Since becoming a doula a lot of people have asked me what a doula is and why they would need or want one involved in their pregnancy, labour and delivery or postpartum period. Even though doulas have been around for thousands of years it is still a fairly new profession in modern times and there is a fair amount of confusion about what doulas do and what their role in birth and the early postpartum period is.
In the past few years the number of professional doulas has grown and the practice of having a doula has increased. The word doula comes from the ancient Greek and means "woman who serves", and that is still basically what a doula does. Nowadays, the role of a doula has been tailored and specified to mean a woman who serves as a birth companion or helper in the prenatal and/or early postpartum period, providing non-medical emotional, physical, and educational support to mothers and their families. It is important to note that no one can predict the path a labour and delivery will take and doulas can not guarantee that your birth experience will go the way you want it to or be without complications. No one can. Doulas do their best to educate you so you can make informed decisions, support your choices, provide emotional and physical support during labour and delivery and support you in the early postpartum period.
I recently got together with my sister-in-law, Elle Lindquist, and filmed a Q&A about what a doula is and does.
Here are some of the questions that I have been asked about what I do as a doula, what the role of a doula is compared to other birth support persons, and why a mother may or may not choose to have a doula at her birth or involved in her early postpartum period.
1. Why would I need a doula, I have a midwife? Don't they basically do the same thing?
Midwives are great. I loved my midwife attended births and I love working with the midwives. They are usually very woman-centred and provide more continuous care than obstetricians or GP's are able to. While doulas and midwives often have similar approaches to care there are a few very important differences.
Midwives are specialized medical professionals. Their job is to ensure that the mother has a successful pregnancy and birth, which means at it's most basic level a living mother and child. They are very good a making mothers feel great during the process, but if anything medically needs to be assessed, consulted about and/or preformed it is the midwife's responsibility to do that and sometimes that trumps everything else.
Also once baby is here, you only see your midwife a few times for a check up. You may have more questions about parenting then they have time to answer or knowledge about. Their focus is on pregnancy and labour an delivery.
Doulas are non-medical professionals hired by the mother to help her in non-medical ways. Our only job is to provide continuous care for the mother. We make sure mommy knows what is happening, what her options are, how to advocate for herself, and help her with physical and emotional comfort measures. We stay with the mother while the midwives are attending to the medical aspects of birth. For example, as the time for the actual birth of the baby approaches midwives have to prepare their equipment and items for the baby. They are not usually fully focused on helping the mother through the increasingly intense contractions because they have medical responsibilities that must be taken care of. Doulas by contrast do not have anything medical to prepare and are free to stay with the mother, helping her focus, move to whatever position she feels she needs to be in, encouraging her and keeping her informed the entire time.
You may find that once your baby has arrived you have a boat load of questions or are feeling overwhelmed. Postpartum doulas come to your home to help you and your family make the transition to parenthood or to parenting multiple children easier. They are also trained to recognize the signs of postpartum mood disorders and can intervene early thorough education, recommendations for help and supporting you if needed.
2. Time availability:
When you have a midwife appointment you are generally allotted 15-20 minutes and in that time you do the regular physical checks to make sure everything is tickety-boo with baby and you, plus ask any questions that you might have and discuss anything that has come up with the pregnancy. Sometimes that is not enough time to feel like you really understand what is going on and what is coming up.
Doulas are able to spend more time with the you and your family. I often sit with mothers for a few hours at a time explaining various aspects of pregnancy, labour, delivery or the postpartum period. If I don't visit at home, we call, text or email back and forth until she feels like she has been listened to, had her questions answered and has a plan in place if needed. This becomes more important in the last few weeks of a woman's pregnancy as she often has a lot of questions or something might come up at an appointment that she would like more information about. Doulas provide information, options and a listening ear and we generally have more time to spend with the mother.
3. Number of patients/clients:
Midwives have many women that they care for. Which means that they have to balance their time between their patients. If two women go into labour on the same day the midwife has to attend to each one in some way. That may be with home visits early in labour, phone consultations or arranging for their backup midwife to take over. Sometimes they are able to come to your home and assess your labour and support you physically and emotionally, but sometimes that isn't possible. They could be with another patient or your home is at the edge of their catchment area and they may not have enough time to go between all the places they need to be. In which case they will give you instructions about when to come to the hospital or when they will be able to come to your home. You are left to labour on your own until that time.
