As an Ob/Gyn, I get a lot of questions about doulas. What is a doula? Are you a doula? Do I need a doula? Where do I find a black doula? Does the hospital still have free doulas? Will I be forced to push on my back if I don’t bring a doula? Do I cancel my doula if my pregnancy becomes high-risk?
What Is a Doula?
Let’s start here. The word ‘doula’ made its way into the common North American language in the 1970s as part of a movement to support breastfeeding. The word ‘doula’ originates from a Greek language root that means ‘female slave,’ or the slave who serves the childbearing woman. As a result, some have proposed the replacing the term ‘doula’ with ‘paramana”, a modern Greek word that means ‘next to the mother’. The modern context of ‘doula’ is far distanced from forced labor, and it is unlikely we will replace ‘doula’ with ‘paramana’, but if someone requests to be referred to a ‘paramana’ instead of ‘doula,’ I understand why that might be.
Most current doulas are women, but the communities of doulas are expanding to represent the gender spectrum. Most doulas work for themselves as a private business, but there are growing groups, agencies, and hospitals that are employing doulas. In some states, health insurance companies pay for doulas! We are working towards this in Missouri. I know of at least one Missouri Medicaid plan that offers doula support. Hopefully, soon professional doula support will be available for all who are interested.
What Does a Doula Do?
The details of the services any one doula provide varies by her experience, training, interest, and what you ask her to do. Many doulas offer a variety of packages depending on what you are looking for. In general, a doula is a companion and support person during pregnancy, birth, and the early postpartum time. There is a growing industry around doulas, and there are now professional training programs that offer doula certifications. Long before certification programs popped up, there were doulas within families and communities that rallied to help a new mom and family prepare for, welcome, and keep their new precious baby alive. Early parenthood is hard, and women have always needed nurturing during this transition. I love learning from my patients about how different cultures support new babies and moms and the special traditions they value and bring to our births and postpartum experiences. Ever heard of ‘la cuarentena’? Or oxtail soup to bring down the milk? Or that where the placenta is buried guides the soul back to earth upon death?
The type of support a doula provides depends on your unique arrangement but generally always encompasses emotional and physical support. If you are working with a professional doula, she will also be able to share evidenced-based information about certain things related to pregnancy, birth, and postpartum—e.g., can it be normal to labor for 23 grueling hours for a first birth? (The answer is YES)! If a partner or other family member is involved, the doula will support them as well (they may not know they need support, but they do)!
Many people think a doula is just there to help with the birth and prevent a cesarean (it is true that cesarean births are less common when a doula is part of the care team)! Of course, support in labor and delivery is critical, but the postpartum weeks need a lot of support too—and they last much longer! Some nights seem to never end in those first few weeks. So don’t skimp on the postpartum part of the package!
Many women are no longer birthing in a close-knit family or community with a tradition of rallying to the cries of a newborn and now have to rely on hiring a doula to help survive this transitional time. Globalization and modern careers often mean aunties or grannies are not next door anymore. If utilizing a postpartum doula is an option, I tell every mom to take it!! (Even if grandma does live next door, a doula’s support can be great)!
My Pregnancy Is High Risk, Why Would I Have a Doula?
I hear this a lot, actually. This represents a common misconception about what doulas are capable of doing for you. Doulas are not just for ‘granola moms’ or ‘natural’ vaginal births. In fact, I argue that for high-risk moms, doulas can play an extra-critical role as part of her care team. If your pregnancy is complicated and your doctor visits are filled with shared decision making about which medical risk is right for you, how to manage your infusions for Crohn’s, all the pre-op evaluations you need, the cardiologist’s recommendations for monitoring your heart strength at delivery or how to reduce your risk of seizures, then we have less time to talk about all the other stuff. A doula is well equipped to help prepare and educate you about skin-to-skin, delayed bathing, perineal care, sleep hygiene survival tips, nipple care, what to pack (don’t forget the earplugs and eye mask), what foods to stockpile to help your milk come in, setting up your house to be comfortable for feeding and changing the baby, etc. And they can do this separate from a doctor visit where you are digesting whether a 1 in 757 odds your baby has Down’s is reassuring or terrifying to you.
The doula can be extra helpful for the partner when things are complicated with the mom and/or baby. In tense situations, when the medical information is flying fast and things are happening emergently, the partner can feel very disempowered and alone. A doula is a great person to help provide a space and circumstances where the partner can feel re-engaged and heard and find ways to remain actively supportive of their growing family.
If you always planned on using a doula before discovering your pregnancy was high risk, I will tell you that you need a doula even more now!
