What is a Doula? Understanding a Doula’s Role in Childbirth

I will never forget talking with VBAC dads on our podcast and bursting into laughter when I heard one father’s answer to the question, “What is a doula?”

Chicken dancing hippies.

In other articles on the blog, we’ve cleared up the myths with statistics and facts about doulas, and talked about what it’s like being a career doula — we even train VBAC doulas.

In this article, we will talk about what a doula does (and doesn’t do), why you REALLY want one, and how to find the best doula for your birth.

What does a doula do? 

A standard elevator pitch for a doula goes something like this: 

A doula is part of the birth team who cares for the birthing person by providing informational, physical, and emotional support. A doula also helps parents do a lot of legwork before birth by providing access to unbiased resources and helping them advocate for themselves.

yours truly, Julie Francom

But what does that mean specifically? 

It’s tough to explain exactly WHAT a doula does because it varies from birth to birth and parent to parent. With the four areas of support mentioned above in my elevator pitch, let’s break it down.

Doulas help you access the right information

On the intake form I use with new doula clients, one of the questions is, “Why do you want a doula?” 

Often, the answer is something like, “To fill me in on the things I didn’t know I needed to know.” (enter, me!).

Doulas are a wealth of knowledge, and there are all kinds of benefits of a doula as a partner throughout your pregnancy and birth experience.

Most professional doulas have taken an in-depth training program and attended many births. Their education and experience give them the ability to connect you with the information you need to know, depending on what you want for your birth. 

Doulas become very familiar with the birth process and the ins and outs of your local community of hospitals, birth providers, and other resources for new parents. If you need facts about VBAC, you are considering home birth or hospital birth, or even planning a family-centered cesarean, experienced doulas can help you connect the dots.

Doulas know how to get their hands on the most up to date information that relates specifically to your needs. They provide unbiased information, bringing the knowledge to you from trusted and evidence-based resources.

Doesn’t that sound so much nicer than digging through google yourself? 

Doulas provide physical support during labor and birth

I cannot count the number of times I have cursed myself after supporting a long labor and birth for not keeping up with strength training. Sometimes mothers need a lot of physical support. I leave the hospital almost limping, hopping into a warm bath the second I get home to soothe the aches of supporting a laboring parent. 

Some of the ways a doula provides physical support are:

• Applying counterpressure on the hips, knees, lower back, or wherever it makes the parent feel most comfortable. 
• Assisting the parent in walking, moving in and out of the bed, toilet, or chair, and various labor positions.
• Applying hot or cold washcloths to the forehead, back, or shoulders.
• Light touch massage or foot rubs.
• Using a rebozo or other Spinning Babies® techniques to help fetal positioning. 

Doulas provide emotional support and comfort

The right doula knows how to help you feel in control, empowered, cared for, and proud of the work you do during your pregnancy and birth. 

We provide comfort, encouragement, and knowledge that comes with lots of experience, and we stay by your side during labor and birth. Whether you are laboring at home, a birth center, or hospital, your doula will be with you.

While doulas do not have medical training like your provider, we are pros at bringing a soothing voice of encouragement. We help you feel comfortable and calm during labor with different labor positions, the perfect breathing exercises, and relaxation techniques like hypnobirthing.

We also know how to provide information without bias in a personal but professional way to enhance your overall birth experience.  

Many doulas are also trained in non-medical pain management techniques such as reflexology, aromatherapy, music therapy, massage, or foot zoning. As you interview doulas, ask them what other training or services they provide.

Doulas can be birth advocates

Advocating for a client is a controversial topic in the doula world. There are many interpretations of the word advocacy, and some doulas do not consider it part of their role. 

DONA International, the first doula training and certification organization, considers advocacy part of the doula’s role — as long as they do not make decisions for clients or speak for them.

The doula advocates for the client’s wishes as expressed in her birth plan, in prenatal conversations, and intrapartum discussion, by encouraging his/her client to ask questions of her care provider and to express her preferences and concerns. The doula helps the mother incorporate changes in plans if and when the need arises, and enhances the communication between client and care provider.

Clients and doulas must recognize that the advocacy role does not include the doula speaking instead of the client or making decisions for the client. The advocacy role is best described as support, information, and mediation or negotiation.

