Written By Yiska Obadia
Photography By Zivar Amrami
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Introduction: Here’s a question for you. What do you know about doulas?
Part I: The What and Why of Doulas
Part II: The How, When & Who of Doulas
About the Author
Whether you’ve heard of doulas or not, this guide will teach you everything you need to know about doulas. If you’re reading this, you probably have questions.
• What exactly is a doula?
• What do doulas do?
• Are doulas like midwives?
• Why would you want a doula?
• Will a doula replace your partner?
• Do you really need a doula?
• Even if you’ve heard amazing things about doulas from your friends and family, how should YOU go about finding a doula?
• Specifically, a doula that will be a good fit for you and your family?
• When do people hire doulas?
• How much do they cost?
• When do doulas show up to your birth?
• Will a doula support the birth YOU want?
The purpose of this guide is to answer these questions so you can better understand what doulas do and don’t do, and make an informed choice about whether or not a doula is right for you.
I can’t imagine given birth without one! Hopefully by the end of this guide you will discover if you feel the same. And if you already know you want one, this guide will help you understand how to go about finding YOUR ideal doula.
What exactly is a doula, what do doulas do, are doulas like midwives, why would you want a doula, and will a doula replace your partner?
The terminology for doulas originates from the Greek word for “female servant”. In our context here, I’m referring specifically to birth doulas, as in those who support birthing people and their families before, during and immediately after childbirth. (Other doulas include postpartum doulas, abortion doulas, and end of life doulas.)
Birth doulas specifically provide emotional, physical, and informational or educational support throughout this crucial, life-changing time.
Especially for first-time parents, there are many unknowns about the birth process, and the thought of having a trained and experienced support person present throughout that experience is often welcome. Not only for the birth parent, but for partners and dads as well.
Current day doulas are essentially filling in the gaps where labor support is lacking in modern society. Over the years doulas have been increasing in popularity as a way for expectant parents to augment their birth team with the additional support doulas uniquely provide in modern birth.
Care providers such as obstetricians and even midwives alone cannot simultaneously provide the full scope of their clinical services while providing the continuous emotional and physical support that labor demands.* (See the note on midwives at the end.)
Often first-time parents don’t realize just how much support people in labor can use! Between the need to stay continuously hydrated, fueled, massaged, held, encouraged and otherwise attended for an unpredictable duration over at least one sleepless night…the old saying, “it takes a village”, applies, without a doubt, starting at birth.
You also may not realize how much labor happens without the presence of your primary care providers. Doctors and nurses come in and out only as needed for medical attention. Even midwives will generally recommend a doula show up to a birth well before they are needed on the scene, at home or in hospital.
Partners and other family members may needlessly feel overwhelmed if they are expected to be the laboring person’s sole source of support.
In fact, doulas often act as a support to partners as well; by sharing the responsibilities of providing support, clarifying what’s happening when they may feel uncertain, and helping them to assist you better!
Partners also understandably need breaks, especially in the event of a long birth, and often benefit from the comfort of knowing someone else will be attending to their partner when they are resting.
Alternatively, doulas are uniquely charged with the role of providing continuous labor support from the moment they are called to your birth to the moment your child is in your arms. Not to mention their role in helping you prepare for your birth prenatally and supporting you in the immediate postpartum period.
Key points to understand about the role of doulas:
• Doulas DO NOT make medical decisions for you. Instead they work to provide you with the information you need to make your own informed decisions.
• Doulas also DO NOT replace dads. No one loves you like your partner. No one is becoming a parent with you like your partner. Simply put, no one can take your partner’s place.
• Doulas will, however, always be an extra pair of hands.
• Doulas come with the tricks of the trade to help you labor more comfortably. They may suggest effective laboring positions, movement and breathing techniques, offer comforting touch, verbal coaching, and a variety of comfort measures, as needed.
• Doulas will give your partner a guilt-free break.
• Doulas will answer your questions, before, during and after you give birth. And if they don’t know the answer to a question, they will plug into their larger network of birth professionals and evidenced-based resources to help you find the answer.
• Doulas will believe in you when you’re not so convinced. Doulas will believe in you when you’re downright certain you can’t do it!
