The word doula is a Greek word that means Women’s Servant. Women have been serving other women in childbirth for centuries and have proved that support from another woman has positive effects on the labor and birth process.

A doula is a childbirth professional who understands the natural process of having a baby. The doula accompanies the woman in labor, provides emotional and physical support, suggests comfort measures, and provides support and suggestions for the partner to create the most positive, healthy, and enjoyable experience possible. Whenever possible, the doula provides antepartum and postpartum emotional support, including explanation and discussion of practices and procedures as needed.

A doula does not perform clinical or medical tasks such as taking blood pressure or temperature, fetal heart tone checks, vaginal examinations, or postpartum clinical care. A doula advocates for her client's wishes as expressed in their birth plan, in prenatal conversations, and intrapartum discussion. She helps the mother incorporate changes in plans if and when the need arises, and enhances communication between client and caregiver. A doula does not speak for or make decisions for the client. The advocacy role is best described as support, information, and mediation or negotiation.

What are the benefits of hiring a doula?

Numerous studies have revealed the benefits to having a doula present during labor. A recent Cochrane Review, Continuous Support for Women During Childbirth, revealed a very high number of positive birth outcomes when a doula was used. When a doula was present, women were less likely to have pain relief medications administered, less likely to have a cesarean delivery and reported having a more positive childbirth experience.

Doulas often use the power of touch and massage to reduce stress and anxiety during labor. According to physicians Marshal Klaus and John Kennell, massage helps stimulate the production of natural oxytocin. The pituitary gland secretes natural oxytocin to the bloodstream which causes uterine contractions and also secretes it to the brain, which results in a feeling of well being, drowsiness and a raised pain threshold. Synthetic IV oxytocin can not cross into the blood stream and brain, so it increases contractions without the positive psychological effects of natural oxytocin.

At least thirteen scientific studies evaluating the effectiveness of doulas have shown that having a doula present at your birth can have the following results:

* Shorter labor by 25% (average two hours less for first time mothers)

* Reduced need for pain medication

* Fewer episiotomies

* 40% reduction in the use of forceps

* 40% reduction in the use of Pitocin

* 50% reduction in cesarean rate

* 60% reduction in the request of epidurals

* Greater satisfaction with the birth

* Better mother infant interaction/bonding

* Improved neonatal outcomes

* Increased breastfeeding success

What do birth doulas do and what do their services include?

Most doula and client relationships begin a few months before the baby is due. During this time they establish a relationship that gives the mother complete freedom to ask questions, express fears and concerns and take an active role in creating a birth plan. Most doulas make themselves available to the mother by phone to answer questions or explain any developments that may arise in pregnancy. Doulas do not provide any type of medical care. However, they are knowledgeable in the medical aspect of labor and birth so they can help their clients get a better understanding of procedures and complications that may arise in late pregnancy or during birth.

During labor, doulas are in constant close proximity to the mothers at all times. They can provide comfort through pain relief techniques, such as breathing, relaxing, massage and laboring positions. Doulas also encourage participation from the partner and offer reassurance. The goal of a doula is to help the mother have a positive and safe birth experience.

After the birth, many labor doulas will spend a short time helping mothers begin the breastfeeding process and encourage bonding between the new baby and family members.

Most birth doulas provide:

* At least two antepartum (prenatal) visits to get acquainted and provide birth plan counseling

* Availability by phone/email 24/7 to answer questions and go over concerns

* Continuity of care during labor and birth

* Immediate postpartum support and breastfeeding support after the birth

* Breastfeeding support if needed

* At least one postpartum visit

* And more

Does the doula take the place of the father?

The role of the doula is never to take the place of the father or partner in labor, but to compliment and enhance their experience. A doula can actually bring a couple closer together. By ensuring that the partner’s needs are met (food, drinks, and emotional support) only then can s/he give the mother undivided attention. Today many more partners are taking a more active role in the birth process, but still some partners feel that this is a huge expectation, and would rather be able to enjoy the birth without having to stand in as labor coach. Birth can be a stressful time for both mother and partner. Many times partners worry that they are not doing enough or the right thing. A doula helps by giving suggestions, providing encouragement or giving needed breaks during a long labor.

