What is a doula?
A doula is a woman who provides support to a couple during pregnancy and birth. She attends the birthing family before, during, and just after the birth of a baby. She uses her knowledge and experience to provide emotional and physical comfort, plus information and education. “Doula” is a Greek word that means “woman’s helper” and the term was used to refer to the female servant of the woman of the house. The labor Doula is a servant to the needs of women giving birth.
Does hiring a doula make a difference?
Evidence-based research shows that having continuous companionship of a doula during labor offers the following benefits:
• 50% Reduction in cesarean rates
• 60% Fewer requests for epidurals
• 25% reduction in length of labor (1.5 to 2.5 hours shorter)
• Reduction in use of pitocin (artificial oxytocin)
• Reduced neonatal hospitalization and rate of complications
• Fewer forceps/vacuum deliveries
• Increased rate of breastfeeding
• Reduction in postpartum depression
References
1.) Kennell, J.H.; Klaus, M.H.; McGrath, S.K.; Robertson, S.S.; Hinkley, C.W. “Continuous Emotional Support during Labor in a U.S. Hospital.” Journal of the American Medical Association 265(1991):2197-2201
2.) Sosa, R.; Kennell, J.H.; Robertson, S.; Urrutia, J. “The Effect of a Supportive Companion on Perinatal Problems, Length of Labor and Mother-Infant Interaction.” New England Journal of Medicine 303(1980):597-600
How are doulas trained?
Lumina Birth doulas are all trained and certified (or working towards certification) by an internationally recognized and reputable professional birth association. These include Childbirth And Postpartum Professional Association (CAPPA), Doulas of North America (DONA), Childbirth International, and Association of Labor Assistants and Childbirth Educators (ALACE – International Birth & Wellness Project).
Does a doula enhance the father’s experience or hinder it?
The following is excerpted from “Dads & Doulas: Key Players on Mother’s Labor Support Team” by Doulas of North America (DONA)…
Today, a father’s participation in birth preparation classes or his presence at prenatal visits and in the delivery suite is a familiar occurrence. Yet, we sometimes forget that the expectations of his role as a “labor coach” may be difficult to fulfill. Sometimes it is also culturally inappropriate for an expectant father to be so intimately involved in the process of labor and birth. The father-to-be is expected among other things to become familiar with the process and language of birth, to understand medical procedures and hospital protocols and advocate for his partner in an environment and culture he is usually unfamiliar with. A doula can provide the information to help parents make appropriate decisions and facilitate communication between the laboring woman, her partner and medical care providers.
At times a father may not understand a woman’s instinctive behavior during childbirth and may react anxiously to what a doula knows to be the normal process of birth. He may witness his partner in pain and understandably become distressed. The doula can be reassuring and skillfully help the mother to cope with labor pain in her unique way. The father-to-be may need to accompany his partner during surgery should a cesarean becomes necessary. Not all fathers can realistically be expected to “coach” at this intense level.
Many fathers are eager to be involved during labor and birth. Others, no less loving or committed to their partner’s well being find it difficult to navigate in uncharted waters. With a doula, a father can share in the birth at a level he feels most comfortable with. The doula’s skills and knowledge can help him to feel more relaxed. If the father wants to provide physical comfort such as back massage, change of positions, and help his partner to stay focused during contractions, the doula can provide that guidance and make suggestions for what may work best.
Physicians, midwives and nurses are responsible for monitoring labor, assessing the medical condition of the mother and baby, and treating complications when they arise. But childbirth is also an emotional and spiritual experience with long-term impact on a woman’s personal well being. A doula is constantly aware that the mother and her partner will remember this experience throughout their lives. By “mothering the mother” during childbirth the doula supports the parents in having a positive and memorable birth experience.
The benefits of doula care have been recognized worldwide. The Medical Leadership Council of Washington, D.C, the Society of Obstetricians and Gynaecologists of Canada and the World Health Organization are among the many healthcare organizations that value the benefits that doulas provide to women in labor.
