Guest Author - Sarah Masterson

Every mother could use a little mothering herself, now and then. And – if you ask me – never is this more true than when she’s laboring and giving birth.

Enter the doula (pronounced doo-lah).

By now you’ve probably at least heard of this special type of birth professional. Particularly in urban areas, they’ve made a big comeback in the past few years and are now in huge demand by women of all backgrounds and financial means. Yet, for many pregnant women, what a doula actually does (and why it matters) remains a mystery.

The doula is nothing new. In fact, she’s a revival of the practice followed for thousands of years (except for a lull from the nineteenth and most of the twentieth centuries, when the male-dominated “medical model” took over birth) of laboring women being attended by other women, who support and encourage them with special skills and plenty of empathy.

The word itself – doula – comes from the Greek and refers to a woman who helps other women. These days, this help includes an informational/educational role about labor and birth, as well as continuous physical AND emotional support during labor and delivery.

Doulas work in a variety of settings – hospitals, freestanding birth centers, home births. Some of them specialize or have a preference, while others are generalists. Some prefer to work with women whose goal is an unmedicated vaginal birth, while many others are skilled at supporting women who plan for medical intervention (such as an epidural).

What your doula does with you and for you during labor and delivery will largely be a matter of preference – your individual wants and needs. A doula will meet with you several times in advance of the birth (so start shopping around in your second trimester!) to discuss your hopes, plans, expectations, anxieties, and fears about birth. She can be your best coach and advocate by getting to know you long before labor starts.

This is not to suggest that the doula replaces your partner/spouse, your doctor, or your midwife. The doula can provide physical and emotional comfort during labor, but she does not practice medicine or perform exams. She does not make medical decisions, but she can provide an educated, listening ear to a mother who needs it.

The truth is, doctors and midwives have their hands full during labor and delivery, and typically are not able to provide the type of one-on-one pain management and immediate presence a mother can benefit from. Labor and delivery nurses in hospitals are even more burdened with multiple patients to care for and responsibilities that take them away from a laboring woman’s bedside. In addition, partner/spouses – especially first-time daddies or those who have older children to attend to during labor – can be too overwhelmed to provide the kind of support a laboring mother really wants and needs. Ideally, the doula is a helper to both the woman and her partner, supporting them in whatever ways they find helpful. She exists to help – not to replace.

Many dads find the presence of a doula very comforting, lessening their anxiety and the pressure they feel to help their partner through hours of intensive labor. Good obstetricians and midwives likewise understand and appreciate what a doula offers. They know what the latest research clearly shows – In studies of thousands of births, the presence of a doula is associated with:

• lower incident of emergency c-section
• lower incident of birth complications overall
• shortened length of labor
• decrease in need for pain medication
• enhanced ease of early breastfeeding
• decreased anxiety for the birthing mother and her partner.

For a variety of reasons, we also see longer-term benefits of doula support. For example,

• fewer feeding problems with breastfeeding babies one month after birth
• significantly better infant health at six weeks after birth
• significantly better maternal health at six weeks after birth
• significantly lower rates of postpartum depression, self-esteem, and anxiety concerns in mothers six weeks after birth
• significantly more positive reports of marriage/relationship perception six weeks after birth.
• more reports of positive, successful bonding from both mothers and fathers six weeks after birth

The doula’s role is unique. It requires particular aptitudes and attitudes, and it has its own professional standards and specialized training. Essentially, a doula is trained to be a childbirth educator, a knowledgeable childbirth specialist, a counselor and mentor, a proactive advocate and sometimes mediator, a massage therapist, and a pain relief guru. She has in-depth knowledge of pregnancy, the stages of labor and delivery, as well as communication skills and therapeutic touch. There are now several nationally- and internationally-recognized educational organizations and associations for labor doulas.

Standards and expectations for trainees are high, and getting higher all the time. This is great news for the families they serve. Organizations training and certifying doulas include DONA (Doulas of North America, www.dona.org), ALACE (www.alace.org), CAPPA (www.cappa.net), and most recently, BirthWorks (www.birthworks.org). On the West Coast, check out PALS (www.pals-doulas.org), and in Houston, the Community Doula Program (www.communitydoula.org). You can get a feel for the philosophy and training curriculum/requirements for each organization by visiting their websites. Most of them also have a database of certified doulas. You can look up the certified doulas working in your area!

Finding the right doula is like finding the right mate (though without the bands of gold and the long-term commitment!). Choose carefully, and you’ll choose wisely. Don’t hesitate to talk with more than one doula before making a decision about who to go with. A good match is as much about “personal chemistry” as anything else – You want someone you really click with and feel at home with from the get-go.

Some other questions to ask prospective doulas:

• How many births have you attended as a doula?
• Do you have any preferences about working with medicated vs. unmedicated labor?
• What are some of your favorite techniques for helping women manage pain during labor?
• How long will you stay with me after the birth, and will we have a postpartum visit? Will you come to my house in early labor, or do you only meet clients at the hospital/birth center?
• What are your rates for doula services, and what type of payment arrangements do you offer? Do you have a back-up doula, in case you're ill or delayed when my labor begins? (And if so, can I meet the back-up doula in advance?)
• What is your general philosophy of labor and childbirth support?
• What will your role be as my doula?
• Do you have any referrals you’d be willing to share with me?


Happy doula hunting!