What to Expect from Doula Care

What you should know before interviewing a doula.

Finding the perfect support for you and your family is a must during pregnancy, birth and postpartum. When seeking out birth services, including care providers and assistants, you should be confident in those person’s abilities and comfortable with the standards they portray. You don’t have to settle for a doctor you don’t like, nor do you have to hire the first assistant you interview with. These people can become like a member of your family and you want them to be worthy of that honor.


My husband doesn’t see a need for another person in the room, won’t the nurses be enough? Your husband is right, it is possible for many people to come and go from your birth room, however those working as part of the birth team have their own jobs to perform. The doula is the only person who is a constant presence during your labor and birth. No shift change, no paperwork and no other clients to care for. Your doula is the only person aside from your family, that is there solely for your benefit. The task of support and comfort can mean long hours of hard work and commitment. Whether you choose professional support or family support, the work of labor is not meant to be handled alone. Plan to bring your mother, a sister or best friend to assist you and your partner in your birth.


How will my doula support me? Doulas offer informational, emotional, physical and advocacy support. In pregnancy, Doulas are usually available by phone and in person when you need them. Research and information are available to help you make choices. Massage is offered for physical comfort, help with sleeping positions, showing you exercises to decrease pain and muscle aggravation and help to align your baby for an easier birth (Optimal Fetal Positioning). A doula provides emotional support through pregnancy, over-date births, issues with anxiety and stress, and many, many more issues. During labor and birth Doulas are a constant presence.  Once called upon they give emotional support, physical support through massage, movement and positioning and encouragement to you and your family. For postpartum visits, some Doula’s will supply you with a story of your birth, offer breastfeeding help, help with managing a fussy baby and emotional support for those first few weeks with your new baby.  Some doula’s also offer household support or getting meals to you.


What are the costs for doula services?  Competitive fees with payment plans are usually options.  Pregnancy, labor & birth support average about $400.00.  Services also usually include: Breastfeeding and baby care support, unlimited phone access to your Doula, postpartum visits, and possibly light housekeeping and errands for at risk moms at extra cost. This service benefits moms who need extra support because of birth or family circumstances. Each Doula will have her own pricing and availability.


If I transport to the hospital or choose an epidural? How would a doula help me?

As part of your support team, your doula can help you make the decisions that are best for you and your baby. Once you have the information you need to make informed choices for your care, then it is their job to fully support those decisions. The facts are, even if you transport to a hospital from an out-of-birth setting, you cannot just walk into the hospital and get an epidural. Once you present in labor, your status will be checked, the nurse will check your dilation and effacement, the strength and timing of your contractions and your emotional state. If you are in very early labor, your cervix is dilated to less then 4 cm, the baby is still very high or your labor pattern is erratic you may have to wait for changes to receive an epidural. Epidurals are most effective when given between 4-8 cms. If you present after 8 cm your doctor will assume you are progressing quickly and may want you to avoid an epidural because it can slow progress. Once at the hospital it takes 45 minutes or more for an epidural to be administered and pain relief to take effect. If there are others in need of an epidural or C-sections taking place you may have to wait longer. Once the epidural is in place the work is not over, you must be turned from side to side every half hour or so, you may have windows of pain, itching, chills, sweats or side effects that are more serious. When pushing starts it can take 1-2 hours longer with an epidural requiring more effort from mom and her support team. Because your doula is a constant supporting presence, whether at home, or the hospital, you will have other options at hand for pain management. You and your family will have emotional support and advocacy available to you. Transporting to the hospital or having an epidural for birth doesn’t take the hard work, emotional needs or physical comfort needs away. It actually increases the need for a Doula, as you no longer have the physical means to manage some of these on your own and you have to look to outside physical support.  Doulas are great for hospital births!


I’m being attended by a midwife, won’t she doula me? It depends on where you are birthing. If at home, ask your midwife if she brings assistants with her. Some homebirth midwives bring assistants to help with support. A minimum of 4 people to support you would be appropriate, your partner, the midwife for your care, an assistant for the baby’s care and an assistant for your support. At home there is also the need for food preparation and cleaning. This needs to be done during the birth and after. If your midwife does not employ assistants, it would be worth your time to look into doula assistance. If your birthing at a birth center, the doula would be an important part of your birthing team. Some birth centers employ doulas, so check into what your center offers. Even a midwife at a birth center cannot focus on comfort measures. She is responsible for your clinical management and may have to split her time between you and another client. For a hospital birth, a doula is quite necessary for support. You may have hired a midwife for your delivery, but your birthing in the hospital. Hospitals are clinical places with rules and procedures. Your midwife will have other clients to tend to and will be working under an obstetrician. It would be beneficial for you to labor at home as long as possible if you want a low intervention birth and are planning on birthing in a hospital.  Midwives love doulas!


My provider said a doula would cause tension and would prefer me not to have one. What should I do? It is good to remember that you are the consumer. Your wishes should be honored, and if you wish to have extra support, then you should have extra support. Doulas do not work against your care provider. They do not interfere with medical care and they do not ask you to go against your provider’s care. Doulas offer you solid evidence based information so that you can make informed decisions and informed refusal if that is the case.  A patient who has questions that may require more time and a busy provider may see that at a bother. A patient who wants lower interventions takes more time and energy and the provider may be too busy to comply. If you are uncomfortable or unhappy with the care your provider is showing you, you have the choice at anytime in your pregnancy to change to another provider. A good provider will welcome the chance to work with an educated patient and enjoy the presence of a doula during birth.


When should I hire a doula? Any time in pregnancy you feel you need extra support, education, information or advocacy. It is generally a good idea to meet with your doula a couple times before your birth. This way you can build a relationship, talk about needs and wishes and work out a system that best supports you. Usually this is done starting at 32-34 weeks and then weekly contact, whether by phone or in person until birth. However, if you are high risk or have concerns you can contract doula support at any point in your pregnancy, even during fertility treatments.


My partner is concerned about being pushed aside. Will a doula replace my partner or be overbearing? On the contrary, all of the research has shown having a woman knowledgeable with birth actually helps both client and partner feel calm, relaxed and safe. A doula should compliment the relationship that exists between the partner and client. The doula’s job is to ensure the partner participates as much or as little as they want. The doula should never interfere with partner support. I have enjoyed helping several couples in birth and my greatest joy is witnessing the bond that creates itself in such intimate moments. Women are more satisfied with their partners and partners are more comfortable supporting when doula support is available to them.


Can I tell my provider “No” or refuse routein interventions and procedures? You are the consumer and the one in charge. While you have hired your care provider for his/her medical opinion, it is just that, an opinion and not a rule or law. Hospital protocols and expectations may be waived if you are low risk. Ultimately you are the one who must decide what choices are right for you and your baby. Most hospitals are very aware of women’s expectations for natural birth and baby care. If your provider disagrees, he/she has the option to transfer your care to another provider who is more willing to support your needs and wishes. This is also true for you, as the consumer. You have the right and ability at any time during your care to transfer to a provider who will support you in your choices. You may say “No”…..regardless of outcome the decision is solely yours.  An excellent idea is to prepare a birth plan with your doula or childbirth education class and to present this to your care provider ahead of time.  That helps both of you communicate and avoid unpleasant surprises on both sides.