When you’re pregnant, especially for the first time, you think about every aspect of your pregnancy, delivery and life with a new baby — sometimes in alarming detail. You take childbirth classes. You do hospital tours. You read books on what to expect during and after pregnancy. You have your birth plan, your medical team and possibly a support person or two, but the uncertainty hangs over your head: What if your partner is too exhausted to support you, or your or your baby’s health necessitates your birth plan going out the window? This is where a birth doula comes in.
Lisa Greaves Taylor, founder, childbirth educator and podcast host at Birth Matters and director of the East River Doula Collective describes a birth doula’s role as akin to an event planner and day-of wedding coordinator. Not only are they there to help prepare you for the big day, but they are also there during labor helping you navigate any unexpected twists and turns, says Greaves Taylor. “So many things can come up on the big day that a childbirth education class can’t fully prepare us for,” she explains. “It’s really helpful for laboring parents and couples to have someone there with them to give them anticipatory guidance in addition to physical and emotional comfort measures to help it go as well as possible.”
Research also shows that having a doula present during labor and delivery improves outcomes, reduces unnecessary interventions and increases birth satisfaction. Read on for more from the experts and parents we spoke to on what doulas do, how they can benefit the labor experience and how to manage the cost.
What is a birth doula?
According to Greaves Taylor, “a doula is a non-clinical, professional support person who provides all the other important kinds of support a person needs for the journey into parenthood — things like emotional, informational, physical, self-advocacy support, sometimes spiritual support and more.” Some doulas are birth doulas focused on the prenatal and labor and delivery period, while others are postpartum doulas, assisting families after the baby arrives. And some doulas cover both phases
Many birth doulas work alongside the parents leading up to the labor, during and then for a short period after the baby’s arrival, depending on their agreement. For example, Bori Laki, a birth and postpartum doula in Great Neck, New York, provides two to three virtual or in-person prenatal meetings with the couple, an open line of communication leading up to their due date, she meets them at their home or the hospital during early labor and stays for a couple of hours after birth to get them settled. She then visits once more a few days later, when they return home.
Doula vs. midwife — What’s the difference?
While some people may confuse the two, doulas and midwives fulfill two very different roles. Simply put, midwives have medical training, while doulas do not. Midwives are either certified nurse-midwives (CNMs) or certified midwives (CMs) and can conduct physical examinations and prescribe medications, among other care needs someone might have during the pregnancy, childbirth and postpartum periods. Their training “is mainly to protect the physical health of the birthing parent and baby and [address] any medical needs they might have,” says Greaves Taylor.
On the other hand, while doulas can be certified, they aren’t always, and they aren’t required to be in the United States. However, if they choose to be, DONA International has arguably the best-known certification program in the field. Their approved workshops require at least 16 hours of instruction and may be longer. The workshops cover “evidence-based information about the benefits of doula support, the history of birth, the significance of doula support to families, practical hands-on techniques” and more, according to the DONA International website.
Different types of doulas
In addition to birth doulas, you might hire a doula to assist with conception, postpartum life or the entire duration of your reproductive journey. Here’s what you can expect from each type.
- Fertility doulas: As the name implies, “Fertility doulas can help support people who are struggling to conceive and are needing to seek out alternative conception methods,” says Greaves Taylor.
- Postpartum doulas: During “the fourth trimester,” or the first 12 weeks following delivery, this type of doula assists with baby care but also addresses “the needs of the postpartum person to ensure a smooth and supported recovery,” says Damary Franco, a birth and postpartum doula in Los Angeles, California.
- Full-spectrum doulas: This type of birth partner has the experience to support someone at any point in their reproductive journey.
“It’s really helpful for laboring parents and couples to have someone there with them to give them anticipatory guidance in addition to physical and emotional comfort measures to help it go as well as possible.”
— Lisa Greaves Taylor, founder, childbirth educator and podcast host at Birth Matters
What does a birth doula do?
Every pregnancy, labor and delivery, and postpartum period will be unique to each family, but there are some generally agreed upon ways doulas can help during these stages.
During pregnancy
In this early stage, the focus is on getting to know each other and getting comfortable. Greaves Taylor says that one to three prenatal visits with the expectant parent and/or the couple is typical — for the doula to share their knowledge of what to expect, but also to get to know each other and learn how to best support the birthing parent and partner when the time comes. During the prenatal visits “they get a sense of how to fit in like a piece in a puzzle in a very customized way for that family,” she says.
