What is a doula?
A doula is a labor support professional who “mothers the mother” during childbirth, as well as during the prenatal and postpartum periods. Birth doulas provide support to pregnant women prenatally, through labor and birth, and in the early days postpartum. Postpartum doulas provide in-home services to families after the baby is born, typically lasting from three weeks to three months, or longer with special circumstances. Some doulas combine the birth and postpartum roles into a complete service package, thereby offering continuity of care throughout the childbearing year.
Doulas are non-medical care providers. Their role is limited to informational, emotional, physical, and logistical support. They do not provide clinical care such as taking blood pressure or checking dilation in labor, nor do they give medical advice. Doulas typically employ comfort measures such as massage, hydrotherapy, and help with relaxation. Doulas strive to provide nonjudgmental support rather than imposing their own values and beliefs on their clients. Doulas do not take the place of dads, partners, or other family members who want to help you. Their job is to facilitate everyone’s optimal participation at your birth, as well as to provide support to the entire family through the postpartum recovery and adjustment period. If you are a single mother, your doula can serve as your primary support person so that you are never left alone in labor.
A selection of services provided by birth doulas
- Nutritional counseling
- Tips for coping with discomforts of pregnancy
- Preparation for birth
- Assistance in creating a birth plan
- Comfort measures in labor
- Suggestions and support for positioning in labor
- Continuous support throughout labor and birth
- Troubleshooting for difficult births
- Facilitate communication and informed decision making with your health care providers
- Support for dads and partners
- Natural birth coach and advocate (if that is what you want)
- Support for VBAC (Vaginal Birth After Cesarean)
- Cesarean and post-cesarean support
- Respect for the bond between mom and baby in those tender early hours
- Encouragement and skilled support for breastfeeding mothers
- Postpartum home visit(s)
- Community resources and referrals
A selection of services provided by postpartum doulas
- Breastfeeding support
- Newborn care
- Comfort measures and support for the mother’s physical recovery
- Shopping, errands, meal preparation
- Laundry, light cleaning, household organization (not housecleaning)
- Sibling adjustment support (not babysitting or nanny services)
- Depression screening and referrals
- Education on infant topics
- Community resources and referrals
Shifts worked by postpartum doulas vary. Some may do overnights while others may offer only weekday hours when their children are in school, and so on. Expect a typical shift to be from three to four hours, though some doulas may work an eight-hour day. There are no rules–it is up to you and your doula. Typically, support is more concentrated in the first two weeks and then gradually the family weans off of doula support. However, in special circumstances such as families with multiples, preemies, and babies with special needs, or moms suffering from postpartum depression, a postpartum doula may be involved over a longer period of time.
Before hiring a postpartum doula, consider whether or not you are really seeking a nanny for your other children or house cleaning help. If those are your primary motivations, then you should hire a nanny or house cleaner and will probably come out better financially by doing so. Another option may be to start out with a doula for the first couple of weeks while mom is recovering physically, adjusting emotionally, and may be in need of breastfeeding support, and then transition towards hiring a nanny later (say, in the case of twins or multiples).
What is a certified doula?
A certified doula has chosen to complete a certification process through a recognized doula association such as DONA International, ICEA, or others. While certification processes differ in the details, certification generally means that a person has: (1) completed a proscribed training program, (2) documented a minimum level of hands-on experience with positive client evaluations, (3) completed reading requirements, and (4) agreed to work within the Scope of Practice as defined by the certifying organization. The process certainly guarantees a minimum level of training and experience for providing doula services. Doulas represent an effort to professionalize the traditional role of the female support person at birth and during postpartum.
Many of the doulas listing their services on this site are in the process of completing certification requirements. When you accept a less experienced, non-certified doula to support you, you are meeting someone who is very passionate about her new life path serving moms and families and is eager to be of service. Her enthusiasm to simply support you in your process is a gift. In return, your volunteer doula may ask you to give her permission to submit confidential forms related to your care that will help her become a certified professional doula.
Is certification important?
It depends upon whom you ask. From the consumer perspective, good worth of mouth in the community, or a recommendation from a trusted friend trumps certification any day. Certification is no guarantee that your doula encompasses the personal qualities of patience, humor, compassion, integrity …
On the other hand, some insurance companies may reimburse for doula services. The National Uniform Claim Committee (NUCC) (the folks who assign billing codes and provider identification numbers for insurance reimbursement purposes) has defined the role of the doula and assigned a provider number and billing codes for doula services. This is not a guarantee of reimbursement (that is up to your insurance company and your own direct advocacy efforts with them), but it certainly enables the process. As the practice of reimbursement becomes more common, hiring a certified doula is likely to increase your chances of reimbursement. When hiring a doula, ask whether any of her clients have been successful in getting reimbursement or partial reimbursement for her services, whether or not she has a provider number, knows which codes to use, and can provide you with a proper receipt to submit to your insurance provider.