The father’s presence and loving support in childbirth is comforting and reassuring. The love he shares with the mother and his child, his needs to nurture and protect his family are priceless gifts that only he can provide. With her partner and a doula at birth a mother can have the best of both worlds: her partner’s loving care and attention and the doula’s expertise and guidance in childbirth.
Why do I need a doula if I have my doctor or midwife? Won’t the nurse be there, too?
In a typical hospital labor, the nurses will be in and out to monitor the baby and meet your needs for comfort and medical assistance. Both will have 1, 2, or up to 6 other patients to attend to at the same time. Care providers have paperwork to do, appointments to keep, shifts to change, rounds to make, or sleeping to do. You may have never met the doctor on call, and you’ve certainly never met your nurse. In contrast, a doula has a relationship with you and knows your perspective on birth. She provides continuous support and assurance during the intense experience of labor. Your nurse or doctor, though competent, are not there to be a companion, advocate, or coach throughout labor. It makes a tremendous difference to have someone there on your team to give peace of mind and guidance.
How is a doula different from a midwife?
A doula is not a medical professional. Any procedures considered medical care are outside of her scope of practice, such as cervical exams, taking blood pressure or temperature, listening to fetal heart tones, or advising on medical decisions. A doula’s support is non-medical and she will not proscribe or administer “medical” care. She doesn’t take the place of a midwife, nor does a midwife do the doulas work. The doula will help a couple get the information they need to make their own informed medical choices about their care. Even a midwife, in a hospital birth setting, will not stay with the laboring couple to coach them through the process. Only a doula will provide constant support in labor, starting at your home if desired.
What if I might want an epidural or something else the doula doesn’t agree with?
It’s not a matter of the doula’s opinion or personal preference. Your birth is your birth, not the doula’s birth. The doula’s goal and desire is to support the parents in the birth preferences THEY choose toward the goal of a wonderfully satisfying welcome of their new baby. Part of her job is to help you think through the pros and cons of your options, then let you decide what works for you in the circumstances of your labor. She’s not there to give opinions or make your decisions. The doula empowers the laboring women and her partner to feel confident in their choices. Labor can otherwise feel overwhelming because of the powerful forces of labor, the systematized care in most hospitals, and the deeply emotional miracle of childbirth. The doula brings a peaceful environment to all of that, no matter how labor unfolds or what the mother chooses is best for her labor.
What will a doula do for us during labor?
She brings reassurance and calmness to you and your partner. This is imperative during labor so the mother can release as much anxiety as possible, letting her body relax into birthing her baby. The doula will make suggestions for labor progress, and help with relaxation, massage, breathing patterns, positions and other techniques for comfort. A doula can help describe and interpret the hospital “lingo,” also making sure that you know what you need to know to truly make informed choices throughout labor. A doula assists in physical comfort, labor positions, and emotional encouragement. She helps the dad or partner be supportive and loving through this unique time.
How does a doula interact with hospital staff and doctors?
Your doula works for you, not your caregiver, or the hospital. She believes that you are in charge of your own birth. It is a great honor to be entrusted with helping you through this miracle of life’s journey. Having a doula will give both parents added assurance and confidence, and less stress and confusion, so you can enjoy this amazing experience to the fullest. A doula will do her best to create a peaceful environment where everyone helping the mother becomes one positive support team. She can also help you with the confidence to kindly stand firm on your desires, if the need arises. The Lumina Birth doulas have excellent relationships with many OB/Gyn and midwifery practices in hospitals around Atlanta.
When will we meet with the doula?
You can meet with a doula, or more than one, at any time in your pregnancy. Some couples contact us early in pregnancy, and some when they have just a few weeks to go. Sometime midway through pregnancy is ideal because you have time to decide who to contract with, and time for all of you to get to know each other. After contracting with your doula, you have her available for answering your questions and giving you information along the way. You will usually meet with a doula twice before your labor.