Scope of Practice: Birth Doula, DONA International

Advocacy can happen in many different ways as a doula but, but none of them should include speaking on behalf of the client. 

Advocacy may look like this:

• Helping you to know how to communicate, understand, and ask for what you need. 
• Asking YOU what you want.
• Supporting the decisions you and your partner make.
• Amplifying your voice by repeating what you said or asking hospital staff if they heard you. 
• Creating space and time for you to catch your breath, review your options, and make a decision without unnecessary pressure.
• Facilitating open and honest communication between you, your provider, and other members of the birth team. 
• Teaching effective communication between you and your birth partner, before birth begins, so it is easy to understand each other while you are in labor.
• Helping you create a home birth plan.
• Observing the birth space, noting all the interacting parts, and keeping you informed. Your doula can let you know what’s happening by asking you if you gave consent for a procedure or if you want time to talk things through. For example, if I see a nurse starting Pitocin after delivery, I could say to you, “It looks like your nurse is about to start Picotin. I remember we discussed this prenatally and you wanted to decline. Is that still the case?” This communication opens the path for you or your partner to step in before any action is taken. 
• Translating medical terms and explaining procedures and interventions in an easy-to-understand way. 

Why hire a doula? 

Besides all the many beneficial aspects of hiring a doula, there are some significant research-backed health benefits, too. A 2016 Cochrane review of 26 research studies concluded that continuous labor support, specifically with a doula, improves birth outcomes. 

“Women who received continuous labour support may be more likely to give birth ‘spontaneously’, i.e. give birth vaginally with neither ventouse nor forceps nor caesarean. In addition, women may be less likely to use pain medications or to have a caesarean birth, and may be more likely to be satisfied and have shorter labours. Postpartum depression could be lower in women who were supported in labour, but we cannot be sure of this due to the studies being difficult to compare (they were in different settings, with different people giving support).”

Continuous support for women during childbirth, Cochrane.com

The best results in birth outcomes happen with the support of a doula, a person NOT in the birthing person’s family or social circle. 

These benefits include:

• 39% decrease in Cesarean births
• 15% increase in spontaneous (non induced) vaginal birth
• 10% decrease in the use of narcotic pain relief
• Average length of labor decreased by 41 minutes
• 38% decrease in the risk for a baby having a low 5 minute Apgar score
• 31% decrease in the risk of the birthing person being dissatisfied with the overall birth experience

Wow! For data junkies like me, those numbers speak volumes. 

Doulas typically meet with you prenatally several times to get to know you, and if you have a birth partner, we get to know them too. We support you all the way through labor and birth, and immediately postpartum. We also come to see you for at least one postpartum visit. 

You can think of having a doula for your birth in the same way you might want an event planner for your wedding, or a tour guide for a big trip. They know all the secrets of the process, how to get the details you want, and the best way to have this once in a lifetime experience! 

Many of my clients become my friends and we keep in touch long after the birth of their babies. The relationship and connection can run very deep.

What don’t doulas do? 

I have been known to say a time or two that doulas are magical. While there are some pretty amazing things doulas do, it is important to note their limitations as well. 

Sometimes, there is confusion about the scope of a doula. Let’s clear that up right away. 

Doulas are not medical professionals

I have seen many people ask, “If I have a doula, do I still need a midwife?” 

The answer is YES! 

Doulas do not replace your main medical provider. You still need a Midwife or OBGYN to do all the prenatal checks and make sure you and baby are healthy and well during and after labor.

Doulas do not give medical advice, diagnose or prescribe anything, and do not intentionally catch babies. I say intentionally because in case of a fast labor, if health providers are not available, your doula will not let your baby fall on the floor.

Doulas do not tell you what to do

While doulas can help you find your voice and learn how to effectively communicate with your care team, they do not speak for you. 

They also should not tell you to do things such as when to go to the hospital, and they should not speak to medical staff for you. 

They may provide several solutions for you or let you know where you might be in the labor process, but ultimately, you are the decision-maker. 

Doulas do not replace your partner

We go over this a lot in our VBAC prep course. Your doula does not knock your partner down to “third-wheel” status. 

