Do I need a Doula? FAQ

I am a doula, so obviously I believe that most people need a doula, or someone who performs the functions that I do, on their team. That is my statement of bias.

I am certified by two different organizations, however, this will include as many options available to you as I can find to list. If anyone has more numbers available, please feel free to contact me.

Enjoy!

Robin Elise Weiss, ICCE, CD(DONA), NACA, BCCE
Pregnancy/Childbirth
pregnancy.guide@miningco.com

Contents

What is a doula?

The term doula is Greek for slave or servant. Doulas provide emotional and physical support during pregnancy, labor, birth and postpartum. (NOTE: In some areas, the term doula only refers to postpartum help, in this FAQ I am dealing only with Labor support.). They call themselves many things including: Childbirth Assistant, Labor Support Professional, Birth Assistant, Birth Companion, etc.

A doula does not speak for a couple, provide medical or clinical skills (See Question #2 on Monitrices.), or act in any unprofessional manner (Most organizations have Policies that each doula must follow.).

A doula provides:

explanations of medical procedures
emotional support
advice during pregnancy
exercise and physical suggestions to make pregnancy more comfortable
help with preparation of a birth plan
massage and other non-pharmacological pain relief measures
positioning suggestions during labor and birth
helps support the partner so that they can love and encourage the laboring woman
avoid unnecessary interventions
help with breastfeeding preparation and beginnings,
written record of the birth
many other possibilities that vary from doula to doula

What is a monitrice? And how does she differ from the doula?

A monitrice is sometimes a nurse or a midwife, or someone who is professionally trained to provide clinical skills to a couple (fetal heart tones, blood pressure checks, and vaginal exams).

There is some debate over monitrice versus doula. This basically states that the careprovider (CNM, OB, or DEM) should be providing the clinical skills freeing the doula or monitrice to provide the emotional support that the client needs.

What does a doula cost?

This also varies from area to area and doula to doula. Some of this is based on the experience your doula has, some is based on the going rate in your area. the basic range would be from $200-$800. However, most doulas will barter, set up a sliding scale, or payment plans to help those who can't afford a doula. So, do not let this keep you from hiring a doula.

Where can I find a doula?

I am going to give basic suggestions and then list the organizations that I am aware of.

Places you can try to find a doula: organizations dealing with childbirth, your birth place (hospital or birth center), your childbirth educator, your care provider, lactation consultants, La Leche members, anyone who has recently had a baby or works in the field.

Doulas of North America (DONA)

1-206-324-5440 will put you in contact with members in your area.

AskDONA@aol.com is the e-mail address.

snail mail address:

DONA
1100-23rd Ave. East
Seattle, WA 98112

ALACE

ALACEHQ@aol.com for e-mail

snail mail address:

ALACE
PO Box 382724
Cambridge, MA 02074
(617)441-2500
FAX: (617)441-3167

National Association of Childbirth Assistants (NACA)

snail mail address:

NACA
219 Meridian Ave.
San Jose, CA 95167
(408)225-9167

The Bradley Method®

1-800-4-A-BIRTH

What can a doula do for me?

According to Mothering the Mother, How a Doula Can Help You Have a Shorter, Easier and Healthier Birth, by Kennell, Klaus, and Kennell (1993), having a doula can give you a:

50% reduction in cesarean rates
25% shorter labor
60% reduction in epidural requests
40% reduction in oxytocin (pitocin) use
30% reduction in analgesia use
40% reduction in forceps delivery

Books to Read

The Birth Partner by Penny Simkin, PT, CD(DONA)
The Birth Book by Dr. William and Martha Sears, RN IBCLC
Special Women, Polly Perez
Mothering the Mother: How a Doula Can Help You Have a Shorter, Easier & Healthier Birth by John H. Kennell , Phyllis H. Klaus , Marshall H. Klaus
"The Whole Nine Months," Parenting, Gayle Pryor, May 1992, p34.
Active Birth by Janet Balaskas
Good Birth, Safe Birth by Diana Korte and Roberta Scaer
Natural Childbirth the Bradley Way by Susan McCuthcheon
Silent Knife: Cesarean Prevention & VBAC by Nancy Wainer Cohen & Lois Estner
Open Season: A Survival Guide for Natural Birth and VBAC in the 90's by Nancy Wainer Cohen
Obstetric Myths Versus Research Realities by Henci Goer
Natural Birth After Cesarean: A Practical Guide by Johanne C. Walters , Karis Crawford
Easing Labor Pain by Adrienne Lieberman
Rebounding From Childbirth: Towards Emotional Recovery by Lynn Madsen

Questions to ask a prospective doula.

Is she certified?
Does she provide prenatal and/or postpartum visits?
What can you expect during these visits, if offered?
How many births has she attended?
Can she provide references?
What form of training has she had?
What types of births has she witnessed (Cesarean, epidural, intervention free, VBAC, teen birth, etc.)?
Her fee? And does she have a sliding scale or other arrangements available?
Has she ever worked with your care provider or at your place of birth?
Does she has back-up arrangements available?
What will her role be in early labor?
Will she provide labor support at your home prior to going to the place of birth?
Is she familiar with many methods of childbirth?
How does she define her role during labor and birth?

The bottom line is do you and your partner like her.

