A Doula May Be Your Best Advocate When Giving Birth, Especially If It's Your First Time
If you’re anything like me, when you hear the word "doula," the image of a zen-like woman calming and coaching an expectant parent through childbirth immediately comes to mind. And then...you pretty much draw a blank. What exactly does being a doula entail beyond being present at a baby’s grand entrance into the world? And what are some of the benefits of having a birth doula in addition to a doctor or midwife? Not to mention, what do they cost?
If you’re a parent-to-be asking these questions to your friends, family members, and anyone else who might have insight, look no further. Here, professional doulas and docs answer all your burning q’s—and more!–so you (pardon the cliché) know what to expect when you’re expecting:
First things first, what exactly ~is~ a doula?
Think of a doula as a therapist of sorts to guide you (and your partner, if applicable) through the birthing process—giving you emotional, spiritual, informational, and physical support from pregnancy to postpartum.
"Birth doulas counsel pregnant people and their families through prenatal meetings, offer continuous support throughout the duration of childbirth, and follow up postpartum,” says Ashley Brichter, founder and CEO of Birth Smarter, a birth and postpartum doula, childbirth educator, and lactation counselor. Serving as your personal coach and cheerleader through this milestone moment, "doulas have been shown to reduce the risk of cesareans, shorten the length of labor, reduce the likelihood of unnecessary medical interventions, and improve the overall satisfaction with the birth experience," Brichter adds.
With many doulas having decades of experience at thousands of childbirths, count on them to be a source of strength and tranquility during what may be a daunting and even scary experience. FYI: Unlike midwives, who are trained medical professionals and who focus on delivering the baby, doulas focus on the care and comfort of the new parent(s). Both can be present at labor.
Did you know? The demand for midwives has increased for at-home births due to COVID-19:
What are the benefits of having a doula?
For starters, they can help improve the birth experience for any spouses or support persons present at the birth of your baby. "One of the unexpected benefits of having a doula support your birth is getting your partner involved to the extent that you're both comfortable. I've had clients whose spouses were a little standoffish—they want to be helpful, but it's really hard to see someone you love in pain," shares Vanessa Hawke, certified doula at Bebo Mia, a training and mentorship organization for birth workers. "Their first instinct at birth may be to suggest pain meds—which, sometimes, is totally fine. But if the client has already said they don't want any pain meds, having someone bringing it up a lot can feel discouraging and frustrating."
A doula can also reassure the partner that what they're seeing is totally normal, she adds. Even better: They can emphasize to the partner that both the birthing parent and baby are safe and suggest ideas for how they can get involved and offer their support that align with the birth plan.
How do you find the right doula for you?
When it comes to hiring someone to be present with you during one of the most intimate experiences of your life, having a solid bond with them is key. Remember, one person’s dream doula may not be your cup of tea—and that’s totally okay.
"It’s really important to hire a doula who you have been able to meet and interview ahead of time and feel very comfortable with—to make sure that they are a good 'fit' for you and your needs," advises Dr. Jessica Madden, MD, board-certified pediatrician and neonatologist, International Board Certified Lactation Consultant (IBCLC), and Medical Director of Aeroflow Breastpumps.
You should make sure the doula clicks with your partner and lives close enough that they can be with you on short notice. "I would also make sure that you and your doula share similar approaches to medical intervention," Dr. Madden adds.
Right now, you’ll want to do these initial doula screenings via virtual consultations, a service many doulas now offer in light of the ongoing COVID-19 pandemic. (These days, some doulas also offer their services completely virtually—that is, they attend your prenatal meetings and birth through a screen—so that’s something to consider as well.)
Echoing Dr. Madden’s message, Hawke shares: "The most important thing to consider when you're hiring a doula is the level of connection you feel with them." She often encourages potential clients to consult with a few other doulas before they hire her, just to make sure she's a good fit. "Most of us have similar education and skill sets, but we all have different personalities," Hawke explains. "You don't need to find someone just like you, but it is important to have someone who complements your personality."
To find a doula, many midwives, OB/GYNs, and health care systems provide recommendations for local doulas, says Dr. Madden. Or, you can ask friends, family members, and local mom groups for referrals. (But remember: A doula your bestie adores may not be right for you, so always trust your gut when it comes to hiring someone.) Brichter also recommends checking out DoulaMatch.com and scoping out potential doulas on Instagram.
How much do doulas cost?
Doula costs typically range from $200 to $5,000, depending on the doula’s level of experience, your location, and how frequently you want to meet with them. Unfortunately, most insurance policies don’t include doula services, but you may be able to pay for them with your health savings account (HSA), flexible spending accounts (FSA), or health reimbursement accounts (HRA). Oregon, Indiana, and Minnesota have passed legislation for third-party reimbursement for doula services through Medicaid (in Indiana, funding for the law has yet to be provided as of press time), according to the Maternal Health Task Force at the Harvard T.H. Chan School of Public Health. A pilot program in New York for Medicaid participants is also underway.
There are many doulas who provide low- to no-cost support, with some hospitals providing volunteer doulas for qualifying families, says Hawke. To find an affordable or free doula near you, try Googling "volunteer doulas" or "free doulas" plus the name of your city, or ask your healthcare providers for a recommendation.
"There are also community doula programs that serve specific groups—BIPOC, trans, and LGBTQ birthers, as well as others—for low or no-cost, or on a sliding scale," Hawke adds. Searching online for "birth justice organizations" along with the area you live in may prove helpful for those in the BIPOC community.
What should expectant BIPOC parents know about hiring a doula?
It’s important to consider the devastating data surrounding expectant mothers in marginalized communities and mortality. "Black, American Indian, and Alaska Native (AI/AN) women are two to three times more likely to die from pregnancy-related causes than white women–and this disparity increases with age," according to a 2019 report conducted by researchers from the Centers for Disease Control and Prevention (CDC) published in Morbidity and Mortality Weekly Report (MMWR). For Black and AI/AN women older than 30, pregnancy-related deaths per 100,000 live births was four to five times as high as the mortality rate for white women.
"Doulas provide a voice and advocacy, especially for BIPOC parents who may not feel comfortable speaking up to their medical providers. A doula can also help prepare parents with questions to ask about their prenatal, delivery, and postpartum care to ensure that they are informed and can research what they’re being told about their health and the health of their baby," says labor and postpartum doula Talitha Phillips, CEO of Claris Health, which among other services, connects individuals to doulas who provide free and affordable care.
Phillips also stresses that doulas help clients transition from pregnancy to parenthood, providing emotional support and assistance with breastfeeding, nutrition, ensuring new parents get proper rest, and more postpartum. "All of these things can affect the rates of postpartum depression and general health," she comments. "Having a doula can also increase safety for Black women in a hospital setting and provide additional support should she choose an out-of-hospital delivery. Having a doula can decrease the level of labor intervention, including medication and cesarean sections. This positively impacts birth outcomes."
For more information, check out the National Black Doulas Association for more resources and a doula directory.
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