"Frequently Asked Questions (FAQs) About Doulas"
Kat Hickey, TD(DONA) answers all the public's questions about what doulas, (birth and postpartum), do and don't do, how they serve families, prices for doulas, documented benefits of having a doula present at birth and much more! Take a look at this comprehensive FAQ and learn all one needs to know about doulas and how to go about hiring one!
What is a doula?
There are two types of doulas: birth (labor support) doulas and postpartum doulas. Click here for more information about each type of doula: birth doulas and postpartum doulas.
BIRTH DOULAS
What are the benefits of hiring a birth doula?
There are many reasons an expectant family might choose to hire a birth doula. The doula is the one professional in the birthing room whose primary concern is the satisfaction of the laboring couple. In addition, studies have shown that a doula’s presence and service can reduce the need for interventions including Cesarean section, epidural, labor induction and also increase the rates of successful breastfeeding and maternal satisfaction.* Whether planning a Cesarean section or VBAC (vaginal birth after Cesarean), medicated or unmedicated birth, all couples can benefit from a doula’s care.
What services does a birth doula typically offer and what does it typically cost?
A doula’s ‘tangible’ services can include one to two prenatal meetings and one postpartum meeting in the birthing family’s home, telephone and email contact throughout pregnancy, continuous support through labor, birth and the early postpartum period, on-call service (being available for the birth beginning at 37 weeks until the baby is born), and telephone contact postpartum for questions and problems.
The prenatal meetings allow the parents and doula to become acquainted and discuss preferences for the birth. The doula may help the couple formulate a birth preference list or “birth plan”, which is not a plan at all, but rather a list of the couple’s preferences for labor, birth and the postpartum period. It would be impossible to write a script for the birth, of course, but this “plan” allows the parents to list the ways they would like to manage labor and handle complications, if necessary. Doulas usually like to be contacted as early as possible in labor, so that arrangements can be made for her to attend the birth. The doula and the parents maintain contact by phone until they decide it’s time for the doula to come, either to the home, or to meet the parents at the planned place of birth. The doula stays with the family through the birth of the baby and an hour or more after. The doula can help with the baby’s first feeding and some like to take photos as the parents get to know the new baby. If mom and baby have to be separated after birth, having an extra support person can allow the partner to stay with the baby, knowing that mom is still being attended to by the doula. If a Cesarean section becomes necessary, the doula can continue to support the parents in the operating room.
Please consult each individual doula’s list of services; some offer specialized services including childbirth education, photography, birth art, massage and others. Doulas in the Fort Wayne area usually charge a global fee. The average cost is about $400-600 per birth. If the cost is prohibitive for you and your family, please discuss payment arrangement with one of the local doulas. Many doulas are willing to work out payment plans or, if you have a service to offer, you can barter with her for services. Sometimes, you can hire a doula in training for a reduced rate. Doulas agree that every woman who wants a doula should be able to have one, and are often willing to make arrangements for a woman who really wants doula service.
What is the process involved in hiring a birth doula?
Most local doulas offer a complimentary first consultation. This is a time where the expectant couple can meet the doula, either at home or a public location. This is an opportunity to ask questions about doula services in general, and about the doula’s particular style and experience. This is a good time to see if the birthing family and the doula are a good match. It is a great idea to interview more than one doula. This allows families to choose the one with whom they feel most comfortable.
Upon hiring a doula, most will ask for a deposit and/or sign a contract stating and agreeing upon the services the doula does and does not offer. These things help ensure that the doula knows she has been hired and can hold space open in her schedule to attend the birth.
What is a doula’s scope of practice (what does a doula do/not do)?
A birth doula accompanies a woman in labor, provides emotional and physical support, suggests comfort measures, and provides support and gentle suggestions for the partner. A birth doula does not perform clinical or medical tasks such as taking blood pressure or temperature, fetal heart tone checks, vaginal examinations, or postpartum clinical care. The doula advocates for the client's wishes as expressed in her birth plan and in prenatal conversations by encouraging her client to ask questions of her caregiver and to express her preferences and concerns. The doula helps the mother incorporate changes in plans if and when the need arises, and enhances the communication between client and caregiver. The advocacy role does not include the doula speaking instead of the client or making decisions for the client.
