Benefits of Having a Doula

Hadley Roberts, Intern
Jun 24, 2024
4 min read

Well, first, what is a doula?

History of Doulas

The work of full-spectrum doulas today, providing continuous support to birthing people throughout their pregnancy, has been practiced in many cultures throughout history. In the US, the medicalization of childbirth in the late 19th to early 20th centuries led to a transition away from these practices and toward a new standard of hospital births performed by white, male medical professionals. However, social births and “midwife-attended home births persisted as the norm for many who lived in rural areas, particularly for Black women in southern states.”(1) In the late 20th century, white middle-class American women began to push back against medical practices in perinatal care, and a movement to train and certify doulas gained traction. The limited perspective of those leading the movement has led to training and popular books in the field that do not acknowledge “the debt of knowledge and experience that North American doulas owe to dozens of traditional cultures” and strayed from the kinds of birth companionship that were often communal, unpaid, and did not require formal certification. Additionally, white-led doula organizations “did not recognize or address their own racism and internal sense of superiority” for many years.(2)

That being said, the current work of doulas includes support for birthing people at the hospital and at home. Many doula trainings today give credit where credit is due: to the many communities who have been practicing doula work long before it garnered its definition by the North American movement.

What are the different types of doulas?

Doulas’ work across the many types can be generally described under the pillars of physical support, emotional support, informational support, and advocacy.

Birth Doula

Birth doulas are doulas who are trained to “provide emotional and physical support, educational and advocacy guidance, and supported navigation through the entire childbirth process.”(4) They sometimes work with or through a hospital.

Postpartum Doula

Postpartum doulas provide families with information and guidance on caring for a new infant (ex. feeding or soothing), transitioning into their new roles (ex. sleeping, eating, wading through hormone shifts), and supporting the birthing person (ex. food prep or babysitting).

Full Spectrum Doula

What distinguishes full-spectrum doulas is the continuity and breadth of their care. Full spectrum doulas offer support throughout the perinatal period, including pregnancy, childbirth, miscarriage, stillbirth, the postpartum period, and/or abortion.

Mel received their full spectrum training at Ancient Song, a beloved doula organization in New York. The core values of the organization that Mel carries with them include community, family, reproductive justice, birth justice, racial justice, and culturally appropriate care. If you’re curious, you can read more about Ancient Song here. Mel has also received training for being a VBAC doula and an infant feeding and lactation specialist. They are ready to support your journey and your wishes.

Abortion Doula

Abortion doulas provide someone with support through the process of getting an abortion. As Ash Willams, an abortion doula in North Carolina, describes:

“An abortion doula is a person who provides emotional, informational, and when given consent, physical support before, during, and after abortion. Because I'm a transgender person, it's really important for me to be able to offer gender-expansive care for the people that I serve.

And I'm also funding people's abortions as well. So anything from letting people know what clinics are OK to go to, where they can actually receive care, to explaining sedation options for them, and then going out to do what's needed to find and then increase access to all of the things someone needs as it relates to abortion”.(5)

Fertility Doula

A fertility doula supports those who are trying to conceive, navigating fertility treatments, or experiencing infertility challenges.

Community-based Doula

Community-based doulas are doulas who provide support to a particular community of which they are a part. The community could be geographic or a community around shared identity and experiences. Ancient Song describes how their community-based model “provides holistic, culturally-relevant care to women of color and low-income women who would not otherwise be able to afford care,” helping to “reduce racial disparities in maternal health and birth outcomes.”(6)

End-of-Life/Death Doula

End-of-life doulas are doulas who “[provide] emotional, practical, and spiritual support to people who are dying, and to the loved ones around them.”(7) This work can look like discussing how the person would like to be remembered, planning their future care, or “simply [sitting] at someone’s bedside.”(7)

Transition Doula

A transition is a companion who provides support, education, and advocacy specifically tailored for people receiving gender-affirming care, including hormone, surgical, and non-medical transitions. Transition doulas aim to empower their clients to make informed decisions about their gender identity and expression while providing a safe and supportive space for them.

