What Is A Doula?
Not only will I answer what a doula is, but I’ll also dive into specific doula niches that you most likely never knew existed.
First, let’s talk about what doulas do NOT do:
Doulas do not give medical advice or replace the partner or caregiver. A doula does not diagnose medical conditions, perform clinical procedures, administer medication, interpret clinical results, prescribe medication, prescribe alternative therapies, or make medical decisions for the patient. In some cases, a doula may also have training as a nurse or other healthcare professional. In these cases, the doula should present their healthcare services as separate from their services as a doula.
Outside of that, they do so much.
Doula Definition And Meaning:
The word “doula” comes from ancient Greek, meaning “a woman who serves.” Quite literally, a doula hired for your birth is there to serve you, the mother, and support you and your family in any way she can.
What Is A Doula?
Doulas supplement (not replace) medical support and having one can provide the following:
- reduce the overall Cesarean birth rate by 50%
- reduce the length of labor by 25%
- reduce Pitocin use by 40%
- reduce the need for forceps delivery 40
- reduce requests for epidural pain relief by 60%
- A decrease in the length of labor
- A decrease in negative childbirth experiences
A doula can help you and the dad-to-be have a positive and safe birth experience:
- During labor, a doula can take over coaching now and then to give the dad a break.
- When desired, a doula can completely free the dad-to-be from coaching tasks — they can enjoy the process and focus on supporting you emotionally.
A doula provides support to a pregnant woman before, during, and after pregnancy, and offers physical and emotional support to the pregnant woman and her family. While doulas are not primary caregivers, many pregnant women rely on doulas throughout the pregnancy period to help them sort through their choices to make their own informed decisions.
According to the Doulas of North America (DONA), a doula is, “a trained professional who provides continuous physical, emotional and informational support to a mother before, during and shortly after childbirth to help her achieve the healthiest, most satisfying experience possible.”
Doulas have become more popular in the United States since about the 1980s. Pregnant women brought female friends or childbirth instructors for support during labor and to advocate to help them avoid cesarean births, which were on the rise. Since that time, the role of a doula has broadened to provide support throughout pregnancy.
Many pregnant women engage a doula to provide the support that they do not receive from their doctors and nurses. Doctors and nurses may be busy taking care of a number of other patients, updating charts, and monitoring patients. This leaves many pregnant patients without someone to provide emotional, spiritual, or physical support.
Doulas understand pregnancy and childbirth as a normal part of life, not a pathological condition requiring treatment like a disease. Doulas often focus on supporting the natural birth process and advocating for the mother in a hospital environment, although many doulas are comfortable in a hospital setting and even in the event of a cesarean.
Doula Vs Midwife
It is important to understand that a doula is not the same as a midwife. There is one significant difference between a midwife and a doula. Midwives provide medical care for you during pregnancy, birth, and the immediate postpartum period. Doulas provide you and your family with emotional, informational, and physical support during pregnancy, birth, and the immediate postpartum period.
A midwife is a health care provider, while a doula is more of a coach. You might choose to have a midwife instead of an OB for prenatal care and to deliver your baby — midwives can deliver babies in hospitals, birthing centers, or even in your home.
A certified nurse midwife (CNM) requires formal education, nursing licensure, and training. Midwife programs must be accredited by the Accreditation Commission for Midwifery Education (ACME). In order to practice as a midwife, individuals must pass the American Midwifery Certification Board (AMCB) exam. Direct-entry midwives are trained in midwifery only and typically attend home births.
How To Become A Doula; Doula Training And Certification
If you’re wondering how to become a doula, there are so many organizations that offer training and certification for doulas, it can feel overwhelming. Organizations with higher-level certifications include DONA International, Childbirth and Postpartum Professional Association (CAPPA), and International Doula Institute. There are many, many other organizations that offer training. My caution to you is that although they may seem appealing in cost, they may not properly equip you with the amount of knowledge you need to be a skilled and competent doula.
Certification usually takes several months, is fairly intense, and generally requires a multi-day workshop, assigned reading, attendance and assistance at a number of births, a personal statement, and recommendations. Training includes learning about the birth process, possible medical issues, ways to offer support to mothers during labor, and advocating for the mother in the hospital.
According to DONA, there are seven primary roles of a doula:
- To recognize birth as a key life experience that the mother will remember all of her life;
- To understand the physiology of birth and the emotional needs of a woman in labor;
- To assist the woman and her partner in preparing for and carrying out their plan for the birth;
- To stay by the side of the laboring woman throughout the entire labor;
- To provide emotional support, physical comfort measures, an objective viewpoint, and assistance to the woman in getting the information she needs to make good decisions;
- To facilitate communication between the laboring woman, her partner, and clinical care providers; and
- To perceive the doula’s role as one who nurtures and protects the woman’s memory of her birth experience.
