What Exactly Is a Doula and Should You Hire One?
When it comes to pregnancy, birth, and postpartum support, there are a lot of trained professionals and experts who can help you in the transition to motherhood. You've got your ob-gyns, midwives, perinatal therapists, pelvic floor therapists, health coaches, and…doulas.
Dou what now? Essentially, doulas are trained companions who provide support during *all* different stages of the reproductive process, including pregnancy, postpartum, childbirth, miscarriage, and loss, explains Richelle Whittaker, L.P.C.-S., an educational psychologist certified in perinatal mental health. And today, as the COVID-19 pandemic has left new parents in serious need of support, many new moms and dads are turning to doulas to fill gaps in care. (Read: 6 Women Share What Getting Virtual Prenatal and Postpartum Care Has Been Like)
"Especially during postpartum in a pandemic when you're isolated, you've underslept, and you're thinking everyone has it more figured out than you do, new parents need as many champions in their corner as possible," says Mandy Major, a certified postpartum doula, and CEO and co-founder of Major Care.
In the U.S., doulas are considered to be very optional, but that's not the case everywhere. "In other countries, this type of care is totally normal and part of the postpartum process. Here, we don't have that, and it's a huge gap in our system," says Major.
While doulas aren't medical professionals, they are trained in the perinatal period of pregnancy and postpartum and can be a serious benefit to moms-to-be and new parents. Training will vary depending on what type of a doula you choose (birth doulas, for example, have different training than postpartum doulas) but traditionally, training involves an intensive workshop where doulas-to-be learn about how to effectively support new families and become certified. DONA International is the leader in evidence-based doula training and certification and many groups around the country offer DONA-approved doula training.
And the education doulas receive — and then share with clients — pays off: Research suggests the use of doulas can help cut time spent in labor, decrease negative birth feelings, and reduce rates of C-section.
Plus, during what can often be a tumultuous time in your life, a doula provides a listening ear, a helpful hand, and a whole lot of support. But what exactly is a doula—and should you consider hiring one? Here, what you need to know about the important profession and how to go about hiring a doula if you feel it's the right fit for you.
What Is a Doula?
The basic definition of a doula is someone who supports families on their reproductive journey, providing emotional, physical, informational, and advocacy support, explains Quanisha McGruder, a full-spectrum doula (read: covers allll stages of the reproductive process).
Think about a doula as your BFF when it comes to pregnancy, birth, and/or postpartum: "You can trust your doula to listen to your deepest fears and provide useful information to face that fear head-on," says Marnellie Bishop, a certified birth and postpartum doula. They're often a supplement to the care that you already have, enhancing it and building your confidence throughout pregnancy, birth, and postpartum. (Related: Amy Schumer Opens Up About How a Doula Helped Her Through Her Complicated Pregnancy)
Doulas also tend to be in a unique and intimate position since they often see new parents in their homes, explains Bethany Warren, L.C.S.W., a therapist certified in perinatal mental health. "Providing home-based and custom-fit services seems to create a lovely rapport between the new parents and the doula," she says. "I find that parents who find a good fit with their doula feel supported throughout this important time."
After all, while we often talk about the importance of a "village" in raising a child, it also takes a village to protect and raise new parents, says Warren. The biggest difference between, say, the care that a night nurse provides and the care that a postpartum doula provides? A night nurse's care centers around the baby, whereas a doula's center is the family and the household, explains McGruder.
Doulas can help you set realistic expectations (i.e. separate your experience in pregnancy and postpartum from what the media *says* it should look like), make decisions when plans change (read: suddenly, you need a C-section or get an unexpected diagnosis), and understand your experience through ups and downs.
What a Doula Helps with — and What They Don't
There are four main areas that doulas tend to support new parents in the most: information support, physical care, emotional help, and advocacy, says Bishop.
As COVID-19 has shifted, well, pretty much everything as we know it, many doulas have pivoted their services to provide virtual care, education, and resources, utilizing the phone, text, video chat, or web-based services. (For example, during pregnancy, you could chat through your postpartum prep plan over the phone with a doula and/or FaceTime about all of your questions.)
Just note that currently, in some states, doulas are not seen as essential healthcare workers and are only allowed in the hospital during delivery as a support person in lieu of the birth partner, so it's important to check in with your hospital or birthing center's guidelines. You'll likely still be able to FaceTime a birth doula for delivery, but again, best to double-check with your hospital or birthing center to be safe. (Related: Some Hospitals Aren't Allowing Partners and Supporters In Childbirth Delivery Rooms Due to COVID-19 Concerns)
Here's a brief look at the types of support that a doula might provide:
Information support. The birth and postpartum process can be confusing (hello, info galore to sift through, advice to consider, and books to read). A doula can help you understand medical tests or procedures before they happen, clarify medical lingo, help you find evidence-based info, and help your partner understand what's going on. Some even offer childbirth education training, says Bishop.
