Doula: A Growing Need

Updated: Feb 19



As a professional childbirth educator, a full-spectrum doula birth coach, and an Elite Doula Birth Coach trainer, I believe every single soon-to-be mom and pregnant mom needs to hire a doula. Yes, she needs a doula. There were almost 4 million babies born in the U.S. in 2018, yet interestingly enough, a nationwide survey in 2012, revealed only 6% of women who gave birth in the U.S. received supportive doula services. That same study found that of the 75% of women who had no doula support had heard of doulas and 27% of those women reported they would have liked to have a doula's support. There is a huge gap between the desire for a doula's support and the number of moms who actually utilized and benefited from a doula during pregnancy, birth and postpartum.



A doula is not just for the hippie-dippy, crunchy mom who wants an all-natural under water birth in a yurt. Doulas are not just a trendy new thing you’ve been hearing about on the rich and famous moms’ Instagram posts. A doula is not only for the single mom without a husband/partner or other natural support systems. And, a doula does not replace your OB or midwife, she does not provide you and your baby medical treatment, and she does not catch your baby.


So, What Is a Doula Anyway?


Well, “If a doula were a drug, it would be unethical not to use it.” ~ Dr. John Kendall

The terms doula and birth coach are quite often used interchangeably. Regardless, the concept of having a doula or birth coach is nothing new. A doulas roots date back to the beginning of time, as evidence of doulas supporting birthing women have been depicted in countless ancient archeological findings. In modern times, the term doula was first coined in the 1960s by Dana Raphael, a pioneering advocate in the natural birthing and breastfeeding movement in the United States during the 1970s. Since then, doulas have unfairly been associated with the hippy all-natural birthing scene. Thankfully, over time, societal views on doulas have changed, and their value is being widely recognized throughout both the professional medical and natural birthing communities alike.


A doula provides mom with the most up-to-date evidence-based education, as well as personal and individualized support throughout her pregnancy, birth and postpartum period. According to The American Pregnancy Association, “The doula is a professional trained in childbirth who provides emotional, physical, and educational support to a mother who is expecting, is experiencing labor, or has recently given birth. Their purpose is to help women have a safe, memorable, and empowering birthing experience.”

To me, a doula is so much more, and since there is a lot of misguided and inaccurate information floating around out there about what a doula is and is not, as well as her scope of practice, I want to clear a few things up.


Dou·la /ˈdo͞olə/ - comes from ancient Greek term meaning a woman who serves or a woman slave and it’s sometimes referred to as “mothering the mother.” A doulas knowledge includes professional training, as well as ancestral wisdom passed down from generation-to-generation. Today, doulas are sometimes referred to as non-medically trained labor coaches.

Doulas have professional training and experience in fertility, pregnancy, labor & delivery, childbirth education, postpartum maternal care and well-being, newborn/infant care and early childhood parenting, and sometimes PAIL (Pregnancy and Infant Loss) bereavement knowledge and skill either through an organization, her own experiences, private training, or any combination of her life experiences.

She is a practitioner. She is a professional. She is a birthworker. She is a birth coach. She is a DOULA.

She gives professional, emotional, educational and informational support to moms during pregnancy, birth, postpartum, and loss.

She is all-knowing in childbirth education.

She is a breastfeeding guru.

She is moms advocate and speaks up when mom can’t find her own voice due to trauma, fear, or lack of knowledge.

She is a postpartum and maternal mental health professional.

She statistically has helped birthing moms have more satisfying births with lower incidences of unnecessary medical interventions during labor and delivery.

She statistically has helped lower the risk of postpartum depression.

She works hard.

She DESERVES a living wage.

She is her own boss - a boss babe.

She is NOT a maid - despite what some may think.

She is NOT a high-priced nanny.

She is NOT always without medical or mental health training.

She comes with her own unique skill set.

She is NOT ethically bound to someone or some big agencies ideals of scope of practice or ideals on how she supports women - one size does not fit all.

She is NOT limited in her own unique abilities as dictated by some certifying agencies.

She is NOT formally or legally regulated by any state entity - or other doulas’ beliefs for that matter!

She has full autonomy - the same we strive to give our clients.

In the end, if you my sister doula, have the experience, knowledge, training, skill set, life experiences and ability to serve a woman in anyway outside the parameters some larger agencies have set for their own benefit - and it does not legally or ethically venture into a regulated professional scope of practice that you are not qualified for - then by all means DO YOU!

Doula - DO YOU!

PS - I do want to add that if a doula is trained in other professions such as a social worker, pastor, massage therapist, herbalist, nurse, counselor, therapist, coach, etc., and is serving her clients in a dual role wearing multiple hats - it is ethically best practice to be transparent and make her additional role/skill set known to her clients.

That is what a Doula is!



Photo Credit: Frederick Birth Center


How doulas help with better outcomes for a healthy mom and healthy baby.


