What is a doula anyway?
For many years I did not know the answer to this question. I had been told by someone who was studying to become a doula that they "attend birth," but that was the end of the description. Like many, I did not know the difference between a doula and a midwife, and it was one of the questions I asked when I was interviewing doulas for my first pregnancy.
A doula is not a medical professional, they are a support person for you and your family. You do not hire a doula or a midwife. You hire a doula in addition to a midwife or a doctor. And you can have a doula regardless of the type of birth that you are planning to have.
Doulas are not regulated the way that medical professionals are. This means that the doula works for you and not the hospital or the health care system.
Do I really need a doula if my partner is going to be with me?
The short answer is yes. If this is your partner's first birth experience then they may not have the knowledge or experience to support you in the way that you need to be supported. When we are pregnant we are extremely vulnerable to scare tactics and manipulation. And when we are in labour we are highly suggestible. Something as simple as having a person in the room who is scared, is enough to derail your birth experience. There is also a prevalent cultural belief that doctor knows best, the health care system has only our best interests in mind, and that we need their permission when we are on their turf. This potentially opens us up to coercion, abuse and trauma. When it comes to birth, ignorance is not bliss. It may be difficult for your partner to see you in labour and they may want to help you by suggesting unwanted interventions. They may also be susceptible to coercion and scare tactics, and side with the doctors out of fear for your well being.
A doula is experienced with navigating the maternity ward and may be able to offer valuable advice, especially if you are planning a hospital birth, and especially if they have a lot of experience in your hospital of choice. A doula is also support for your partner, and they may be able to help get them on the same page as you when it comes to your birth plan. A doula will be with you throughout your labour and birth. They can stand in while your partner takes a break or needs to leave for any reason. Your midwife or doctor will be more limited in their availability to you depending on what else is going on at the same time and local protocols. A doula will be present for you physically and can offer non medical comfort measures in the form of acupressure, massage, a tens machine or use of a rebozo (a shawl used as a comfort measure).
I am planning to take a prenatal course, do I still need a doula?
It is a good idea to take a prenatal class with a midwife or a doula in addition to what the hospital offers, and many doulas offer childbirth education as part of their birth packages. The class with the hospital will give you valuable information about what to expect and what your options are within the hospital. Make sure to ask lots of questions about what the risks are with each option, because they may not offer you that information. A prenatal class with a midwife or a doula will help you to understand the process of labour and what will be happening with your body. They will also have knowledge about non-medical comfort measures you may want to try.
Is a doula covered? How much do they cost?
In general, doulas are paid out of pocket, though some extended medical benefits will cover the cost of a doula. This is because the doula works for you and not the medical system. This means that they are the one who truly has your best interests in mind in the hospital. The cost of a doula varies from $800 to $1500 depending on experience and what is included in the package. If cost is an issue for you, there are some doulas who offer sliding scale payments or are willing to take on pro bono clients. Doulas work very hard for you because they care about the kind of birth experience that you have. Because of this, doulas experience a high rate of burnout. Any dollar spent on a doula will be 100% worth it, and the value that you get will be far greater than the amount you gave them.
How do I find a doula?
There are several ways to find a doula, and word of mouth is a good start. Ask locals what doula they used and what their experiences were. If you have a midwife you can ask them if they recommend anyone. If you are in a prenatal class you can ask the facilitator. You can also do a google search and look for reviews online.
Check your local doula association websites for their directory.
Some other websites to try include:
What should I consider when hiring a doula?
If this is your first birth experience, then a more experienced doula is going to be in your best interest. It's also good to know that there are different schools of thought when it comes to doula training. It's a good idea to ask your doula where they were trained and to learn more about their particular school and what their teachings are. It's also important to express to your doula how you want to be supported. Some doulas will reach out to you from time to time, and some will wait for you to contact them when you need them. Some will offer you advice and some will wait for you to ask questions about a particular topic before sharing their experience.
Anything else I should know?
Doulas have hospital privileges which can be revoked at any time if the hospital is unhappy with them. Unfortunately there is a very fine line that they have to walk and this could effect your experience. There are also some doulas who offer virtual support and this can also be an option if they are not able to be physically with you for any reason. A doula cannot speak for you. In the hospital, the only one who can speak for you and make decisions is you. The only exception to this is if you are unconscious and unable to make decisions for yourself. In that case the doctor will make the decisions, hopefully in cooperation with your partner. It's a good idea to have signed paperwork that designates your partner (or a person you trust) as your alternate decision maker. Ultimately, you will be responsible for any decisions made. It's common for your hospital notes to say "patient requested" even if the option wasn't your idea or you were coerced into it. A doula can be there to help you stay calm in stressful situations and to help you go through the decision making process to decide what feels right for you in the moment. A doula may also have other things that they cannot do for you due to liability reasons, such as drive you to the hospital or assist with your birth. And some doulas will not attend a planned unassisted home birth, and again, a virtual doula might be of interest to you in a situation where a doula cannot be physically present for any reason.
Overall hiring a doula will be a good investment regardless of your situation, care provider or birth plans. A doula will support you throughout your birth journey and help you to have an empowered experience. The value that you will receive will far outweigh the costs. And finally, it is important to choose the right doula for you based on your individual needs.