Childbirth Companions and Birth Assistants

Doula care for pregnant women




What Is A Doula?
What Types Are There?
What Can A Doula Do?
What About The Father's Role?
What Are The Benefits Of A Doula?
What If I Want A Medicated Birth?
What Do Postpartum Doulas Do?
Do Doulas Help With Postpartum Depression?
How Do I Find A Doula?
How Much Do They Cost?
Doula Standards of Practice
What Alternatives Are There?

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Information On Prenatal Care

What Is A Doula?

A doula is a woman who is trained as a childbirth companion. Doulas are becoming increasingly popular as studies show that women supported by doulas are less likely to require a C-section delivery, induction or epidural pain relief. The name is derived from a Greek word used to describe important female servants who thousands of years ago helped their mistresses with childbirth. Doulas are also known as labor companions, labor support professionals/assistants and birth assistants.

What Types Of Doulas Are There?

There are 3 types of doulas, although some doulas are trained in all 3 areas:

Antepartum Doulas:
These provide support to expectant mothers who are experiencing high-risk pregnancies and those that have been recommended bed rest because of pregnancy complications.
Birth or Labor Doulas:
These provide support before, during and directly after childbirth.
Postpartum Doulas:
These support new moms in the weeks following childbirth. They provide advice about childcare and how to breastfeed. Occasionally they get involved in physical support by cleaning, cooking and looking after other children when the mother needs a break in the postpartum period.

What Can A Doula Do?

This depends on what point of your pregnancy you hire one. Most doulas are hired a few months before childbirth and help with the design of a birth plan. They are available to couples to answer any questions arising from the pregnancy, which first time moms find particularly valuable. Although they do not offer any medical care they are knowledgeable about most of the aspects of childbirth delivery, so they can help their clients understand the process and any potential complications that may arise. On request they can visit the woman at home when early labor contractions start. Once the mother arrives at the hospital or birthing center, the doula stays close to her at all times. Typically the doula's role will be to comfort, support and encourage the woman through her contractions. She will go through the breathing techniques which the mother learned in prenatal classes and can provide pain relief by massaging and giving advice on labor positions. A doula also acts as a mediator and advocate with other members of the woman's pregnancy healthcare team and is aware of the mother’s choice for either a medicated or unmedicated birth. Although she will not take the place of a midwife, she will augment their support. This is particularly useful if the midwife is responsible for several labors at the same time, or if the labor is long and the midwife changes with shifts. After the birth, many doulas spend a little time with the mother helping her with the breastfeeding process and encouraging a bond between mother and the newborn.

What About The Father's Role?

Although an expectant father may fear the interference of a third party, a good doula will help him relax so that the mother relaxes. Today, although many men are taking active roles in the birthing process, many still prefer to enjoy the delivery without having to standby as a labor coach. With a doula on standby the father can offer emotional support to his partner without the stress of having to remember all those things he learned in birthing classes.

What Are The Benefits Of A Doula?

Numerous studies continue to show the benefits of having a doula present during labor. According to the Continuous Support for Women During Childbirth Report (Cochrane Review), women who gave birth with the aid of a doula were less likely to need pain relief medications, were less likely to require a cesarean birth and reported having a more positive experience from childbirth. Other studies confirm this by showing the rate of C-sections reduced by 50 percent when a doula was present. Also, the length of labor was reduced by 25 percent, the request for an epidural pain relief by 60 percent and the use of oxytocin by 40 percent. Studies also show births attended by doulas are less likely to require the labor inducing drug Pitocin, vacuum extraction or forceps.

Doulas place importance on the power of touch and massage. According to some studies, massage helps stimulate the natural production of oxytocin. This hormone stimulates labor (it is also known as the ‘love’ hormone because it may influence our ability to bond with other people) when it crosses into the bloodstream. It results in a 'good feeling' and drowsiness which may help raise a woman's pain threshold. If synthetic oxytocin is given to induce labor, it cannot cross into the blood stream, so that although it increases contractions, the woman does not benefit from the other natural positive effects.

Studies show that babies born in the presence of a doula have shorter hospital stays, are admitted less often to special care nurseries, breastfeed more easily and are more likely to have bonded with mothers in the postpartum period.

What If I Want A Medicated Birth?

Having a doula present at birth is beneficial, no matter what sort of birth you plan. Although women tend to require fewer medical interventions when a doula is present, their role is to help you have a safe and enjoyable birth, not to choose your birthing method. If you choose a medicated birth, the doula can still offer the same emotional and physical comfort supports such as a massage. It is rare for medications to take all the pain or discomfort away, so this support is still valuable. If an unplanned C-section arises, the doula can help explain the process to the mother and support her because she is likely to feel unprepared. If complications arise, she can stay with the mother while the father accompanies the baby to the nursery.

