What is a Doula and Do You Need One?

written by: Lo Mansfield, RN, MSN, CLC

Are you pregnant and asking yourself “what is a doula?” I’m not surprised! The term gets thrown around a lot, but sometimes we don’t fully understand who they are or what they can do. But – you are in the right place. I’m going to answer that ‘what is a doula‘ question for you. Because I think these birth professionals can be absolute game-changers in a birth experience. And, I think it is is disservice if families don’t know about them. Everyone deserves to know who they are and what they can do, and then you can decide if you’d like them to be a part of your birth experience.

What is a doula?

Let’s start with basics. Doulas are best classified as a “support person.” They are most often known as helpers for labor and birth, but there are doulas who also serve families postpartum too! In general, their support is emotional, mental, and physical, but it is not medical. They are incredible supporters of physiological birth, and often have many tricks to help with pain management, fetal positioning, and movement and mobility in labor, as well as healing and support after birth.

What’s the difference between a doula and a midwife?

This is a good question! And it’s what I meant when I said that doulas are “not medical.” For a long time, many people have confused doulas and midwives. But they are very different birth providers! Doulas are support people only. Not all of them are licensed and they do not require superivsion.

The “work” that a doula does may include conversations, physical touch, education, and help with making decisions. It does not include medical care (or clinical care). They are not licensed or trained to do things like diagnose, give medical advice, or perform any type of clinical procedure or assessment. Those things are the job of a midwife, a registered nurse, or a physician. These are the providers who do things like order or administer medications, check your cervix, or assess you and your baby’s heart rate and contraction pattern.

For more on what a midwife does, check out this piece. Midwives often get confused with doulas because their care model is so supportive. However, they are very different providers with more skills and medical freedoms that allow them to assess, advise, and care for you.

Should you get a doula?

Let’s go over some pros of hiring a doula. A doula’s care model focuses on physical support, emotional support, and educational or decision-making support, for both the laboring person and their partner. A 2017 Cochrane review related to doula support in labor states that:

“Continuous support during labour may improve outcomes for women and infants, including increased spontaneous vaginal birth, shorter duration of labour, and decreased caesarean birth, instrumental vaginal birth, use of any analgesia, use of regional analgesia, low five-minute Apgar score and negative feelings about childbirth experiences. We found no evidence of harms of continuous labour support.”

Did you catch all of that? The benefits of continuous labor support include:

  • decreased likelihood of cesarean section
  • decreased use of pitocin
  • decreased need for instrumental delivery
  • decreased use of pain medication
  • shorter labor duration
  • increased likelihood of vaginal delivery increased
  • decrease in low 5 minute Apgar scores
  • less maternal dissatisfaction with labor experience

I think it’s also important to note the value a doula can offer to the non-laboring partner. They can assist them in supportive techniques, coach them in ways to help, and step in to be supportive if or when the partner needs a break. Often, people wonder if their partner can be their doula. I really think the answer to that is “no.” An educated partner can be an absolutely incredible birth supporter, but often, the right doula offers a special type of support that just can’t be replicated by someone else.

What are the disadvantages of having a doula?

This is an important question to ask! Many see the benefits of a doula and automatically assume “yes, that’s for me.” But there are things about doulas that some families would consider cons, so you’ll want to think these through as well. Cons of hiring a doula may include:

  • Getting in the way of a partner feeling supportive and needed
  • The financial cost
  • Inexperience not leading to the benefit expected
  • Pressure to have an unmedicated birth
  • Having to have another person inside of your birth experience

Do doulas believe in epidurals?

As you dig into your ‘what is a doula’ question, you may come across the idea or assumption that doulas don’t like or support epidurals. While this could be true for some, it really shouldn’t be. A good doula is a non-judgmental supporter. They will be willing to take on all types of families with all types of birth plans, including those who’d like an epidural. They will also spend time with you prenatally learning your birth hopes and goals and then help you work towards those. And lastly, their work also includes the ability to recognize when or if you change your mind about anything, including epidurals.

Do you still need a birth plan? I’d love to have you use mine. Snag a copy of yours here.

When to get a doula?

