A Doula Can Reduce Your Odds for a Cesarean

Numerous clinical studies have found that with a doula who provides continuous support during labor, women have shorter labors, fewer complications , and fewer cesareans. Women are also less likely to need pitocin (a labor-inducing drug), drugs for pain relief including an epidural, and forceps or vacuum extraction. They are also more likely to be satisfied with their birth experience. Research shows that all women should be allowed and encouraged to have continuous support during labour1_Page_11

The American College of Obstetricians and Gynecologists and the Society of Maternal-Fetal Medicine state, “one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula.”

In an increasingly high-tech environment, birth doulas are gaining popularity with expectant parents and quickly becoming an integral part of the maternity healthcare team.

The word “doula” comes from ancient Greek and today refers to a woman trained and experienced in childbirth who provides continuous physical, emotional, and informational support to the mother before, during, and immediately after childbirth. The terms “birth assistant” or “labor assistant” are sometimes used as synonyms for “doula” but usually refer to women who assist midwives and perform medical tasks such as vaginal exams, monitor fetal heart tones and provide labor support.

Why a Doula at your birth?

With a doula at her birth, a laboring woman is never alone. A mother can count on her doula to guide her and support her in the kind of birth she wants.

Nurses, midwives and physicians are responsible for the medical care the laboring woman needs and may care for more than one woman at a time. The doula’s only focus is on the mother’s emotional and physical needs.

Medical caregivers and expert organizations recognize that continuous emotional support and comfort in labor can help women have shorter, easier labors and reduce the risks for complications including the need for a cesarean delivery.

Studies from several countries including the United States, Sweden, South Africa, Canada, Guatemala and Mexico show that when doulas attend births, women have shorter easier labors, request less pain medications including epidurals, are less likely to require oxytocin to speed up labor, and the use of forceps or vacuum extractors. Babies are also healthier and breastfeed more easily. Mothers have also said they were much more satisfied with their birth experience.

What do doulas do?

In their book, Mothering the Mother; How a Birth Doula Can Help You Have a Shorter, Easier, and Healthier Birth, Dr. Marshall H. Klaus and Dr. John Kennell recognized researchers in maternal-infant attachment, and Phyllis H. Klaus, M.Ed., CSW, a psychotherapist specializing in the care of pregnant women and new parents explain that the doula’s role is “designed to provide a nurturing, helpful, and objective female supporter so that the family member chosen to be present does not have sole responsibility for the labor. It is not an attempt to interfere with the relationship between the woman and her partner or other family member.”

A doula helps the mother prepare for and carry out her plans for the birth. She can suggest physiological positions and comfort measures to help labor progress and reduce the pain of labor. She can also facilitate communication between the laboring woman, her partner, and her caregivers.

Happy Young Attractive Mixed Race Family with Newborn Baby.

The doula recognizes that childbirth is a key experience the mother will remember for a lifetime and helps to make that experience as satisfying and empowering for the mother as she can.

Although many parents attend childbirth classes today, they sometimes find it difficult to integrate what they learned in class with the actual experience of labor. The journey to birth can be much longer or more difficult than anticipated.

What about the father’s role?

A doula’s presence also impacts the father’s participation at birth. Fathers tend to feel less anxious, take fewer breaks away from the partner, stay closer to her and comfort her with his touch more often.

Many fathers also feel more relaxed with the presence of a doula Fathers may be surprised and overwhelmed by the intensity of the pain their partners’ experience.

Complications can occur that may upset the hopes and expectations that the couple had for their birth. A trained labor assistant can help the mother feel more in control and reassure the father that although labor is intense it is progressing normally.

How do I find a doula?

Many doulas have their own private or group practice. Fees for doula services in the United States vary from $300. to $1,800. However, some doulas provide free services to economically disadvantaged mothers while others with clinical experience may charge as much as $1000 in large metropolitan areas. Fees usually include two prenatal visits, continuous support throughout the entire labor, no matter how long it lasts, and one or two postpartum visits.

Over 100 US hospitals provide doula services as part of their maternity care package by having doulas on staff or contracting with a doula service. With a hospital doula service, parents may or may not have the opportunity to meet their doulas before labor begins. Doulas assist mothers at home births as well as in birth centers. Many community maternity centers also employ doulas for their clients.

How do I pay for a doula’s services?

Although the care that doulas provide is non-medical, it does have medical and financial benefits. Many hospitals are recognizing that factor and some insurance companies are beginning to reimburse parents for doula services. Medicaid funds are sometimes allocated for doula services by some county agencies and private foundations have also provided grants to cover the cost of doula care.

Parents in the United States may have a flex-spending account in which a percentage of their wages are placed in a pre-tax account that can be used for non-covered medical expenses. Hospitals and individual physicians who directly employ doulas may also bill for doula services.

How do I select a qualified doula?

Doulas can receive training and certification from several local, national, and international organizations. Training programs usually require prior knowledge of childbirth, selected reading material, and a two or three day seminar that includes hands-on practice of skills including relaxation and breathing techniques, positioning and movements to reduce pain and enhance the progress of labor, massage and other comfort measures.

Doulas who are also certified have completed additional requirements than include attending several births, evaluations from medical care providers and parents, additional education, observation of a series of childbirth classes, and a written exam or an essay that reflects a knowledge of the fundamental concepts of labor support.

What questions should I ask a prospective doula?

Parents considering a doula at their birth may want to begin interviewing a few a couple of months before their baby is due. They may want to have a phone interview before meeting personally with her. To help parents feel comfortable with the doula they hire, it is important to ask a few questions:

  • What training have you had?
  • Tell me (us) about your experience with birth, personally as a doula?
  • What is your philosophy about childbirth and supporting women and their partners through labor?
  • May we call you with questions or concerns before and after the birth?
  • When do you join women in labor? Do you come to our home or meet us at the hospital?
  • Do you meet with me (us) after the birth to review the labor and answer questions?
  • Do you work with one or more backup doulas when you are not available? Can we meet them?
  • What is your fee? How do you expect payment to be made?

Parents need to feel very comfortable and reassured with the doula they hire. Several doula training and certifying organizations require doulas to meet strict professional and ethical standards.

By taking the time to interview a doula and find out about her professional training, and the special services that she can provide parents will be more satisfied with their birth experience.

References: DONA International, See the video,  The Essential Ingredient: Doula

For more information about doulas:

Lamaze Blog, Science & Sensibility

Medscape, OB/GYN and Women’s Health

Cochrane Data Base of Systematic Reviews, Continuous Support for Women During Childbirth

Mother’s Advocate, video

To find a doula in your community :

International Childbirth Education Association

Lamaze International

Birthworks International

ALACE, International Birth and Wellness Project

Childbirth and Postpartum Professional Association


Updated August 25, 2016.