What is a Doula?

A doula is a woman experienced in childbirth who provides continuous physical, emotional and informational support to the mother and partner during pregnancy, birth and early postpartum.  In much of the world today and throughout history women support women through labour and birth.

 

What’s the difference between a midwife and a Doula?

Doulas work as part of a team with doctors or midwives, but not instead of.  They provide non-medical support and comfort measures (ex. Encouragement, massage, positioning suggestions).  They do not perform clinical tasks such as heart rate, blood pressure or internal exams.

Midwives are highly trained in the medical aspects of birth.  They carry oxygen, medicines, resuscitation equipment and other gear, and are known as primary care givers during birth.  In North America primary/medical birth care is offered by either a midwife or a physician.

 

Why choose a Doula over simply using a friend or family member as support?

Doulas are trained and experienced in childbirth support.  They know the sounds and behaviours of labouring women and what they may indicate about progress.  Doulas are trained in pain reducing comfort measures, natural methods to keep labour progressing and to support both the labouring woman and her partner.  Doulas are familiar with local hospital policies & practices and have often built a rapport with the doctors, nurses and midwives.

 

How does a Doula fit in with nursing staff?

Doulas do not replace nurses or other medical staff, but rather work as part of the team.  They are there to comfort and support the mother and her partner.  Nurses change shifts; doulas stay.

 

How does a Doula assist with communication in hospitals during labour & birth?

During prenatal meetings Doulas learn what’s important to a couple and discuss how to make informed decisions.  A Doula may remind or encourage a client to ask the questions necessary to understand a procedure and make informed decisions.  Doulas do not speak on a client’s behalf nor intervene in their clinical care.  They do not make decisions for clients, nor judge the decisions clients make, but are there to support those decisions.

 

What difference does the presence of a trained Doula have on birth outcomes?

The presence of a Doula tends to result in shorter labours with fewer complications and less interventions.  When a Doula is present during and after childbirth, women report greater satisfaction with their birth experience, make more positive assessmentsof their babies, have fewer caesareans and requests for medical intervention, and less postpartum depression.  In case of unplanned circumstances, Doula support helps reduce negative feelings about one’s childbirth experience.  Studies have shown that babies born with Doulas present tend to have shorter hospital stays with fewer admissions to special care nurseries, breastfeed more easily and have more affectionate mothers in the postpartum period.

Analysis of six randomized trials demonstrates that lack of Doula presence correlates with:

• Double the overall caesarean rate

• 33% increase in length of labour

• 67% increase in oxytocin use

• 2 ½ times more requests for epidurals

 

Will a Doula make my partner feel unnecessary?

A responsible Doula compliments and enhances the father/partner in their supportive role rather than acting as a replacement.  The presence of a Doula allows the partner to support the labouring woman emotionally during labour and birth without the pressure to remember everything they learned in childbirth class.  A Doula is supportive to both the mother and her partner, and plays a crucial role in helping the partner become involved in the birth to the extent he/she feels comfortable.  Studies have shown that partners usually participate more actively during labour with the presence of a Doula than without one.

 

How often and when do we meet?

We will meet 2-3 times before the birth.  The introductory meeting is anytime – it’s never too early.  The prenatal meetings are best done between 24-36 weeks.  After your baby is born there will be a minimum of one postpartum visit, more or less based on agreement.

 

Are Doulas only used if planning an un-medicated birth?

The role of the Doula is to help attain a safe and pleasant birth, not to choose the type of birth.  The presence of a Doula is beneficial no matter what type of birth you are planning.  In fact, women who choose a medicated birth need as mush support as those who choose a natural birth, but a different kind of support.  For women who know they want a medicated birth, the Doula still provides emotional support, informational support and comfort measures to help the woman through labour and the administration of medications.  Doulas can help a mom deal with possible side effects and by filling in the gap that medication may not cover; rarely does medication take all discomfort away.

For a mother who faces a caesarean, a Doula provides comfort, support and encouragement.  Often a caesarean is an unexpected situation and moms are left feeling unprepared, disappointed and lonely.  In this case Doula support is especially helpful during the early post partum period.

 

What if I planned a drug free birth then change my mind during labour?

Doulas don’t make decisions for clients or intervene in clinical care, nor do they judge women’s choices.  They provide informational and emotional support while respecting a woman’s choice.

 

What kind of comfort measures do you use during the labour and birth process?

While there are common comfort measures taught in Doula training courses, each Doula also brings her own tools and methods.  Ours would include:

• Positioning suggestions

• Massage and various touch methods

• Encouragement and reassurance

• Heat or cold as desired

• Hydrotherapy (water for comfort in labour and/or water birth)

• Create space for the partner and recommendations for the partner to offer support

• Calm reassuring presence who trusts the birth process

 

When do we call you in labour?

Please call at the first signs of suspected labour.  We will discuss what those are.  From then on you would keep us posted on your progress and what is happening.

 

When and where do you join us in labour?

When depends on the woman, her partner, and the labour.  Early support often takes the form of checking in by phone and/or dropping by your home to check in.  Your Doula joins you either at your home or in the birth centre/hospital and remains with you until 1-2 hours after the birth.

 

How does shared care work?

Doulas often team up to provide enhanced care.  Clients benefit from combined experience, education and availability.  Since Doulas are on call for up to a month for each client, shared care allows them time for important life events and days off without having to turn clients away or rely on unfamiliar back-up.  Clients meet with Doulas prenatally so they can become familiar with the team.

 

Do we pay more to work with a team of Doulas?

No.  Fees are outlined in the agreed upon contract.  The cost of working with a team of Doulas is the same as hiring one of us individually.

 

What kind of postpartum support do you offer?

Your birth Doula usually stays for 1-2 hours after the birth, until you’re ready to be on your own with your baby.  We also visit in the first day or two postpartum, offering basic breastfeeding support, answering questions, and going over your birth.  We are available for questions and can offer resources (educational and community).  A second post partum visit can be offered and agreed to in the contract.

 

What if I need extra help with breastfeeding or baby care?

The information above describes our work as birth Doulas.  Another kind of Doula, a Postpartum Doula specializes in extended care and breastfeeding support.  There are also breastfeeding counselors and lactation consultants that can be arranged through public health or hired privately.  We can provide resources to these services.  If you are on the Mother Baby Unit at Regina General Hospital the nurses or unit Lactation Consultant can also provide support.

 

Where does the name Doula come from?

In ancient Greece “Doula” meant the highest female servant who helped the lady of the house through childbearing.  Medical researchers Marshall Klaus and John Kennell, who conducted several randomized clinical trials on the medical outcomes of Doula attended births, adopted the term to refer to labour support as well as prenatal and postpartum support.

 

1. Klaus, M.H.; Kennell, J.H; Klaus, P.   “Maternal Assistance and Support in Labor: Father, Nurse, Midwife or Doula?” Clinical Consultations in Obstetrics and Gynecology 4 (December 1992)

2. Sauls, DJ.   Effects of labor support on Mothers, Babies, and Birth Outcomes. J Obstet Gynecol Neonatal Nurse.  2002 Nov-Dec; 31(6):733-41

3. O’Driscoll, K. and Meagher, D.    Active Management of Labor. 2d ed. London: Bailliere Tindall, 1986

4. Klaus, M.H. and Kennell, J.H.   Parent Infant Bonding. St. Louis: C.V. Mosby, 1982

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FAQ borrowed and adapted from Angie Evans @ BirthWays International.com