Doulas or birth coaches empower women to have the best birth possible. Studies reveal women who have doulas have more positive birthing experiences and better birth outcomes for both mom and baby. “Doula-assisted mothers were four times less likely to have a low birth weight (LBW) baby, two times less likely to experience a birth complication involving themselves or their baby, and significantly more likely to initiate breastfeeding.” (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3647727/)


Statistically, having a doula or a birth coach as an advocate and to provide emotional, educational and physical support has significantly reduced the risk of Cesarean births, as women tend to have more successful unassisted vaginal births including VBACs – vaginal birth after Cesarean. Doulas have reduced the need for unnecessary medical interventions such as episiotomies, forceps and vacuum-assisted births, moms have lower rates of birth complications, and their babies have higher Apgar scores. Doulas help relieve fear and anxiety associated with birth and women who have doula birth coaches are found to have shorter and better birthing experiences without the use of or need for pain medication during delivery. Women who have a doula have lower risk of postpartum depression and better maternal well-being. Doula birth coaches are proven to statistically increase mother/baby bonding and attachment, as well as increase breastfeeding success and overall breastfeeding satisfaction.


To date, there are no known negative effects to having a doula birth coach, and both mom and babies statistically have much better outcomes.

What is a postpartum doula?


That’s a good question because as of late it depends on who you talk to. Sometimes people use postpartum doula and the outdated term “night nurse” interchangeably. Some call postpartum doulas a nanny for both mom and baby. Some use the term infant care specialist. Even the bigger certifying doula agencies can’t seem to come up with a consensus on the role of or services provided by a postpartum doula.


Postpartum doulas differ from a doula birthing coach or birth doula, in that postpartum doulas support mom during her 4thtrimester, and they support the entire family after bringing a new baby home from hospital after birth or adoption, or in some instances after the loss of a baby. They provide mom physical support while she recovers physically from childbirth and adjusts to mothering a newborn. A postpartum doula helps mom with breastfeeding support or infant feeding support, education on newborn and infant care, infant soothing and safe sleep techniques, as well as parent and infant coping skills. Depending on the doula, she may provide services such as running errands, picking up older children from school, she may take on some light housekeeping duties, she may provide childcare for older siblings, she may provide childcare for baby while parents rest during the day, or they could even offer extended nighttime services so parents can sleep throughout the night without waking to care for their baby.





The differences between a doula and a midwife.


A midwife is a highly trained medical professional who provides women with low-risk pregnancies the same medical treatment and care during pregnancy, labor and delivery as an obstetrician would. She is responsible for mom and baby’s medical health and well-being throughout, whereas your doula birth coach is an additional support on your birth team who is also highly trained and educated in childbirth. Midwives and doulas often work side-by-side during pregnancy, labor, delivery and postpartum – each with their own skill set. While your midwife is all about your and baby’s medical care, whereas your doula birth coach is providing constant guidance, emotional and physical support to help with better outcomes for both mom and baby.


During labor and delivery, your midwife and the nursing staff are not available for one-on-one individual attention, as they have other patients to care for at the same time. Your doula birth coach is with mom at all times throughout her labor and delivery helping her with all the non-medical issues of birth. Your doula birth coach may have medical training, but in that moment, she is there to mother the mother and act as her advocate. Your doula birth coach is right by your side with her doula bag of tricks in tow. She is suggesting different comfort measures and best positions to help mom feel more comfortable and to help labor move along and to get baby low. We wipe your brown, apply warm compresses or cold packs, use counter pressure and massage, offer guidance with patterned breathing and guided imagery, use essential oils and AromaTouch therapy, and will assist you in the shower for comfort and natural pain management. It has been proven that a mother with continuous labor and postpartum support decreases the need for unnecessary medical interventions, pain medications, cesarean deliveries, and a decreased risk for postpartum depression.


Choosing a doula.


Finding a doula who shares your birth philosophy, values, and makes you feel safe and comfortable is essential. Whether she has attended 1,000 births or 5 is not important. What is important is when you find the one that feels right – book her early – the earlier the better. Doulas schedules can fill up quick, as most will only take a certain number of clients each month to ensure availability for the big day. Elite Doulas block out time to ensure we are on call 24/7 starting 2 weeks before and 2 weeks after your estimated due date. We don’t want to miss your birth anymore than you want us missing it due to scheduling conflicts.

Ask your friends, your OB or your midwife for personal referrals to doula birth coaches in your local area. You can browse through doula websites to get a feel of who you would be working with beforehand, and most will offer free consultations. There are sites like DoulaMatch to search for local doulas, but know a lot of doulas do not register on those type of sites, so you could miss out if that is your only go-to when searching for a doula.




Photo Credit: Huffpost


Doula training.


Although certification to practice as a doula birth coach is not required in the United States, most doula birth coaches have extensive education whether they certified with a training agency or not. A lot of the bigger doula training organizations, such as DONA International, ICEA, CAPPA, Childbirth International, and ProDoula – have a lot of restrictions on how a doula can or cannot serve their clients, as well as dictating the types of clients she serves. Within these organizations you will find differences and similarities. Some of these larger organizations are not Christ-centered, and for instance may use gender-neutral language, and insist on doulas being all-inclusive with the clients they serve, including the LGBTQ community. For some, that is not in line with their moral values, which makes it hard. They may train on how to support women who choose abortion, which is extremely troublesome for a lot of doulas. Those larger organizations also require re-certification every year, essentially making doulas pay to keep their certification up-to-date. A lot of doulas will start off training with a larger organization and never end up certifying for a plethora of reasons, some of which are already listed.