What do doulas charge for their services?
Because individual doulas are self-employed and set their own rates, there is no precise standard to determine how much you should pay for doula services. Some doulas have a set fee, while others may use a sliding scale so that they can provide services to clients at a range of income levels. Expect doula rates to vary based on level of experience, additional services provided, geographic area, and certification status.
In general, birth doulas charge from $500 to $1200 for a package of services that includes the birth. Keep in mind that this fee is likely to include phone consultations and prenatal and postpartum visits, as well as compensating the doula for the days and weeks she commits to being on-call for you, in addition to paying for her services at the birth itself.
Postpartum doulas generally charge from $20 to $35 per hour. Presumably, the more experienced, and therefore more skilled, doulas are the ones charging the higher fees, with less experienced doulas starting out at the lower end of the scale.
What are the benefits of doula support?
There have now been several studies on the benefits of continuous labor support on labor and birth outcomes. Laboring women who are supported by doulas have lower cesarean rates, lower instrumental delivery (forceps and vacuum extraction) rates, and are less likely to use epidurals or pain medication than women who do not have doula support. Women supporated by doulas also have shorter labors, report more positive childbirth experiences overall, and are more likely to breastfeed. Furthermore, their newborns have higher one-minute and five-minute Apgar scores (a routine assessment of the newborn’s well-being immediately post-birth).
Postpartum doulas can have a strong impact on early parenting success. The evidence shows that women who use a postpartum doula have increased rates of breastfeeding, decreased rates of postpartum depression, a stronger bond with their newborns, greater self-confidence in their parenting abilities, and increased understanding of newborn care.
Is it appropriate to have a doula if my partner will be at the birth?
Yes! The doula’s role includes supporting the laboring woman and supporting her partner. Your doula should be able to work alongside your partner and/or other family members and show him/her/them how to best support you. If you and your partner have taken childbirth classes, the doula can remind you of techniques you learned in class and provide guidance through the physical and emotional challenges of labor and birth. Your doula can enable your partner to take a break, facilitate communication with your care providers, and, in short, be an excellent addition to your birth team.
Is a doula appropriate if I have an epidural?
Yes! Many women are unsure of whether they will want an epidural (or know they will want one) prior to going into labor. While you should ask your doula if she is comfortable working with women who choose a medicated birth, the role of the doula is not to critique your birth choices but rather to support you and ensure that your wishes are respected. A doula can improve your chances of having an unmedicated birth if that is what you prefer, but she should also be able to provide you with non-judgmental emotional and physical support in the context of a medicated birth. Women who choose to use an epidural during labor can especially benefit from a doula during the pushing stage, as this stage can take longer for medicated births due to the decreased physical sensations intrinsic to the use of epidurals. In addition, because the medications used often make babies less alert than normal, it is extremely helpful to have a doula during the immediate postpartum period so that she can support early breastfeeding efforts. Epidurals provide pain relief, not emotional support!
Is a doula appropriate if I am having a planned cesarean birth?
Yes! Although women having planned cesareans do not experience labor in the same way as women planning vaginal births, a doula can still be helpful to prepare you for the experience. Your doula can help you learn about the choices that you have in the context of a cesarean birth and can also provide emotional support before, during, and after the surgery. Because recovery from a cesarean often takes longer and is more complex than recovery from a vaginal birth, a doula can be an asset to parents during the postpartum period. A postpartum doula can help with newborn care, provide breastfeeding support, prepare meals, and help the household keep functioning while you recover from surgery and adjust to life with a newborn in the home.
How can I find a doula?
Doulas for hire can be found on the following websites:
If you cannot afford to hire a doula, the Doula Directory offered here provides a list of volunteer doulas. The Directory also lists doula programs and other nonprofit service providers who provide free or lower-cost services. If your baby’s father is unavailable to support you because he is away on active duty in the military, there may be free help available to you through Operation Special Delivery.
Tips on hiring/selecting a doula
- First, screen to see who is accepting clients around your due date.
- Ask how much the doula charges and what services are included in her fee.
- If the answers to the first two questions lead you to want to pursue the possibility of working with this person, then you could ask for some time for a short phone interview.
