WHAT IS A DOULA?
A doula is a professional labor support. Doula’s came about when women decided they wanted to have a trained support person stay with them for the duration of their labor. With our modern hospital system set up the way it is, nurses are there for 8-12 hour shifts and then they leave you and doctors wander in 5 minutes before you deliver. This means that you can’t count on anyone to stay with you and be there to support you the entire time you labor. That puts everything on the woman-alone. That’s really hard.
Doulas have attended births, have studied birth and are well trained in labor and delivery. They don’t have any medical training and are not equipped to deliver babies (and if they claim to and call themselves a “doula” I’d consider that a red flag). They have tools and tricks they use to ease labor pain, support your spouse as he supports you and knowledge about the ins and outs of the hospital and why/how they do things. Good doulas will support you in the decisions that you make and advocate for you to help make your wishes happen. Hiring a doula doesn’t mean you are certain that you want an unmedicated birth-often doulas are there to help you up until the epidural and then continue to advocate for you beyond that (ie “Are you sure she consented to an episiotomy?”) You can read more about what doulas do and do not do in the DONA International’s standard of practice for birth doulas written here.
There are many different kinds of doulas with different specialities. Some doulas prefer to assist only at homebirths, others feel more needed in hospital. There are postpartum doulas that are trained to help care for you after you deliver-helping with housework, meals and breastfeeding. There are even c-section doulas that specialize in helping women navigate a planned c-section. And bereavement doulas for women that have or are going to suffer a loss.
WHY A DOULA?
I love The Business of Being Born series. More Business of Being Born (Part 3) talks specifically about doulas and why you would want to hire one (I linked to Amazon but you can watch it free on Netflix). I attribute the success of my second delivery to my birth team. I 100% could not have done that on my own-it was because I was continually supported by someone that I was close to and had a supportive spouse that knew what to do. I didn’t have a doula, but a midwife that acted as my doula when I needed her and a husband that was already a pro-hip-squeezer. I was lucky. If I wouldn’t have had the reassuring voice of Katie telling me I was ok, I would have panicked and really struggled.
If nothing else, that’s the biggest thing I think doula’s offer is a voice of reassurance. In your vulnerable state during labor you need someone you can trust, that you know has seen this a million times to tell you that you are not ripping in half, you’re not dying, you’re actually doing a really good job and you’re having a baby and it’s going to be ok. Unfortunately this role can’t always be fulfilled by your Mother or Husband-two people that have told you every time you’re sick that “You’re fine, quit whining!” My husband meant everything to me squeezing my hips and wrapping himself around me-but as soon as he tried to talk to me I was lost. I needed Katie’s voice to to that.
From Evidence Base Birth:
So what is the evidence for doulas?
In 2012, Hodnett et al. published an updated Cochrane review on the use of continuous support for women during childbirth. They pooled the results of 22 trials that included more than 15,000 women. These women were randomized to either receive continuous, one-on-one support during labor or “usual care.” The quality of the studies was good.
Continuous support was provided either by a member of the hospital staff, such as a midwife or nurse (9 studies), women who were not part of the woman’s social network and not part of
hospital staff (doula 5 studies; childbirth educators 1 study, retired nurses 1 study), or a companion of the woman’s social network such as a female relative or the woman’s partner (6 studies). In 11 studies, the husband/partner was not allowed to be present at birth, and so continuous support was compared to no support at all. In all the other studies, the husband or partner was allowed to be present in addition to the person providing continuous labor support..
Overall, women who received continuous support were more likely to have spontaneous vaginal births and less likely to have any pain medication, epidurals, negative feelings about childbirth, vacuum or forceps-assisted births, and C-sections. In addition, their labors were shorter by about 40 minutes and their babies were less likely to have low Apgar scores at birth.
What does this mean?
It means that if you have continuous labor support (that is, someone who never leaves your side), you are statistically more likely to have better outcomes and your baby is more likely to have better outcomes!
WHEN SHOULD I HIRE A DOULA?
Start looking as soon as you’re prego. If you’re going to participate in any childbirth education classes that’s a great place to ask around OR if you’ve hired a doula you could ask her for a recommendation for which class to take. I’ve been hired as early as 8 weeks and as late as 36. The benefit of hiring a doula earlier on is that she can become a great resource for you throughout your pregnancy. She can help educate you, meet your care provider, your spouse, recommend some reading and answer late night text messages about burning pregnancy questions you can’t sleep without knowing the answer to and webMD says it’s cancer (it’s always cancer).
HOW DO I FIND A DOULA?
A simple google search in your area could probably find you one-but I’d recommend asking around first. Priority number one with a doula is that your personalities work well together. You want to feel comfortable with this person, you want to feel supported and you want to know that she will help advocate for you. If you’re wanting an epidural and you can feel judgy vibes coming from your interviewee…she’s probably not the one. You don’t need to feel judged in labor. You also want to look for experience. How many births has she attended? How did her labors go? Does her birth philosophy align with yours? Does she get along with your care provider? Is she familiar with your hospital/birth center? I had a good friend hire a doula that she considered so beautiful and sweet and when labor came she was intimidated by how pretty and perfect she seemed and felt uncomfortable being less than pretty and perfect in front of her. You really don’t want that.
To sum it up-you want a doula. Your partner-they’ll benefit from a doula too. Most importantly? Your vagina will thank you.