How can we get every pregnant woman a doula? 

Kerri went into the hospital to deliver her first child with all the preparation a hospital birthing class could provide. She had a basic birth plan, and a lot of nerves about how delivery would go. Even with her preparation and planning, the next 24 hours would be full of questions, uncertainties, and discomfort. Could she have a say in what was done? Was it normal to labor for this long or in this way? Was there anything she or her partner could do to help get through the pain and avoid an epidural, like she described in her birth plan?  

Kerri’s is a common experience, especially for women going through their first labor and delivery. Even with preparation, it can be difficult to know what to expect and how to handle the questions and labor experience while in the moment. For this reason, Kerri decided that she’d walk into her next baby’s delivery with the support of a doula.

Doulas have become more common over the years and mothers’ desires to have them attend their births continue to rise. In one research study, 27% of mothers who knew what doulas were said they wanted one! Why is this?

What is a doula?  

A doula is a companion who provides continuous support to a woman during labor and delivery. A doula is trained to provide information and support (both physically and mentally) to a woman as she labors. Unlike hospital staff who change with shifts and serve multiple women at once, doulas are there to provide continuous support to one woman alone.  

This is exactly what Kerri wanted, and it transformed her labor experience. The long hours of contractions were still there, of course, but the feeling of being in-the-dark was gone. Her doula, Sharon, provided her with the tools and support she needed to get through labor, advocate for her preferences, and have a safe delivery.  

These are the goals of a doula, and why many women consider hiring one to be a part of their labor and delivery experience. Having a doula can provide much needed encouragement and direction, even though doulas do not provide medical advice or make decisions for their clients. Instead, they seek to allow the woman to have the birth experience she desires, if possible.  

What care does a doula provide during pregnancy, labor, and postpartum?   

Sometimes a doula will specialize in fourth trimester care, but traditionally, doulas offer care throughout pregnancy, labor, and a set number of postpartum check-ins or in-person visits. 

Pregnancy support  

While the focus of a doula’s work is primarily during the active labor and delivery hours, her support during the later stages of pregnancy is beneficial, too. This is when she reviews a mother’s plan for birth, identifies her preferences and priorities, and helps to prepare the mother for what’s ahead.  

By having an idea of what will happen and how the doula will be there to help her manage pain and encourage advocacy, the mother can feel more confident and hopeful about the experience. This can be transformative for those who do not get the experience they dreamed of, but are still able to prioritize certain aspects of the labor and birth experience. For instance, a doula may explain how moms who have unexpected c-sections can still advocate for skin-to-skin time immediately after delivery. The doula would then be present during the Cesarean section and ensure that the mom’s request for skin-to-skin time is honored, if at all possible.   

Labor and delivery support

During labor itself, the doula does not leave the mother’s side, unless by request or if they’ve passed 24 hours and need some time to recover themselves. She focuses on the physical safety of mother and baby, certainly, but also improving the mother’s overall experience of and satisfaction with labor. Together, the doula and mom have established helpful and realistic expectations for birth beforehand. So when a mom begins to labor, she already has an idea of what to expect and what kind of support she’ll receive. From the start, she knows she is not going to labor alone.  

Doulas provide physical support like counter pressure, and coach moms on positioning suggestions, use of various labor tools, and massage. And of course they offer the much-needed emotional support of encouragement and praise.  

Postpartum support   

After birth, the doula may remain in order to provide additional support. Some mothers even choose to hire a postpartum doula specifically, who will arrive after delivery and care for mother and baby in those first few days. “A postpartum doula provides evidenced-based information on things such as infant feeding, emotional and physical recovery from birth, mother-baby bonding, infant soothing, and basic newborn care.” 

Even if a mother does not work with a postpartum doula specifically, she will receive some level of follow-up care from her doula as she adjusts to her newborn and heals from the birth.  

Doulas can make a real difference 

Imagine the difference in Kerri’s experience between her first and second birthing experiences! In the first, she felt alone, confused, and uncertain about her options. In the second, she went in with clear expectations and a plan B if things didn’t go as expected. She felt hopeful and ready, because she had an experienced doula who knew how to help manage her pain. She felt confident because she was not the only one advocating for her needs and preferences. The physical and emotional support given by a doula before, during, and after delivery have the potential to positively transform the entire birthing experience for a woman!  

What does the research say on the difference doulas make?

What does the research say about how doulas make a difference for moms and babies? Why is this the case?

Women who have doulas report less labor pain 

Research studies show that the support of a doula lowers a woman’s perception of pain during labor [1]. It’s not that the intensity of the pain is different for women working with a doula, but the type of continuous support provided impacts how the woman’s brain processes the pain itself. This mechanism is called Central Nervous System Control and it helps interpret labor pain as less unpleasant than it would be otherwise.  