During labor and delivery
When the doula joins the birthing parent is an inexact science due to the fact that labor can last a long time and everyone progresses at their own pace. However, a parent might have their doula meet them at home or at the hospital once they’re in active labor. And they typically stay with the parents until they are settled in their recovery room.
Angela Gotz, a parent of two in Winona, Minnesota had a doula present for both of her children’s births. With her first, the doula met her at the hospital when she was in active labor. Her son was in a difficult birthing position, and her doula helped guide her through different movements, in hopes of getting the baby into a better position.
With her second child, the doula’s presence allowed Gotz’s husband to attend to their first child, without leaving her alone. The doula also tracked her eating, drinking and toilet usage, which came in handy at the hospital later (they were able to provide accurate details for the medical staff). This confidence in the doula’s record keeping gave them some space from the medical team, which ultimately allowed Gotz to have a successful vaginal birth after cesarean (VBAC).
During labor, birth doulas may provide physical comfort measures, says Greaves Taylor, such as massage or counter pressure. “Throughout this time, [they] also provide strategic guidance to help the labor go as efficiently as possible, including taking into consideration the position of the baby and offering guidance on positional movement strategies to help labor progress as needed,” she notes.
Ultimately, the doula is there to support the family unit during labor, including reminding the birthing partner to stay hydrated and rest during a long labor, says Greaves Taylor.
“Every day is different when I work with families, but the heart of it stays the same. By addressing any nuances that arise in baby care, I empower parents with the knowledge and skills they need to navigate this journey with confidence and ease.”
— Damary Franco, a birth and postpartum doula in Los Angeles, California
During the postpartum period
If the couple hires a birth doula, it is common practice for the doula to visit the family once more shortly after they are discharged from the hospital — to touch base once the dust has settled and debrief. It can be used to process the birth, provide breastfeeding support or newborn care assistance, depending on the family’s wants and needs, says Greaves Taylor.
If the parents have hired a postpartum doula, however, the postpartum period is when the work begins, and the emphasis is on “bonding and education to facilitate a smooth transition into their new roles,” says Franco.
“Every day is different when I work with families, but the heart of it stays the same,” she adds. “I provide guidance on lactation and bottle feeding, ensuring parents feel confident in their feeding choices. I also cover essential topics such as safe sleep habits and effective techniques for soothing the baby. Together, we focus on recognizing hunger cues and understanding the baby’s unique habits, which can significantly enhance their caregiving experience. By addressing any nuances that arise in baby care, I empower parents with the knowledge and skills they need to navigate this journey with confidence and ease.”
Additionally, Franco says that as a postpartum doula, she may jump in when there are sleep issues, allowing the postpartum parent to get adequate rest. She may also connect the parents with additional resources and professionals, when and if needed. Ultimately, her goal is to “create a safe and nurturing environment where parents feel supported both physically and emotionally during this critical time.”
Who should hire a doula?
Hiring a doula is a very personal decision, as it requires involving a new person into a very intimate stage of your life. So, while it may not be a priority for everyone, the experts we spoke to recommended having a doula if you meet any of these criteria:
First-time parents
Every pregnancy and delivery is unique, but it can be a particularly intimidating experience for a first-time parent. “When it’s our first time, and therefore there is a lot more that’s unknown, having a doula can be particularly valuable,” says Greaves Taylor. A birth doula can help mitigate those feelings of anxiety, as they serve as a non-judgmental, steady and experienced source of birth support.
People with complicated pregnancies or deliveries
Some women are lucky enough to have uncomplicated pregnancies and deliveries, avoiding conditions like gestational diabetes, breech babies, preeclampsia, induction and C-section. However, for the many who require interventions to deliver a healthy baby, a birth doula can help reduce the stress on the parents by helping them navigate the numerous decisions thrown at them during the days leading up to their due date and during delivery.
Birth doulas can also lend their expertise when it comes to laboring with an epidural. After all, despite the fact that “a lot of people think that doulas are only for someone who wants an unmedicated birth, that couldn’t be further from the truth,” says Greaves Taylor. Instead, if things take a more medicalized turn in the delivery room (such as with an epidural, an induction or a C-section), doulas may have strategies and techniques up their sleeve to help labor progress as efficiently as possible.
