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| Frequently Asked Questions About Doulas
What kind of training did you receive to become a doula?
I received my training in 2007 with the Association of Labor Assistants and Childbirth Educators, also known as ALACE. ALACE's rigorous labor assistant certification program includes attendance at a 26 hour workshop, 6 births, and a series of childbirth classes, along with the completion of a required reading list. The ALACE workshop covered the anatomy and physiology of labor, as well as techniques for providing physical and emotional support to women in childbirth.
Six months after my initial training workshop with ALACE, I attended a birth doula training presented by Birth Arts International. Birth Arts appealed to me because of their approach to supporting women in pregnancy and birth. Several of the women who teach the courses are not only midwives or midwife assistants, they practice another form of holistic therapy, whether it be massage, or herbs, aromatherapy, or something similar. Birth Arts was critical to my development as a doula because the training guides you to look within yourself and helps you to define who you are as a person and as a birth doula.
In addition to the support and education I've received from ALACE and Birth Arts, I have supplemented my training by enrolling in classes covering various subjects related to pregnancy, labor and the immediate postpartum period. I also study evidence-based research through online resources and networking with other childbirth professionals, so I can keep current with developments in this field.
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Why should I hire a doula?
A birth doula will be a wonderful emotional and physical support person through your labor and delivery. She is educated in relaxation techniques, laboring positions, emotional support, birth and delivery options, and more. She will know how to help you achieve your birth goals and help the father support you in ways he may have never even though of, even if he has already taken a childbirth education class. A doula is your partner or advocate, educating you about what is happening to you, what your choices are, and allowing you to make informed decisions on how you want your labor and delivery to go. A birth doula's support reduces anxiety and stress (what has been shown to increase labor length, lessen uterine contraction productivity, and open up more possibilities to complications) and research has repeatedly shown that women who receive continous support from a doula during labor are:
In 2004, a systematic review was published that summarized the experiences of close to 13,000 women who participated in 15 randomized controlled trials. Comparing women who received continuous labor support with women who did not, studies have shown that women who received continuous support during labor and childbirth were:
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less likely to use pain medication
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less likely to have an epidural
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less likely to give birth by cesarean section
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less likely to give birth with forceps or vacuum extraction
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less likely to be dissatisfied with their birth experience, thus reducing the likelihood for postpartum depression
Hodnett ED, Gates S, Hofmeyr G J, Sakala C. Continuous support for women during childbirth. The Cochrane Database of Systematic Reviews 2003, Issue 3. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.
More likely to:
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initiate and continue breastfeeding
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be satisfied with their birth experience
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feel more confident in their ability to mother
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bond faster with their newborn
-"The Doula Book", Klaus, Kennel, and Klaus 2002
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What is a birth doula's role at the birth?
My role may differ from client to client. It will depend on your preferences and the circumstances of your birth. In one birth, the mother might need constant support from her husband, in which case I might be focused primarily on supporting the husband so that he can continue to support his wife. In another birth, the father and I might take turns providing emotional and physical support to the laboring mother. At other times, the father might provide all of the emotional support while the I provide the physical support. In some labors, I work more closely with the medical staff. I can help with continuity of care as the care providers change work shifts, updating the new care providers on the couple's wishes if the mom is too far into labor to want to discuss these preferences. Sometimes I provide ideas, and at other times, I share information about procedures under consideration. Sometimes I provide emotional support such as encouragement, affirmation and prayer, and at other times I focus on physical comforts like massage, hot and cold compresses, etc. I am ready to step in to whatever role the birthing couple needs at any given moment.
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When should I hire a birth doula?
It really works out well if your birth doula can be hired at least 4 weeks before your due date. This gives you both the opportunity to really get to know one another before the birth. The earlier you begin your search, the more time you will have to interview prospective birth doulas and find one that matches well with you and your partner. It also ensures the doula you like will have availability in her calendar to accept you as a client.
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Do I have to have an unmedicated birth if I hire a birth doula?
I am able provide support for any type of birth, whether it is medicated or unmedicated, vaginal or cesarean. My role is to give information to my client to help them make the most informed decisions about the choices they have control over. I can help the couple navigate any unforeseen events during labor and support the mother in deviating from her birth plan when necessary.
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My husband/partner will be at the birth. Why should I hire a birth doula?