What does my due date mean?
The estimated due date (EDD) is the midpoint of your due month, not an expiration date! Babies born between 38 and 42 weeks gestation are within the normal length of human pregnancy, not “early” or “late.” It may be a good idea to tell friends and family that you are due “in mid March” instead of giving them an exact number. That can save a lot of bothersome, though well meaning, phone calls and comments at the end of your pregnancy, when you need encouragement and endurance to wait until your baby is ready, not impatience. Remember that only 3 percent of women actually give birth on their due date.
The estimated due date is calculated from the start of the mother’s last menstrual cycle. Sometimes that date is unknown because of irregular cycles or lack of careful recording. Sometimes you may know exactly, without a doubt, the day of conception. In either case, you could calculate an estimated due date, based upon your own intuition, that is quite different from what your doctor/midwife calculates on the due date wheel. This could make a difference in what interventions may be suggested or demanded at the end of your pregnancy, so be sure to discuss any due date discrepancies carefully with your care givers.
What is the best position for labor?
The best position for labor is whatever is most comfortable to the mother. Your doula and other birth resources can suggest a variety of helpful positions. Lying on your back is the least helpful position because it reduces the size of the pelvic opening, decreases blood/oxygen flow to the baby, and puts undue pressure on the back.
Will a doula come to my house during labor?
A doula will come to your home if you ask her to during labor, especially if you want to stay home as long as possible before going to the hospital. She can give some guidance as to when is a good time to go to the hospital, though that is ultimately up to the laboring woman to decide. A doula can ease the transition from home to the hospital environment, with its changing shifts, admission questions, discomforts, and fetal monitoring. And, of course, if you are planning a home birth your doula will be there at your home from the time that you need her.
Will a doula attend my home birth?
Some of the Lumina Birth doulas have had and/or attended home births. We love being there in the couples’ own environment. It is so peaceful! If you are considering a home birth, you can find midwives in Georgia at Georgia Midwifery Association, and advocacy at Georgia Friends of Midwives. A woman has the right to give birth in the place of her own choosing. Home birth is not illegal in Georgia.
Why should you take a Lumina Birth class when your hospital offers childbirth (and breastfeeding!) classes, and possibly for less time or money?
Good question! Typically, though there may be exceptions, a hospital’s course will focus on teaching you what they offer – epidurals, pitocin, IV’s, etc. They are most interested in teaching you how to be a good patient. They are not so good at teaching you tools to work through labor – and 95% of all labors are low-risk, in hosptial-speak, which is to say, perfectly biologically natural. In short, the hospital environment does not treat birth as the normal physiological process that it is, but as a crisis waiting to happen that must be managed and avoided at all cost. They are in the business of risk mitigation for sick people and insurance companies. Pregnancy is not an illness, thus birth becomes a casualty of a flawed system. The cost of maternity care is a perfect indicator of that, since for-profit hospitals are in large part carried financially by lucrative maternity departments. All of our childbirth instructors are trained and certified by childbirth professional associations. At a hospital, that’s not guaranteed. Classes may be taught by nurses who have not been trained to be childbirth educators. An independent childbirth class gives you a fresh, non-medical perspective. And, with Lumina Birth, you will also find a great team of labor and postpartum doulas, possibly even your class instructor herself!
How do doulas set their fees?
Each doula that is a member of the Lumina Birth community sets her own fee as an independent contractor. While some professions are hourly, doula work is not. It is amazingly inexpensive if one considers all that goes into serving each couple’s birth.
The Hours: For couples having their first baby, an eight hour labor would be considered fast, as most first labors are anywhere from 12 to 24 hours. Some doulas have spent a continuous 36 hours or more providing labor support. An average time is closer to 8-12 hours per birth. There is also another 6-10 hours in pre and postpartum visits, phone calls, email, travel time, and record keeping tasks. The fee quickly translates to less than $20 per hour, and that is before expenses, supplies, web site fees, and self employment taxes. Since we don’t know in advance how long we will be with any particular client, the doula tries to find a balance in fee between the very long labors and the shorter ones.
