What Is a Doula and Should You Hire One for Your Baby's Birth?

Have you been planning out every last detail of your baby's arrival, from writing up a birth plan to figuring out how you'll manage labor pain? Here’s one more thing you may want to consider: whether you want to hire a doula, a trained labor companion.

A growing number of parents look to hire a doula for a myriad of reasons, including to reduce medical intervention during birth. While many hospitals and doctors let the process happen on its own these days (instead of inducing labor or using other medical means to make things go faster), a doula can be extra insurance that you get the birth experience you want.

But doulas aren't just for moms and families who choose an unmedicated birth. They can provide much-needed labor and delivery support to anyone who wants it. And the right doula won't judge your decisions about pain relief — or anything else.

Here’s why you may want to consider working with a doula and how to find the right one.

What is a doula?

A doula is a trained professional who provides emotional, physical and informational support to new and expectant parents before, during and after birth, as well as possibly while trying to conceive or in the early postpartum period.

A doula is a professional pregnancy companion whose goal is to help families have a safe, healthy and positive labor experience.

There are a few different types of doulas:

• A birth doula assists during pregnancy, labor and childbirth.
• A postpartum doula, as the name implies, helps the family during the postpartum period, the first few weeks after the baby is born.
• A fertility doula can help during the conception process and may be especially beneficial for families who are struggling to get pregnant.

The good news is many doulas offer all services (known as full-spectrum doulas), so if that's something you're interested in, you may be able to stick with one doula throughout the whole process.

What does a doula do?

A doula’s duty is to provide a continuous source of comfort, encouragement and support (both emotional and physical) during labor.

Unlike an OB/GYN or midwife, a doula does not have medical training — they're there to serve as a soothing voice of experience, help with relaxation techniques and breathing exercises, offer advice on labor positions, and so on.

A few of the ways doulas can offer support include:

• Before your due date, your doula will meet with you a few times so you can get to know each other. They'll learn how to best support you, such as by providing supportive referrals to ensure you have the best birth possible (for example, a chiropractor, acupuncture provider, pelvic physical therapist or prenatal massage therapist), and go through a few basic childbirth education touchpoints.
• A doula can offer a treasure trove of non-medical pain-management techniques including massage, reflexology, aromatherapy, music and mantras. They'll try different combinations to find the right one for you.
• A doula serves the important role of helping advocate for you in your most vulnerable times in labor and in the immediate postpartum period. They'll help ensure your voice is heard and your preferences are honored by your medical team.

One thing a doula doesn't do is relegate your partner or coach to third-wheel status. A good doula will never push a co-parent or other coach aside but instead enhance that support — and even help them relax, which in turn will help you relax.

Doulas vs. midwives: What's the difference?

Some people think a doula and a midwife are the same thing, but their educational backgrounds and duties differ.

Midwives

A midwife can be either a certified nurse-midwife (CNM) or a certified midwife (CM). CNMs are medical professionals (like registered nurses) who have completed graduate-level programs in midwifery and are licensed and certified by the American College of Nurse-Midwives to practice throughout the U.S. and its territories.

CMs are also certified by the American College of Nurse-Midwives, but they don’t have nursing backgrounds (though they have completed the same midwifery graduate programs as CNMs, and they've also taken bachelor’s level health and science classes). CMs are licensed to practice in certain states.

Both certified nurse-midwives and certified midwives are trained to care for low-risk pregnancies (including ordering tests, prescribing medications and providing routine gynecological care such as physical exams) and to handle deliveries without complications.

Doulas

Doulas, on the other hand, don't need a graduate-level education. They also don’t need to be certified, though many are. The largest and best-known certification program is offered by DONA International. DONA-approved workshops provide a minimum of 16 hours of instruction time, with an emphasis on practical, hands-on techniques, the history of birth, the benefits of hiring a doula, and the significance of doula support for families. 

Doulas don’t perform medical procedures (which means they don’t deliver babies) and they aren’t permitted to prescribe medications. Since they aren’t busy with the medical side of things, doulas are able to provide uninterrupted emotional support to moms and their families during labor and delivery.

Whether you choose to see an OB/GYN or a midwife as your prenatal medical practitioner, you can also hire a doula since their jobs differ.

What are the benefits of having a doula?

A doula offers support throughout labor, delivery and beyond.

Doctors or midwives may change shifts, and some may only be present during the final stages of birth. Doulas, however, typically meet with you before the birth, will stay with you during the entire labor and delivery process, and will often make one or two post-labor follow-up visits to check on your progress if you're breastfeeding and make sure baby is latching on correctly.

Studies have shown that doulas can help cut back on time spent in labor, reduce a mom’s and/or coach's anxiety, lower the rate of medical interventions (including C-sections) and improve mother-baby bonding post-birth.

If you're choosing to breastfeed, their assistance has been shown to improve the odds of breastfeeding success, since many doulas are also lactation consultants.