I do not replace the role of your chosen birthing partner. As a birth doula, my role is to assist and support the mother and her partner in achieving their birthing goals. I work very closely with any other coach present, and use my training to assist and empower the birth partner to be actively present during the labor and delivery. I will always help the father support the birthing mother, showing him the techniques and positions that will help her, enabling him to offer the emotional support and love only the father can provide. My presence allows the father to experience and enjoy the birth, support the mother to his capacity, but not to be the sole support to meet the mother's many needs. Many times, the fathers will feel relief knowing there is someone there who knows what the mother is going through, and can help the both of them better understand the process, the choices, and help support the mother in physical and emotional ways that can make all the difference. Working together, the father’s knowledge of the mother, and my knowledge of birth can give the ultimate level of comfort and support to the laboring woman and best provide her with the opportunity for a birth experience she will remember with joy for the rest of her life.
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What is the difference between a birth doula and a midwife?
Unlike a midwife, birth doulas do not perform any medical tasks. Birth doulas cannot evaluate the mother or baby for health problems, do not take blood pressure, monitor the baby's heartbeat, do vaginal exams or administer medication. Many birth doulas are from non-medical backgrounds but are highly trained in the mechanics of labor and in non-pharmalogical pain management techniques and are trained to provide a high level of emotional support. They may use massage, counterpressure, position changes, hot or cold packs, aromatherapy, visualization and other measures to help their clients during labor.
A midwife’s role at births is to be the primary care giver. She monitors both mother and baby for potential health problems and performs duties such as vaginal exams, suturing, blood pressure, heart rate, and overall evaluations of the health of the mother and baby. A midwife has been trained to attend births as a medical professional as well as provide a level of emotional support to the mother.
The priority of the midwife, doctor or nurse is to tend to the physical health of the mother and baby, while a birth doula’s priority is the emotional health of the mother, her partner, and their baby. Birth doulas do not replace professional medical care.
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How does a birth doula work with hospital staff?
I am not there to take the place of the healthcare team. Primary care providers are responsible for the medical health needs of the mother and baby. I help ensure that the mother’s non-medical needs are met. I do not perform any medical or clinical procedures. I provide continous emotional and physical support throughout the entire labor and delivery, and for a few hours postpartum. I act as a liaison with the medical staff, but do not make decisions for the mother.
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Won't my nurse be able to give me the support I need when I'm in the hospital?
Labor and Delivery nurses may not be able to provide the constant support you desire during labor. Nurses are usually providing care and treatment for many patients at a time, and are also responsible for a tremendous amount of paperwork. This limits the time spent with each individual patient. The nurse's main responsibility is to monitor the progress of the laboring woman and give that information to the care provider. As a birth doula I will provide you with continuous support throughout your entire labor, not affected by shift changes, and help for some time after the birth as you and your partner are getting to know your new family.
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What if my doctor doesn't want a birth doula at my birth?
Unfortunately there are some doctors who have misconceptions about a birth doula's role. Birth doulas do not make your choices for you or challenge the doctor or hospital staff when a decision has to be made, but there have been some birth doulas who have done just that and have alienated medical staff by their behavior. If you are planning to have a birth doula at your birth and your doctor is not supportive of this, you might want to shop around for a doula-friendly practice.
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Will my birth doula come to my home when I'm in labor?
Depending on your comfort level, you may spend early labor at home with your me there to help you, or you might decide to meet me at the hospital. If your water breaks, your doctor will likely want you to go to the hospital, and you will most likely be admitted, whether or not contractions have begun. If you do plan to stay at home in early labor, I can help make you comfortable and be an attentive companion. When you are entering active labor I will assist in the transition from home to hospital.
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I am planning to have a home birth. Do I still need a birth doula?
This depends on your preferences and on your midwife. Some midwives work with apprentices who will fill the role of a doula. Most midwives offer a very high level of emotional support, regardless of whether they work alone or with apprentices. There are benefits to hiring a doula separately, however. Having a birth doula at your home birth ensures that the level of emotional support will be maintained even in the event of an emergency, during which the midwife and apprentice could be too busy to offer much emotional support. As your doula, I will also provide an increased level of postpartum support.
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Does medical insurance cover birth doula services?
Some women have had success with insurance claims; many women have not. However, studies are being done in hopes of changing this. The presence of a doula does save individuals and the nation money. According to Klaus and Kennell, births attended by doulas could mean a $3500 savings for individual families and therefore reflect a $2 billion annual reduction in national medical care costs. If finances are an issue for you and we are unable to work out a payment plan, I can recommend a volunteer doula for you.
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