What is a Doula?
According to DONA International, a doula is a professional who is trained in childbirth and provides continuous support to a mother before, during, and just after birth or during the postpartum period. Doula comes from a Greek word that means “a woman who serves”.
Watch the DONA International video- The Essential Ingredient: Doula (contains some birthing nudity)
Doulas “mother the mother.” While performing her role, a doula:
- Continuously reassures and comforts the mother (the key word is continuous—a doula never leaves the mother’s side)
- Provides emotional support
- Uses physical comfort measures: breathing, relaxation, movement, positioning
- Gives evidence-informed information to aid confident decision-making about various birth choices and options
- Advocates for the mother and helps facilitate communication between the mother and other care providers
- May look after your partner or other children as well, but their primary responsibility is to the mother
It’s also important for you to understand what doulas do NOT do. A Doula does not replace medical care. Doulas are NOT medical professionals. They do not perform clinical tasks such as vaginal exams or fetal heart monitoring. They do not give medical advice or diagnose conditions. They do not judge you for decisions that you make. They do not make decisions for you. They do not let their personal values or biases get in the way of caring for you. They do not take over the role of your husband or partner. They do not deliver the baby. They do not change shifts or abandon you. You can read more about what Doulas do and do not do in the DONA International’s Standard of Practice for birth and postpartum Doulas.
How is a Doula trained?
Doula training focuses on the “art of labor support,” that is, the emotional needs of women in labor, and nonmedical physical and emotional comfort measures. The program requires that participants have some prior knowledge, training, and experience relating to childbirth, and consists of an intensive two to four day seminar, including communication skills, understanding of the psycho-emotional experience of childbearing, hands-on mastery of comfort and labor enhancing measures, such as relaxation, breathing, positioning and movements to reduce pain and enhance labor progress, touch, and many others.
To become certified by DONA International, the doula meets the following requirements:
- either a background of work and education in the maternity field, or observation of a series of childbirth classes;
- either a background of work and education in the lactation field, or attendance at a professional level breastfeeding course lasting a minimum of three hours;
- agreement to adhere to DONA International’s Standards of Practice and Code of Ethics;
- attendance at a doula skills workshop offered by a DONA Approved Birth Doula Trainer;
- completion of extensive background reading from a list of recommended books and published articles;
- submission of an essay that demonstrates understanding of the integral concepts of labor support;
- receipt of positive evaluations from clients, doctors or midwives, and nurses;
- submission of detailed records, observations and essays from a minimum of three births;
- development of a client resource list with a minimum number of entries in specific categories;
- continuing membership in DONA International
How is a Doula different from a Midwife? (*see note)
Read the difference explained beautifully HERE.
Midwives are qualified health care providers who go through comprehensive training and examinations for certification. Certification is offered by the American College of Nurse Midwives (ACNM) and the North American Registry of Midwives (NARM). Midwives provide an array of health care services for women that can include medical histories and gynecological examinations, contraceptive counseling, prescriptions, and labor and delivery care. Providing expert care during labor, delivery, and after birth is a specialty of midwives. The practice and credentials related to midwifery differ throughout the United States. Below is a brief description of each of type of midwife:
- Certified Nurse-Midwife (CNM): an individual trained and licensed in both nursing and midwifery. Nurse-midwives possess at least a bachelor’s degree from an accredited institution of higher education and are certified by the American College of Nurse Midwives.
- Certified Professional Midwife (CPM): an individual trained in midwifery who meets practice standards of the North American Registry of Midwives.
- Direct-Entry Midwife (DEM): an independent individual trained in midwifery through a variety of sources that can include: self-study, apprenticeship, a midwifery school, or a college/university program.
- Certified Midwife (CM): an individual trained and certified in midwifery. Certified midwives possess at least a bachelor’s degree from an accredited institution of higher education and are certified by the American College of Nurse Midwives.
- Lay Midwife: an individual who is not certified or licensed as a midwife but has been trained informally through self-study or apprenticeship.
