What is a doula and why do I need one?

Take it from a pro with over 20 years of experience supporting parents from pregnancy to postpartum: there is a lot to take in as you transition into your new role as a parent and welcome your baby into the world. At boober, we have matched thousands of families to care providers, pregnancy to postpartum (including lots of doulas!), and we know every pregnancy and birth is unique. 

No matter if it’s your first, second, third or even fourth time welcoming a new baby, it’s completely understandable that you would feel a little apprehensive or unsure about all that is to come in pregnancy, childbirth, expansion of your family, postpartum, lactation and beyond. There is no one better to help you navigate all these changes than a doula. 

But what is a doula, you might ask? And do you really need one? Let’s explore the answers to these questions.

What is a doula?

The original definition of the word doula comes from the Greek language and has been translated as “enslaved person” or a “woman who serves.” Given this problematic history, some people use other terms instead of doula, such as birth worker, birthkeeper, childbirth support person, postpartum companion, among others. Regardless of the term the person chooses, the working definition of a birth doula is more or less the same: a trained, non-medical professional who provides physical, emotional, informational support, and more to families before, during, and after childbirth. 

You might think of a doula as similar to a real estate agent who helps you purchase a home, a mountain guide to help you find your way up a challenging alpine trail, or an event planner to help make your wedding as seamless as possible. 

A doula helps expectant families navigate their way through the often-intense, often-rewarding, but physically and emotionally rigorous birthing process and care during the postpartum period. Having a doula on your birth team can make a huge difference in positively shaping the experience and outcomes of your labor and delivery and postpartum period.

Doulas vs. midwives: what is the difference?

Both doulas and midwives support people during pregnancy, birth and postpartum, so it is no surprise that many think their jobs are the same. But the truth is that doulas and midwives actually have entirely separate training and skill sets. A doula does not replace a midwife, but a doula can complement their work in your birth.

While doulas provide continuous, non-clinical support, midwives are licensed medical professionals. These care providers assist low-risk pregnant people and their babies through delivery in different settings, including hospitals, birth centers, and home births. Compared to OBGYNs, midwives have lower rates of intervention during childbirth, such as epidurals, episiotomies, and births requiring the use of an instrument, such as forceps. 

The Midwifery Model of Care treats pregnancy and birth as a normal part of life that should involve medical intervention only if necessary. Midwives are trained to recognize when interventions are necessary, and when this occurs, they work in tandem with an obstetrician, a surgeon who is able to deal with the more severe complications of labor.

Whether you choose to deliver your baby with an OB-GYN or a midwife, a doula, who works for you and you alone, is an excellent companion to have throughout pregnancy, birth and postpartum.

What services does a doula provide?

Birth doulas and postpartum doulas provide a wide variety of services that can be tailored to your particular needs and desires. 

A birth doula supports you during labor and delivery, while a postpartum doula offers knowledge and support once you bring your baby home. Some doulas provide both postpartum and birth support and some are specialized.

Here are a few examples of the services that doulas can provide to birthing people and their partners/families:

1. Doulas provide physical support

A major part of doula training focuses on the numerous techniques to help you minimize the pain or discomfort commonly experienced in labor. 

Doulas can help you move and change positions to support optimal fetal positioning, so that your baby is well-positioned and aligned in your body, which can shorten your labor. Some of the physical supports they use include various massage techniques, acupressure, aromatherapy, water therapy, guided visualizations, and heat or cold.

Scientific studies show that doulas reduce medical interventions during labor, such as the use of pain medications, forceps, and cesarean births. 

Postpartum doulas are also trained in a variety of techniques to help you recover and heal from childbirth and physically adjust to new parenthood. 

Postpartum doulas can help you establish breastfeeding/chestfeeding, set you up with sitz baths or vaginal steaming, and simply hold or wear your baby so that you can shower, eat, and get adequate rest. Some postpartum doulas even offer services such as postpartum meal preparation or overnight care.

2. Doulas provide emotional support

Transitioning from pregnancy to parenthood is no small undertaking. During labor and postpartum, new parents often experience emotional extremes. 

Doulas offer emotional support in the form of a calming presence, reassurance, encouragement, companionship, deep listening, and validation, that can reduce stress, anxiety, fear, confusion, discouragement and more. Your doula is your personal advocate who is committed exclusively to protecting and supporting your emotional well-being during labor. 

Research shows that the presence of a doula increases people’s satisfaction with their births, even when their birth was challenging or did not go according to plan. During the postpartum period, a doula will help you navigate the emotional rollercoaster and feelings of isolation that sometimes result after birth, due to hormonal changes and more. A postpartum doula can also help you recognize the signs of postpartum depression and postpartum anxiety, and help you seek additional support.

3. Doulas provide informational support

Doulas can help parents find evidence-based information about the various choices they will have in pregnancy, birth and the early postpartum period. 

Since doulas are trained in the various interventions of childbirth, a doula will be able to inform you if a care provider is about to perform an intervention without explanation or consent. 

