The word ‘doula’ — pronounced ‘doo-la’ — is a Greek word meaning ‘woman servant or caregiver’. More recently, it refers to someone who offers emotional and physical support to a woman and her partner before, during and after childbirth.
A doula (also known as a birth attendant) believes in ‘mothering the mother’, enabling a woman to have the most satisfying experience that she can, from pregnancy and into motherhood. This type of support allows the whole family to relax and enjoy the experience too.
DONA (Doulas of North America) explains how doulas fit into the birth team: “Women have complex needs during childbirth. In addition to the safety of modern obstetrical care, and the love and companionship provided by their partners, women need consistent, continuous reassurance, comfort, encouragement and respect. They need individualised care based on their circumstances and preferences. The role of the birth doula encompasses the non-clinical aspects of care during childbirth.”
Despite doulas being fairly unheard of in Australia, they have been actively supporting women for a very long time and are fast growing in popularity, as a result of positive word of mouth and the need for increased support.
Doulas are trained and experienced in childbirth and are usually mothers themselves. They have a good knowledge and awareness of female physiology, but a doula does not support the mother in a medical role – that is the job of the midwife or doctor. She works on keeping birth normal and empowering, and should the birth become complicated and require medical assistance, a doula will still remain by your side and help in any way she can. She will not make the decisions for those she supports, but she assists them through the decision making process and provides balanced information so the couple can make their own choices.
Many women consider doulas to be a must for those giving birth in a hospital, due to the over-medicalisation of birth – unnecessary inductions have skyrocketed and are partly to blame for the 1 in 3 Australian babies now born by caesarean section. In Australia, some hospitals have caesarean section rates as high as 50% and higher. This is a terribly high statistic, well above World Health Organisation recommendations, which makes us amongst the highest in the world. Given the long term emotional and physical effects this can have on the mother, her partner and baby, a doula to me is like an ‘insurance policy’ – which can help protect you from a disempowering, disappointing experience or unnecessary procedures and intervention. With a doula, you know that someone is always on YOUR team, holding the space for you and your family. She works for you and has your best interests at heart, unlike hospital staff who have to abide by policies, which are not always best for a birthing woman, but best to avoid legal issues and to keep things running as a business.
What Does A Doula Do?
A doula may provide some or all of the following, dependent on her training and skills (she may be more than just a doula – some doulas are also qualified in other therapies):
- Birth education and preparation
- Birth planning (including creating a written birth plan/birth preferences document)
- De-briefing previous births
- Massage and other comfort measures
- Optimal fetal positioning
- Suggest positions and changes to help ease pain and facilitate a smoother, more effective labour
- Provide reassurance and encouragement
- Talking through emotional blockages which may come up in labour
- Keep your ‘environment’ going – aromatherapy, music, candles etc
- Assisting you with negotiation of your preferences for birth if what you want and the hospital wants differs
- Photography and/or video if you wish to have momentos of your partner supporting you, the birth itself and those precious first moments as a family, together
- So much more
But I believe the biggest bonus of a doula is that fact that she is a professional birth support person – she has been trained in the art of birth support and has a keen eye and intuition on what a labouring mother needs. Things which a hospital midwife unfortunately does not have time for, and things which partner may not pick up on (or situations he may not know how to deal with). She has a mind that is caring and nurturing, yet able to remain calm and focused even if things go off the rails. Family and friends tend to have an emotional connection that can mean in the event of a problem or at the peak intensity moments, they can buckle not knowing what to do, say or think. A doula can think clearly, see pros and cons of any situation and relay them to the couple to make their own decision. When we’re stressed, we don’t make the best decisions, and in hospital, that may make your partner/mother etc. completely agreeable to what’s being put on the table, because they are uncertain or scared. A doula can help explain what’s happening with compassion and without judgment or medical jargon, so its easier for you to understand.
