The Role of Doulas

By OBOS Pregnancy & Birth Contributors | October 16, 2010
Last Revised on Apr 3, 2014

The word doula (pronounced DOO-luh) comes from ancient Greek and translates to handmaiden or servant. Labor doulas, also called birth doulas or childbirth attendants, are women who are trained to provide practical and emotional support to women and their families during labor and birth. Postpartum doulas support and address the needs of mothers and their families at home after the birth.

Doulas support mothers in many ways. All doulas facilitate communication between women and their caregivers and encourage women to advocate for themselves and to participate in informed decision making about their care. Labor doulas stay with women for the entire labor, offering encouragement, suggesting techniques for increasing comfort, and helping establish breastfeeding. Postpartum doulas offer hands-on guidance with the baby, help with breastfeeding, emotional support as the mother heals from the birth experience, and practical support including organizing the home, doing errands and cooking meals.

The key component of doula care is the nurturing and caring presence of the doula. As doulas like to say, they mother the mother. Doulas don’t perform any medical or clinical tasks.

Throughout history, women have been supported by other women during childbearing. Yet, as families begin living farther apart and as birth becomes increasingly medicalized, fewer women receive this kind of support. Because they have many other responsibilities and are usually attending more than one woman, doctors, maternity nurses — and sometimes even midwives can rarely be with a woman continuously. Fathers and partners offer support, but they too are experiencing the birth of their baby and coping with their new and evolving identities.

Labor and postpartum doulas have stepped into this vacuum a space traditionally filled by the mothers, aunts, sisters, grandparents and neighbors in our communities and their use is becoming more popular in the United States and around the world.

Typically, doulas are privately hired by women and their families. Most women first meet a labor doula in the second or third trimester of pregnancy. In prenatal meetings, an expectant mother and a labor doula will discuss the mothers birth preferences and the doulas ability to meet or adapt to those needs, the mothers thoughts about drugs and interventions, and her fears and/or concerns about labor and birth. She and the doula will also explore the kinds of emotional support and comfort techniques she may find helpful.

Doulas may offer their clients further information on pregnancy and childbirth, though they do not make any medical recommendations or clinical assessments, and may assist them with developing a birth plan. Some doulas have additional training as childbirth educators, lactation consultants, and/or hypnotherapists.

What labor doulas offer that most medical caregivers do not is provide continuous support to the laboring woman. The labor doula routinely arrives when labor begins or whenever the woman is ready for additional support. The doula may meet the mother at home hours before she leaves for the hospital or birthing center.  A doula remains with the mother continuously throughout labor and stays until a couple of hours after the birth.

Numerous studies have shown that women who receive continuous support are more likely than women who do not receive continuous support to have a spontaneous vaginal birth. They also have slightly shorter labors and are less likely to use pain medications, and more likely to be satisfied with their birth experiences.

The labor doula usually makes a postpartum home visit in the week following the birth as well. If additional support is wanted or needed, the woman and her family may hire a postpartum doula.

While certification is not required, many doulas choose to become certified by organizations including DONA International and the Childbirth and Postpartum Professional Association (CAPPA).  Certification programs vary in length and rigour, but typically require attendance at a multi-day workshop, additional reading and issue-specific trainings, proof of attendance at a certain number of births, descriptions of support provided at each birth, recommendations from mothers, family members and health care providers, and a personal statement. There has been more than a 800 percent increase in the membership of DONA International since 1994, two years after it was first founded.

For more information, see Resources to Learn About Doulas (Labor Assistants) from Childbirth Connection.