Doulas come to you when you want them to and stay with you providing continuous care until a few hours after the baby is born. When you are in labour and you want your doula to come and help you, they come. You are the only person that they care for at a time. Their focus is on doing whatever needs to be done to help you feel comfortable, confident, informed and encouraged.
Note: When interviewing a doula be sure to ask how many clients she takes at a time. If you would be the only client due during your "on-call" period.
2. I'm just going to get the epidural as soon as I can so why would I need a doula?
I feel it's pretty safe to say that most hospitals and birth centres don't admit labouring women after the first couple of contractions. General rule of thumb for heading to the hospital is when contractions are occurring every 4-5 minutes, lasting 60 seconds and have been doing so for at least an hour. They also have to have some intensity to them, mommy needs to focus to get through them. At some hospitals they won't admit a woman until she is at least 4cm dilated either. Getting to that point can take a while. Then you need to be admitted, they have to locate the anesthetist, and he/she has to actually be available. Then they prep everything and hopefully there isn't an emergency that pulls the doctor away. Doula's help you get to the point where the meds kick in without loosing your mind. After the meds are working doulas help you reposition periodically to help labour progress. Moving within the confines of the bed helps your cervix dilate evenly which, in turn, helps labour progress quicker. Movement and massage also helps reduce muscle and joint aching after delivery and the epidural wears off. Doulas also help when it comes to pushing. Epidurals make it harder to work with your body and push in different positions. Doulas help keep you focused, and encourage you to try different positions if needed. Doulas also help you establish breastfeeding, which can be a bit more difficult for babies that react to the epidural (sleepy, less able to latch).
While epidurals take away all or most of the pain they do not relieve any anxiety a woman may be feeling, especially if she was not originally planning to have an epidural. Doulas can help with relaxation and help you process why the epidural was needed if it wasn't planned.
Sometimes by the time mommy is ready to be admitted she dilates so quickly that there is no time to get an epidural and while the medical staff are rushing around trying to get everything ready for delivery mom is just left to deal with the most intense part of labour. Doulas are with mom early in labour and stay with her and focus on helping her. We also help keep partners calm and helpful.
3. This hospital has really good nurses how would a doula be helpful?
Nurses are medical professionals that are assigned to more than one patient at a time. While they provide good care, it is not usually continuous, they don't always respect your birth plan and desires, they don't come to your house and care for you in early labour before you are eligible for admission, and they don't know you. They also work shifts. So depending on how your labour progresses and when you are admitted you could go through a series of nurses and have to go through your birth plan/wishes each time. Doulas, by contrast, provide continuous care at your home and at the hospital, respect your wishes and care for you while you partner updates the new staff about where your at, how your doing and what you'd like for your labour and delivery. Some nurses are great, some are not and there is no way to guarantee that when you go into labour the awesome ones will be assigned to you. Having a doula that knows you, has been with you for the whole labour, knows what is working for you in labour, knows what you'd like to happen and is there to care for just you helps protect your space. Protecting your space means that you are able to focus on the task at hand and not worry about anything else.
4. My partner will be there. I don't know why I would need a doula.
Partners are awesome and you may very well not need a doula. Your partner may remember everything learned in prenatal classes, keep a calm head if anything unexpected happens and meet and surpass all of your emotional and physical needs. Which is amazing!
For those of you that are not sure, or have partners that are nervous about knowing what to do and how and when to do it and/or have never experienced birth or experienced birth with you or in the fashion (ie home birth) that you want, a doula may be helpful. It is important to note that doulas do not replace partners. Doulas and partners generally make a great team. Here's why:
- Doulas make partners look awesome. We help your partner know what to do and when to do it to provide awesome care to you.
- Doulas remember what we learned in prenatal classes and we help partners remember too.
- Doulas have experience that your partner may not have. Is this your partner's first baby? Will your partner want support to feel confident and helpful?
- Doulas know what questions to ask if unexpected things happen during labour and help you and your partner stay calm so you can get the information you need to make informed choices. Often times if the unexpected happens, partners can feel panicked, helpless or confused. Doulas support them to help them feel better, more informed, and helpful in whatever the situation may be.