Both Midwives and Doulas have an important roll in assisting childbirth and both are a valuable asset to have on your team. Midwives are responsible for all the medical checks, monitoring, and exams that take place during labor and delivery with focus on clinical tasks. Midwives differ from Doulas in that CNM’s usually work for a hospital or clinic and are bound by the rules and policies of the institutions in which they work, which may influence the types of care they are allowed to provide, and they may have to care for several patients simultaneously. Birth Doulas typically work independently or in a team of Doulas at hospitals, birth centers, or home births. A Doula is responsible for the comfort and care of just one mother during her entire labor and delivery, with 100% of her attention on providing the mother with continuous, uninterrupted care.
Does the Doula replace my partner?
The woman’s partner (the baby’s father or another loved one) is essential in providing support for the woman. A doula cannot make some of the unique contributions that the partner makes, such as a long-term commitment, intimate knowledge of the woman and love for her and her child. The doula is there in addition to, not instead of, the partner. Ideally, the doula and the partner make the perfect support team for the woman, complementing each other’s strengths.
In the 1960s, the earliest days of fathers’ involvement in childbirth, the expectation was that they would be intimately involved as advisors, coaches and decision-makers for women. This turned out to be an unrealistic expectation for most men because they had little prior knowledge of birth or medical procedures and little confidence or desire to ask questions of medical staff. In addition, some men felt helpless and distressed over the women’s pain and were not able to provide the constant reassurance and nurturing that women needed.
With a doula present, the pressure on the partner is decreased and he or she can participate at his or her own comfort level. Partners often feel relieved when they can rely on a doula for help; they enjoy the experience more. For those partners who want to play an active support role, the doula assists and guides them in effective ways to help their loved ones in labor. Partners other than fathers (lovers, friends, family members) also appreciate the doula’s support, reassurance and assistance.
Is there any research on Doulas and their affects?
In the late 1970s, when Drs. John Kennell and Marshall Klaus investigated ways to enhance maternal–infant bonding they found, almost accidentally, that introducing a doula into the labor room not only improved the bond between mother and infant, but also seemed to decrease the incidence of complications. Since their original studies, published in 1980 and 1986, numerous scientific trials have been conducted in many countries comparing usual care with usual care plus continuous labor support.
In fact, the largest systematic review of continuous labor support, published in 2011, reported the combined findings from 21 randomized controlled trials, including over 15,000 women. The trials compared “usual care” in the hospital with various types of providers of continuous labor support: a member of the hospital staff (i.e., a nurse); a family member or friend; and a doula (not a hospital employee, family member or friend) whose sole responsibility was to provide one-to-one supportive care. While overall, the supported women had better outcomes than the usual care groups, obstetric outcomes were most improved and intervention rates most dramatically lowered by doulas. According to a summary of the findings of this review, the doula-supported women were:
- 28% less likely to have a cesarean section
- 31% less likely to use synthetic oxytocin to speed up labor
- 9% less likely to use any pain medication
- 34% less likely to rate their childbirth experience negatively
Obstetric outcomes were most improved and intervention rates most dramatically lowered by doulas in settings where:
- the women were not allowed to have loved ones present
- epidural analgesia was not routine (when compared to settings where epidurals are routine)
- intermittent auscultation (listening to fetal heart rate) or intermittent (versus continuous) electronic fetal monitoring was allowed
Read more about the medical evidence for Doulas from Evidence Based Birth HERE.
Insurance companies in some countries are increasingly offering coverage for doula services, either as a listed service, through the clients’ flexible spending accounts, or as part of their universal health care coverage. Grant funding for doula services is also sometimes available, and, in the USA, some Medicaid–funded health agencies have contracts with doula organizations to support women in poverty and women with special needs. Although some health insurance and flex pay plans pay for doulas, at present, private doula care is usually paid for directly by the client.
*It is important to note that the state of Georgia prohibits CNM’s from attending home-births, and does not legally recognize CPM’s, CM’s, DEM’s or Lay Midwives. This is not in the best interest of women or babies, and there is a Big Push to change this, but the law stands for now. There is no such prohibition for Doulas and home-birth. This generally means that your only legal option for trained, compassionate care during a home-birth is with a Doula or unlicensed Midwife (many of whom are truly spectacular, but who, like Doulas, will typically not have admitting privileges at local hospitals). If home-birth is something that interests you, I will be thrilled to help you find every resource in the area and to assist you in fulfilling your wishes with support, understanding, and compassion.
Special thanks to DONA International for the use of this information, which can be found HERE and HERE.