Doulas: Responsible Only to Mothers

Historically, women in ancient societies were surrounded by female members of their family, supporting them during childbirth. Over time, medical doctors took over the birthing process, but the role of the Doula has been making a big comeback in recent years.

Even though Doulas are considered “non-medical birth workers,” there is substantial evidence from clinical studies that the efforts of a Doula lead to better birthing outcomes

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Doulas: Responsible Only to Mothers

Historically, women in ancient societies were surrounded by female members of their family, supporting them during childbirth. Over time, medical doctors took over the birthing process, but the role of the Doula has been making a big comeback in recent years.

Even though Doulas are considered “non-medical birth workers,” there is substantial evidence from clinical studies that the efforts of a Doula lead to better birthing outcomes

What are those Clinical Benefits?

Women who use a Childbirth Doula are…

31% more likely to describe birth in a positive way
38% less likely to have babies with APGAR scores that require referral for special care
25% less likely to give birth via a cesarean section / delivery

Furthermore, women who use a Doula also are…

Having labors that are 41 minutes shorter, on average
10% more likely to give birth without pain medicine (analgesia / anesthesia)
Having lower rates of postpartum depression

The clinical benefits are so strong that the World Health Organization believes all births should have a birth companion present, such as a Doula, as noted within their Safe Childbirth Checklist Implementation Guide

What are those Clinical Benefits?

Women who use a Childbirth Doula are…

Boobfairy - doulas

Furthermore, women who use a Doula also are…

Boobfairy - doulas

The clinical benefits are so strong that the World Health Organization believes all births should have a birth companion present, such as a Doula, as noted within their Safe Childbirth Checklist Implementation Guide

How Common is a Doula?

Doulas are fast-becoming commonplace in the United States. Much of its growth can be attributed to the numerous celebrities who have opened up publicly about using them for their own pregnancies.

“A-List” celebrities that have used a Doula include:

“A-List” celebrities that have used a Doula include:

Meghan Markle, Jessica Biel, Heidi Klum, Jessica Alba, Anne Hathaway, Kate Hudson, Nicole Kidman, Kristen Bell, Alicia Keys, Ashley Tisdale, Christy Turlington, Rebecca Minkoff, Alyson Hannigan, Amy Schumer, Erykah Badu (and became a midwife & doula herself), Mandy Moore, Kelly Rowland, Doutzen Kroes, Kelly Ripa, Mayim Bialik, Alanis Morissette, January Jones, Jamie-Lynn Sigler, and Mila Kunis

In 2006, only about 3% of parents reported using a Doula, but by 2012, that number had doubled to 6%. A more recent “Listening to Mothers in California” survey from 2016 reported that 9% of survey respondents had a Doula with them during their labor and birth, a 300% growth rate since 2006.

Higher than average Doula usage was reported by survey respondents that identified as Black (15% used a Doula) and Latina (10% used a Doula)

What Do Doulas Actually Do?

A Doula is a non-medical birth worker that nurtures and supports the birthing person throughout labor, birth, and often into the postpartum period too

Their role is to provide continuous support to the mother and are responsible solely to the mother and not to any other party or facility, such as a hospital administrator, Physician, Midwife, or any other healthcare personnel

A Doula Provides Four Pillars of Support:

1. Physical Support

Aspects of physical support provided by a Doula may include soothing with touch, assisting with water therapy, applying warmth or cold, assisting the birth person in walking, providing massages, and feeding food, ice chips, and drinks

2. Emotional Support

Doulas provide encouragement, praise, reassurance, and a calming, caring presence. They help birthing persons to think more positively about themselves and/or their situation and help them conquer their fears or feelings of self-doubt

3. Informational Support

Doulas might help “translate” medical terminology, procedures, and situations into “plain English,” suggest breathing, positioning, and relaxation techniques while in labor, and provide evidence-based information about different pregnancy and childbirth options

4. Advocacy

Doulas support the wishes and rights of the birthing person by encouraging that person to ask questions and verbalize their preferences to care providers, support the birthing person’s decisions without judgement or undue influence, and amplify the person’s voice so that their concerns are heard and are not dismissed or ignored or made to feel pressured into a certain decision

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What is a Postpartum Doula?
How Does it Differ from a Childbirth Doula?

Postpartum Doulas help parents to navigate the “fourth trimester;” that dizzying and often stressful and hectic early days of parenthood, post-birth

Most Postpartum Doulas are Childbirth Doulas that have received extra training in helping families better transition between the prenatal and postnatal period of their lives

Common Tasks of Postpartum Doulas

The tasks that Postpartum Doulas perform can vary widely depending on the needs of each family, but usually include a mix of parental teaching techniques in addition to assistance with childcare and household work

Sample Activities Include:

  • watching over the baby (and/or other children) while mom naps,
  • preparing simple meals for the family and performing light household chores like laundry and washing dishes,
  • running errands and coordinating doctor’s appointments,
  • calming a cranky infant, changing diapers, and troubleshooting feeding problems,
  • installing car seats, organizing the nursery, and teaching parents how to properly use a sling or other baby-related equipment,
  • introducing pets to the baby, keeping unwanted visitors at bay, and babysitting to give parents some alone time together

Postpartum Health

But one of the biggest (and often misunderstood) benefits of having a Postpartum Doula around is that a Doula can provide an outside perspective and help spot any potential warning signs, such as possible symptoms of postpartum depression or other maternal adjustment issues. While Doulas are not medical professionals, they are trained to look for signs that further medical assistance might be needed and will help find resources that mom might need.

