Should You Have a Doula?

A doula is a professional support person who provides physical and emotion assistance throughout the stages of labor. Doulas do not hold medical licenses, and many are trained via workshops or apprenticeships. Although their training may vary, doulas are an invaluable resource to laboring women and their partners.

Doulas and Your Labor Experience
There is good evidence that having a female support person with you in labor leads to a more satisfying birth experience. Simply having someone there — solely for you — can help to make the experience less frightening and more pleasurable.

Doulas provide assistance at home and in the hospital. When you are still at home, your doula offers ideas for coping with the pain of early labor. She allows your partner or other support person to take a break and offers everyone reminders to eat and stay hydrated.

As labor progresses, your doula can reassure you and identify normal physiologic changes such as stronger, more intense contractions, bloody show and episodes of nausea. This type of reassurance not only creates feelings of safety but can also decrease pain.

Your doula can also let you know when things are abnormal and can advise you to call your healthcare provider when you need medical advice. Though doulas are trained in labor support, it is important to remember that since your doula is not medically licensed she will not be making clinical decisions about your care.

In the hospital, your obstetrician or midwife may be busy with other patients on the labor floor. Your doula can ensure that you are never alone or without guidance. She can also help you with decision-making. You may be given options about various interventions, styles of pushing or requests to do something that deviates from your birth plan. Your doula can help you articulate your needs and questions and advocate for you if you feel unable to do so on your own.

Your doula will translate medical jargon and assist you in making decisions in a way that keeps you feeling empowered and calm. The most effective doulas will offer advice and support without being a barrier to medically indicated interventions or needed changes in the plan of care.

Postpartum Assistance
It’s typical for a doula who has worked with you during your pregnancy and labor to provide at least one visit with you after your baby is born. This home visit gives you an opportunity to process your labor and to ask any questions you might have. In addition, it allows your doula to do a general check-in about your physical and emotional well-being.

Some doulas focus exclusively on providing support during the postpartum period instead of during labor. They can help with anything from breastfeeding advice to housework to extending emotional support during this uniquely challenging time.

Choosing a Doula
If you are considering hiring a doula, take the time to interview more than one. It’s important that the person you pick is someone with whom you feel comfortable and someone whose ideas about labor align with your own.

Prepare questions for her in advance, so that you obtain the information you need to make a well-informed decision. Consider asking her about her training, how many births she has attended, costs of her services (doulas are rarely covered by health insurance), if her schedule is constrained by any other obligations, and whether she has a back-up doula for times when she is not available.

Typically, the doula you decide to work with will want to meet with you a few times prior to your labor to gather information about what’s important to you, to educate you about how she might be of assistance and to help you with your birth plan.

Sarah Kleinman, CNM, is a Certified Nurse Midwife in Boston who delivers babies at Beth Israel Deaconess Medical Center.