In the case of a C-section, a birth doula may also be able to step in to emotionally support the birthing parent in the operating room or recovery room, or even stay with a birth partner if the delivery requires them to not be present. And if that help isn’t needed during delivery, the parents may be able to shift the support to postpartum hours.
Those who require additional support
When Gotz was pregnant with her first child, she didn’t have any family in-state and was keenly aware of the fact that the nurses would be in and out of the room and would likely change shifts while she was there. Knowing that a doula would be a consistent source of support made it a no-brainer. “[The doula helped] advocate for me, ensure my wishes were met and made sure my husband was taking care of himself so I didn’t have to worry about that,” she says.
Greaves Taylor adds that a doula (or another form of support person) is essential for single parents or for those who have a partner who doesn’t want to be involved in labor support.
How much does a doula cost?
This question is understandably at the top of mind for many parents. And hiring a doula can be an expensive expenditure, with the cost dependent on a number of factors, including the doula’s level of experience and where you are located. However, if using a birth doula is important to someone, Greaves Taylor advises that there are affordable avenues to explore.
- New doulas: In order to gain experience while they are working toward their certification, newer doulas (who have still gone through training) may offer a lower fee.
- Sliding scale fees: Some doulas may offer their fees on a sliding scale, allowing some flexibility for lower-income families.
- Through insurance: Depending on the state, doula support may be covered by Medicaid. Additionally, some employers may offer fertility insurance through companies like Progyny and Carrot, and certain policies reimburse for doula care.
- Community doulas: There are some doulas who regularly keep their rates lower in order to be accessible to those who need support but can’t afford high fees.
“The most critical factor in finding the ‘right’ doula for you is seeking a good personality fit. Think about yourself in your most vulnerable state and possibly literally naked and ask yourself when you’re interviewing a doula if you would feel comfortable, supported and peaceful in that state with this person.”
— Lisa Greaves Taylor
How to find the right doula
When looking for a doula, you can ask for personal recommendations from friends and family. Many local providers and collectives have their own websites, as well. But if those don’t turn up your perfect fit, there are a few national networks you can browse:
- Doula Match: A nationwide doula directory
- Doulas of North America (DONA)
- National Black Doulas: A nationwide directory of Black doulas
- Queer Doula Network: An international network fo LGBTQ+ -affirming doulas
Once you’ve narrowed your search down to a few possible doulas, the experts and parents we spoke to agreed that you should interview them, either in person or via video chat.
“You want to make sure you really feel safe and comfortable with this person,” says Gotz. “They are going to be with you during a very vulnerable time for you. It is crucial that you have a certain level of comfort and trust.”
When it comes down to it, Laki advises finding a doula that you connect with and who has a nonjudgmental approach and you feel will support your choices during labor.
Greaves Taylor agrees: “The most critical factor in finding the ‘right’ doula for you is seeking a good personality fit. Think about yourself in your most vulnerable state and possibly literally naked and ask yourself when you’re interviewing a doula if you would feel comfortable, supported and peaceful in that state with this person.”
She continues, “A lot of people assume they need to hire a doula who attended a certain number of births or has enough experience. While there is something to be said for experience, a good personality fit is the ultimate thing.”
A final word on hiring a birth doula
Hiring a birth doula can be a daunting thing to check off your birth preparation checklist — finding someone who has the level and type of experience you desire and is someone you’d be comfortable being vulnerable around can feel like a Herculean task. However, hiring a doula can be an invaluable investment in your childbirth experience, providing physical and emotional support and informed guidance on your journey into parenthood.
“I strongly recommend using a doula for anyone who doesn’t have an experienced friend or family member to be with them,” Gotz adds. Or even if you do, a birth doula has significant training, knowledge and experience most family members and friends won’t have. They can step in and provide comfort measures like massage when your partner needs a break, or translate and work through medical advice with you. “Having someone knowledgeable who you trust and feel comfortable with makes all the difference,” says Gotz.
As Greaves Taylor sums it up, ultimately, in addition to improving birth outcomes, it can also be deeply meaningful to have a somewhat objective witness during this sacred rite of passage.