Other Services (Certifications) Likely Offered by Doulas

Doulas often hold other certifications too, such as in the areas of CPR / First Aid, childbirth education, lactation support, infant massage, and even the new field of “babywearing”

They might also have expertise in other services that you are interested in too such as belly casting, waterbirth pool rentals, TENS device rentals, placenta encapsulation, belly binding, and birth / baby photography

A great way to help simplify your life is to find a Doula that you like (and trust) that offers a wide range of services that you plan to purchase at some point so you can get them all from the same source. Perhaps you know you want to rent a pool for a waterbirth, take post-birth baby photos, and also get postpartum support? Well, you can likely find a Doula that can help with all 3 areas. By coordinating all activities and support through one, experienced caretaker, it can help relieve much potential stress as well as free-up a lot of extra time for you.

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What Types of People Tend to Benefit More From Hiring a Doula?

  • Single parents
  • Parents with a partner who is often away for work or overseas in the military
  • Parents that have moved to a new area, away from family and friends
  • Parents with a limited support network
  • For mothers where English is not their primary language and want extra help to better understand often-confusing, medical terminology
  • For mothers who identify as part of a historically underrepresented ethnicity (e.g. Black, Indigenous, and/or Latina)
  • For parents that want more privacy / separation from their significant other during labor (e.g. the man stays in the waiting room while the Doula is in the delivery room with the mother)
  • Extra support and “feminine energy” from another woman who has been through it before
  • But, it’s really for anyone and everyone. We all could use some extra support. One of our co-founders hired a Doula even with a supportive husband who works from home

Doulas Are More Common in Subsequent Births

Perhaps surprisingly to some people, Postpartum Doulas and other Maternal & Child Health practitioners are more often hired by “returning” parents who are having their 2nd or 3rd child, instead of first-time parents. From the “Listening to Mothers in California” survey, 57% of the respondents either “definitely want” or “would consider” using a Doula for a future birth, with that percentage going as high as 66% for Black women.

This tends to happen because parents who have been through the process before KNOW how hectic this time period can be in their lives and want the extra support to help relieve some of that stress. New parents, however, are not as sure what they are getting themselves into and think they can manage just fine on their own. And while they tend to get through it okay, they come to realize that hiring some extra support would have been helpful for better maintaining their mental and physical health. And then they vow to find a Doula the next time around.

Things to Consider When Hiring a Doula

Hiring a Doula is a deeply personal choice. In addition to physical and emotional support, a Doula also provides informational support and advocacy. For those two reasons, you likely want to find someone who is educated with abundant experience and relevant certifications and also someone who shares similar values and viewpoints as you do. A Doula should respect (and accept) your choices and be the advocate on your behalf, helping you to see your birth plan through to the end.

If there are certain physical and/or emotional areas of support that you want in a Doula, then also ensure that those services can be provided to you. And lastly, although of much less importance compared to the other criteria, is if your Doula can also provide extra services that you might want, such as birth photography and belly casting. By bundling services together, you can save time by coordinating logistics with fewer people and possibly save money too with a package discount.

Cost and Insurance Coverage

The price for a Childbirth Doula can vary widely based on experience, certifications / qualifications, level of time commitment / interaction, whether the Doula is independent or part of an agency, extra skillsets they might possess, and location.

Childbirth Doulas tend to provide services as part of an all-in, packaged bundle (but hourly rates are common too) during pregnancy and prices range anywhere from $600 for a brand-new Doula with limited skills and time commitment to over $2,500 for an experienced Doula that is part of an agency located in an expensive area of the country.

Postpartum Doulas usually provide services on an hourly rate, which usually range between $25-$60 an hour. Often, Postpartum Doulas will require mothers to purchase a set-package of hours as a minimum commitment, e.g. a support package of 50 or 100 hours. By purchasing an upfront package, families can usually get a deep-discount off of the average, hourly rate.

Many insurance companies are beginning to understand the value that Doulas provide to families and are coming around to offering coverage for Doulas, but it’s still rare overall. Some, but not all insurance companies, will cover part (or all) of the cost of a Doula. It’s important to check with your health insurer to find out what benefits your health plan policy provides for you during your pregnancy.

In general, it’s best to keep your expectations low when it comes to getting monetary support from your health insurer for Doula services. Since Doulas are not considered “medical workers,” health insurers usually don’t want to pay for them and therefore don’t extend coverage to you.

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