Hiring a Doula
Benefits and Tips

"If a doula were a drug, it would be unethical not to use it" -John H Kennell, MD


Maybe you’ve been thinking about hiring a doula. Perhaps you’ve never even heard of a doula. Here I’ll explain what a doula is, what she does and the benefits of having one. I’ll also give you some tips on finding the right doula for you, and questions to ask when hiring a doula.

What is a Doula and What Does She Do?

A doula is a trained labor support professional. She provides women and their families with physical and emotional support and encouragement during pregnancy, throughout labor and after the birth. Doulas are trained to understand and respect the natural process of birth, and most have been through childbirth themselves.

What a doula does changes from mother to mother, because each woman has different needs. A doula can help with natural pain relief and relaxation, make suggestions for labor progression, and help with positioning.

Just as important as the physical support, a doula provides a tremendous amount of emotional support and encouragement during labor and birth. For a homebirth, a doula might have a bit of a different role, cooking for the mother, or taking care of other household needs.

Generally, when you hire a doula, you can expect a couple prenatal visits prior to your labor. She helps you make your birth plan and finds out exactly what you’re looking for with your birth. Your doula will answer any questions you may have about your pregnancy. Many doulas will go to prenatal appointments with you if you ask.

When you go into labor, your doula will come to your home or the hospital and help you through your labor. Usually doulas stay after the birth for a while to help you establish breastfeeding, if needed. Some doulas also offer a follow up appointment when your baby is a couple weeks old to see how you’re doing and answer any questions you may have.

Benefits of Hiring a Doula

There have been many studies done to evaluate the benefits of hiring a doula. Studies have shown that having continuous labor support can:

• Lead to shorter labor

• Decrease the need for epidural and narcotic pain relief

• Decrease likelihood of Cesarean section

• Decrease use of assisted delivery (forceps/vacuum)

• Decrease the use of pitocin

• Improve breastfeeding

• Decrease postpartum depression

• Increase satisfaction with birth

• Improve mother-infant interaction

“One of the reasons for the increased number of medicated births, epidurals, and cesarean sections among prepared couples' birth experiences seemed to be the absence of experienced support …” (Trueba, et al)

The Cochrane Collaboration’s Pregnancy and Childbirth Group in Oxford, England has published an analysis of studies involving nearly 13,000 women, and states:

“Given the clear benefits and no known risks associated with intrapartum support, every effort should be made to ensure that all labouring women receive support, not only from those close to them but also from specially trained caregivers. This support should include continuous presence, the provision of hands-on comfort, and encouragement.” (Hodnett, et al, 2003)

Clearly, there are dramatic benefits to hiring a doula. Still, you may be asking yourself, “What’s the point of hiring a doula if I’m planning an epidural anyway?” or, “Isn’t that my husband’s job?” Maybe you’re wondering why you should bother hiring a doula because you assume the nurses at the hospital are going to provide you with the support you need.

What About the Father?

I can’t overemphasize that doulas are a support for both mother and father, not a “replacement” for the father. Many men are unsure how they can best help when their loved one is in labor. It’s hard for him to hold his wife, look her in the eyes with encouragement, and massage her back all at the same time!

A doula can guide the father and other family members in comforting the mother, giving them suggestions on how they can help her. Also, a doula is less emotionally attached, and can help calm both partners if they become anxious. Doulas allow for fathers to be at the mother’s side continuously. The doula provides an extra person to run after necessities, help with other children, or the like. Fathers consistently report positive experiences from hiring a doula, and did not feel that the doula interfered with their role.

As odd as it may seem, studies have shown that having only fathers, friends or other family to support during labor does not result in the same benefits as doula support. Obviously this doesn’t mean that other support people aren’t valuable. It shows only that there is a benefit to having a detached, trained professional to support. Hiring a doula provides you with someone whose only priority is to take care of your needs.

Benefits of Hiring a Doula If You’re Planning an Epidural

Even if you’re planning on having an epidural during your labor, there are benefits to having a doula to support you. Most importantly, your doula can support you emotionally and provide encouragement. Just because you don’t feel the same pain you would without an epidural, doesn’t mean you won’t feel the same emotions. It may also help you to have someone there that can explain to you what’s happening during your labor. She can help you physically in the time before you receive the epidural, and also help coach you during the pushing stage. Sometimes labors progress too quickly to get an epidural. If this happens, you will have the continuous support of your doula.

The Role of Nurses

Nurses are there to provide you with medical care, not to be your primary labor support person. It’s not that nurses don’t care about supporting you. Nurses have many demands on them, and simply don’t have the time to massage your back and hold your hand throughout your labor. There are times when a nurse can help for a few minutes at a time, but a nurse’s primary role is taking care of your medical needs. Studies show that nurses only spend, on average, 15 minutes of their 8 hour shift providing physical or emotional support to their patients in labor.

What a Doula Does Not Do

Doulas are not medical care providers and do not perform any clinical tasks. They do not measure blood pressure, monitor your baby, or do vaginal exams.

Doulas do not make medical decisions for you. Your doula will answer any questions you might have that will help you make decisions for yourself. A doula’s goal is for you to make informed decisions, but the decisions are yours. She will not speak to your doctor on your behalf, and will not intervene in your care.

Tips for Hiring a Doula

Since childbirth is such an intimate event, it’s important that you hire a doula that suits you. Most doulas offer a free consultation to get acquainted and see if you are a good fit for each other. During this interview, make sure you feel comfortable around her. Is she a good listener? Does she seem at ease with you and comfortable with your choices?

Here are some questions to ask before hiring a doula:

• What training and experience have you had?

• Do you have a backup doula in case you can't make the birth, and can we meet her?

• What does your service include, and what do you charge?

• How do you see your role at the birth?

• When will you come after I go into labor? Will you come to my home before going to the hospital/birth center?

• Do you have any other clients due around the same time as I?

• Do you work with any particular doctors, hospitals, or midwives?

• Do you have any references?

• What is your philosophy about birth?

By meeting your potential doula in person, and asking a few questions, you should have no problem hiring a doula that will help you have an awesome birth experience. Consider hiring a doula. It may just be the best birth decision you make.

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