Kerri’s experience is a great example! Her labors were very similar in how long they lasted and the intensity of the pain, but her experience was far better during her second delivery. Was this the Central Nervous System Control in action? Possibly so!  

Moms with doulas have fewer medical interventions during labor

Even though doulas do not offer medical advice or services, their participation during a delivery has the potential to improve the physical safety of mother and baby. In a 2017 review of the impact of continuous support during delivery, researchers looked at 26 trials of almost 16,000 women across 17 countries and found that women receiving continuous care were significantly less likely to need intervention during delivery, including forceps, vacuum use, or cesarean section. This was true for all those offering continuous support during delivery, such as designated hospital staff, doulas, or partners and friends. However, the care provided by a doula showed the largest decrease in risk of a cesarean section delivery — an impressive 39%!  

Doulas are particularly important for women of color

The beneficial effects of a doula may be especially critical for minority groups, like women of color, who are more likely to experience poor birth outcomes. The CDC states that American women of color are three times more likely to die in childbirth. Additionally, black women experience higher rates of cesarean sections, preterm birth, low birth weight, and infant death. These statistics are unacceptable. Women of color deserve better, and doulas may help improve these numbers.   

How we can increase doula access for all pregnant women 

The benefits of doula support to a pregnant mother are clear, so how can we increase access to doulas for all pregnant women? A large-scale change will require the partnership of big players like hospitals and insurance companies teaming up with community resources like nonprofits and local programs. These types of partnerships have increased in the last few years, like the new collaboration between Aetna and Mae Health. Continuing these relationships will only lead to increased access and more positive birth experiences for women and families [2].  

We can all be a part of achieving this goal by working toward systemic changes that increase doula access. Collectively contacting local legislators, hospital boards, and insurance providers with the following suggestions are a great start:  

• Formalize doula training through licensing or regulation in order to ensure proper training and knowledge 
• Designate doula care as an approved service for all Flexible Spending Accounts (FSA) and Health Saving Accounts (HSA) 
• Include doula care as a part of covered Maternity Services by insurance providers  
• Create and utilize more grants and scholarships specifically for birth support workers, like doulas 

• Establish contracted relationships between hospitals and birth support services 
• Educate the public on the short and long-term benefits of doula support to increase positive birth outcomes 

Are you a pregnant woman looking for doula access now?  

Increasing access to doula care for all women is a fantastic goal but many women are simply looking for ways to work with a doula now. When looking for your own doula, check out your local doula services by searching online or asking nearby friends and family. If you find that access is difficult financially, there are many resources available to you! Here are a few to help you find the support you need:  

• Call your insurance company, or check with your HR department, to see if doula care is covered by your provider  
• Call doula providers in your area and ask about sliding scale payment options. Some doula collectives even have a pool of resources reserved for low-income clients.  
• If you have Medicaid and live in Minnesota, Rhode Island, Oregon, or New Jersey, you may receive doula support with your Medicaid benefits! Even if you live outside of these states, call your Medicaid office to check on the status of doula support in your area, as new programs are starting all the time.
• Investigate local nonprofit doula agencies. These provide doula services to low-income parents through grants and donations.  
• Don’t live in an area with doula access? You can still make use of virtual support through organizations like JustBirth Space, a free resource that allows you to text a doula for specific answers to pregnancy and postpartum questions. 

To sum, doulas can play an important role in keeping the labor and delivery process safe and dignified for moms and babies. Doulas offer continuous physical and emotional support, in addition to helping the mother advocate for her needs. Though they are not medical personnel, they are trained and experienced in labor, and know the monumental impact of massage, movement, or a change in position at just the right moment. Perhaps most importantly, they can help maintain a calm, respectful environment in the delivery room, and empower the laboring mother (and her partner!) with words of praise and encouragement.

References:

[1] Chaillet, Nils et al. “Nonpharmacologic approaches for pain management during labor compared with usual care: a meta-analysis.” Birth (Berkeley, Calif.) vol. 41,2 (2014): 122-37. doi:10.1111/birt.12103

[2] Sobczak A, Taylor L, Solomon S, Ho J, Kemper S, Phillips B, Jacobson K, Castellano C, Ring A, Castellano B, Jacobs RJ. The Effect of Doulas on Maternal and Birth Outcomes: A Scoping Review. Cureus. 2023 May 24;15(5):e39451. doi: 10.7759/cureus.39451. PMID: 37378162; PMCID: PMC10292163.