A doula may be especially helpful for a mom-to-be who's on her own, either by choice or because her partner can't be or isn't present (for reasons including military deployment). 

How does the doula process work?

Doulas usually meet you around your seventh month of pregnancy to discuss a birth plan — including whether you want a drug-free birth or one with an epidural or other pain management medication, and what labor techniques would work best for you. 

If you're planning to hire a doula, you should start looking as soon as possible so you have enough time to interview candidates and make sure your choice is available around your estimated due date.

During labor and delivery, a doula will be there to help you manage pain, ease stress and reassure you when you need it most. A doula will also help you labor at home for a healthy amount of time to reduce the risk of unnecessary interventions.

Many OB/GYNs and midwives are comfortable working with doulas in the delivery room because they realize the importance of the tasks they perform.

Roles are clearly spelled out, with the doula offering moral support for you and your family, and the OB/GYN or midwife overseeing your medical care and the delivery of your baby.

It’s always good to give your practitioner a head’s-up that you’ll have a doula present during labor and delivery. If they don't seem in favor of a doula, ask why. Make sure you and your doctor or midwife are on the same page in terms of support for you and your baby.

Is a doula for me?

If you think you might want or need additional support and coaching in the delivery room, a doula could be a good choice for you. And if you have your heart set on a specific birth plan, a doula can be a good option because she'll be your advocate if you're having a hard time fighting for yourself.

Doulas are usually trained to support all kinds of births. Families who want to try "natural births" (meaning without medication) are sometimes more likely to hire a doula, but doulas are there to support you no matter what your decisions are about pain medication and other aspects of labor.

If you're not the type to want someone cheering you on every step of the way — and you don't feel the need to have extra support in the delivery room outside of your medical team and your support partner — then you may not want or need a doula. 

What's more, since hospitals may limit labor and delivery guest lists, a doula can step in for other family members (like mothers and in-laws) if necessary. 

How much does a doula cost?

The cost of a doula varies based on where you live, the number of visits you schedule and the services you’d like to receive (although most usually cover a prenatal visit, labor and delivery, and post-delivery follow-up).

You can expect to pay between $800 and $2,500 for your doula, give or take, with doulas costing more in big cities like New York. Some doulas charge by the hour, while others have a flat fee.

If you’re worried about how to afford a doula, there’s some good news. While you may have to take care of it as an out-of-pocket expense, you may also be able to offset at least part of the cost, since some health insurance providers cover doula care. And some states currently cover doulas under their Medicaid plans, while others are considering similar legislation.

Call your provider and ask for their policies on labor support, childbirth education and lactation support. Also ask whether you can use your health care flex spending or health savings accounts (if you have them) to contribute to the cost of a doula.

How can I find a doula?

It’s a good idea to start looking for a doula as soon as possible, with the goal of hiring someone by about week 20 of pregnancy. Many experienced doulas fill up quickly with repeat clients and word-of-mouth referrals. That said, it’s never too late to hire a doula — even right up to your due date.

The best way to find a doula is through word-of-mouth referrals. Start by asking your health care practitioner as well as family and friends for recommendations.

It’s good to interview at least three. Remember to listen to your gut and pick the person you have chemistry with: A doula will be with you during the most intimate experience of your life, so it’s important to feel a strong emotional connection with them.

Additionally, you can also search for a doula online at the following organizations, which train and certify doulas throughout the U.S. and worldwide. These online directories allow you to search by location, doula type, certification and services offered:

• Childbirth and Postpartum Professional Association (CAPPA)
• DONA International
• Birthing From Within
• DoulaMatch.net
• Doula Trainings International
• Hypnobabies, which certifies doulas who specialize in hypnobirthing
• National Black Doulas Association (NBDA), a nonprofit organization connecting Black families to certified Black doulas throughout the U.S. The maternal mortality rate among Black women is the highest among different racial and ethnic groups, according to the Centers for Disease Control and Prevention (CDC).

What about a postpartum doula?

A postpartum doula is focused on the wellness of both the postpartum mother and the baby. They're there to support the postpartum parent's physical and emotional healing in addition to helping with baby skills, such as bathing, diapering, swaddling, sleeping and breastfeeding.

These postpartum doulas are very often certified lactation counselors, so they can help with latching techniques (one of the most common breastfeeding challenges). They’re there to advise you and give you the confidence to take care of your baby, as well as be on the lookout for signs of postpartum depression.

If you think there’s a chance you may want to work with a postpartum doula, make sure to ask your birth doula candidates for their specific certifications, since some are only trained for birth, some are certified just for postpartum and others have expertise in both pre- and post-birth support.

Whether you choose to go with a birth doula, a postpartum doula or a doula who does it all, having a specially trained companion has many benefits. The continuous, one-on-one care and physical and emotional support for both you and your family can make your pregnancy, delivery and postpartum experience a lot easier and more enjoyable.