There are many overlaps across the different kinds of doulas. Many types have no single, standardized certification process, and instead have several certification programs, often with their own focus and philosophy. However, many doulas' philosophies emphasize client agency and informed consent. Doulas of various types also seem to have a predisposition to giving a shit about things that matter, particularly injustices. They have a disposition to heal, both at work and beyond it. This healing spirit may be best exemplified by the history of doulas and street medics. Here’s an example of the Southen Birth Justice Network doing that work:

"In the spirit of Assata Shakur and the community health model advanced by the Black Panther Party, Southern Birth Justice Network and a host of doctors, first responders and other emergency health workers trained community members in CPR administration, gun shot wound, pregnancy, and emergency response techniques to provide a community based alternative to EMTs and paramedics in marginalized communities....The purpose of this event was to share information and resources to prepare everyday people to deal with life threatening emergencies. Street Medics is a concept that originated in the US during the Civil Rights and Anti-War Movement with the idea that we have to care for and protect our own."(3)

What a Doula is Not

doula comforting laboring person on toilet pregnant person in labor at birth center with partner — Photo by Jacinta Lagos

What is the difference between a doula and a labor & delivery nurse?

Doulas are not medical professionals in their capacities as doulas; however, doulas can certainly attain the education and training to be medical professionals in addition to being doulas. Medical professionals in the hospital, like labor and delivery nurses, also may not see your interests as paramount over the hospital's or other patients' interests, unlike doulas. More on this later…

What is the difference between a doula and a midwife? Doula versus midwife

A midwife is a trained healthcare professional who is trained to monitor the health of the pregnant person and the fetus, provide medical interventions as needed (such as administering medications, performing suturing, and managing complications), and assist with childbirth. Like doulas, midwives can work in various settings, including hospitals, birthing centers, and homebirth practices.

Depending on the region and their level of training, midwives may be certified nurse-midwives (CNMs), certified midwives (CMs), or direct-entry midwives (also known as certified professional midwives or licensed midwives), each with varying scopes of practice and educational backgrounds.

In Illinois midwife news, following the Licensed Certified Professional Midwife Practice Act, Illinois became the 37th state to provide licensure to Certified Professional Midwives(CPMs). Prior to this law, midwives were only given licensure if they were certified nurse midwives(CNMs) with a nursing license. Although CPMs cannot get their license until the rules for the act are adopted, it is a big step forward. For example, it can increase the number of providers in areas with fewer birthing hospitals. It also helped advance the push for midwife services to be made reimbursable by Medicaid through HB4343. If you are skeptical that this change may standardize or professionalize care in a way that perpetuates the issues within medical establishments, that is understandable. However, the act details that some traditional midwives may be exempt from licensure. Namely, it states that licensure is not required for 1) traditional birth attendants following cultural, Indigenous, or religious traditions and serving a member of that culture, identity, or religion, 2) a midwife student, or 3) a midwife assistant. Additionally, it reiterates parents’ ability to choose who is involved in their childbirth regardless of licensure (which can be seen as both a hopeful and scary affirmation). This act is good news because it allows CPM licensure to be detached from nursing licensure and affirms midwives’ credibility as healthcare professionals.

What is the difference between a doula and a labor companion?

You may wonder “Can my friend or family member be my doula?” While they cannot offer the same information, techniques, expertise, and experiences that a trained doula provides, a friend or family member can be a wonderful resource and addition to your birthing experience.

In a 2020 study across four countries (Myanmar, Ghana, Guinea, and Nigeria), researchers found that the presence of a labor companion regardless of formal training helped protect birthing people from mistreatment.(8) A 2022 review found that formally trained doulas who were not a part of the medical staff brought about the most beneficial positive effects of continuous labor support.(9)

Now, let's get into the good stuff...