For more information, see the scope of practice page on the DONA International website at http://www.dona.org/aboutus/standards_birth.php.
What if I want to change my mind!? (About anything on the birth plan or anything that was discussed prenatally)
The doula’s job is to support each decision that the couple makes. When a laboring mom feels as though what she is doing in labor isn’t working, that is a great time to explore options with her partner, doula and care providers. The couple will have the opportunity to ask questions about benefits versus tradeoffs of position changes, medication, or other activities or interventions. If intervention or medication is being considered, the doula may ask if the mom would like her care provider to check her cervical progress first.
Many moms find themselves asking for medication during the transition phase between active labor and pushing. This is the hallmark of transition; feeling overwhelmed. The laboring couple and the doula may decide on a “code word” to use if the mom is really suffering and wants medication. That way, mom can feel free to say “this is too hard” or “I can’t do it anymore” after a difficult contraction without anyone offering her medication or intervention. A doula’s primary goal is to help the laboring couple have their safest and most satisfying birth. The decision whether or not to include medication or intervention during labor is entirely theirs.
What if my doctor/midwife says I don’t need a birth doula or can’t have a birth doula?
There are several reasons why a care provider might be apprehensive about a couple hiring a doula. It is a good idea to ask the care provider why they don’t feel a doula would be necessary or helpful.
First, the doctor/midwife may have had a difficult experience with a doula that did not work within her/his doula scope of practice (for more about a doula’s scope of practice, see question above). Rarely, there is a doula who feels her primary responsibility at a birth is to push her personal agenda or prevent the care provider from “doing something” to the mother. Giving the care provider the opportunity to share their experience or to meet the doula may help with this concern.
Second, a midwife or doctor who spends time with a client in labor may be offended that the couple wants to hire someone else to do labor support. Some care providers take great pride in the fact that they sit with their clients during labor and help them work through contractions.
A couple can try to find out the care provider’s true reasoning for discouraging use of a doula. Sometimes, a doula will be willing to attend the expectant couple’s prenatal appointment to meet the care provider. Meeting the doula ahead of time may help a care provider feel better about having a doula in attendance at a birth. If a couple is unable to come to an agreement about having a doula at their birth, they may want to look carefully at whether the couple and the care provider share the same philosophy of birth. It is important to realize that a birth doula cannot “defend” a laboring mother against a care provider who has a conflicting philosophy of birth. This scenario puts the couple, the doula and the care provider in a difficult situation and it will not help the couple in achieving the birth they want. A doula that follows the doula standards of practice is a tremendous help at a birth and can help lighten the load of all people involved, including the partner, nurse and primary care provider. It is very helpful for an expectant couple to make sure all the members of their birth team are on the same page before labor begins.
What happens if my birth doula has an emergency or is at another birth and can’t come?
It is very unusual for a doula to miss a birth. Most doulas do not take on many clients with overlapping due dates for that reason. However, it’s always best to have arrangements in place, so local doulas employ the use of a “backup” doula. There are two ways to select a backup doula. The couple’s doula can choose another local doula to be the backup, or if a couple has interviewed more than one doula, the couple may suggest the backup doula with which they feel most comfortable.
How is a birth doula different from a midwife?
A doula and a midwife do have some skills that overlap, but they are completely different professions. A midwife studies normal birth from a clinical perspective. She is primarily responsible for the safety of mother and baby. She is acutely trained to observe the course of natural labor and to recognize problems if they should arise. While many midwives do offer labor support and comfort measures, their primary concern and responsibility is the clinical care of mom and baby.
A doula’s specialty is the comfort care of the laboring family. The doula can offer comfort measures to mom in labor, but also make sure the partner feels supported and nurtured. She can update and reassure family members in the waiting room. If mom and dad are laboring well together, the doula can run out for snacks and drinks for the birth team or take a few photographs of treasured labor moments. She can dim the lights, turn on music, or massage mom’s feet. A doula’s words are carefully chosen to encourage mom’s progress and to overcome any negativity or fear in mom or others present at the birth.
A mother-friendly care provider (doctor or midwife) and a doula can be a great team that helps the laboring family to achieve the birth they desire.
