Today, many women are choosing doulas to assist in childbirth instead of gynecologists. Doulas perform a variety of services and can aid in delivery of your baby at home or in the labor and delivery room of the local hospital. Also known as midwives, doulas have been delivering babies for centuries. However, before choosing a doula to assist you in childbirth there’s a few things you should be aware of.

What is a Doula?

A doula is a woman who has experience or has taken special education in the safe labor and delivery of babies. Doula is defined as a “woman caregiver.” She stays by your side throughout your labor and delivery to assure that things progress normally and safely and gives you emotional and physical support. A doula may or may not offer prenatal and postnatal care.

A doula cares for the mother. She encourages, comforts and supports you through your pregnancy, labor and delivery. She informs you on your condition and helps you communicate with health care professionals if you’ve chosen to give birth in a hospital setting. She helps you cope while you’re in labor, rubs your back, puts cool compresses on your forehead, wipes perspiration from your brow, holds your head while you vomit, holds your legs when you bear down and holds your hand to give comfort. She will stay close to your side and give you pieces of ice to suck on as well as emotional and physical support. She often agrees to be a photographer and always takes your partner’s needs into consideration. If you are delivering the baby in your home, she prepares food, assists with labor and birth, cares for the newborn, tidies your room and does all post delivery clean up and laundry.

Tools of the Trade

Doulas carry tools of the trade. When your doula arrives, she will probably carry a birthing ball, which you can use to support yourself in a wide range of positions. She may also carry a rice sock that can be heated in the microwave and applied to your groin or back for pain relief. She may also bring along a variety of aromatherapy oils that will relieve stress and help you relax while you’re in labor.

Visits

A doula should visit your at least once before you give birth and preferable more, so the two of you can get to know each other. She should know exactly what your preferences and priorities are and be willing to accommodate them. If you have any concerns about the labor or birth, be sure to voice them. Your doula will attend you throughout the labor and birth and should make at least one postnatal visit to assure that things are going smoothly. Ask her if she will be available to accept phone calls about any concerns you may have before and after your baby is born. It is in your best interests for her to be willing to help you after the birth of your baby by giving non-medical advice or by referring you to agencies that can assist you with any problems that may crop up.

Doulas do not prescribe medications or take care of any medical aspects of your pregnancy or post natal care. They do not monitor your vital signs or those of your baby during labor and delivery.

Pros and Cons of a Doula

Pros

If your pregnancy has gone smoothly with no possible risk factors, a doula will give you far more physical and emotional support than other health care professionals. With a doula by your side, you are more likely to:

• Feel the doula is in control of the situation and more able to help you cope.

• Feel less anxiety and pain throughout the child bearing process.

• Feel a higher level of self-esteem and take pride in your performance during labor and delivery.

• Feel more satisfaction through the labor and delivery.

• Feel more comfortable with your mothering skills.

• Feel it is in the best interest of you and your baby to breastfeed as long as possible.

• Feel positively toward your baby.

• Feel less overwhelmed after the birth and have a lesser chance of suffering from postpartum depression.

Women who are cared for by doulas are less likely to require pain medications or epidurals during labor and delivery. This lessens side effects for both mother and child. When a doula is beside a mother to care for and support her, the following benefits have been noted:

• Reduction for the need of Pitocin to bring on stronger contractions.

• Reduction of the need for an episiotomy.

• Reduction of the need for forceps and vacuum extractions.

• Reduction of the need for cesarean sections.

Because of the above factors, there is less need for medical intervention, which means fewer newborns experience the following:

• Have health problems when born.

• Require treatment for any infections, which includes spinal taps, blood tests and babies being separated from their mothers in order to receive special care.

• Are sent to the postnatal Intensive Care Unit.

• Have to stay in hospital for extended periods of time.

Cons

For the most part there are really no disadvantages to having a doula attend the labor and delivery of your child. However, as in all professions, some doulas are better than others. Possible problems that may arise include:

• The doula participating in a specific part of the delivery that your partner should be doing, such as cutting the umbilical cord.

• Judging whether or not you need pain medication or an epidural.

• Causing problems with medical staff.

• High costs for services.

• Health care professionals who are hostile toward the doula for no reason.

The Doula's Affect on Pregnancy and Birth

Provided you take special care to hire the right doula and that health care professionals aren’t hostile toward her or resentful of her presence on “their turf,” you have much to benefit with a doula at your side. She can help prevent the need for medications and procedures that may cause problems for you and your baby and provide a great birthing experience for you and your partner.

Questions to Ask a Prospective Doula

When you are choosing a doula, the first thing you should find out is if she is certified. Though certification doesn’t necessarily mean the doula gives excellent care, it does indicate that she has met certain standards in her field. However, lack of certification doesn’t mean the doula isn’t qualified to provide excellent care for both you and your baby.