What are the benefits of having a full spectrum, birth, or postpartum doula? B

Benefits of having finding getting a doula

Greater likelihood of good health for you and the baby

Having a doula has been shown to improve your emotional and physical health along with the baby’s. A review of studies on doulas and birth outcomes found that “doula guidance in perinatal care was associated with positive delivery outcomes including reduced cesarean sections, premature deliveries, and length of labor. Moreover, the emotional support provided by doulas was seen to reduce anxiety and stress. Doula support, specifically [for] low-income women, was shown to improve breastfeeding success.”(10)

Continuity of care

Doulas, particularly full-spectrum doulas, provide continuous care throughout the perinatal period including prenatal, labor, and postpartum support. Some doulas, like Mel, offer additional services like lactation support, placenta encapsulation, and birth photography. During labor, on a more hour-by-hour, minute-by-minute basis, doulas are there with you continuously in ways that medical providers are not. Medical providers often provide brief check-ins, with a focus on carrying out medical tasks. These medical tasks exist within a context that often devalues the emotional care, mutually informed care, and companionship that doulas facilitate. Your doula will have known you for a longer period of time, so they will be better at assessing where you are at, knowing what questions to ask, reminding you of your plans, and helping make changes to those plans when needed. They can know your history, what might be triggering to you based on past trauma, and the dynamics of your relationships with medical professionals and possibly even your birth team. After birth, doulas provide support while you adjust to your new role as a parent including scheduling sleep, planning meals, dealing with hormone shifts, etc. Continuity of care is an essential ingredient in the positive effects associated with having a doula by your side.

Informational support & client agency

Doulas provide informational support to birthing people and partners on a myriad of topics including prenatal education, the week-by-week of pregnancy, lactation support, postpartum education, hormone changes, nutrition advice, and so much more.

Doulas can provide clients with information about medical interventions before they get to the hospital, are exhausted, and have to make decisions about their future child. They can help facilitate conversations and planning around what the birthing person is most comfortable with and help them assert their preferences in the hospital. Knowledge of what is happening throughout pregnancy along with the medical options available allows for informed consent: when you can make decisions regarding your healthcare with a full understanding of your options and are given the space and time to choose what happens. Although each situation is unique, having a doula present may decrease the likelihood of medical interventions, particularly unwanted or unexpected interventions. A study conducted in 2008 on mothers giving birth found that the Cesarean rate for the first-time mothers with their partners alone (25%) was higher than with both their partner and a doula (13.4%). Among mothers who had a medically induced labor, the Cesarean rate without a doula (58.8%) was much higher than with a doula (12.5%). Fewer women in the doula group required an epidural.(11) A doula can also ensure you have an informed birth team. Studies on fathers found that “fathers have said that when they had labor support from a midwife or doula, things were explained to them, their questions were answered, their labor support efforts were guided and effective, and they could take breaks from the emotional intensity of the labor without abandoning their laboring partner. Doulas can educate partners not only about birth, but also about how to advocate for the birthing person.”(2)

The Sankofa Center of New York powerfully writes, “we believe self-determined reproductive wellness can heal generational wounds of oppression and disease and change the overall health for future generations.”(12)

Physical support & pain management techniques

Physical support that doulas can provide includes comforting measures, positioning during labor and birth, hydration, nutrition, assistance with mobility, breathing and relaxation techniques, and guidance on how partners can physically support you.

Emotional support

Doulas' emotional support is unique as the continuity of their care builds a foundation of trust and familiarity. Consequently, even their presence in the birth room can be calming and reassuring. Beyond a comforting presence, doulas can provide relaxation techniques, visualization exercises, mindfulness practices, breathing techniques, etc. to support you emotionally.

Whole-patient care

Many doulas aim to provide whole patient care, meaning every aspect of the patient’s needs, past experiences, and identity are taken into account. This form of care is demonstrated in language-specific care, community-based care, and gender and sexuality-informed care. For example, in a 2021 study, “Indigenous doulas...emphasized the need for one’s Indigenous culture, language, and traditions to be present in the birthing space to protect the well-being of Indigenous birthing families."(13) Whole-patient care is not a matter of consideration as much as it is a necessity in order to truly meet the social, emotional, and informational needs of the birthing person, and many doulas know this.