My partner doesn’t want a doula/is afraid the doula will take his place. Is that true?
This is an incredibly common concern. For more information, please read the DNFW article: “Doulas Helping Dads.”
Do I need a birth doula for a homebirth?
It is a good idea for the family to look at the other members of the birth team when deciding whether or not to hire a doula for a homebirth. Some midwives really enjoy providing labor support, while others tend to be more focused on clinical concerns. An expectant family can ask what the midwife typically does at a birth.
There are several tasks that tend to be individual to homebirth. Is the couple planning to have photographs or video taken of the birth? If there are older children that will be at the birth, is there a person designated to be their primary caregiver? Will there be other family members present at the birth? Are these family members comfortable with homebirth? Could they provide labor support and relief to the partner or midwife, or will they require support and encouragement themselves? It is possible to have too many people at a birth, but it is incredibly unusual to have an experienced doula at a homebirth and not find an important role for her to fill.
POSTPARTUM DOULAS
What are the benefits of hiring a postpartum doula?
In times when families lived together or nearby, a new mom’s mother or mother-in-law often spent weeks caring for the new family. This allowed the new mom to adjust gradually to her new responsibilities, while still eating well and having her home lovingly tended. Now, in an age where many people live far from immediate family and new grandparents often work full time, there is a great need for postpartum care. New families can find that care in a professional postpartum doula.
Postpartum doula service is wonderful for all new families. Families might find themselves really considering services, especially if they are expecting multiples, have little family in the area, have had a difficult pregnancy, or if they’ll be having a Cesarean birth. All new mothers deserve the additional care provided by a postpartum doula.
What services does a postpartum doula typically offer and what does it typically cost?
A postpartum doula’s “tangible” services include one or more prenatal meetings and hourly service based on the schedule you request. The doula can perform any of a number of household jobs including: preparing meals, doing laundry, tidying the house, washing the dishes, entertaining and caring for siblings, grocery shopping and running errands and much more. Postpartum doulas are also trained to troubleshoot problems with breastfeeding. Doulas are experienced in recognizing things that are “out of the ordinary” in the postpartum period and recommending consultation with a midwife or physician, if necessary. Many moms find that the encouragement offered by a postpartum doula helps them recover faster and become a more confident mother.
Most postpartum doulas charge an hourly rate for services. They may come to the home for a four or six hour shift, for example. They may offer a discounted rate if the couple purchases a package, such as twenty hours of service in one week. If the expectant couple has family and friends who want to give a gift to the new family, postpartum services make a great gift. Ask your doula about “registering” for postpartum services.
What is the process involved in hiring a postpartum doula?
Most local doulas offer a complimentary first consultation. This is a time where the expectant couple can meet the doula, either at home or a public location. This is an opportunity to ask questions about doula services in general, and about the doula’s particular style and experience. This is a good time to see if the birthing family and the doula are a good match. It is a great idea to interview more than one doula. This allows families to choose the one with whom they feel most comfortable.
Upon hiring a doula, most will ask for a deposit and/or sign a contract stating and agreeing upon the services the doula does and does not offer. These things help ensure that the doula knows she has been hired and can hold space open in her schedule to attend the birth.
What is the difference between a postpartum doula and a baby nurse?
A baby nurse is hired to care for the baby. Her number one priority is to meet the baby’s needs herself and free mom up to meet her own needs. A postpartum doula is hired to care for mom and baby as a unit. Her number one priority is to meet mom’s needs so that she, in turn, can care for baby. As mom becomes more confident in her instincts to care for the baby, she is able to take over more of the household responsibilities from the doula. The doula works to help mom become more independent each day. Many postpartum doulas joke that their goal is to “work themselves out of a job”!
Where should I begin if I am interested in becoming a doula?
You can read more about the training to become a doula on the DONA International website at www.dona.org. The Doula Network of Fort Wayne offers support for local women who are interested in becoming a labor support or postpartum doula. Contact the DNFW at fortwaynedoula@gmail.com.
*Klaus M. H, Kennell J. H, Robertson S. S, Sosa R. Effects of social support during parturition on maternal and infant morbidity. British Medical Journal. 1986;293:585–587.