Due to the fact that there is no regulating body for doulas, and no universally-accepted competencies, some training can be less than ideal. It IS possible for you to be can be held liable for medical malpractice cases if there is a claim of negligence by the mother, so make sure you’re following all protocols, not overstepping your role, and gaining training through a credible source, as well as acquiring liability insurance.
State regulations vary, so another avenue to cover is if your state has guidelines, and to follow them. Many states, counties, etc.. have coops or committees that are inclusive to all doulas and I would encourage you to be involved in your community and with the other doulas in the area.
Are Doulas Covered By Insurance?
The short answer is — that depends on several things. In the state of Nevada where I live, I am able to accept Medicaid at a lower rate, and several people fought for us to be able to do that. As this is being written, the doulas who are Medicaid providers in the entire state need to share only 15 women annually that Medicaid will approve. This is something we’re working hard on, so many more low-income, marginalized, and minority women have access to doulas.
Due to the lack of coverage for these demographics, doulas in my area have more Diversity, Equity, and Inclusion for Birth Workers training to help us to bridge the gap, and fully understand the challenges economy and ethnicity can create.
Other insurance companies MAY accept doulas and reimburse you for at least part of the amount you are charged. I have paperwork for my clients to submit my services to their insurance company in the hopes that they are reimbursed even in part. I’m paid by the client and do my part in helping them with this reimbursement.
Types Of Doulas:
There are several types of doulas and although this isn’t an exhaustive list, it should encompass most of the doulas out there. I elected to get additional training as a bereavement doula, and an adoption & surrogacy doula. In my experience, postpartum doulas are in pretty high demand, and not many women want to focus as much time and energy on that area. It means the doula is working nights and getting little sleep, so it’s important for them to take care of themselves.
- Birth Doula — most doula training is geared to help women who are pregnant. Services begin during pregnancy and extend to the first week or so after delivery
- Postpartum Doula — although this is covered in birth doula, it’s also separate for families who want to hire someone on a regular basis, including overnight to help transition with baby
- Fertility Doula — supports people on their pathway to pregnancy and parenthood
- Abortion Doula or Full Spectrum Doula — a support person who brings the doula model of care to any pregnancy discourse and outcome, including miscarriage, planned abortion or medical termination
- Bereavement Doula — A bereavement doula or a “loss doula” is a doula who walks with, supports, and helps families who are experiencing the loss of their baby. This generally does not include abortion, although counseling post-abortion is possible
- Adoption Doula — Specializing in newborn adoption support in conjunction with every member of the adoption team and lend their expertise to help ensure a smooth transition for the birth mother, the baby, and the adopting family
- Surrogacy Doula — Similar to an adoptions doula, working with a surrogate planned placement and the parents whose biological baby it is
- Antepartum Doula — Serves a mother who is experiencing a high-risk or difficult pregnancy.
- End of Life Doula or Death Doula — logistical planning for the time before, during, and after death; conducting rituals or comforting practices; helping the dying person reflect on their life and values; and explaining the bodily functions of dying to caregivers
The History Of Doulas:
The concept of having a companion providing support to the birthing woman dates back to prehistoric times, evidenced by archeological findings of stone carvings and statues and anthropological studies. The contemporary role of “doula” first emerged in the United States in the 1960s when women began desiring unmedicated, low-intervention births and began to have friends and others with formal or practical knowledge about childbirth provide them with support during pregnancy.
The term doula was first used in a 1969 anthropological study conducted by Dana Raphael, a protégée of Margaret Mead, with whom she co-founded the Human Lactation Center in Connecticut, in the 1970s. Raphael suggested it was a widespread practice that a female of the same species be part of childbirth, and in human societies, this was traditionally a role occupied by a family member or friend whose presence contributed to successful long-term breastfeeding.
Two physician-researchers, Marshall Klaus and John Kennell, who conducted clinical trials on the medical outcomes of doula-attended births, adopted the term to refer to a person providing labor support.
In 1992, Doulas of North America (later DONA International) was co-founded by Klaus, Kennell, Phyllis Klaus, Penny Simkin, and Annie Kennedy, becoming the first organization to train and certify doulas. The organization with the backing of the research of Klaus and Kennell helped lend credibility and professionalize doulas. Due to the lobbying efforts of DONA International, the term doula was accepted into the American Heritage Dictionary and Oxford Dictionary in 2003, followed by Merriam-Webster Dictionary in 2004.
In 2008, activists in New York City began the Doula Project, to expand the role of the doula to other reproductive experiences beyond birth.
Reach out to me if you have questions about becoming a doula! I’ll continue writing more on this topic, as this is hardly exhaustive. Let me know if you have questions or would like information on specific aspects of being a doula.