There are two types of doulas, birth doulas and post-natal doulas, with many doulas performing both roles. The difference is that the role of the post-natal doula is to nurture the mother at home after childbirth. This may include further breastfeeding support, light home duties, massage, emotional and physical support for the mother and so on. Post-natal doulas are particularly in demand as support for new mothers has reduced in modern society. Needless to say, studies show that post-natal doulas make a huge impact on the well-being of mothers.
Where Do Doulas Work?
A doula works in birth centres, private and public hospitals and at homebirth in conjunction with midwives – but never as the sole carer at birth. Birthing without a midwife or doctor present is known as free-birthing however BellyBelly recommends birth with at least a qualified midwife or doctor.
The Promise Of A Doula
1. You cannot hurt my feelings in labour
2. I won’t lie to you in labour
3. I will do everything in my power so you do not suffer
4. I will help you to feel safe
5. I cannot speak for you; but I will make sure that you have a voice and I will make sure you are heard
What Are The Proven Benefits?
A recent review of many studies from around the world have concluded that a doula’s support is more effective than hospital staff, friends or family. You can read the review here.
Studies (and reviews of the studies) consistently demonstrate very impressive benefits for the mother, father and baby, including:
- Fewer caesarean sections
- Reduction in the use of forceps and vacuum
- Fewer requests for epidurals
- Reduction in the use of synthetic oxytocin for inductions or augmentations
- Reduction in use of pain medication
- Reduction in labour length
- Increased rates of breastfeeding at 6 weeks post-partum
- Higher self-esteem, less anxiety and less depression at 6 weeks post-partum
The benefits are significant. Most of the women in the studies were accompanied by male partners, however study results show that women who had the support of a male partner and a doula fared best, for example, the caesarean rate of women supported by both a male partner and a doula was significantly lower (15.4%) than the caesarean rate for women supported only by their partners (24.4%). The studies also clearly show the positive benefits of doula support occur regardless of a woman’s economic status or whether or not they were privately insured. Its simply about having the right support with you at birth.
What About The Woman’s Partner?
According to the studies (and from personal observations in births I have attended) rather than reducing a partner’s participation in the birth process, a doula’s support complements and reinforces their role. Partners feel more enthusiastic and that their contribution to the labour and birth was meaningful and helpful. I often find when partners have a visual on how to support a woman i.e. watching a doula support her, they feel more confident and relaxing having seen some ideas to try themselves. In the studies, not only did partners report higher levels of satisfaction after the birth, but mothers reported feeling more satisfied with their partners role at birth too. Over 30% of women reported that their relationships were better post-birth than they were prior to the birth.
What Will My Ob/Hospital/Midwife Say?
More obstetricians and midwives are becoming aware of the doula as they become more popular; most are very supportive or are not bothered by a doula – in fact obstetricians and doulas rarely cross paths. If they do, it’s often for a very short time, during the birth.
In a recent birth I attended, a student midwife told me that they were currently doing a unit on birth support in her studies, and she was very impressed about the benefits and outcomes achieved with women who have doulas.
There is the occasional story I hear about some obstetricians not wanting a woman to have a doula present, however ultimately it is your own choice and decision as to the level of care you receive. An obstetrician is not present for you throughout most of the labour, only if you need intervention or to catch the baby (if they make it!). So continuous support from a known carer is crucial while you labour – because what happens during the labour can affect the outcome. It also is very telling about the sort of care you may receive at the birth if your Obstetrician is not open to you looking for ways to help reduce your chances of interventions. If your doctor is not supportive of you making choices, decisions and avoiding intervention, you may end up feel unsupported and disempowered in labour.
What Training Do Doulas Receive?
In Australia, there are several ways a Doula can train, through courses conducted by very experienced Doulas – some of which are also midwives, doctors and educators. Again, this is not medical training – doulas are trained in professional birth support. As part of a doula’s training, she may be required to read certain materials, attend several births (as an unpaid trainee), write assignments/reports, attend birth education classes and other requirements. If you are interested in becoming a Doula, see our BellyBelly article, Doula Training In Australia.
What Do Couples Think of Doulas?