- Doulas and partners can spell each other. Partners need to use the washroom, eat and sleep. I have gone to clients who are experiencing long early labours and taken care of mom while her partner sleeps so that he is able to make it to delivery.
- Doulas let partners know what is normal. Birth can be scary for people who love you. Women make sounds that they have maybe never made before and most partners feel relieved to have someone tell them that not only is it normal, but it's great! We also show partners how to help mamas make the sounds that are helpful in labour.
- Some partners want to be hands on after delivery with skin to skin, diapering etc. and doulas encourage, help and guide partners so that they feel confident in their parenting ability right from the start. Some doulas will take photos too, which frees up your partner to be more hands on with labour, delivery, cord cutting, skin to skin and more.
5. My mother/mother-in-law/sister/aunt will be with me. What else can a doula do?
There are a few ways to look at this:
1. Your family members are awesome and respect your wishes and want to do whatever they can to make your birth a wonderful experience. In this case doulas help them do that. Sometimes we model comfort measures, or breathing techniques, we encourage your support persons, we spell them, same as partners they need to eat, sleep and use the washroom, we keep them informed, calm and comfortable with whatever happens.
If you have an awesome family you may not need a doula to be there, and that's awesome. There is no replacement for respectful and caring family support. One option to enhance your family's support skills is to use a prenatal doula who will meet with you and your family prenatally to help you all feel prepared and educated, show comfort measures and breathing techniques that your extended family can use to help you and then wish you the best for your labour. Prenatal doulas are available for phone/text/email, but do not attend your birth.
2. Your family members are a bit more set in their ways and feel like your birth experience should be a certain way. In this case, as always, doulas provide un-biased support. We support what you want. We keep your space so you are free to handle labour in the way you want or the way your body needs you to. We don't get upset if you are in pain, because we know it's all part of the process and you'll either deliver or ask for meds when you want them because you feel you need them, not just because your family members are stressed out at seeing you in pain. Or if you want meds and your family thinks that's not what you should do, doulas help you get what you need and keep the relatives informed and in line. Doulas understand that your labour is your labour, not your mother's or sister's or aunt's and you may need support from a non-family member to ensure that your desires are understood and respected.
3. Family members want to be supportive but are outside their comfort zone. Doulas help them be apart of the birth while respecting their boundaries and filling in the gaps so mom still gets the care she needs and the other family members feel good about their role.
6. I'm going to be induced.
In the case of inductions doulas provide information about why you would need one, the different methods available, the benefits and risks accosiated with each one, and are able to spend more time answering your questions. Yes, medical persons do this also, but you may find that you would like more time to go over things then you are allotted at your appointment. We support you through your choosen method just like we would if labour started on it's own.
7. This is not my first baby, I know what to expect, so I don't see what a doula could do to help me.
Every birth is different. Doulas often work with mothers who have had negative experiences and would like the opportunity to have a try for better birth experience. Doulas work with women who will be doing a VBAC. Doulas work with women who want to try something else. Often when it is not your first baby you have a better idea what you like and what you do not. Doulas help you advocate for yourself so you can have the birth experience that you want. It is important to understand that no one can guarantee that your labour will go the way you want it and in the case that something unexpected happens doulas can help you stay as close to your desires as medically possible. Usually just having someone explain things to you and care for your physical, emotional and spiritual (if desired) needs increases your enjoyment and satisfaction.
Doulas also help with siblings. If you are planning on having older siblings present at the birth, doulas help prepare them for the experience and support them through the birth if that's what's needed. Postpartum doulas come to your home and take care of light housekeeping, food preparation, baby's laundry, infant care, breast and bottle feeding support and help with siblings, which may include entertaining them so mom can rest or attend to baby, explaining things about newborns at their level, or modeling ways they can help care for baby with out accidentally hurting them.
8. Labour and delivery are an intimate time I don't want a stranger in my birth room.
This is very true. There are a lot of women who do not want anyone else in their birth room and that's great. Doulas respect the fact that our services are not for anyone. Women need to be free to do labour in a way that relaxes them and makes them feel comfortable and confident and if that means no strangers then there shouldn't be any strangers in the room.
For those of you on the fence about if you want a stranger in the room I'll go over the most common reasons women are unsure about having someone they barely know involved in such an personal and intimate time.