• Doulas can help you feel confident in your birth choices and will help you remember your most significant birth preferences in the heat of the moment. No matter what, a doula should never push their own agenda. Wherever, however, and with whomever you choose to give birth is up to you, even if that changes.
• Doulas will help you engage with your care provider in an informed and empowered way as shared decision makers in the unfolding of your birth.
• There is even evidence that doulas may help you avoid unnecessary interventions. While it is important to understand doulas absolutely cannot guarantee outcomes, their presence has been shown to improve birth outcomes by a number of markers, including lower rates of intervention and increased rates of satisfaction, regardless of outcome. Meaning, even when interventions are deemed medically necessary, doulas can contribute to a positive birth experience however birth unfolds. (See evidence-based resources at the end.)
Do you really need a doula?
What do you think? Do these points resonate? Despite being your most strong and powerful during labor, birth makes most people simultaneously feel their most vulnerable. Adequate support is paramount to help people feel the kind of safety, confidence, and calm they typically desire during such a pivotal, life-altering experience.
I can’t tell you how many times a woman has said that they couldn’t have done it without the help of their doula!
And just as many have lamented in hindsight that they wish they had hired a doula for the birth of their child.
Whether you’re decided or not, let’s address our remaining questions.
How should you go about finding your ideal doula, when do people hire their doulas, how much do they cost, when do doulas show up, and will a doula support the birth YOU want?
Here are the 7 most common considerations for choosing the right doula for you. The following points will also give you plenty of fodder for asking pertinent questions when interviewing potential candidates.
1) Your budget:
This very practical consideration should not be a deterrent to finding your doula. Doulas are often available in a wide variety of price ranges. Those with more experience will typically charge higher fees, while newer doulas will tend to be priced at the lower end of the fee scale. Some newer doulas or “doulas-in-training” may even offer their services on a voluntary basis, free of charge, for people in need. In NYC fees range from $200-$3500, just to get a sense of the range. The majority are priced somewhere in the middle.
2) Experience level:
Doulas also come in a wide range of experience levels. Some are newly trained and may have attended a handful of births, or none at all. Others are highly experienced, in practice for decades with hundreds of births under their belt. And then there’s everything in between.
For some of you experience level will be highly significant. For others, less so, especially when considering financial constraints.
As a point of assurance, I recall being as supportive a doula when I attended my first birth as I am now, over 100 births later. Of course I “know” more, but the women who I supported in those early years didn’t need that knowledge to feel 100% supported and satisfied by the doula I was back then. Most people drawn to this work have an instinct and passion for birth that in many ways makes up in spirit for what they lack in experience.
3) Types of training:
Nowadays there are numerous doula training and certification bodies, such as Doulas of North America (DONA), Doula Trainings International (DTI), Birth Arts International, Birthing From Within, ProDoula and others, each organization with its own training style.
While individual practices vary, such as amount of on-call time provided, or number of prenatal or postpartum visits, all doulas are trained to provide continuous AGENDA-FREE physical, motional and informational labor support as described in part I.
Doulas are trained to never push their own agenda, and should support your birthing and parenting choices without projecting any personal preferences on to you. Doulas are trained to support YOUR vision for your birth, be that natural or medicated, at home or in hospital, etc. If you suspect otherwise from someone, I would say this person is not a good fit.
All doulas are committed to providing continuous labor support, and should provide you with adequate back-up support if need be. This is something you’ll want to ask your candidates about.
Many doulas may have specific passions and complementary trainings that may appeal to you: Some are trained or well-versed in hypno-birthing and lactation support for example, or have an affinity for working with certain populations such as single mothers, people of color, LGBTQ clients, VBACs, twin births, couples planning natural births, couples planning medicated births, home births, women with a history of anxiety and depression, people who’ve conceived through IVF, high-risk births and others.
If you think you might prefer a doula with any of these specialties, that would be something to inquire about when approaching and interviewing potential doula candidates.
Some doulas are also nurses, birth photographers, massage therapists, acupuncturists, yoga teachers, postpartum doulas, placenta encapsulators, etc. You may want to consider if hiring someone with these additional skillsets would enhance your birth experience.