Number of Clients Per Month: A doula makes a commitment to be available and on-call for your due MONTH. That’s four weeks of being available for each client. We try to space out due dates to avoid overlap of clients in labor, but even that is no guarantee. One of our doulas once had two clients due in the same week who gave birth 6 weeks apart. Very occasionally, a doula will have more than one client needing her at the same time, and therein lies the beauty of a doula group. Lumina doulas back each other up so that no one is left without support. Some of our doulas have young children, so taking one or two clients a month equates to a full load. We need to be rested and prepared at all times. One cannot be exhausted from a late night the day before, then called on by a client at 11:00 pm and be expected to stay awake all night.
Number of Clients Per Year: Doulas have to plan months in advance for family trips, conferences, or other commitments that cannot be missed. One 5 day trip and our schedule is blocked out from taking clients for weeks on either side. This is another benefit of working with a doula group; couples are pretty much guaranteed that someone, or more than one, will be available to be on-call during their due month.
Self-Employment & Experience: A self-employed professional’s income is only half of what they earn, after deductions for self-employment tax, business expenses, time one is not available to take clients, continuing education, communications & marketing, transportation to clients’ homes, and so on.
Adding it Up: All of that said, a huge factor in determining fees is what the market will bear. In Atlanta, the range is typically from $400 to $800. Being a doula requires a great deal of personal sacrifice, including a willingness to be awakened an hour after going to sleep in order to attend a labor for the next 16 hours (that’s usually how it goes!). There is also the looming possibility of interruption to the family schedule, carpools and childcare to rearrange, friends and fellow doulas on-call with us, and husbands or employers who have to adjust to an unknown length of our absence. For those of us who have husbands, we couldn’t do this without their support and flexibility. Even so, we’ve had to call friends to come over in the middle of the night when husbands are out of town. We love the backup of fellow doulas at Lumina, because it can allow for the occasional weekend away while on-call (we always inform our clients if this happens). We also never know what we will encounter at a labor – we may lose an entire night’s sleep, nap sitting up, wear out our bodies standing next to a woman in labor, eat only granola bars and nuts for several meals, end up holding a vomit bowl, or get splashed with blood, meconium, or amniotic fluid. Only women with a passion for normal birth do this work! It is our calling.
Experience: Doulas also factor into their fee the value they bring to each client based on previous experience. To each birth we bring our heart and hands, as well as valuable experience and expertise having served many couples. Each birth is different and unpredictable; each adds to her knowledge base about birth, particular hospitals, caregivers, nursing practices, etc. Some doulas bring additional skills to the table, such as massage, hypnotherapy, other training, childbirth education, professional relationships, or simply a presence and philosophy that makes her the right match for you. As doulas, and often educators as well, we must keep up to date on the latest studies, procedures, announcements by ACOG that affect practice, policies, each hospital’s protocols, and knowledge of providers. Most doctors, midwives, and nurses only know about their way of doing things. As doulas, we have seen the variations from hospital to hospital, between caregivers, and over time. The ability to work with a many different care providers teaches us different approaches and tricks, which is a unique aspect of the doula profession. Every birth is unique and rich. Each client relationship teaches us something new. We bring this wealth of knowledge and skills to your birth.
The Bottom Line: None of us gets rich doing doula work. Some may offer doula services at lower rates. They may be offering less time or services, may still be gaining certifying birth clients, have less overall experience, or are otherwise in a financial position to offer free or reduced rates. If you are still hesitant about the value of doula services, check out our Buzz page to see what past clients have to say about us, or ask for referral phone numbers if you’d like to call and ask past clients more questions. They’ll tell you it’s worth every penny, and then some!