- Ask about her level of experience, whether or not she has been formally trained as a doula, whether or not she is certified, and what her philosophy of care is (e.g., what are her thoughts and experience with breastfeeding?). You might want to know if she is a mother herself, what she thinks her biggest strength as a doula is, what she enjoys most about her work, etc. For a more complete list of potential questions, see below.
- An enthusiastic but inexperienced doula with whom you feel a warm rapport may be preferable to a more experienced doula with whom you feel uncomfortable, for any reason. Trust your instincts. This is all about getting your needs met.
- As you move through this process, you will likely have narrowed down your selection to one or two people with whom both you and your partner (if any) should meet in person and interview.
- Ask for and check references. The most useless doula in the world is the one who is unreliable (if she doesn’t answer her phone when you are in labor, who cares how skillful or “nice” she is?). Doulas who have created good word-of-mouth about their services are likely to want to ensure that you too are a satisfied customer.
- Check credentials. If the doula claims to be a DONA International-certified doula, you can confirm her certification by using the DONA online doula locator. I expect other certifying organizations have a similar system.
- Does the doula have an agenda (my way or the highway)? If so, is her agenda congruent with yours? Try to think of a few questions before the interview that are designed to get at the answers most important to you. Have your partner articulate any questions or concerns he/she may have as well. In the end, make sure you choose someone who can provide nonjudgmental support for you and your family. You don’t want to have to hide your diet pop cans or your toddler’s play guns when your doula comes to your home, nor apologize for a medicated birth if those are your choices. (I’m having a hard time letting the diet pop statement stand, because it’s SO bad for you, but I hope that makes my point about nonjudgmental support … I would not be the doula for you if you wanted me to bring you your diet pop in labor, or at least, I would be very challenged in this regard.)
- In the case of hiring a postpartum doula, many couples find themselves in a rather urgent frame of mind (“Can you start today?”). Consider starting with a one-week commitment from your doula with the possibility of extending beyond that time frame. If integrating a stranger into your home proves more stressful than helpful, you may have chosen the wrong doula.
Sample questions to ask a prospective doula
The best way to choose your doula is to consider the fact that the doula will be present at your birth, or providing in-home support at a time when you may feel vulnerable. Ask yourself with whom you (and your partner) feel the most comfortable. Just what are you looking for? What helps you when you are feeling stressed? Information, humor, kindness, massage, a flexible attitude, a good listener? Are you looking for a mother figure or more of a big sister? The personality and beliefs of your doula may well be more important than any other factor. If you choose to interview one or more doulas, it can be helpful to ask the following questions. In the final decision, trust your gut. A less experienced, uncertified doula may resonate better with you than the most experienced doula in town.
- How long have you been in practice as a doula? How many families have you served?
- Are you a mother yourself? (This may or may not be important to you. Doulas who are not mothers themselves may have more time to focus on you and your needs, while doulas who are mothers themselves certainly will bring an added dimension of understanding to their care. On the other hand, experienced mothers may be more opinionated about the “right” way to do things, based upon their own beliefs and experiences. Look for someone capable of flexible, nonjudgmental support or, if she has an agenda, make sure it’s the same as yours!)
- Do you have experience with other clients whose situations are similar to mine (first-time mothers, natural/medicated birth, same hospital, home births, older mothers, single mothers, VBAC moms, etc.)?
- How much do you charge? Under what circumstances would I receive a refund?
- What is included in your fee (prenatal/postnatal visits, phone support)?
- Do you work with a backup doula?
- Do you have any references from families with whom you have worked?
Additional questions for birth doulas
- How certain are you that you will be able to attend my birth? Do you have any other commitments during that time period?
- How do you picture yourself supporting me and my partner during the birth?
- Do you provide labor support at home in early labor for women planning hospital deliveries?
- Do you only work as a birth doula or can we also hire you for postpartum work if needed?
Additional questions for postpartum doulas
- Are you available for overnight help, weekend help, daytime help, etc.?
- How much experience do you have providing breastfeeding support?
- What services do you provide or exclude? (For example, some doulas may be willing to do some sibling care, scrub out a bath tub, or walk the dog, while others may not. Really think through what you anticipate your needs will be and then ask questions to determine if the doula can meet your needs. In some cases, parents might be better off hiring a babysitter or nanny if their concerns revolve around balancing the needs of a two-year-old and newborn twins.)
- Do you have any add-on services (such as bringing meals, massage, etc.)?