The best advise it to do your research. Find a certifying organization that has the same values and philosophy surrounding birth and working with families as you do. Then, look to see if you have to re-certify every year. Do you have to pay for each certification individually – fertility doula, birth doula, postpartum doula, bereavement doula, etc.? Do you have autonomy in choosing what services you offer, what clients you serve, and where you serve them? Do they limit and/or dictate your scope of practice? Will they tell you to stay in your lane (I absolutely hate that phrase) even if you have the training and credentials to serve your clients in different capacities? Do they allow you to serve moms who choose a free birth at home without a medical professional (not that I ever would for obvious legal liability reasons)? Or, if you want to use essential oils, herbs, and only work with certain clients will they drop your certification? Will you be chastised and scolded, or even booted if you maintain autonomy and stick to your values and spiritual belief system, or heaven forbid use traditional language for families – mom, dad, man, woman?


The Elite Doula & Co is going against the grain and making a difference in the doula community. A big difference between the larger certifying agencies and EDC is the respect for and encouragement for true advocacy for our clients we serve. Most agencies do not allow doulas to speak up and advocate for our clients when they can’t find their own voice due to trauma or crisis, or simply because they do not know any better. In fact, those other agencies teach doulas that they should never speak for or advocate for a client, instead teach their doulas to encourage their client to do it for themselves. This is worrisome on so many different levels, but lets just start with there are times when our clients are literally unable to find their own voice – in the instance of trauma or crisis.


Some other differences are that The Elite Doula and Co is Christ-centered in our practice and training, in that we use traditional language, respect autonomy in choosing the clients that are best suited for each doula, and although doulas are trained to do so, we do not actively support women through abortions, unless in dire circumstances of high-risk life-saving medical necessity. We do not require yearly re-certification, so once you graduate you are an Elite Doula for life. Of course, our Elite Doulas are encouraged to continue their education, and we offer continuing education on a regular basis. The difference is – we don’t kick you out for not giving us more money!


If you are ready to take the next step and begin your Elite Doula Coach journey, we'd love to have you join our family of Elite Doulas! You can find out more about our philosophy, values, and opportunities here.



Birth coach tips.


The number 1 birch coach tip I have for you is – your husband is not your doula birth coach! Your husband and family members have completely different roles. No matter how much you argue, the fact is your husband and your doula birth coach each have value and purpose, and they will never replace the importance of each other.


Whether you choose an OB/GYN or midwife for your medical care provider, do not underestimate the importance and value of having a doula birth coach by your side. Believe me, the cost of hiring a doula is an investment you will not regret.


When you find the right doula, book her early! Stay in touch and keep her up-to-date with everything. You are never a bother. Call her, text her, email her, ask her and lean on her for the support you need and to answer all your questions. She is a vault of knowledge and support. Do not hire her and then fall off the face of the earth until it’s the final stretch and time for your prenatal visits and birth planning time.


It’s a blessing you have her during your 4thtrimester – your postpartum period once you bring baby home. She is there to make sure mom and baby are doing their best. She will help you with infant care techniques, sleep solutions, help you problem solve, help with breastfeeding, child safety, maternal wellbeing and so much more. Remember, she is not your nanny. She is your doula!

Know the difference between doula vs. midwife. Your doula will not catch your baby. Your doula is not responsible for you or baby’s medical health. And, your doula is not responsible for birth outcomes. She is there to support and guide you through your birth journey - whatever may come your way.


And lastly, remember women who hire doula birth coaches and have continuous labor support statistically have less trauma and stress associated with birth and have more positive birth experiences, they have higher positive birth outcomes for both mom and baby, have shorter labors, lower risk for fetal and maternal death, they are less likely to need epidurals, narcotics, and other pain medications, they are less likely to deliver via cesarean, have better breastfeeding outcomes, and they are less likely to have postpartum depression and anxiety.


When you hire a doula – you generally will have a much safer and better overall birthing and parenting experience. Now who doesn’t want that?



References:

Dekker, R. (2019, May 4). Evidence on: Doulas. Retrieved from https://evidencebasedbirth.com/the-evidence-for-doulas/

Wikipedia contributors. (2020, January 15). Doula. In Wikipedia, The Free Encyclopedia. Retrieved 07:55, January 26, 2020, from https://en.wikipedia.org/w/index.php?title=Doula&oldid=935852915

J Perinat Educ. 2013 Winter; 22(1): 49–58. doi: 10.1891/1058-1243.22.1.49

Wolfe, Kaylee S., "A Doula Can Only Do So Much": Birth Doulas and Stratification in United States Maternity Care" (2015). Honors Projects. 37. https://digitalcommons.bowdoin.edu/honorsprojects/37

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