I’d recommend you begin looking for a doula as soon as you know you want one. If you can start this process by 20 weeks or so, that’s great. Many doulas will spend some time with you and any birth partner prenatally, so it is really nice to get this time to get to know them. Another practical reason to find a doula earlier on is simply because they can only take a certain number of families on as clients. Those who are well-liked and respected usually fill up quickly with repeat families and word-of-mouth recommendations.

If you do decide to hire one later on, that really is okay too. I don’t think it is ever too late to make this choice. Just know your first choice may be full or you may have a bit less time to get to know who you end up with.

How do you choose a doula?

As you begin to search for a doula, I’d encourage you to pay attention to their licensure and training. Do some learning about your options and consider interviewing them! It’s important to understand that while many doulas (12,000 in over 56 countries!) are licensed by Doulas of North America (DONA), this is not required to call yourself a doula or to offer services to women and their families. If DONA licensure matters to you, then you will want to consider doulas who have done the work to receive that licensure. CAPPA and ToLabor certify birth doulas as well.

If you’d like to begin a doula search right now, here is the DONA search tool. Another great way to find a doula can be through social networking mom groups and word-of-mouth recommendations.

Questions to ask your doula

I really do think interviewing doula candidates is so important. Hopefully, you have the ability to choose between a few and find that best fit. Remember, doulas spend time with you in your home prenatally, they may labor with you at home, and they will be intimately involved in your birth process, wherever that occurs. As you interview them, really try to picture them being in your home and a part of your experience! Additionally, don’t forget to check-in with any birth partner and consider how they feel with the candidate.

Possible interview questions

  • How were you trained and are you licensed?
  • How many births have you attended?
  • Why are you a doula?
  • Do you attend births a home, centers, and hopsitals?
  • Will you meet with me prenatally? How often?
  • How does your pricing work?
  • Do you do postpartum doula work?
  • Do you offer a postpartum meeting to answer any L&D questions I may have?
  • Do you have a back up and/or work with others?
  • Would you be on call for me?
  • How many clients do you have around my due date?
  • Do you offer any other services (like placenta encapsulation)
  • Do you have any references and/or reviews?
  • Do you have a “style” of support? How would you describe it?

There are other questions you can ask, of course! But whatever you ask, remember that this is ultimately about fit with you. If you don’t enjoy their company in the interview, there’s a good chance you won’t during your birth either!

What does a doula cost?

On average, a birth doula usually costs between $500 – $2500. This is a big range, and there are definitely outliers on both sides of that. Usually, their prices depend on their location, availability, and level of experience. Some doulas also offer additional services, like photography or placental encapsulation, and that will change your costs as well.

Typically, these support people are not covered by insurance, so whatever you pay for their help will come out of your own pocket. If you have an HSA or FSA fund, I would encourage you to see if those funds can be spent on this service.

Free doulas?

Guess what? Sometimes you can find a doula who is in training and they will work with you for free or for a very small payment! Sunday Tortelli, former president of DONA international says “In order to become a certified doula, the doula-in-training must go through a certification process, which is kind of like apprenticing. They are required to attend births and provide doula services, so some doulas are willing to volunteer to earn their certification quicker.” If there is a local birth center nearby, you can consider asking them for any referrals. The DONA website and the birth educators at local hospitals may be helpful too.

The takeaway on ‘what is a doula’ and if you need one

Ultimately, I believe that the choice to use a doula is one you and your partner should make together. Do you have to have one? Nope. Can your birth partner be a wonderful support for you? Yes! But, the right doula can absolutely change the story of your birth, supporting you, your partner, and your baby in ways you didn’t even know you would need. If you are desiring one and your family can financially afford one, I think they can be a wonderful contribution to your birth team.

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About the Author

Lo Mansfield RN, MSN, CLC, is a specialty-certified registered nurse + certified lactation consultant in obstetrics, postpartum, and fetal monitoring who is passionate about families understanding their integral role in their own stories. She is the owner of The Labor Mama and creator of the The Labor Mama online courses. She is also a mama of four a University of Washington graduate (Go Dawgs), and is recently back in the US after 2 years abroad in Haarlem, NL.


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