They can also translate medical jargon and explain medical procedures in a way that will help you and your family understand what is going on. Doulas make sure your right to make informed decisions about your body and baby are honored and will help the birthing person speak up to ask questions and to share their preferences.

4. Doulas provide partner and family support

Partners are going through their own emotional experience during labor and the postpartum period. Some partners can find it very challenging to see and properly support the person they love while they are going through the intensity of childbirth. 

Additionally, they are about to witness the birth of their own new little human, and have to transition into their own new parenting role, as well. 

During birth and beyond, doulas can also be of great help with older siblings, who may need some extra love and attention during this major transition.

How do I know if a doula is right for me?

Hiring a doula can feel like a big financial and emotional commitment, so you should think it over carefully. 

A doula might be right for you if you:

• Want continuous support from the beginning of labor until after your baby is born
• Have a specific birth plan you would like to make a reality when possible
• Want to avoid or reduce the likelihood of medical interventions like cesarean birth
• Want someone to help you communicate better with care providers
• Want support with lactation and babycare as soon as baby arrives
• Want support in the early days after birth to help in the transition to parenthood

If any of these are things you value in your birth experience, a doula may be an excellent choice for you. 

Even if you have a partner, friend, or family member who will be the primary support person during labor, you may still want to hire a doula so that they will have the additional knowledge and experience a doula brings, and so that they have someone to relieve them if they are in need of a break or the emotional intensity runs too high. 

Having a doula can help take some of the pressure off of your partner and ensure that you have continuous support throughout your labor.

How much does a doula cost?

You might be saying to yourself, “This all sounds great, but how much does a doula cost?” A birth doula typically sets their fee based on their experience. 

A recently trained doula may charge anywhere from $0 to $1,000, whereas a doula with a number of births and a few years of experience may charge anywhere from $1,000 to $2,500. 

A birth doula with extensive experience, however, may charge $2,500 to $6,000 or even more. Typically a birth doula fee is a flat rate which includes at least one prenatal meeting, 24/7 on call support from 37 weeks or so until the baby is born, continuous labor support from the time the doula joins you until 1 to 2 hours after the baby is born, support with infant feeding in the first hour or two after birth, and one postpartum visit after the birth.

Postpartum doulas, on the other hand, generally do not set a flat fee, but charge by the hour or in packages of hours. Postpartum doulas typically charge between $30-$80 per hour, and usually require a minimum number of hours when you book, like 3-4 hours for a daytime shift and 7-10 hours for an overnight shift. The hourly rate is usually tied to the doula’s experience, skill set, and additional certifications or offerings. 

Are doulas covered by insurance?

You also might be wondering, “But how can I possibly pay for this?” While you may have to pay out of pocket, increasingly health insurance plans are offering doula services as a covered benefit. 

Ask your doula for a superbill so that you can try to submit for coverage or check if Medicaid in your state has started to cover doula services yet. You also may be able to pay with an FSA or HSA card, if that is a benefit you have available to you through your work so be sure to check with your benefits provider for specific details.

Rather than filling your registry with items you may never end up using, you can ask friends and family to purchase gift cards for you to put toward doula services. 

Many newer doulas, or those still in training, may offer services at a lower cost in exchange for your evaluation as they work toward getting certified or simply to gain experience. 

There are also many Community Doula organizations that directly support lower-income parents, as well as many doulas who are willing to work on a sliding scale if you are in financial need.  

Where do I find a doula and what questions do I ask when choosing one?

Finding the right doula is a process that can take weeks or even months. Of course, there is Google, but that can easily become overwhelming. You can try to ask your healthcare provider or the place you intend to birth to see if they have a list of doulas in your area. 

Referrals from friends or family members are another great way to find a doula, though you cannot guarantee they will be in your budget or available for your due date. 

At boober, the company I founded in 2017, we provide a concierge service to match you with the right doula, who is available for your due date at the price you are seeking. We will also match you to doulas who fit certain criteria, if, for example, you are looking for a person who has a similar life experience, race, religion, etc. or a particular skill set or certification like massage or lactation. 

Once you’ve narrowed down your list, be sure to interview a few doulas before making your choice. It is important to ask some questions to make sure that you would be a good fit for each other. A brief interview will help you get a sense of their personality, practices, and the style of support they provide. 

Here are a few questions to get you started:

• What services will you provide during labor and delivery? What is included in your package?
• What is your approach or philosophy to labor and delivery?
• What is your experience in the labor and delivery field?
• What are your qualifications and training?
• How long have you been providing doula services?
• What is your fee and what does that include?

Now that you know what a doula is and what they do to help families experience a safe, positive and affirming birth, we hope you will consider taking advantage of their invaluable support. At boober, we are here to help you find just the right doula for your birth and beyond.

Sources

Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. Continuous support for women during childbirth. Cochrane Database Syst Rev. 2017;7(7):CD003766. Published 2017 Jul 6. doi:10.1002/14651858.CD003766.pub6

Gruber KJ, Cupito SH, Dobson CF. Impact of doulas on healthy birth outcomes. J Perinat Educ. 2013;22(1):49-58. doi:10.1891/1058-1243.22.1.49