“If a doula were a drug, it would be unethical not to use it.”

John Kennel

Doula (pronounced doo-lah) is a Greek word meaning “women’s servant.” A labor or birth doula is a formally or informally trained support individual who provides a range of support to those who are pregnant, birthing, and postpartum and focuses on them with continuous one-on-one attention during labor.

Doulas have been around in one form or another since the dawn of humankind (even some non-human mammal species have been observed laboring with “birth attendants”). This article adeptly details the history of birth attendant work.

Some birth/labor doulas may choose to refer to themselves as a labor companion, labor support specialist, birth professional, birth/labor assistants, birth coach, birth consultant, or birth keeper.

What I Do Before Birth

• share resources & information pertaining to you
• help you formulate your unique Birth Plan
• assist with questions you may not feel comfortable immediately asking your care provider
• make referrals to local pregnancy-related resources as needed
• connect personally with you as a comrade through this journey
• visit with you during a scheduled prenatal meeting
• remain on-call 24/7 from 38 weeks of pregnancy onward

What I Do During Birth

Physical Support

• provide comfort with pain-management techniques of your preference (massage, counter-pressure, etc)
• assist with water therapy
• apply hot/cold sensations
• ensure you are nourished by giving food & drink
• maintain the birth environment
• birth pool set-up/clean up
• suggestions for physical support, in case of virtual services

Emotional Support

• reassurance
• praise
• company
• encouragement
• mirroring
• help you keep perspective
• …and work through fears & doubts

Informational Support

• give early labor support via phone (or throughout, in case of virtual services)
• give reminders to eat & use the bathroom
• time contractions if desired
• explain medical procedures & options (not medical advice)
• suggest beneficial laboring positions (important even with an epidural)
• …movement ideas
• …breathing & relaxation

Partner Support

• assist partner by giving them a break without leaving you unsupported
• help partner interpret labor progress
• take non-professional photos as situation allows

Advocacy

• support without judgment
• hold space; your agenda is my agenda!
• facilitate communication between parents & birth team
• amplify your voice if it isn’t being fairly recognized
• empower you to ask questions & verbalize your position
• serve as a witness, providing peace of mind
• stay aware of intended procedures so parents have opportunity to give informed consent
• provide a record of events during labor

What I Do After Birth

• assist with beginning breastfeeding, if needed
• help explain birth place procedures
• help you get settled in your recovery room, if at the hospital
• visit with you during a scheduled postpartum meeting
• debrief the birth experience with empathy
• discuss risk factors and/or any concerning symptoms of postpartum mood disorders (100% shame-free; I’ve been there myself)

What I Do NOT Do

• perform clinical tasks (vaginal exams, fetal heart monitoring, etc.)
• give medical advice or make diagnoses/prescriptions
• make decisions for you
• speak to birth staff on your behalf
• impose personal preferences upon you
• usurp the role of your partner (if applicable)
• attend intentional free-birth (planned unassisted)
• predict or guarantee any aspects of your birth
• bear responsibility for your birth’s outcome
• drive you (client) to the birth location
• catch your baby
• in case of virtual services, I do not physically meet you in labor at any point

As a doula, I do not provide medical care and cannot take the place of a midwife, obstetrician, or other clinical worker at a birth. However, I’m knowledgeable about an expansive number of medical aspects that may arise in childbirth, giving you a better shot at making informed decisions.

What The Stats Say

Partner’s Role in Birth

“My husband (partner) is my left hand and my doula is my right.”

Doulas Making a Difference

“In one landmark study that evaluated the effects of doulas and fathers working together, researchers found that combining a supportive partner and a doula significantly lowered the mother’s risk of Cesarean compared to just having a supportive partner alone. In 2008, McGrath and Kennell randomly assigned 420 first-time mothers to have routine care (including a supportive partner) or care that also included a professional doula whom they met for the first time during labor. […]

The results showed a substantial improvement in outcomes for women who had both a birth partner and a doula, compared to having a birth partner alone. The Cesarean rate for these first-time mothers was 25% in the group with a partner only, and 13.4% in the group with a partner and doula.” – Evidence Based Birth

References

• “A grounded theory study of effective labor support by birth doulas.” In Human Development and Family Studies, Vol. Doctorate University of Wisconsin, Madison, Wisconsin, pp. 452. Gilliland, A. L. (2010a).
• “A randomized controlled trial of continuous labor support for middle-class couples: effect on cesarean delivery rates.” McGrath and Kennell. Birth. 2008 Jun;35(2):92-7.
• “Continuous emotional support during labor in a US hospital.” Kennell, Klaus et al. JAMA. 1991 May 1;265(17):2197-201.
• “Continuous support for women during childbirth.” Bohren, Hofmeyer et al. Cochrane Database Syst Rev. 2017 Jul 6;7:CD003766.
• “Impact of Doulas on Healthy Birth Outcomes.” Kenneth J. Gruber et al. J Perinat Educ. 2013 Winter; 22(1): 49–58.
• “Listening to mothers III pregnancy and birth: Report of the third national U.S. survey of women’s childbearing experiences.” New York: Childbirth Connection. Declercq, E. R., Sakala, C., Corry, M. P., et al. (2013).

Additional Resources

• Benefits of a Doula Present at Birth – American Association of Pediatrics Journal
• Doula Care and Breastfeeding Success – Journal of Obstetric, Gynecologic, & Neonatal Nursing (JOGNN)
• Evidence On: Doulas – Evidence Based Birth
• Having a Doula: Is a Doula For Me? – American Pregnancy Association