Here are some examples of organizations affirming the need for intentional doula care that recognizes different relationships to birth, birthing, and medical institutions:

Black Mammas Matter: “BMMA uses the phrase “BLACK MAMAS” to represent the full diversity of our lived experiences that includes birthing persons (cis women, trans folks, and gender expansive individuals) that are people of African descent across the diaspora (Afro-Latinx, African American, Afro-Caribbean, Black, and African Immigrant).”(14)

Southern Birth Justice: “Birth Justice recognizes that all peoples can birth and be parents; People of color, immigrant peoples, and LGBTQ+ communities in particular have survived a history of trauma and oppression around our decisions to have and not have babies. We know that when we, mothers and parents, are empowered, our community is transformed. If we bring our babies into the world, with justice, in the natural way, without anyone telling us how to do it, then it nurtures our innate power as mothers and parents to create a free world for our children to play and learn and grow. Birth Justice includes access to health care during the childbearing year that is holistic, humanistic, and culturally centered. This health care is across the pregnancy spectrum including: abortion, miscarriage, prenatal, birth, and postpartum care. Birth Justice includes the right to choose whether or not to carry a pregnancy, to choose when, where, how, and with whom to birth, including access to traditional and Indigenous healers, such as midwives and other birth workers, and the right to breastfeeding support. The complete range of pregnancy, labor, and birth options should be available to everyone as an integral part of reproductive justice. These are our rights as mothers and parents.”(3)

They only have eyes for you

In contrast to medical professionals or your partner (who may be managing their own anxieties), a doula’s sole focus is you and your needs. They are not thinking about bed availability or recording data for the hospital, and they can care for you beyond clinical care. The only employer whose approval and opinion matter to them is you. People often report thinking that the nurse would have been in the room longer than they were. In a 2008 study in the U.S., nurses spent approximately 31% of the birthing person’s labor in the room, and they were largely there to administer clinical care, check the fetal monitor, maintain equipment, or document at the computer.(15) So, while nurse and doula responsibilities may sometimes overlap, nurses will likely only practice them in brief moments and during active labor rather than providing continuous guidance or care.

Advocacy

This one is a bit more tricky. Advocacy can have different definitions and forms, and it is not practiced uniformly by all doulas. A large part of many doula’s practice is equipping people with all of the information they need to make their own decisions, but allowing them to make those decisions themselves and not speaking on their behalf, if possible. If advocacy in the hospital is a benefit drawing you toward getting a doula, please don’t be afraid to ask doulas directly what their advocacy will look like in the hospital, from getting doctors to respect your pronouns to questioning a medical intervention you wanted to avoid. Some doulas may use more subtle advocacy techniques such as asking you what you want, coaching you and your birthing team on how to talk to providers, reminding you of your previous decisions, or explaining any intervention that a provider may be suggesting (or acting upon). Advocacy can make a large difference, sometimes a critical difference, particularly for Black birthing people. Black birthing people can experience what is known as obstetric racism or the “threats to maternal life and neonatal outcomes,” including “critical lapses in diagnosis; being neglectful, dismissive, or disrespectful; causing pain; and engaging in medical abuse through coercion to perform procedures or performing procedures without consent.”(16) This form of violence has led some doulas, particularly Black doulas who regularly combat this racism, to use a wider array of advocacy skills. Doulas may reduce the risk of violence; however, obstetric racism is ingrained in the hierarchies and history of the medical field, making it difficult to assure anyone of full protection in the hospital.

For more information about the health risks Black birthing people may face: https://blackmamasmatter.org/wp-content/uploads/2024/03/2024-BMHW-Toolkit.pdf

For affirmations of Black birthing people’s rights in the hospital:

https://southernbirthjustice.org/birth-justice - Birth Justice Bill of Rights