Childbirth is more than a medical event; it is a transformative life experience. In the past, female relatives or friends would assist new mothers during and after delivery. Modern healthcare practices, cultural shifts, and geographic distance leave many families without this important support. Doulas are nonmedical birth coaches that fill this void for new parents and families. Growing evidence confirms that parents who use doulas have less pain, shorter labor, and more fulfilling birthing experiences. Research also indicates that doula support benefits families adjusting to a newborn.

The History of Doulas

The word doula means “female slave” or “woman’s servant” in Greek. The term was reintroduced in the 1970s when medical anthropology referred to breastfeeding support from outside the nursing mother’s family. In the early 1990s, doulas became more involved in supporting women in labor, delivery, and postpartum periods thanks to the publication of Mothering the Mother.Women who do not have family or friends to support them during labor may desire the services of an experienced doula. There are two types of doulas: birth doulas that support a woman and her partner in the labor and birth processes, and postpartum doulas that advise and help a mother and her family with adjusting to life with a new baby.

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Easier Labor and Delivery

The supportive presence of a doula during and after labor and delivery is associated with substantial benefits for new mothers and their families. The World Health Organization states that individuals who hire doulas tend to have shorter labor and require fewer medical interventions such as pain relief medication and oxygen than those who do not have a doula present. A 2017 Cochrane Library systematic review found that women who use doulas report a more positive childbirth experience.

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Fewer Preterm and C-Section Births

One out of nine US infants is born preterm or before 37 weeks of gestation. These newborns incur ten times the medical costs of full-term infants. A 2016 study published in Birth found that participants with doula support had a 22% lower incidence of preterm births.

One of three infants is born by cesarean section, incurring twice the cost of infants born vaginally. Research suggests that the continuous presence of a doula — even without epidural analgesia or the support of a companion — may have a positive impact on birthing outcomes. The 2017 Cochrane Review discovered that women who received doula support in labor were significantly less likely to require cesarean delivery or instrumental vaginal birth.

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Physical and Emotional Support

Doulas provide physical and psychological support to help birthing parents maintain feelings of comfort, control, and confidence. Examples include constant presence, soothing touch via massage or counter-pressure, positioning, assistance with water therapy, and homeopathic remedies. Doulas also promote empowerment and affirmation by offering praise, positive perspectives, and reassurance.

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Informational Support and Advocacy

Doulas help keep mothers and their partners aware of birthing options and what is happening during labor. They suggest relaxation and breathing techniques and explain medical procedures. These birthing coaches support parents in their birth plans and other decisions about labor and childbirth. Examples include encouraging the parents to ask questions, gathering information, and verbalizing preferences without feeling pressured.

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Help for the “Fourth Trimester”

New parenthood can be a vulnerable time for parents, regardless of whether they're first-time parents or already have other children. Families going through the “fourth trimester” can benefit from the support, assistance, and advice of postpartum doulas. These specialists work flexible schedules that can include partial or full days, nights, and weekends.

Postpartum doulas help enhance the post-birth experience by actively listening and encouraging new parents and other family members. They also explain normal newborn behavior and offer soothing techniques. They may even assist with light housework duties such as dishes, simple meal preparation, and handling the baby’s laundry.

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Doulas do not require certification, but most professionals agree it is best if expectant parents seek one that has received official training. Several organizations train and certify doulas in labor support. This training typically includes attending childbirth classes, workshops, and reading. Students must also attend live births.

Since each organization implements its own training practices, the quality and knowledge base of doulas may vary widely. Prominent agencies require breastfeeding training and investigating local referrals for future clients. Favorable evaluations from supported parents and essays demonstrating an understanding of primary doula support concepts may also be required.

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While doulas receive training and certification in labor support, they are not medical personnel. They cannot monitor your labor or baby, nor can they perform a cesarean delivery. Doulas cannot give medical advice or administer medications. While more and more hospitals are welcoming doulas to the birthing team, some obstetricians will not work with these professionals.

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Growing Acceptance

Demand for doulas is increasing, and doctors and government officials are encouraging a greater expansion of their role. The American College of Obstetricians and Gynecologists notes the impact these professionals have on improving labor and delivery outcomes, and it recommends integrating doulas into existing obstetric care. Medicaid coverage for doula services is available in some states and is expected to spread throughout the nation.

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Questions to Ask a Doula

Childbirth brings an unprecedented change in the lives of a family. Expecting and new mothers need to be assured that those involved in their labor and postpartum experience are trained and sympathetic to individual needs and preferences. Become acquainted with prospective doulas by asking questions such as:

  • Where did you receive training?
  • What is your experience as a doula and do you have references?
  • Have you had a background check and a recent test for communicable diseases such as TB?
  • Do you hold CPR certification?
  • Exactly what services do you offer?
  • What is your philosophy about childbirth?
  • What are your fee schedule and refund policy?

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