A Guide to Having a Doula-Supported Birth

If I asked a group of people if they knew what a doula was when I trained to be one in 2005, I’d be met with mostly blank stares. I myself had only known about the term for a short while, after a college class exposed me to the problems of the U.S. maternity care system, and changed the trajectory of my activism. Becoming a doula was, at the time, a potential step on the path to becoming a midwife, but it became instead a concrete way to offer support to pregnant and parenting people. The concept of a doula itself has since become way more mainstream—most people nod with recognition now when I ask if they know what a doula is. But you might still not quite know what exactly having a doula-supported birth entails. If you’re thinking of hiring a doula, here are some things to keep in mind.

What Is a Doula, Anyway?

At its most basic, a doula is a person who is trained to support people during pregnancy, childbirth and after. Birth doulas are support people, hand-holders, but also trained in techniques for navigating the challenges of pregnancy, birth, and early parenting. While the training, background, and experiences of doulas can vary widely, at its core being a doula is about offering undivided support to the pregnant person. A doula will help that person advocate for their needs, navigate the choices that come up during the pregnancy process, and assist with managing pain during labor through breathing, position changes, and much more. Unlike medical providers, who are often managing multiple patients at once, doulas provide continuous support throughout the birth process to just that one person. The word “doula” was adopted in the 1970s, when this role was created as an intervention to the challenges of hospital birth. The word doula itself comes from Ancient Greek, and its etymology has caused some to reject that word altogether--it’s translated as woman helper or female slave. Because of this, some birthworkers, especially people of color, have rejected the term in favor of labels like birth companion or birthworker instead.

For some communities, having doula support can be the difference between avoiding health problems, and ending up with major complications or even death.

Why Would You Want a Doula?

Research has shown that having this kind of support during pregnancy and birth (even as basic as someone simply being with you during the process) improves outcomes and satisfaction for the parent and child. Having the support of a doula can lead to a much more positive experience, lower rates of interventions like epidurals and c-sections, and a smoother process overall. For some communities, having doula support isn’t just about having a more positive birth experience. It can be the difference between making it through pregnancy and birth without health problems, and ending up with major complications or even death. Along with doulas becoming a much more mainstream and accepted part of the childbirth process, we’ve also finally seen attention to the maternal health crisis facing women of color--in particular Black women. In comparison to white women, women in these groups are much more likely to face issues like going into labor too early, having a baby born underweight, and even infant and maternal mortality. Black women face the highest incidences of these problems, followed by Indigenous women and some groups of Latinas and Asian Pacific Islander women. The reason behind these disparities is, simply put, racism, and specifically the way racism becomes a consistent stressor that impacts health and wellbeing. So for these communities, having a doula can be a life-changing intervention, because that kind of compassionate and consistent support can offer a buffer to the stress of racism during a crucial time for parent and child.

What Will a Doula Do?

This depends a lot on the doula, their approach, and what kind of support you need. Most doulas meet with the parent(s) a few times during pregnancy to get to know each other, offer suggestions for reading or learning, and help the parents plan for their birth. The bulk of the doula’s work comes when labor starts. They might meet you at home and be with you there while you are in early labor, helping you to navigate contractions. If you have a partner, the doula might offer suggestions for their support of you. If you’re birthing at home, they’d likely stay there with you until the baby is born.

One of the biggest benefits to having a doula's support is simply that they are the only person involved who is just focused on your wellbeing.

If you are delivering in a hospital, the doula would come with you, and be there with you until the baby is born. Depending on how long the labor is, the doula might need to take breaks, or they even might work as a team with other doulas who can step in to make sure the person supporting you is well-rested. Some doulas also offer postpartum support, which looks like spending time with you at home after the baby is born, helping with breastfeeding and all of the adjustments to life as the parent of a newborn. One of the biggest benefits to having a doula's support is simply that they are the only person involved who is just focused on your wellbeing. They don’t have to worry about the medical side of what is going on, or the wellbeing of the baby. They can just make sure you have what you need, and help integrate your support people appropriately.

How Do I Find a Doula?

Thanks to capitalism and our problematic health care system, the people with the easiest access to doula support are those who can afford to pay anywhere from a few hundred dollars to a few thousand dollars directly to the doula. Insurance generally doesn’t cover doula support, and efforts to get Medicaid coverage for doulas are still in their nascency (and rife with licensing requirements and other gatekeeping issues). The cost of a doula depends on location and experience. There are organizations that receive grant funding to offer free or low-cost doula services, particularly to BIPOC communities. Newer doulas also often offer their services at a much lower cost as they are getting more experience. And then some doulas use a sliding scale, or other means to offer support at low or no cost to those who need it most. If you can afford to hire doula, the best way to find one is to start with word of mouth. Ask your friends and providers for recommendations, do a good old google search, and reach out to the people that you learn about. There is a lot to say about what to look for in a doula, but the most important thing is that it is someone you feel at ease with, someone you feel connected to, and someone whose approach to pregnancy and birth matches your own. If you’re going to have a partner, family member or friend with you during your birth, they should also feel comfortable with the person you choose.

A Note About Doulas During a Pandemic

COVID-19 has upended everything about our daily lives, and pregnancy and childbirth is no exception. Providers are limiting prenatal appointments and also the number of support people they will allow at a birth to limit exposure risks. This presents a tricky situation for doulas, who, depending on the hospital or provider, may or may not be allowed to be present with the people they are supporting. While some doulas are focusing on advocating for access to hospitals, others are offering support remotely. I recently witnessed my partner, who is a doula, offer phone support to a mama in labor. While nothing can replace being in person with someone, she was able to offer an incredible amount of support without creating any additional exposure risks for herself, the mama, or the hospital staff. Much has changed since I first began volunteering as a doula. It has become an industry in its own right, with all of the benefits and drawbacks that professionalization entails. But the reality is, when the healthcare system is as broken as it is, we need all the support we can get.