1. What is a doula?
2. How does a birth doula serve me?
3. If my partner is with me, why do I need a doula?
4. What are the benefits of hiring a doula?
5. What should I ask a prospective doula?
6. What are typical financial arrangements?

A birth doula, or childbirth assistant, is a trained professional who serves the birthing woman and her partner. A doula supports women in achieving the birth they desire, whether at home, a birth center, or the hospital. She facilitates labor and birth by providing continuous physical and emotional support. She encourages informed consent for all decisions by offering objective, balanced information, and she respects whatever the family decides. In addition, a doula facilitates communication between the laboring woman, her partner, and their care provider.

Professional postpartum doulas are dedicated to making this precious time one of ease and enjoyment. During the “fourth trimester”, both mother and baby are making tremendous and mostly invisible adjustments. The presence of a nonjudgmental, nurturing support person is vital to ease a smooth transition into motherhood. Doula services may include housekeeping, errands, childcare, meal preparation, lactation support, and education regarding common concerns of mother and baby. In addition, many postpartum doulas are also trained breastfeeding counselors.

How does a birth doula serve me?
In the ancient tradition, a doula is a woman who provides wisdom and emotional support for her birthing sisters. She does this first by meeting with the expectant couple prenatally, in order to establish a comfortable relationship. She can help them explore their birth options and write an individualized birth plan. The doula may guide a couple in relaxation techniques or a labor rehearsal. She is available to answer questions and she will be on-call from late pregnancy until the birth.

A doula offers to labor with the couple at their home even if they are planning to birth at the hospital or a birth center. Her experience is helpful in deciding when to travel to the birth location.

Doulas are not medical professionals and do not perform any clinical assessments. Rather, they serve as assistants to the mother. They are skilled at offering guidance for comfortable and effective laboring positions, helping mothers focus during contractions, and easing pain using a variety of non-pharmacological means. Doulas also improve the safety of birth by encouraging mothers’ basic biological needs for hydration, voiding, quiet, darkness, privacy, and warmth.

A doula does not speak for a couple to midwives, nurses, or physicians. She instead facilitates their ability to self-advocate. She gently reminds them to voice their preferences, provides objective information about common procedures, and helps translate medical terminology.

Although nurses are experienced in dealing with a laboring woman's emotional and physical needs, they can seldom offer one-on-one support which lasts throughout the labor. Midwives may be able to offer more labor support, but they too have clinical duties to which they must attend. Continuous support from a doula gives parents the freedom to focus inward as they encounter the joys and possible challenges of their unique birth journey.

Following the birth, a doula remains with the couple and their baby to help initiate and establish breastfeeding. The time she stays varies from doula to doula and from birth to birth, but generally is 1-2 hours postpartum. Doulas will also establish a time to visit mom and baby postpartum, either in the hospital or at home. This visit is a chance for the doula to help the new mother process her labor and birth, and for all to admire the new baby.

In summary, a doula provides:

• late pregnancy advice & support as needed
• assistance in writing a birth plan
• 24-hour on-call availability
• continuous emotional and physical support during labor
• massage and other non-pharmacological pain relief measures
• positioning suggestions during labor and birth
• explanations of medical procedures
• support for the partner so that (s)he can love and encourage the laboring woman
• avoidanceof unnecessary interventions
• help with initial breastfeeding
• other possibilities vary from doula to doula, including: reflexology, aromatherapy, herbs, homeopathy, yoga, photography, birth music, blessingway rituals, & more.

If my partner is with me, why do I need a doula?
First-time parents often feel overwhelmed by the amount of new information they have learned in preparation for birth. Birth can be a powerful emotional journey for both parents. It is comforting to have a knowledgeable doula present who can answer questions in an objective, nonjudgmental manner.

For all couples, regardless of whether they have birthed before, there is tremendous benefit. A doula can create space for the woman’s partner to participate at her/his comfort level, reducing anxiety. Because doulas understand the normal processes of birth, they can reassure partners who may be perplexed by unusual birth behaviors. In addition, even prepared partners may be surprised at the intense work of assisting a laboring woman. A doula can “spell’ the partner when (s)he becomes tired, thus ensuring the mother has continuous support.

Studies show that partners participate more actively during labor when a doula is present. Rather than replacing a loving partner, a doula encourages the partner and enhances her/his ability to provide comfort.

What are the benefits of hiring a doula?
Birth:
According to The Doula Book: How a Trained Labor Companion Can Help You Have a Shorter, Easier and Healthier Birth, by Kennell, Klaus, and Kennell (2002), hiring a doula to attend your birth can give you a:

• 50% reduction in cesarean rates
• 25% shorter labor
• 60% reduction in epidural requests
• 40% reduction in synthetic oxytocin (pitocin) use
• 30% reduction in analgesia use
• 40% reduction in forceps delivery

In addition, the presence of a doula:

• enables partners to participate with confidence
• reduces the incidence of maternal fevers in labor
• decreases the incidence of postpartum depression
• increases successful breastfeeding
• lessens reports of pain at 24 hours postpartum
• enhances health of infants as measure 6 weeks postpartum
• improves a family’s satisfaction with the birth experience
• facilitates increased parental sensitivity and better infant bonding

Postpartum:
When a woman receives ample postpartum nurturance from a doula, she has:

• better sleep
• improved digestion
• greater milk supply
• a positive breastfeeding relationship with her baby
• reduced incidence of postpartum blues and depression
• less household stress and worry
• confidence and peace of mind

What should I ask a prospective doula?

• What is your experience with birth/postpartum, both personally and professionally?
• What is your philosophy about birth/postpartum?
• Describe your doula training.
• Are you certified? By what organization(s)?
• When may we call you? May we call with questions and concerns?
• What are your fees? When is payment expected? What are your refund policies?
• May we request references from former clients?
• What is your experience in teaching breastfeeding techniques?
• What has been your most challenging situation as a doula, and how did you respond?

For birth doula:

• Do you provide prenatal and postpartum visits?
• What can I expect during these visits?
• What is your role in early labor? Active labor? Birth? Immediate postpartum?
• Do you provide labor support in our home?
• What comfort measures do you use for relaxation and pain relief?
• What kind of help do you offer to partners of laboring mothers (women)?
• What types of births have you attended (Cesarean, epidural, intervention free, VBAC, multiples, teen birth, etc.)?
• Have you ever worked with my midwife/physician?
• Are you on-call for more than one client at a time? If so, what are your back-up arrangements?

For postpartum doula:

• What types of services do you offer?
• How soon after birth do your services begin?
• When are you available?
• Are you currently certified in infant/child CPR?

What are typical financial arrangements?
Cost of services varies from doula to doula. In general…
Birth doulas request to be paid a deposit several weeks prior to the birth; usually this represents a proportion of the total fee. Some doulas wish to collect their entire fee prior to the birth, while others are content to receive prompt payment at the first postpartum visit.

Postpartum doulas charge by the hour and typically request to work a minimum of several hours per visit.

Many doulas will work with people who are of limited finances by sliding scale, payment plans, or a barter arrangement. If you feel this is appropriate for you, please discuss it with your doula. We hope that you will select your doula based on an intuitive comfort level and personality match, rather than by financial considerations!