4) Their availability:
The commitment a doula makes when you hire them is to be on-call for your birth from 37 or 38 weeks to 42 weeks or whenever you have your baby. Doulas vary in the number of clients they will take per month so you will want to inquire first and foremost about their availability around the time of your due date. If they are booked or going to be out town, obviously it’s not a match.
Since doulas can book up months in advance, the sooner you select your doula, the better your chances of getting your top choice will be. Most doulas will hold their availability open for at least one week post interview, understanding it may take time to meet with other candidates before making a decision. Especially if you really like a doula, you may want to ask them how long they will hold a spot open for your due date.
Of course, the earlier on you hire your doula, the more you will also be able to get to know them and take advantage of their services prenatally.
Doulas typically schedule one to two prenatal visits with you at your home sometime between 32-36 weeks. Generally they will also offer unlimited phone and email support as needed.
In the end, it is never too late to hire a doula. It doesn’t happen often, but I have had people hire me within just a week or two of going into labor!
5) Personal affinity:
At the end of the day, once you know your doula is available for your due date and fits your budget, in my opinion, more significant than their training and experience is simply how well you “click”. It may sound silly, but this person may be with you for 24 hours or more in some cases and they should be someone you feel that kind of comfortable around. You’ll want to appreciate their sense of humor, their personality, their attitude.
Mostly you’ll want to like how you FEEL in their presence.
- Would you feel most comfortable around someone who is gentle and laid back?
- Confident and take charge-like?
- Nurturing and mother-earthy?
- Rational and great with facts and science?
- Light hearted?
- Perhaps a combination of these traits?
Whether interviewing over the phone, on skype or in person, assessing your personality match should be at the top of your list of priorities.
6) Their terms:
Every doula has their own contract with its precise terms so you can understand things like, when are payments expected, how many prenatal and postpartum visits are included in their service package, when does their on-call time start, when to call them in labor, how do they handle back-ups, missed births, precipitous labors, unexpected c-sections, etc.
Since none of us can control or predict how or when a birth will unfold these contingency policies are important. Your doula should always have a backup available in case they fall sick, have a family emergency, a trip is planned some point during your on-call window, or end up being at another birth when you start going into labor. You must know, that while rare, it can happen.
For some, meeting or at least speaking with your doula’s partner or back up beforehand is comforting. For others, just knowing that your doula’s got it covered, on the off chance you need one, is enough.
Regardless, this is something that can be helpful to discuss prenatally.
Finally, when the time comes, remember your doula wants to be there for you! Do not feel bad calling in the middle of the night. A doula’s job is to support and comfort you even it’s too early to join you physically at your home or hospital. You should feel free to use them for emotional support and guidance as you need it. The details of when to call or text them during labor is something most doulas will discuss with you prenatally.
7) How to find your doula:
Word of mouth referrals offer a great way to begin your doula search. Friends, friends of friends, family, trusted online peer groups, your prenatal yoga teachers, prenatal massage therapist, childbirth education instructor, doctor or midwife, can all offer suggestions of doulas to start with who you know already come highly recommended.
Alternately, local doula agencies often host regular “meet the doulas” events where you can interview several candidates in one sitting and see firsthand if you hit it off with someone in particular.
Finally, google searches in your area can be helpful in narrowing down your search if you are specifically interested in a doula who is also a massage therapist, or yoga teacher, lactation counselor, acupuncturist, nurse, placenta encapsulator, and so on.
As with all things birth, trust your gut.
Ask as many questions as you need to feel satisfied. Honor what you want, and surround yourself with the people who will support you in creating that. You and your baby deserve nothing less.
*People often confuse doulas with midwives despite there being a major difference in their roles. Midwives are primary care providers, like obstetricians, responsible for the medical well-being and clinical needs of mother and baby. The role of a doula is distinctly non-clinical and it is out of their scope to offer medical advice.
Instead they provide emotional, physical and informational support throughout the birth process. While midwives are often emotionally and physically supportive, this is not their primary task.
[***The evidence for doulas:*]
Photo Credits: Zivar Amrami
Yiska Obadia is an experienced birth doula, massage therapist, acupuncturist and childbirth educator. She is the author of Comforting Touch for Birth: A Guide for Doulas and Expectant Parents and lives, teaches, and practices in NYC. For more information, visitwww.yiskaobadia.com.