. Non-judgment

 

 

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2018-06-10T17:18:57+00:00Pregnancy|

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