- I don't want anyone to see my private areas. Doulas honestly don't care what your bits look like, and we are not the ones all up in your lady place…that's for your doctor, nurse or midwife. We are up at your head whispering encouragement, instructions, or breathing with you to help you focus and stay in control.
- What if I pee or poop or sound like a lunatic? Again, doulas don't care. We are usually encouraging you to make certain noises because they help labour progress. We also get excited when you pee or poop because we know it has to get out of the way for baby to come out. If you pee in the middle of a contraction we get really excited because it means you are relaxing your pelvic floor which is awesome!
- I want to be the one to tell my story. Doulas don't tell your story. It is not our story to tell. We don't go home and tell our families what happened, other than "baby's here, everyone is good", we don't post your news. It's your story, we respect that.
- I don't want someone I don't know at my birth. Doulas get to know you during your pregnancy, the earlier we're hired the longer we have to get to know you. By the time baby is ready to be born moms generally feel pretty comfortable with their doula. If they don't, that's a red flag and they should reconsider having that person attend them. Trust your instincts. The doula you hire has a lot to do with personality and connection. Often times you know pretty quickly which doula is right for you. I always recommend that you interview a few and pick the one that knows what she is doing and you feel comfortable with. Each doula has different skills to offer and you choose the one that matches up with you. The doula that was great for your friend may not be the one for you. Interview a few doulas, check their references, policies, certifying bodies and do your research. Another thing to note is that if you are with an OB you will most likely not know the nurses that will attend to you, and possibly the doctor as a lot of obstetricians work in teams and you get whoever is on call when you are in labour. In that case, your doula is one of the only people you do know.
The thing to remember is what happens in birth stays in birth. The only person who can bring it up in all it's glorious detail is the mother!
If you like the idea of having a doula help you prenatally and in the postpartum period, but would rather not have someone attend your birth, look for a prenatal doula or a doula on call. They provide all the same care prenatally and in the early postpartum period, including phone support during labour but they do not attend your birth.
9. The fee for doula services seems really high, why?
Doula services are not cheap and in most cases they are not covered by insurance. Doulas spend a lot of time with each client and because most only have one client due at one time they are limited in how many clients they can work with each month. Doulas come to your home prenatally, are on call for you 2 weeks before your due date and 2 weeks after, they research for you if needed, provide information and resources, answer questions, and attend your birth from the moment you ask them to come until 2-3 hours after delivery. That can end up being quite a long time. Doulas pay their own transportation, childcare if they need it in order to care for you, food expenses, parking at hospitals and birth centres, insurance and other professional fees. All of that is considered when setting the cost for service.
There are however different ways to afford doula services.
- Some doulas volunteer their services or reduce their fees if they need families for certification purposes.
- Some doulas volunteer their services or reduce their fees for low income families or single mothers.
- Some doulas offer different service packages at different price points.
- Some doulas let you pay in installments.
- Some doulas negotiate their fees to make their services affordable or trade services, just keep in mind how many hours your doula will be working for and with you.
- Some insurance providers will cover the cost of a doula in full or in part. If you have a Health Spending Account with Sunlife Financial, they will reimburse the fee of DONA doulas. Always double check that you are covered and what the requirements for approval are.
- If you are not sure if your insurance provider covers the cost of a doula, submit a request for coverage explaining how it is beneficial to have a doula attended birth, the cost involved, the service provided and the amount you would like covered. You may be turned down, but you never know, you might get some of the cost covered. Also, by submitting written requests you help make insurers aware that the service is wanted and beneficial. Working together mothers can change policies.
If your doula, for whatever reason, is unable to attend your birth it should state in your contract what the refund will be, if any, and any conditions involved. For example, if you cancel because you changed your mind you will most likely be out the entire fee especially if your doula has turned down other clients because you were booked in. If the doula misses the birth at her fault (illness, family emergency) most will refund a portion of the fee.
Those are the most common questions that I get asked about being a doula. If I have missed something, just let me know and I'll add it to the list.
Doulas are not for everyone. They cannot guarantee your birth and postpartum period will be smooth sailing, but we do our best to support mothers educationally, emotionally and physically in the way that she needs and that she responds to best, which has been shown to decrease the length of labour and interventions and increase satisfaction with the experience.