Updated: Nov 30, 2019
What is a Birth Doula?
The word doula is of Greek origin, and means "women's servant." Today, a birth doula is best known as a trained professional hired by a woman to support her during her pregnancy, birth, and/or possibly for some short time in the postpartum period. To clarify, a birth doula is not a trained medical professional (though some doulas do have that background experience to support their practice). Though not a medical professional, the support that a doula can provide for an expecting or recently delivered mother and her family can be an invaluable asset during this time of great transition. It comes in a variety of forms, depending on the mother's specific needs and wants, and includes informational, physical, and emotional assistance. They can help empower you with knowledge on how to advocate for yourself during your labor, and will discuss with you your birth partner your preferences and wishes prior to your labor. This way, you can discuss them with your medical provider during your prenatal visits and everyone remains on the same page.
***On a side note, working with me at Strong as a Mother during one of my small group childbirth preparation classes or individualized consultations is another great way you can work through your birth preferences, but I digress!
How do I find a Birth Doula? Where do Birth Doulas get their Training?
There are multiple professional agencies that certify doulas. When making the choice to utilize their services, please do your homework. Find out where your prospective birth doula has received certification. Learn about their experience attending births. Consider asking if they've worked at your delivering hospital before. Have them describe whether they are able to help with any postpartum needs, and ask them about their style of practicing with their clients. Take that time to interview them. See if you jive together. Check references and testimonials. This point is really important, because the profession itself is unregulated and unlicensed.
If you're not sure where to begin to look for a qualified doula, visit the websites of some of the major certfiying agencies. These include:
Doulas of North America (DONA) International
International Childbirth Education Association (ICEA)
Childbirth and Postpartum Association (CAPPA)
To avoid rushing the process, I'd recommend looking for a doula sometime in the mid-second trimester of your pregnancy. This way you will avoid the risk of your best match not being able to take you on as a client due to having other clients scheduled to be delivered around the same time as you. Contact your delivering hospital as well. Some hospitals, such as Danbury Hospital, can help pair you with a birth doula prior to the day of your delivery.
Birth Doulas and their Benefits
As we've established earlier in this article, birth doulas are there to provide non-medical emotional, informational, and physical support to a woman and her birth partner during pregnancy and labor. Ideally, they work collaboratively with you, your birth partner, and your medical team to help you relax and be present during your birth experience, no matter how you deliver your baby. According to one of my favorite websites, Evidence Based Birth, a birth doula's continous prescence during a birth experience has been shown to help reduce rates of cesarean section, risk of reporting an unsatisfying birth experience, and reduction in the use of pain medication during labor. Labors were also found to be shorter by about 41 minutes (Dekker, 2019).
Maybe you're reading this and saying "I already know that the second I walk into the hospital in labor, I want the staff to give me all the things." Or perhaps you're thinking "How soon can I get my epidural?" Listen sister, you're not the only one. I hear this all the time as a labor nurse. I'm not knocking you for thinking it. Yet, even the best laid out plans can change. Delays in routine care can occur due to emergency situations occurring on the labor unit, waiting for an order from your OB/GYN, waiting on lab results, IV placement, or an anesthesiologist to arrive (in cases of an epidural). There's also the possibility that you arrive quite earlier in the labor process than you thought you were and... Dare I say it? You could get sent home. Due to these and other potential challenges, I can certainly justify the desire to have a certified birth doula at your side to help you work through some unexpected curve balls.
Having said that, maybe you're thinking, "Then what do the labor nurses do while I'm admitted?" Or "Do they just leave me to fend for myself?" Fear not. Once you're admitted as a labor patient, I can assure you that your labor nurse will be by your side as often as possible to offer suggestions on different comfort measures, describe the labor process and what to expect as things evolve, offer pain medication as appropriate, and be an ongoing liason between you and your OB/GYN or Certified Nurse Midwife. More importantly, if something is concerning us during your labor, we descend in droves to intervene and get your provider to the bedside as soon as possible, especially if we are unable to quickly correct the situation with nursing interventions.
To reiterate, labor units can be unpredictably busy, and your labor nurse may not be able to be in your labor room at all times during an uncomplicated early or active labor. Rest assured, we are absolutely a continuous support whenever medically indicated and certainly during the second stage of labor (pushing and delivery), and in the immediate hour or so after delivery.
You will not be hung out to dry in a hospital, in any way... but I do want to clarify this because it is the reality of many labor units. So if in particular, you are hoping for continuous support at all times for you and your birth partner, or if you are very much intent on an unmedicated birth, I'd definitely recommend taking a childbirth preparation class with a certified childbirth educator, such as the one offered by Strong as a Mother, but to also explore the possibility of employing a birth doula.
At the very least, it's 100% beneficial to take the time before labor begins to discuss with your partner who you would want to have at your side in lieu of or to back up your intended birth partner should labor run long or if your partner is fatiguing. They may need reinforcements to help relieve them for food breaks, sleep breaks and so forth. More importantly, you need labor supporter that has energy on board to help you in the best way! Your mother, mother in law, best friend, or sister may be great resources to utilize in place of a birth doula. Though not formally trained, they (hopefully) know you best and can be there to offer suggestions, wipe your brow, encourage your breath and help you make informed decisions when your mind might be exhausted.
Birth Doula Costs
Not surprisingly, doula services are typically not covered by health insurance plans. A quick google search reveals that in Connecticut, birth doulas may charge anywhere from $650 to $1500 to attend your birth. What to Expect When You're Expecting estimates costs to be from $800 to $2500 with average cost around $1200. This can be a cost prohibitive expense for many families and is undoubtedly something to take into careful consideration for the family budget.
The Bottom Line
Because of the many factors listed above, talk with your partner to decide if employing a birth doula is right for you. Do you necessarily need one? No. May their prescence be of incredible value to you during labor? Yes. Again, because they are not typically medically trained, there can be some challenges in your labor that your birth doula may not understand from a medical perspective. These challenges can have an impact on your birth preference list being fully honored or not. Consequently, I've seen some doulas and medical providers bump heads, sometimes not in the most productive way. Ultimately, do understand that just like you and your birth partner, your medical team wants the safest possible delivery for you and your baby. If we can simultaneously support and advocate for your ideal birth preferences, nothing makes us happier.
Though brief, I hope that this post brings you some helpful information about birth doulas, their roles and costs, and helps you make a more informed decision about choosing one. In my next blog post, I'll explore the role of a postpartum doula, and feature answers from an interview I had with a great professional contact who works within this role. So stay tuned, and may you be Strong as a Mother today, and every day.