I Am Having a Scheduled Cesarean. Why Would I Have Doula?
Even if you know you need a scheduled cesarean, a doula can be so supportive and empowering before, during, and after and still make sure the special moments are recognized and honored. Depending on the hospital and circumstances, sometimes the doula can join the partner in the operating room. Even if your baby is going straight to the NICU because of prematurity, a heart condition, or whatever the cause, a doula can help you be sure to capitalize on all the bonding opportunities still possible (i.e., taking your nipple pads to put in the isolette in the NICU, so the baby learns your smell or making sure you get videos of the baby to watch while pumping). The doula can stay with you while your partner stays at the baby’s side to the NICU.
I Want All the Drugs! Why Would I Hire a Doula?
Another misconception about doulas I hear from patients is that their role is primarily to keep you from getting an epidural. Now, if that is your personal goal, your doula will work to help you achieve that for sure. BUT, you do not have to plan to gracefully embrace pain or use hypnobirthing for pain control to benefit from a doula. You can know you want an epidural and still work with a doula successfully. Once you get your epidural, the doula can still help you with a ton of physical and emotional support and help you figure out how to push most effectively. Also, remember the doula is the there for you before and after the birth as well. All good doulas are there to help you achieve your personal goals, and if avoiding pain or the vaginal sensation of birth is one of them, your doula will honor that and still work to empower and support you.
What Is a Postpartum Doula?
Navigating the ‘easiest’ of postpartum courses is exhausting, overwhelming, and a major transition. Many cultures surround new mothers with support, food, nurturing, and exemptions from cleaning and cooking. Did you look up la cuarentena yet? Sadly, North America is not known for systemically or culturally supporting new moms and many new moms feel very isolated after birth.
Most doulas offer a defined support in the immediate postpartum period. Some doulas specialize in postpartum care and offer extensive support—sometimes even overnight services. Some women ONLY hire a postpartum doula. If there was a complicated birth or a baby in the NICU the opportunities for a doula to provide you with discrete supportive care separate from the medical information you are being overloaded with can become even more valuable. If your baby was in the NICU for months, engaging a postpartum doula for when you take your baby home can be very helpful to the transition from highly supervised parenting in the NICU to ‘you’re on your own’ parenting. I think we will see an uptick in the use of postpartum doulas as we learn how to best integrate doulas in the entire maternity experience.
I Am Not Working with a Doula. Will My Desires Be Ignored or Silenced?
Women have wonderful, empowered and healthy pregnancies and births without hiring a professional doula all the time. Access to professional doulas remains quite limited, especially for geographically, socially, and economically marginalized women. Some women do not wish to invite another person into one of the most intimate and vulnerable experiences of their life. If you are not hiring a professional doula, you should still expect and get excellent support from your medical care team, and I encourage you to share your priorities, personal goals and preferences with your provider. You can seek out a provider who works with doulas even if you are not hiring one to be sure you have a provider who is familiar with this type of patient-centered care. Sometimes a formal birth plan works well to help voice your desires and concerns formally. That said, I have patients who feel trying to create a birth plan is too stressful, and we just simply have an open conversation, and I put the highlights in her chart so that everyone on the care team is aware. If there are cultural rituals that matter to you, please share these so we can honor them. I once had a family for whom the first voice and words the baby heard was very important, so we made sure there was silence until the dad sang a special prayer in her ear on mom’s belly (then we all burst into tears).
If you are not hiring a professional doula for whatever reason, you can recruit your own doulas like women have done around the globe for eternity. Seek the support of your friends, aunties, mommas, grandmammas, grandmothers, nanas, sisters, sistas, tias, and whoever else you trust believes in you and will fight for you and your baby. Invite them to support you on your journey and tell them you think of them as your doula. Ask for help and don’t try to be strong for them. Share your fears, ask them what was hard for them, and what helped them during their journey. My doulas were my best friend and my sister. They got me through 2 ½ days of labor and then four hours of pushing (apparently being an Ob/Gyn does NOT get you any personal skills on pushing a baby out). And kept my husband from passing out and hitting his head!
How we support one another in pregnancy, birth and postpartum can look like a lot of different things, but one thing for sure is that we all need and deserve a lot of support during this incredible and tender time. As an Ob/Gyn, I love supporting women on their motherhood journey, but I know they need immense support beyond what I can provide. That is why I love working with my patients’ support communities and knowing when they leave the office or hospital, they are surrounded by a web of support. I am grateful for all doulas, professional and otherwise, who work next to the mother and alongside use birth attendants.
BJC Hospitals and affiliated providers offer a welcoming environment for doulas. Find an Ob/Gyn provider for you.