Should You Work With a Doula During Pregnancy?
Once there was a woman on a delivery table giving birth. On one side was her spouse. On the other was a doula, a birth expert and emotional supporter hired by the couple to guide them through pregnancy and childbirth, rubbing the woman's back to soothe her.
Then, all of a sudden, as the new mom was pushing, she threw up. Her partner looked up at the doula, round-eyed and horrified. He didn't know what to do—was something wrong? But the doula simply gave a smile and a big thumbs up. She kept rubbing the woman's back, and told her she was doing a great job.
That was a story told to Julia Raymond, a former doula and a mom who had doulas attend her two births. Just like that woman's partner, you might not have known that vomiting during labor is perfectly normal and fairly common, and even a sign of progress. That's where doulas come in.
"There is something to be said for someone who knows the lay of the land and can sort of be your guide," Raymond said.
When you're giving birth, or your partner is giving birth, it's hard to remember everything you learned in parenting class or read in how-to books. And it's impossible to predict what will happen during a birth.
"Each birth is so unique, each time is so different that having someone there is really valuable."
What is a doula?
Doulas are trained birth professionals that provide support not in the medical sphere—as a midwife would—but in the emotional realm.
The profession hearkens back to a time when women used to attend one another's births. Female relatives young and old used to help deliver children. Dominant U.S. culture has since shifted significantly.
"That's kind of always been around until it wasn't," Minnesota-based doula and writer Alisa Blackwood said. "And now we ask a lot out of... partners and care providers to fill that role."
A doula is hired to fill that role, meeting with a couple several times before the due date to get to know them and their needs and also to practice "comfort measures"—moves that can help the mom feel more comfortable during labor and delivery, Blackwood said.
During the birth, doulas can be found doing anything from working directly with the mom—helping her move into different positions, giving her positive reinforcement or guiding her in a meditation—to taking care of other tasks in the room, allowing the partner to focus fully on the birth.
"I've had births where I'm doing zero hands-on work," Raymond said. In that situation, the doula might be getting water for the partner or communicating with the doctor or midwife.
The couple "can be in their space and I can be flitting around and can protect the space that the two of them are having and the experience the two of them are having," she said.
A doula is also often the only professional providing continuous care during a birth, Blackwood pointed out. Doctors, midwives and nurses are often attending to many people at once. A doula does not leave the mother's side, providing a link between doctors and nurses who might have to care for other people or change shifts.
Once Blackwood is called to attend a birth—she keeps her birth bag in her car so she can hit the road at a moment's notice—she doesn't leave until the baby is born, no matter how long it takes.
"I've gotten to a birth before and 20 minutes later the baby's out, and I've had a birth where I could have had a long weekend in Mexico and my family wouldn't have known the difference," Blackwood said.
Should you hire a doula?
Both Blackwood and Raymond believe that having doula support is invaluable—and they've been on both sides of the situation. Even if a mother has been through a birth before and thinks she knows what to expect, it never hurts to have more support. After all, every birth experience is different.
"I suppose a doula could be particularly helpful if you or your partner feel intimidated by medical settings or if you feel anxious about the birth," Blackwood said. "A doula could go a long way toward helping you find calm and feeling empowered. Certainly if you're single or your partner can't attend the birth, doula care would be essential."
As What to Expect puts it, "your personality will ultimately decide if a doula is right for you."
One of the most common things that holds couples back from hiring a doula is that the partner worries a doula would replace them during the birth, Blackwood said. The parent giving birth might also assume her partner will provide all the support she needs.
"I think thats asking so much of the partner and I think having a doula frees up the couple to be closer," she said. "Having a doula there helps the partner fully experience the birth and helps the partner not worry about the mother as much. ...
I will say that 85 percent of (partners) will turn to me and say, 'Thank God you're here.' That's not (about) me personally, that's about them realizing how helpful it is to have support."
Blackwood said she tells potential clients to interview at least three doulas before choosing the one they'd feel most comfortable with. After all, the doula will be working with you in your home and will potentially be spending a lot of time with you once you go into labor.
Doulas for everyone
There is evidence to suggest that having a doula on your birth team when you deliver can help reduce risks that come with the territory, according to the American Pregnancy Association. Studies have shown working with a doula correlates with lower rates of C-section and medical intervention during birth.
However, hiring a doula can cost anywhere from $800 to $2,500, with an average cost of $1,200, according to What to Expect. Because of the benefits they can afford parents, there are organizations working to make doulas available to everyone, not just people who can afford to hire one.
In Blackwood's home state, the Minnesota Prison Doula Project provides birth doulas and parenting classes to incarcerated women. According to a BBC report on the program, two in three incarcerated women in the U.S. are mothers and as many as one in 10 are pregnant when they enter prison. The Minnesota Prison Doula Project supports these women in the Minnesota prison system and helps them stay connected to their children after they give birth.
In New York City, The Doula Project connects low-income families with free doulas throughout pregnancy and childbirth.
If you want to find out what resources are available to you in your area, do some research online. There are organizations across the country that want to help connect couples with doulas at lower costs or for free. There are also organizations that specialize in doulas for LGBTQ couples and HIV-positive mothers.
"There are a lot of people who are trying to make sure every birthing family has access to this kind of support," Blackwood said.
For more on the business of childbirth, catch the "Call the Midwife" holiday special Dec. 25. Check your local PBS station for broadcast dates and times or stream online at PBS.org.