Check out this short video on YouTube featuring couples talking about doulas:
Here are a few short testimonials from Australian couples who have used professional birth support:
“A very special thank-you… You made such a difference at the birth for us both, encouraging me when it all seemed too hard and helped me achieve the birth that has given our little girl the best start in life. Thanks for sharing this special time with us. I hope our paths cross again. You are a beautiful person with much to give the world.” — Catherine & Jason
“Thank-you for helping us achieve a wonderful birth experience. I felt safe and far more relaxed knowing I had the right support. Everything went exactly as I wished for with minimum intervention and stress¦ I feel sooooo grateful that we had such a great outcome. I am sure it is even helping me get through these difficult first months. I now know I CAN get through anything with determination, knowledge and support! — Meredith & Chris
“Wow I’m still in shock when I think about that long labour and the fantastic result – it was sooo worth it. I truly know that I couldn’t have done it without you – that is a fact. You are amazing and are truly made for the job – I really can’t thank you enough.” — Bronte & Michael
How Much Does A Doula Cost?
This varies greatly dependant on experience, the state the doula is located in and what packages are on offer. A package offering pre and post-natal visits (generally around 2 hours long each) as well as the duration of the birth can cost around $800-$1000 for an experienced doula in most states, but others charge up to $2,000.
Inexperienced doulas usually charge a lower fee which can vary from ‘costs only’ (e.g. petrol, travel) to around $250-$300. Most doulas offer reduced rates for those in genuine need. Student doulas who are looking for births to complete their training often have no charge at all, but we recommend paying some sort of fee for the value of her time.
Doulas often only attend 1-2 births a month, as many are mothers with young children. Finding last-minute childcare as well as spare time to do visits and attend births is a tricky balance – it often happens during family time on weekends or after hours. So it’s not something women do for monetary benefits, but passion. If you actually did the sums and worked out how much a doula charges, broken down to an hourly rate, its not significant, and for me pales in comparison to the massive physical and emotional health benefits to not only mother, but baby and partner.
After the birth of your baby, post-natal doulas are worth their weight in gold. A birth doula may also be a post-natal doula, or some doulas choose to train as post-natal doulas only. They come into your home and help you out with a huge range of things that will make your days easier and more relaxed. What a post-natal doula offers is varied so you need to check with them what they offer, but here are a few things that may be included:
- Breastfeeding support
- Infant massage techniques
- Bonding support
- Birth debriefing/counselling
- Driving/running errands
- Settling/sleep help with baby
Overnight doulas will stay with you and help out overnight. Packages and prices vary depending on whats on offer, but I have seen prices start around $25 per hour up to around $110 per hour, with most being around the $55-$70 mark. A minimum amount of hours will be required, usually 2-3. Make sure you communicate what you want from your doula to ensure there are no miscommunications and all expectations are realistic and met accordingly.
Finding a Doula
It can be tempting to go with the first doula you meet (because they’re all pretty special) but I do recommend speaking to several doulas, as every doula is unique and has something different to offer. For example, some specialise in certain births, like VBAC (vaginal birth after caesarean), homebirth, high risk, loss etc., and I think you have a unique energy with the people that you meet – it can take a few to know which one feels best. But you will quickly know who you click with. It’s important that you and your partner both meet the Doula, you both need to feel assured and comfortable around her if you’re going to share such a special, vulnerable moment with her.
Looking For A Doula Near You?
Find one in our directory or click below for capital cities:
You can download a copy of our Doula Interview Sheet if you aren’t sure what to ask the Doula.
References and Recommended Reading
Two books which are great to read about the work of a doula are:
- The Doula Book by By Dr. Klaus, Dr. Kennell & Marshall. Klaus and Kennell are founding members of DONA (Doulas of North America, est. 1992) and are seen as foremost experts on doulas in the world.
- Doulas: Why Every Pregnant Woman Deserves One by Susan Ross (AUS)
Some books I believe everyone needs to read about birth includes, New Active Birth by Janet Balaskas and The Thinking Woman’s Guide To A Better Birth by Henci Goer. If you’ve not read these yet, now is a great time.