We will never push your birth partner aside. Our goal is to enhance your partner’s support and help them know the best ways to help you. 

We also help them when they need a break for rest or food. Knowing your partner is relaxed and confident will help you feel that way, too. 

Types of doulas 

Usually, when someone uses the word “doula,” they are thinking of a birth doula. However, there are a few other types of doulas, too. 

Doulas of all kinds are trained professionals. How long does it take to become a doula? In most cases, at least two years.

Postpartum Doulas

Postpartum doulas have extensive training on how to help new parents cope with common issues that arise after the baby is born. They help with nursing, diapering, swaddling, bathing, sleeping, and a lot more. 

They help you have the confidence you need to care for your sweet new addition and are aware of the signs of common postpartum mood disorders. 

If this sounds interesting to you, check in with your birth doulas while you interview them. Many offer postpartum support as well. Some doulas are certified only for postpartum support, some only for birth, and some for both. 

Pregnancy and Infant Loss Doulas

Doulas who have specialized training in stillbirth and infant loss provide special support during the most difficult time for parents. Some estimates show that up to 1 in 3 parents will miscarry or have a stillbirth.

For anyone who has dealt with that, sometimes all you need is a supportive person, who understands what you are going through, to talk with. A specialized doula can connect you to a solid support network. 

My favorite loss training organization is Stillbirthday. You can find a doula through them if you are suffering through a loss, and they work free of charge. If you are supporting someone who had a miscarriage or stillbirth, directing them to support can be really helpful.

Full-Spectrum Doulas

Full-spectrum doulas support families in a large variety of situations with the doula model of care, including but not limited to live birth, adoption, pregnancy termination, miscarriage, and surrogacy.

In a more broad sense, full-spectrum doulas provide support to families whether they are pregnant or not. 

End of Life Doulas

End of life doulas provide support to families preparing for the last days with their loved ones. Just like birth doulas guide and support families in birth, end of life doulas offer guidance and support preparing for death, without replacing hospice or medical care.

Doulas provide emotional, spiritual, and physical support at an intensely personal and crucial time. They assist people in finding meaning, creating a legacy project, and planning for how the last days will unfold. Doulas also guide and support loved ones through the last days of life and ease the suffering of grief in its early stages.

International End of Life Doula Association

Are doulas only for natural birth? 

A common misconception is that doulas are only for those planning an unmedicated or even out of hospital birth. In reality, doulas support all birthing people and all different types of birth. 

We offer support that is non-judgemental. Whatever choices you make for your birth, a doula still provides all the benefits listed above. 

Planning an epidural? No problem. Aside from what is mentioned above, doulas help you get into the best positions to help bring your baby down and make you comfortable and in control.

Want a Cesarean? Doulas will help you, too. Some hospitals allow doulas in the operating room. If not, your doula will be there beforehand to help as you get ready for surgery and afterward to help with the early stages of breastfeeding, bonding, and connection. 

How much do doulas cost? 

The cost of a doula, and a typical total annual doula salary, will vary based on your location and your country. You can expect to pay between $600 and $2,500 for a doula in the United States, with the average cost around $1,200. Doula services include several prenatal visits, unlimited text and phone support, in-person support through your labor and delivery, and at least one postpartum follow up. 

While having a doula might be an out-of-pocket expense for you, many doulas take FSA and HSA payments, and in some instances, your insurance might cover your doula through reimbursement.  

Ready to find a doula? 

Knowing where to start looking for a doula can be overwhelming. Besides connecting with your local community and asking for recommendations, we have a directory of VBAC trained doulas by location. You can also search databases like DoulaMatch, DONA, and CAPPA. 

If you’re concerned about how to have a successful VBAC, involving a doula can help you get the outcome you want.

Interview doulas with your birth partner, and interview as many as you need to until you find the right doula for you. I recommend listening to your gut feeling and choosing the doula who you have the best connection with. They will be part of one of the most memorable days of your life, so having a strong connection is very important. 

If you need help knowing what questions to ask a doula, you can download our doula interview questionnaire to help guide you along the way.

Did you have a doula? What was your experience like? Let us know in the comments below.