What Do Postpartum Doulas Do?

The role of a postpartum doula is to help and support both parents in their new roles. Primarily they are educational, and can assist in breastfeeding education and baby care. Unlike a baby nurse however, a doula’s role is not restricted to the baby, but her focus is to nurture the family as a whole. She is there for any other children in the family and of course the father if he has any questions. Support can last anywhere between 1 to 3 months and usually involves one or two visits to the family per week. Those visits can be for a complete day, 9 to 5pm. Or they can last 3 to 5 hours, or after school until the father comes home. Doulas do not teach a particular parenting approach, their role is to remain neutral listeners and to encourage mothers to find their own parenting style.

Do Doulas Help With Postpartum Depression?

No. Doulas are not qualified to treat postpartum depression. However, they do help mothers considerably by providing emotional and practical support. A doula will do her best to ensure that the mother takes care of herself, is getting enough sleep and eating a proper diet. If she suspects depression is an issue she will refer her client to an appropriate clinician or local support group.

How Do I Find A Doula?

North America
Doulas of North America (DONA)
Phone: (888) 788-DONA (3662)

The American Pregnancy Association can also provide a list of doulas in your area. Call: 1-800-672-2296.

Doula C.A.R.E.
Phone Toll-Free 888 879-3199 or in the GTA 905 842-3385

United Kingdom
Doula UK
Phone: 0871-4333103

Doula Association of Ireland

Questions To Ask A Doula

The most important criteria when it comes to choosing a doula, is choosing someone you feel comfortable with. Most doulas do not charge for an initial consultation, so use it as an opportunity to interview them. Questions to consider asking include:

1. What training or experience do you have?
2. What services do you provide? (labor or postpartum?)
3. How much do the services cost?
4. Are you available on my pregnancy due date?
5. Can you meet me at home before my due date to discuss a birth plan?
6. What happens if you are suddenly not available when I go into labor?

How Much Do Doulas Cost?

Most doulas are independent and are employed directly by the parents. They offer a variety of services which are offered on a full-day basis, part-day, overnight or weekend. Most doulas charge an hourly fee, although these are usually offered on a sliding scale the longer you require their services. The average total fee is between $500 to over $1000, depending on the location and the popularity of the doula. Although this may seem expensive, when you consider the costs of surgical interventions and epidurals (see prenatal care costs) it can prove good value. Presently, most insurance companies do not cover doula expenses. However, to increase the chances of recovering your fees when submitting expenses, it is worth:

1. Only using certified doulas.
2. Submitting a doctor or midwife referral to use a doula service with your claim.
3. If you manage a low medical intervention birth (meaning low cost), point this out.

Doula Standards of Practice

DONA International have set a standard of practice for all doulas who are certified by their organization. Those standards include:

Advice on Services Offered
A doulas role is to provide emotional and physical support to their client and to offer suggestions and support for their partner. The doula provides educational information on childbirth and postpartum issues. They are not allowed to 'prescribe' treatment and any information they give must be on the proviso that the client checks with her doctor before starting any new application. They are never a substitute for prenatal visits with a qualified doctor nor can they offer any prenatal tests. Check out our list of books on pregnancy, some of which address doulas specifically.

Limitations of Services
DONA certified doulas can only offer physical and emotional support. They cannot provide medical tasks such as taking a temperature, monitoring blood pressure or fetal heart beat, or perform a pelvic examination. If the doula is also a qualified healthcare professional and can provide those services she should not describe herself as a doula.

Voice of the Mother
The doula can advocate her clients wishes, as expressed in her birth plan, with other caregivers. This may be in prenatal conversations, intrapartum discussions and during childbirth. At no point however will a doula take a decision for her client, but rather supports, informs and mediates.

When The Doula Cannot Make the Birth
Occasionally it will happen that the doula cannot make the birth, perhaps because the birth occurs earlier or later and she already has another client scheduled. In such instances the doula should recommend another back-up doula in the area.

All doulas certified by DONA International will be trained in childbirth and have attended doula workshops. They will also be required to have attained a certain standard of experience, being able to provide evidence and records of attending at least 3 births. Re certification is required every 3 years.

What Alternatives Do Doulas Are There?

A female friend or relative who has gone through a pregnancy herself may be another alternative. The benefit is you will be comfortable with her, and of course her services are free. On the downside, she will not be as experienced or knowledgeable. One way around this is to have a friend who is a 'lay doula'. A lay doula goes through a half day course and learns the basics. Research shows that the benefits of a lay doula are the same as a professional one.

  Related Articles

For more on pregnancy care before childbirth, see the following:

Pregnancy Ultrasound Scans
Third Trimester Prenatal Visit

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Please Note: Information provided on this site is no substitute for professional medical help. See Disclaimer.
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