Physical care. "It is no secret that pregnancy, labor, and delivery are physically demanding for the pregnant person, but they can be tiring for the rest of the family, too," says Bishop. "Disrupted schedules and heightened nervousness can leave partners and children feeling exhausted even before the baby arrives." Depending on when you choose to hire a doula they can help you pack your hospital bag, teach you comfortable positions for labor, assist you during the birthing process, help you with postpartum healing care, and support you with lactation, she notes.
Emotional help. Pregnancy, childbirth, and the postpartum period can send your emotions for a *loop* (to say the least). But the truth of the matter is, everything from elation to fear (and all the emotions in between) is normal during this time period. A doula can help you feel supported and encouraged no matter what you're feeling, reassure you if you're anxious, allow your partner to have breaks, and offer a positive attitude while you prepare for big changes, says Bishop. (Related: Mental Health Issues During Pregnancy and Postpartum That No One Is Talking About)
Advocacy. Have a hard time speaking up for yourself? Cue doulas! They often coach parents on how to communicate effectively and respectfully during prenatal doctor visits, which helps you feel empowered and confident, says Bishop. They can also work with a birthing facility's staff as well as any visitors to ensure that your needs are met. "A doula will listen and relay messages as needed," says Bishop.
As for what doulas don't do? They don't diagnose, prescribe, or treat any medical concerns (think: high blood pressure, dizziness, or nausea), but they can help point you in the direction of a medical professional who can help. In fact, often, doulas partner with birth providers such as ob-gyns and midwives, pediatricians, mental health providers, and lactation consultants and tend to have a robust local referral network.
"It can be useful to sign a 'Release of Information' so that all of your providers on your team are on the same page," notes Warren. "I have found working collaboratively with doulas to be such a great way of surrounding the parents with as much support as possible, and aiding them in building their village." (Related: Um, Why Are People Getting 'Death Doulas' and Talking About 'Death Wellness?')
How Much Does a Doula Cost?
The cost of hiring a doula depends on a lot of different factors, including where you live and what kind of doula you're hiring. The costs can range from a few hundred dollars (or less) to a few thousand dollars, and even within the same area, it can vary. For example: "In the Portland, Oregon metro area I have seen doulas charge as low as $500 per birth and up to $2,700 per birth," says Bishop (which is, truly, just being there for the birth). "For postpartum doulas, I have seen hourly rates range from $20 to 40 an hour."
Other doulas have negotiable rates and some—including those who are completing doula training for their certification—might even work with you through your birth for free to complete the work they have to do to become certified.
Otherwise, some (but definitely not all) insurance companies will cover some of the costs of doula services—so it always makes sense to call your insurance company to find out what might be covered.
How to Decide If a Doula Is Right for You
Often, the decision to hire a doula comes down to how much additional support you feel that you want, need, and could benefit from. "For many women, pregnancy and childbirth can be both a joyous and fearful experience, so having a doula to walk alongside them on the journey can be an enormous comfort," says Whittaker. "Women who have little to no family support, need additional support for herself and her spouse, have had difficulty having her voice heard during doctor visits, or have had previous complicated pregnancies or childbirth experiences may be prime for doula services."
It's crucial to find the right fit when choosing a doula, meaning your best bet is likely to interview a few. It can be helpful to write down your questions ahead of time, suggests Warren. For one, you'll want to ask about what kind of services the doula you're considering offers (birth, postpartum, or both) and consider where you think you might need the most support. You can find doulas many places, including on DONA's site, and via companies like Robyn, Major Care, Motherfigure, and other online provider sites.
Have no family around and think you'll need help with sleep, dealing with anxiety, and parental support? A postpartum doula might be the best bet for you. If you have a village of support around you but are freaking out about labor and delivery, a birth doula might be the best route, says McGruder. Want support in both areas? Look for someone who can help with both experiences to minimize new faces. (Related: How Mama Glow Founder Latham Thomas Wants to Change the Birthing Process for the Better)
In interviews, consider how the doula responds to your questions. "It is crucial to have someone who will support you in a non-judgemental way regardless of your birth preferences and outcomes," says Warren. "If you don't feel comfortable now in getting to know a doula during the interview stage, then you likely won't when you are at your most vulnerable."