One study showed 60% of fathers that have taken birth education classes become mostly a spectator, as they become overwhelmed with the surroundings. The feeling of insecurity and the sometimes lack of knowledge of what is happening takes its toll on both parents. A doula has accompanied other couples through the birth experience and gained the knowledge needed to help each couple achieve their desired birth experience. She helps the father to be more involved and more effective. The nurses/midwife/physician cannot be with you at every moment or may not be at liberty to answer your questions in an unbiased manner. The doula fulfills this role so that parents receive the information they need to make informed decisions. This in essence, frees up the father to provide uninterrupted emotional support to his partner, and not having to play the role of advocate, liaison, educator, etc., as well as provide support.

What other services does a doula offer?

Many doulas offer other services along with professional labor support, such as:

* Quality childbirth education (even for moms on bed rest since they are done in your home!)

* Birth plan counseling

* Photographing or videotaping your birth

* Breast feeding support

* Postpartum doula care

* And more

What if I have a midwife or am giving birth at a birthing center or at home?

A doula can still provide a valuable service, including personal childbirth education and labor support. Not all midwives provide labor support and this is a very good question to ask her when interviewing a midwife. Some midwives prefer to attend you later in labor or may prefer not to provide physical labor support. The best way to determine how your midwife will be is to ask former clients and see how well they felt supported during labor. Even with a supportive midwife, you may still benefit from a doula's services. Ask your midwife/midwives how they feel about doulas.

How can a Doula help me if I am not having a natural birth?

The presence of a doula can be beneficial no matter what type of birth you are planning. Many women report needing fewer interventions when they have a doula. The role of the doula is to help you have a safe and pleasant birth, not to choose your type of birth. For women who know they want a medicated birth, the doula still provides emotional support, informational support and comfort measures to help the women through labor and the administration of medications. Doulas can work along side medication by helping mom deal with possible side effects and filling in the gap that medication may not cover; rarely does medication take all discomfort away.

For a mother who faces a cesarean, a doula can be helpful by providing constant support and encouragement. Often a cesarean is an unexpected situation and moms are left feeling unprepared, disappointed and lonely. A doula can be with the mother at all times throughout a cesarean, explaining what is going on throughout the procedure while the partner is able to attend to the baby and accompany the newborn to the nursery if problems arise.

What kind of training does a doula have?

There are several paths to becoming a doula. The profession of doula, does not currently have any state regulation and does not require training or certification. There are many wonderful doulas that have chosen not to certify with any of the current organizations. If a doula does decide to become certified then there are several organizations that provide certification.

The basic requirements differ from organization to organization, but comprise some basic training including required reading lists, attendance at a workshop, evaluations from a minimum number of births and an audit of a full series of childbirth education classes. The most important attributes of a good doula are a caring heart, a willingness to work with birthing women, professionalism and hands on experience. A lot of very good doulas have done this work for years, before certification and training was available. Most doulas attend workshops/seminars, keep up with current trends in birth and read childbirth literature and medical journals; whether they are certified or not.

How much does a doula charge?

Generally it depends on the services offered/desired. An average of $400.00 to $1200.00 is not unusual depending on where you live and what services are offered. You are paying for a doula's experience, so it is not unusual for more experienced doulas to charge on the higher end, whereas a more inexperienced doula may charge a reduced fee. Most doulas require a retainer (usually $50.00 to $250.00) upon signing the contract for services and the remainder two or three weeks prior to your due date. Most doulas are willing to work with families if done in advance or upon signing a contract.

Are doula services covered by health insurance?

At this time only a few insurance companies cover doula services, but the numbers are increasing gradually as providers are beginning to recognize the benefits of both improving parental satisfaction and bottom line savings when parents employ a doula for their birth. Factors that may increase your chances of reimbursement include:

* Submitting a doctor or midwife's referral or prescription for doula services

* Submitting well documented statistics of doulas' influence upon birth outcomes

* Actually achieving a low intervention, low cost birth

* Submitting a superbill for doula services complete with diagnosis and treatment codes

* Resubmitting with more documentation if first claim is denied