To Doula or Not to Doula?

More and more of my patients are asking if they should hire a doula. Many are asking what a doula actually does and if they need one. Some say they’ve been offered a doula’s services as a gift from friends, parents, or in-laws. Why is there all this interest in doulas? Probably because social media posts are praising doulas for making pregnancy, delivery, and post-delivery recovery easier, both emotionally and physically. Sounds great, but does the data back this up?

In many ways, it does. A review of 16 studies published in Cureus agreed that doula support seems to increase the chance of a successful delivery and shorten labor¹. And there’s more. Some studies have found that doula support can increase the chance of successful breastfeeding, including earlier and longer lactation². And last, but certainly not least, doulas are available for questions and concerns when your doctor may not be available. No wonder more people are considering using doulas, though the numbers are still under 10 percent of pregnant women.

What exactly is a doula?

A doula is someone specially trained to support you before, during, and after you’ve had a baby. Doulas don’t deliver healthcare services unless they are also a nurse or physician, but they can help ease pain and stress, teach breathing techniques, advise on comfortable positions, and liaise with your medical team and other healthcare providers. In other words, they are your advocate and your aide.

How do I find a doula?

Your physician’s team is a good starting place since most doulas market to obstetricians, and the doctors and nurses will have feedback about specific doulas from patients. National organizations that train or certify doulas, like DONA International and ProDoula, can also help.

But since doula training is not standardized, uniformly certified, or regulated across the states, you will have to do your homework.

1. Ask a potential doula if they have certification, where they were trained, and about their experience.
2. Ask how often they have been a doula before and if they can provide references.
3. Ask about their fees.

Don’t be shy. They will be working for you as well as with you. And since they are often your teacher as well as your facilitator, you want to make sure they are knowledgeable.

Don’t hesitate to ask about their values and views regarding all aspects of pregnancy, delivery, and breastfeeding to make sure they align with your and with your medical team’s practices.

Don’t forget to ask how often they are available for calls, how much time they anticipate you will be spending together, and who their backup is in case they become sick or unavailable when you need them.

Don’t hold back, or you will not know if they get you and if you feel comfortable talking with them.

Resources like the website The Bump have complete lists of questions to ask a potential doula—and it’s so much easier and effective to go down an official-looking list, checking items off, than it is to think of questions on the spot and possibly forget to ask important ones³.

Is "doula" a new name for a "midwife"? No. Certified Nurse-Midwives are usually trained and licensed medical professionals who may also provide gynecologic, pregnancy, and childbirth care, as well as emotional support. Many patients who want to try "natural" childbirth (without painkillers) choose a midwife to help them in case medical interventions become needed.

I know from experience. A midwife/nurse helped me during labor, but she asked for the doula/nurse on staff after my daughter was born because none of the doctors or nurses were able to help me successfully start breastfeeding. They tried, but it was the doula who made it happen—on the first try.

Using doulas may sound like something new, but the practice goes back to prehistoric times, according to stone carvings. After all, friends and family always helped each other through pregnancy and birth. But women used to live in the same or nearby villages, and most of us don’t live together in villages anymore. So, since the 1960s, doulas have become an increasingly popular way of recreating personal, emotional, and physical support during fertility journeys, births, and beyond. The trend is expected to continue. After all, it still takes a village.