Certification wasn’t an option for doulas a decade ago. If the doula you interview isn’t certified, ask her to provide you with her experience and background for labor support and delivery. She may have letters of recommendation or be able to provide you with names and phone numbers of references.

Cost and Services

Ask the doula what she charges and what services she is willing to provide. The package should include one or more prenatal and postnatal visits. Ask her if she is available for telephone calls if you have questions or concerns. Will she provide non-medical advice and meet with you throughout your pregnancy, or will she only attend you once you’ve gone into labor? Will she be available to attend you if you and your partner decide on birthing at home? Will she provide homecare after the delivery?

Some doulas do not assist in birthing, but will give homecare after the baby is born. These postpartum doulas perform light housekeeping tasks, make meals, help with breastfeeding issues and help you learn to cope with your new responsibilities. These services may be provided for a few days or up to a few weeks.

Ask a prospective doula how many clients she services each month. Will she guarantee her services during labor and delivery? Be sure she has a backup plan in case she is ill or has another delivery at the same time as you go into labor. Ask her to introduce you to her assistant or another doula who will step in to take her place should a conflict of interest occur.

Other Concerns

Inquire if a prospective doula has limitations. Will she attend the local hospital that you and your partner have chosen for the labor and delivery of your baby? Will she work with all medical teams and health care professionals?

References

Ask a prospective doula to provide you with references and be sure to check them. These can include letters of recommendation, contact information or names and phone numbers of past clients. All doulas should be more than willing to provide references. If a doula hesitates, resists, or puts off giving you references, a red flag has risen. Continue your search for the perfect doula to attend your labor and delivery.

Doula Contract

Professional doulas always offer a contract to be signed by all parties. A doula’s contract should include:

• Information on the doula’s role during the pregnancy, labor and delivery, as well as prenatal and postnatal care.

• A paragraph that focuses on your priorities, fears and concerns.

• The doula’s availability and whether she works with an apprentice. Also backup information in case she is ill or has another delivery when you go into labor. All times and dates that your doula will not be available should be specified, as well as her cell phone number.

• Information and approximate date and time of a prenatal conference. The contract should specify the information she will need from you and your partner at the conference.

• A date from which she will be available to attend your labor and delivery. Will she be available if you baby is premature?

• What procedures will take place once your labor begins?

• Techniques that the doula will use to make you comfortable during labor and delivery. Does she have a tens machine that will ease pain? What emotional and physical support will be given?

• How long will the doula stay with your after the birth of your baby? Will she assist you in breastfeeding?

• Specific length of time that the doula will remain available to answer any questions or address any concerns; a week, a month?

• Whether or not the doula will provide one or more postnatal visits after the birth of your baby. Will she be available for a weekly visit and one when your baby is ten days old?

• A section listing services that the doula will not provide.

• The total fee for all services.

• Whether or not she will assist at the labor and delivery with no prenatal or postnatal visits for a reduced fee to financially assist those in need.

• When and how the fee will be paid. Is a deposit required? Must you prepay? How many days after the birth is the remainder of the fee due?

• Does the doula allow payments, if needed?

• A clause stating what the procedures are if she fails to attend your labor and delivery.

• The contract should be signed by you, your partner, the doula and her apprentice if she has one. Date should also be specified.

Religion and Cultural Beliefs

If you have specific religious or cultural beliefs that have to do with the birthing process, be sure to explain these to the doula. Is she willing to accommodate them? Most doulas go out of their way to honor both religious and cultural beliefs. If your doula feels that she is unable to oblige you, it might be best to continue the search for the perfect doula for you, the baby and your partner.

Your Partner’s Role

Be sure to discuss your partner’s role with the doula. Is he going to be present to help with breathing techniques and to give emotional support, or does he wish to take an active part in the delivery? Who is going to cut the umbilical cord? Does your partner wish to hold the baby immediately after birth, or does he want to guide it out of the birth canal? Be sure your doula is willing to meet with you and your partner to discuss the role he wishes to play in the birth.

Be sure that the doula you chose is willing to support your partner as well as yourself. At times men don’t understand the instinctive behaviors of women during labor and delivery. He may become upset or overly concerned at behavior which is perfectly normal. Is your doula willing to reassure him and at the same time be able to assist you with labor pain and give you the much needed attention that you deserve?

Some fathers are very eager and excited to assist with labor and delivery. Others are somewhat leery. Be certain that you, your partner and your doula are fully aware of the role your partner wishes to play in the birthing process.

The Choice is Yours

The choice of which doula you will hire to care for you and your baby during the birthing process is yours to make. You and your partner should feel safe, secure and comfortable with your choice and the services the doula will provide. With your doula and your partner in attendance to give you much needed love, support and care during labor and delivery, you will have a positive and beautiful birthing experience.