Written by Lauren Spencer, Doula
Lauren Spencer is a childbirth educator and labor support doula. She is the founder of Beloved Births KC LLC, a small business in Kansas City, Missouri, USA.
Finding out you are pregnant brings up so many emotions. Usually, feelings of excitement, happiness, or shock come first, and then at some point, they overwhelm. You want to do everything “right” and have so many decisions to make. Maybe you have heard of doula care but aren’t sure if it’s necessary or worth it or what it entails. Are doulas more for “crunchy” or “natural” mothers or for all types of birth? Is a doula right for you? Keep reading to find out what doula care is (and isn’t) all about.
What is a doula?
The word doula comes from the ancient Greek doule, meaning "maid servant" or "woman slave" trained to assist in childbirth. Today, the term has evolved to encompass various types of doulas, including postpartum, bereavement, antepartum, full-spectrum, end-of-life, sibling, and birth doulas. While their roles differ, the common thread is unwavering support and service. This article focuses on birth doulas, trained professionals who walk alongside families through conception, pregnancy, labor, birth, and the immediate postpartum period.
What does a doula do?
Many birth doulas are also childbirth educators who provide research, tools, recommendations, and information and answer questions that arise throughout pregnancy and birth. Research shows that doulas reduce the chance of Cesarean Sections by 39% (Dekker, 2017).
A doula will have prenatal appointments where they will mentally and physically prepare the mother for birth. Practicing Spinning Babies techniques such as the Forward Leaning Inversion or Side Lying Release is common during a prenatal. Creating and walking through your birth plan with you will also be an important part of a prenatal visit.
During labor, a birth doula will support the laboring mother with in-person, hands-on support. This often involves pain management techniques, counter pressure, labor positions, optimal fetal positioning, hydrating, nourishing, and advocating for birth choices. Birth doulas often bring tools to enhance the birth environment. Candles, string lights, affirmations, a diffuser, essential oils, and music all help curate a calm and safe birth environment. Birth doulas also bring tools for pain management such as hot and cold packs, massage oil, electrolytes, or a rebozo scarf.
The amount of time spent in person varies depending on the doula and birth circumstances. Generally, a doula is there to support initial feeding and postpartum recovery within the first few golden hours.
After the new family is settled, most birth doulas attend an in-person postpartum visit. During these visits, the doula will check in on how the family is coping emotionally and physically and offer support where needed. Doulas are experts at recognizing the need to refer for further support such as seeing an IBCLC, pelvic floor therapist, postpartum or sibling doula, chiropractor, or a perinatal mental health professional.
Your place of birth is important
One factor that needs consideration when exploring doula care is your place of birth. Your provider and your place of birth have a great deal of influence on your birth experience. Knowing the culture and climate will determine the amount of support and advocacy you will need if your birth preferences are not aligned with their beliefs and common practices. For example, if you want a low intervention, unmedicated birth, you may not want to choose a provider with high Cesarean Section rates or a hospital that frequently pushes induction.
However, not everyone has the flexibility to choose their place of birth due to factors such as insurance, proximity, and/or availability. That makes hiring a doula a great option to help bridge the gap in any misalignment. A doula can help your voice be heard, advocate for you, educate you on your options, and have another set of eyes on the practices and procedures happening in your birth experience. However, some hospitals have policies and boundaries about what they allow doulas to do in terms of advocacy. Make sure to discuss your doula’s role with both your provider and doula ahead of time.
What if I have other support people?
Determining how much support you will need and how much support is already in place will help you determine if you need to add doula care. This is not a one-size-fits-all approach, and answers will vary for everyone. Here are some guiding questions to help you assess your birth support team.
Is this your first pregnancy?
First-time parents have not yet navigated the beauty and challenges of labor and childbirth. It is hard to predict how you will react to the emotional toll, your ability to problem-solve as situations arise, and how you will handle the physical and visual experience of birth. Many first-time parents do not know what to expect in terms of how they will cope with pain and exhaustion during labor. Having an experienced doula for physical and emotional support, encouragement, and reassurance can make all the difference. Additionally, many first-time parents have not yet experienced the medical system in birth. They do not know what they can and cannot say no to or what options they have if they are not all being presented by the provider. An experienced doula will use informed decision-making and education to ensure first first-time parents are not being taken advantage of by the medical system.
Consider personality and preferences
Do you like to be coddled and cared for with compassion or given space with clear and concise communication? Do you prefer lots of hands-on support such as massage, relaxation techniques, and counter pressure, or want an energizing pep talk and pump up? Once you determine your style, make sure your birth partner is able and comfortable to provide that for you. For example, if your birth partner is not great at soothing and giving physical touch but you know that would be helpful, a doula would be a great option.
Protecting your head space
For some families, birth is an exciting event attended by many. Will you have a waiting room full of excited aunts, uncles, cousins, and mother-in-laws? Will your sister or mother be present? While this type of family support is touching, it can interrupt your focus and ability to progress in labor. Your body needs to feel safe and your flow of oxytocin uninterrupted. Having a doula as a neutral party and consistent support can maintain this. A doula can communicate with the family, act as a boundary, or keep people out of the birth space to relieve you from that stress.
Is a doula worth the cost?
After considering the factors discussed above, only you can truly determine the answer to this question. However, there are several options you can explore. Many doulas vary in price depending on experience level, proximity, and package options. If you're experienced with childbirth and confident in your journey but could use extra hands-on support for an unmedicated birth, a newer doula at a lower price might be a great option. If you are high risk or have a provider misaligned with your birth preferences, you may consider paying more for a seasoned doula who is ready to advocate.
Assess and prioritize your budget
Make a list of resources and priorities that you will need for your birth and total any out-of-pocket costs. Will you also need to pay for chiropractic, pelvic floor therapy, a home birth midwife, or lactation services? Will your insurance cover any doula care? Can you apply for reimbursement for any of those services? If you find that doula care is high on your priority list, there are many ways to pay for doula care. Put doula care on your baby registry or use your Health Savings Plan or Flexible Spending Account to pay for services. Many doulas have payment plans and accept some insurances, so make sure you ask these questions if needed as you interview doulas.
How do I find the right fit?
You are at your most vulnerable when in labor. You need to trust and feel loved, supported, and safe during your pregnancy and birth. If your doula does not do that for you, you are not a good match! Set up a consultation before hiring a doula to get a feel for their personality and style of support. Bring a list of questions to make sure you cover everything you need to consider. Seeking a doula with a common belief system that will support you spiritually or that you have a lot in common with usually creates better alignment. Do you need a doula who has a calming, soft voice? Do you need a doula with a specific experience level such as vaginal birth after Cesarean (VBAC)? Consider if they have a backup and availability around your due date. The conversation should naturally flow and excite you if it is a good match. Interview several doulas if you need to and find that perfect fit for you and your family.
Be proactive
Remember that this is your birth experience. Sit and imagine what you would like your ideal birth experience to be like, and then take steps to make that a reality. A doula provides continuity and support throughout your entire journey as you plan and prepare for your birth. A good doula books up quickly, so don’t hesitate to search for one and secure your spot early in your pregnancy!
Read more from Lauren Spencer
Lauren Spencer, Doula
As a teacher and a mom of a toddler, Lauren Spencer is passionate about educating and guiding families through pre-conception, pregnancy, birth, and postpartum healing. Although she supports all types of births, she specializes in pain management and preparation for unmedicated, low intervention birth. She is certified in guiding families through Vaginal Birth After Cesearean (VBAC), supports breastfeeding, and focuses on educating and empowering parents as they grow their families.