Personal Stories and Advice from Doulas, Parents and Care Providers

From: CNMPAT@aol.com:

The best way for doulas to work with providers (at least me and the other midwives I know), is to attend a visit with the client to meet the provider. This provides a way to ask questions of the provider. Granted, physicians might not like this, but it is worth a shot, especially if the doula and client are not confrontational.

From: Sheri Payne

My husband was against it at first. My reasoning which finally got him to agree was that I had never been through a birth before ( although I had witnessed my friend's home birth) and he had never been through one even though he's been trained, so let's have someone with experience on our side. April's right, the nurses leave you alone most of the time. It was nice to have someone nearby who was sympathetic and who could tell me if what I was experiencing was normal. Since we were trying to go as natural as possible, I liked having her around to tell me what she thought about the doctor's suggestions. I'm sure the nurses would have rather given me an epidural than sit through the tough contractions, helping me to work through it. My husband was a great help, but when things got very scary near the end and I was in a lot of pain, he fount it very comforting that Paula (doula) was there to help him, too. Even the toughest of men come apart when their wives are in pain.

From: Rachel :

I had two doulas during labor (not planned that way, the back-up doula came : first, and then decided not to leave when my primary doula arrived.) It was : wonderful. They waited on me, brought me drinks, massaged my back, gave me encouragement, etc. It was even OK with me that my husband took a half-hour : cat-nap in the middle of it all, so he was more able to assist when it came : time to push. They also helped clean up the mess afterward (this was a home : birth), which was very nice.

From: Jiandra@aol.com
Why Use a Doula?

In order to have a positive birth experience, most women need continuous labor support. Although Obstetrical Nurses are experienced in dealing with a laboring woman's emotional and physical needs, they can seldom guarantee the support they provide will last throughout the labor - especially in hospital settings where shift changes, coffee breaks, heavy paperwork and busy nights regularly occur. Some OB nurses handle up to six laboring couples at a time. Midwives may be able to offer more labor support, but they too have clinical duties to which they must attend.

Fathers...

The father or partner, may be better able to provide continuous support but has little actual experience in dealing with the forces of labor. Even fathers who have had intensive preparation are often surprised at the amount of work involved (more than enough for two people). Even more important, many fathers experience the birth as an emotional journey of their own and find it hard to be objective in such a situation.

Will the Doula replace the father?

Some fathers or partners are concerned they may be sidelined or replaced by the Doula during labor. Although individual situations vary, and one should question a prospective doula about her philosophy, generally the answer to this question is no - she will not replace him. Studies have shown that fathers usually participate more actively during labor in the presence of a Doula than without one. A responsible Doula supports and encourages the father and enhances his support style rather than replaces him.

From: Linda

I have been to six births thus far, and I love it as much as I thought I would. It's very hard, emotionally taxing work, but it's so satisfying. I still feel a little unsure because I'm so new, but as my wise boss told me, "When I think about the people who trusted me with their births 20 years ago, I shudder. But the bottom line is, they didn't care about how many "tricks" I knew, all they cared about was that I was there for them and I cared."

From: Kate Hallberg

We met our 'doula in training' or childbirth assistant at our childbirth education class- a lot like Bradley but not really. The two women teaching the class also were childbirth assistants. My husband was initially more interested in the idea than I was, but I had no objections. Leigh met with us on and off before I went into labor and was on call for when I did. She also went to one or two of our obstetrician appointments as well as a hospital tour where we were to give birth. Before the birth she discussed herbal method of inducing labor- See Susan Weed's "Herbal for the Childbearing Year". She also listened when I needed to complain as the due date came and went.

The morning I went into labor she came over and hung out with me for a long time. I had been monitoring my blood pressure as I was borderline toxemic and it was Leigh who noticed I was 'pitting' which is a sign of toxemia after I had been in labor for 12 hours without a whole lot of progress. She also had a fetoscope and was monitoring my daughter and showed my friend and husband how to do it. We ended up going to the hospital Monday night and discovering that I had low fluid volume and my daughter was having heart rate decelerations with every contraction. That's when the fun began. I took black and blue cohosh tinctures all night- administered by Leigh to try and get some progress and avoid pitocin. Leigh was helpful the next day in providing encouragement and suggesting to my husband and my friend what I would like in terms of support. (None of us other than Leigh had been to a birth before.)

After laboring all day Monday and Tuesday I was finally fully dilated Wednesday morning. In the meantime I had an IV painkiller at 30 hours and two walking epidurals following that. Leigh helped the rest of the team support me physically during contractions and finally during pushing. At 57 hours of labor we concluded that Ursula wasn't coming out and we decided to do a c-section. Leigh and my husband were in surgery and then was there to provide a little breastfeeding support and take pictures after the birth. For a week or two afterwards she came over and helped a little and checked on our breastfeeding progress.

I've written this with the doula in the starring role- but what was really more important was the presence of my husband and friend. The doula helps.

From: Sabrina Cuddy

She was wonderful - gave great backrubs in just the right place, helped me get comfortable, made great suggestions, came in when I needed a c-section and made sure we got what we needed to bond, went to the nursery with the baby for a short battery of routine stuff...
Q. If you did it, would you do it again?
A. Yes!!!!

From: Trish Jalbert
We met with our new doula, and she is fabulous! She's as if we made her to order.

From: Anonymous
My doula really helped me through the rough spots. She gave me the encouragement I needed. I have never felt so empowered. My partner was thrilled that she kept explaining everything to him. I liked the way she pulled him into the birth rather than exclude him as he originally thought.