What is a Doula?

A doula is a person trained in the art of pregnancy, birth, and postpartum support. Birth doulas support birthing people and families prenatally, during the birth process, and in the early postpartum period. Postpartum doulas support birthing people and families in the first weeks and months after birth. Doulas understand that birth, and the months surrounding it, is a transformative experience that will be remembered forever. They understand the emotional as well as physical needs of pregnant, birthing, and postpartum people, as well as the dynamics of those in relationship with them.

Generally speaking, doulas do not tell their clients what they should do. Instead, they support their clients’ own decision making processes by helping them get the necessary information, and mentoring them as they sort through that information, as well as their gut instincts, motivations, relationships, and emotional needs. Doulas help people think about what is important to them in the birth experience, and prepare them for the experience of stepping into the unknown.

Advancing Birth Justice: Community-Based Doula Models as a Standard of Care for Ending Racial Disparities, a 2019 paper produced by Ancient Song Doula Services, Village Birth International, and Every Mother Counts, contains the following excellent description of doula work: (content note- does not use inclusive language language)

Doulas are trained to provide non-clinical emotional, physical and informational support for people before, during, and after labor and birth. Birth doulas provide hands-on comfort measures and share resources and information about labor and birth. Doulas can facilitate positive communication between the birthing person and their care providers by helping people articulate their questions, preferences and values.

In addition to providing continuous support during labor and childbirth, birth doulas typically meet with clients one or more times at the end of pregnancy, as well as early in the postpartum period, although some hospital-based doula programs provide care only during labor and birth. In the postpartum period, doulas may offer help with newborn feeding and other care, emotional and physical recovery from birth, coping skills, and appropriate referrals as necessary.

Doulas work with pregnant people to help them experience care that is individualized, safe, healthy, and equitable. Doulas can be particularly beneficial for women of color and women from low-income and underserved communities and can help reduce health disparities by ensuring that pregnant people who face the greatest risks have the added support they need. Doula care can vary significantly depending on their training and approach. Community-based doulas offer an expanded model of traditional doula care that provides culturally appropriate support to people in communities at risk of poor outcomes. They are usually trusted members of the community they serve who are particularly well-suited to address issues related to discrimination and disparities by bridging language and cultural gaps and serving as a health navigator or liaison between the client and service providers.

Benefits of Birth Doulas

Research on the impacts and benefits of doulas at birth has been done since the 1980s.

A systematic review of continuous labor support summarizes the experiences of over 15,000 people who participated in 21 randomized controlled trials. The authors conclude: "Continuous support during labour has clinically meaningful benefits for women and infants and no known harm. All women should have support throughout labour and birth" (Hodnett et al  2011).

The review found that in comparison with people who had continuous support, people who labored without continuous support had longer labors and were less likely to have a “spontaneous” birth (meaning birth without cesarean, vacuum extraction, or forceps).

People without support were more likely to:

Does it matter who provides continuous support in labor?

The review looked at how the effects of labor support varied by the type of person providing labor support, and had the same findings as earlier research: Positive effects of continuous support were strongest when the support person was neither a member of the hospital staff nor someone in the birthing person’s social network, and was present solely to provide one-to-one support. Compared with people who had no continuous support, people with companions who were neither on the hospital staff nor in the person’s social network were:

Support provided by a person that was selected from the pregnant person’s social network (such as a partner, family member, or friend) increased satisfaction, but did not seem to impact use of obstetric interventions.

Support provided by a member of the hospital staff (such as a nurse) did not seem to impact a person’s likelihood of having a cesarean or their satisfaction. The authors note that hospital employees may have divided loyalties and other duties, and may be influenced by hospital policies, which could limit the impact of their supportive care.

Do birth doulas have the same impact in all types of birth settings?

Hodnett et al (2011) found that benefits of continuous labor support are greater when people are in settings:

What factors most contribute to people’s satisfaction in childbirth?

While many researchers focus on “hard data” (outcomes such as medication use, labor length, cesarean rates, etc.), the “soft data” (satisfaction, personal agency, emotional safety, family health) are greater considerations for many birthing families. The Listening to Mothers surveys showed that people who had a doula at their birth gave the highest satisfaction ratings. Postpartum surveys have found that people who are more satisfied with their birth experience, regardless of type of birth or outcome, feel more confident as parents, and feel more positive about their baby. A systematic review of available research (Hodnett 2002) found that the following four factors made the greatest contribution to people’s satisfaction in childbirth:

What makes a Birthing from Within Doula different?

Birthing from Within doulas have a wide range of skills and processes that they can use 'on demand' depending on the needs of their clients and what comes up during labor, as well as in prenatal and postpartum visits.

All of the processes that you learn about in the main Birth as a Heroic Journey course can be used with doula clients. You won't use ALL of them with every client (that would just take too much time and not be necessary!), but it’s a good idea to familiarize yourself with all of them, so that you can always access the perfect tool when the need arises, such as in discussions about (for example) pain medication, cesarean birth, and making tough decisions. Adjust the processes as necessary for the context of one-on-one prenatal/postpartum visits.