What is a Doula?

Doulas, or birthing coaches, provide physical and emotional support to women and their partners before, during and immediately after birth. Their popularity is skyrocketing, but is a doula right for you?

As Nolee Olson and Jack Bogdanski prepared for the birth of their first child, they envisioned the moment after delivery when their seconds-old newborn would be brought to Nolee’s breast. But when baby Ella arrived after an intense late-stage labor and rapid delivery, things didn’t go exactly as the couple anticipated. No sooner had they laid eyes on their healthy eight-pound baby girl than she was whisked aside by hospital staff for a puff of oxygen and suctioning necessitated by her quick trip through the birth canal.

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In that brief but unnerving moment, both husband and wife found reassurance in a familiar face, which remained calm with the confidence that comes with trust in birth. That face belonged to their doula, a professional labor assistant, who the couple hired to serve as their “rock” in the uncharted seas of childbirth.

“It’s going to be alright,” said Oceana Seer, who has spent the last five years attending births as a labor doula.

Doula Way

The word is out among new and expectant parents: Doulas make a difference. Currently, only 5 percent of U.S. women have doula-assisted births, but they’re growing in popular as more doulas (pronounced Doo-lahs) become trained and they’re increasingly recommended by childbirth preparation books and groups.

The word “doulah,” Greek in origin, has come to mean “birth assistant” or “labor coach”. They should not be confused with a midwife who provides medical care. (See “Nurse/Midwives: A Safer Alternative?” for more information.)

Instead, labor or birth doulas provide physical, emotional and informational support to women and their partners before, during and immediately after birth. A doula’s continuous reassurance combined with comfort measures such as massage and advice on labor enhancing techniques can decrease pain and anxiety for the laboring mother. Several studies indicate that a doula’s presence can contribute to shorter labors, fewer complications, reduced rates of Cesarean sections and fewer requests for pain medication.

The ultimate goal of the labor doula is to help each woman have a fulfilling childbirth experience on her own terms, says Carmen Bornn-Gilman, a California-based doula who offers advanced doula training. That holds true whether the woman is striving for a natural childbirth or planning to get an epidural, Bornn-Gilman says. “What I want is for her to have a sense of satisfaction. Mommy’s the boss.”

The Rise of Doulas

Doulas from coast to coast report brisk business and increasing awareness about their services. “You pick up an average pregnancy book and it has a section about professional labor support,” says Bonnie Hannibal, a doula and doctoral student researching women’s choices about labor and birth. “It’s making it into the mainstream birth community.”

It was an article in their local newspaper that sparked Olson’s and Bogdanski’s interest in doulas. “It really intrigued us because (hiring a doula) would not only be a support for me, but it would be a support for Jack — somebody who would be there strictly for us,” recalls Nolee, 37.

Jack, a 46-year-old law professor, saw the doula as someone who could remain “levelheaded” and serve as a liaison to the medical staff at the hospital if necessary.

Successful labor doulas are allies in the delivery room and may even get referrals from the doctors, midwives and nurses they encounter. Doulas do not perform any clinical duties, nor is it their place to make any judgment calls. They help clients make their own decisions by getting them the information they need in terms they can understand.

“It’s like taking the teacher of the birthing class with you to the hospital,” Jack says.

Just as they cannot replace medical staff, doulas do not take the place of the husband or partner. “The mother is having the physical experience of having the baby, but the partner is actually having the baby too,” Seer says. “They have this sacred relationship. My role is to support the two of them.”

Nolee first came to know Seer as her prenatal massage therapist. An interview convinced the couple that she would be the right choice as a labor doula and their partnership was born. “She was very good about asking what we wanted her to do,” Nolee recalls.

A labor doula’s services typically include a couple of meetings before the due date to prepare for the birth and establish a relationship with the woman and her partner. As the due date approaches, the doula is on-call for her clients. She arrives during labor and stays with the woman until after the birth. Once mother and baby are settled in at home, usually a couple weeks after the birth, the doula meets with the family once more to process the whole experience.

A family may also consider hiring a postpartum doula, whose services are different than those of a labor doula. Postpartum doulas specialize in caring for new mothers and babies with services that include breastfeeding support, cooking, childcare, errands and light house cleaning.

Paying for a Doula

Most labor doulas charge a flat fee, which can range from $250 for an apprentice up to $1,500 for an experienced doula in a big city. Many base their rates on a sliding scale according to the client’s ability to pay.

As doulas have entered the mainstream, insurance companies have started to take notice, according to Kristi Ridd, DONA’s administrative director. “Third party reimbursement is happening sporadically throughout the country, and we’re seeing it happen more and more,” Ridd says. However, the majority of doulas are paid directly by their clients, not by insurance companies.

For Nolee and Jack, paying for a doula out of their own pockets proved to be well worth the expense. “It was not just a luxury add-on item,” Jack says. “It was central.”

When the big day arrived, Nolee and Jack spent an uneventful early labor at home together. But by the time they reached the hospital and Seer joined them, things had taken a turn. Excruciating back labor set in.

As Nolee reached the transition stage and contractions started coming one on top of another, the women began chanting together, vocalizing the arrival and departure of each contraction. Nolee recalls Seer’s presence at that time as being “almost hypnotic … a real woman energy.”

“It was very different than the energy from a doctor in a hospital,” Jack adds, noting, “There’s a place for both.”

Seer attributes her calming influence to a philosophy of childbirth that is shared in her sisterhood of doulas. “To believe that birth is a natural process and that women can do this really helps people to relax."

Not sold on a doula? See what a nurse-midwife has to offer.

-Kirsten Lucas Kaufman