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What is a Doula?

If you’re new to the natural pregnancy world, you may have never heard of a doula.  I hadn’t in my first pregnancy.  And once we figured it out, my husband looked at me skeptically and said, “We do not need that.”  So we didn’t really even look into it.

Turns out, we really could have used one.  After the fact, we fully understood what a doula’s role was and why it was a good idea to have one.  Too late for us (that time, anyway), but hopefully not for you!

What is a doula, anyway, and what do they do?

A doula is a type of labor support.  She is not trained to deliver babies; her role is to help with pain management, advocacy, guiding your other coaches in helping you, and so on.  Well — a birth doula, anyway.

There are actually different types of doulas.  A birth doula is just one type, albeit the most common type.  Doulas are generally certified through an agency.  DONA is the most common, though CAPPA is also a certifying body.  Doulas have to attend at least three births, take various workshops (on pregnancy and birth), read books (on birth and breastfeeding), and write papers before they can be certified.  This is sufficient since they are not your care providers. They function as support.

Research has shown that women who use a doula are less likely to use pain medication and often have faster and easier labors.  Doulas are trained to provide physical support and non-medical pain relief, such as suggesting a change in positions, counter pressure or massage, holding you up, helping you walk, and so on.  They do not replace your husband or other support; they supplement it.  A doula is able to help your support person know what to do to help you and guide that person to do so.  A doula can also take over if your support person needs a break, or jump in if you need additional support.

Some doulas specifically function as an advocate.  That is, if you are presented with different options during labor, your doula can talk to you about the pros and cons of each option.  She does not provide advice, because she does not have medical training; she simply helps you to access the information you need to make a decision.  She can ask specific questions of your doctor on your behalf so that you are more likely to make a fully informed decision.  This is in addition to her role as a support person (and not all doulas do this).

A few doulas even function as a “monitrice,” which means that they see you throughout your pregnancy and provide supplemental prenatal care.  They do not deliver the babies, but they keep regular appointments with you and guide you through a healthy, natural pregnancy.  Most often, midwives’ apprentices would fulfill a role like this.

How to Select a Doula

When looking for a doula, ask around.  If your friends have had one, see who they had and if they liked her.  You can also look through DONA and CAPPA to find doulas in your area.  Make sure that your doula is certified and/or very experienced and well-received (there are a few doulas I know who aren’t certified for various reasons, but who have been doulas for 10 years or more).

Make a potential list of 3 – 4 doulas and interview them.  It is very important that you feel comfortable with your doula, because she will be providing support to you at a critical time.  If you just don’t like or feel comfortable with a particular doula, even if she is well-trained and highly recommended, don’t hire her.  It is crucial that you are comfortable.

Doula fees vary widely by state and experience.  Brand-new doulas in the process of certifying will often work for free to get the experience they need.  Newer doulas (who are certified) may only charge $100 – $200.  It is not uncommon to find experienced doulas who charge $400 – $1000 depending on the exact services they will provide.  A monitrice would be on the higher end of that.  A doula who only sees you once or twice before the birth, and during the birth should be on the lower end.  Make sure you find out how many visits are included before signing any papers.  Also ask when the doula will come to you (when you first go into labor?  when you’re ready to go to the hospital?  This, too, varies by doula).

It is also important to ask your doula her back-up policy.  How many births does she take on per month, and what if she’s at another one when you go into labor?  Is there a doula who can cover for her?  What if she is sick?  Ask these questions before you choose to hire your doula, so that you know you will be covered — and by whom — before you are in labor!  If possible, meet the back up doula early just in case.

In addition to birth doulas, there are “postpartum doulas.”  These doulas do not attend your birth.  They come to you after your baby is born and give you advice on breastfeeding, watch any older children, and help with housework.  They are less likely to be certified, though they may have taken some breastfeeding classes.  These doulas may also be able to help you if you have to go on bedrest before your baby comes — watching older children and doing housework for you.  Depending on the amount of help you need and the length of time, the cost can vary widely.  Ask your doula what her rates are.

A few doulas provide both services.  Many don’t (because they could not guarantee a postpartum client they would be available; they may have to leave to attend a birth).  Ask your doula specifically about her services and rates.

Finally, talk to your doctor early on about his policies.  If you are having a doula, it will need to be with your doctor’s blessing and written into your birth plan.  A few do not allow doulas.  This is an issue we’ll talk about tomorrow!

Have you used a doula during birth?  What was your experience?

Top image by TheLawleys

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