Historically, women have always had doulas at their births. The word “doula” is a Greek word loosely translated today as “mother’s servant or helper,” and it is used in a birth context in today’s modern world.
There is frequent misunderstanding between what a doula is and does, and what a midwife is and does.
A midwife is someone who has a four-year university degree, plus an internship. A midwife takes the place of your family doctor or obstetrician while you are pregnant, giving birth and in your postpartum period. You visit your midwife just as you would your doctor and she is responsible for caring for your health and that of your baby up until six weeks postpartum. Appointments with midwives are approximately 30 minutes long, as opposed to your OB visits, which may last all of five minutes. Midwives can order tests and ultrasounds and are able to prescribe medications related to pregnancy. They are also able to help you safely birth your baby at home or in a hospital where they have privileges.
A doula is a professionally trained labour companion and is typically certified by training organizations who have strict criteria for certification. There are basically two types of doulas: Birth Doulas and Postpartum Doulas. Some doulas are certified in both disciplines, while others specialize in one.
Studies have shown that having a birth doula may reduce labour time, reduce or eliminate medical interventions, have reduced caesarean section births and an overall more positive outcome. Birth doulas provide prenatal support and education. They are with you throughout active labour, birth and approximately 1-2 hours after birth. They will also do a postpartum follow-up visit a week or two after birth. During labour, they provide emotional, physical and informational support to both partners, but focus mainly on the birthing mother. It is important to note that birth doulas DO NOT replace the partner! Partners and doulas work together as a team to provide the best care possible to the birthing mom. Doulas help (and teach the partner the ‘how to’s’ of) breathing techniques, position changes, relaxation methods and hydrotherapy, while ensuring moms stay hydrated and visit the bathroom. They provide birthing parents with up-to-date, evidence-based information so that couples/moms are able to make informed decisions about their care and birth wishes. They can translate what I call ‘medicalese’ into plain English so moms completely understand what is being discussed at any time during their labour. Doulas do their best to help moms achieve the birth they want; however, labour is fickle and things don’t always go according to plan. If that happens, doulas are there to support whatever choices moms make by doing their best to ensure that moms have POSITIVE birth experiences, when all is said and done. This is a very important aspect of a doula’s role because any birth experience will imprint itself in your psyche for a lifetime. Whether positive or negative, moms will remember with detailed accuracy how they were made to feel, what people said to them, what was done in the way of medical care. We, however, do NOT catch babies, give medical advice or make decisions FOR moms! We also do not provide any clinical care (even if your doula is also a nurse, it is outside a Doula’s Scope of Practice to provide any clinical care whatsoever!).
The cost of a birth doula is dependent on where you reside. While midwives are covered under OHIP in Ontario and provincial health benefits in most other provinces, doulas are not covered by government plans. Some third-party insurance providers MAY cover a doula’s fee under a Health Spending Account, but you must check with your provider. In Toronto for instance, a birth doula’s fee typically start around $1,000.00 and it goes up from there, depending on the doula’s years of experience, whether or not she is certified, if she’s self-employed or works for a Doula collective/group. Doulas-in-training, or newly certified doulas, can be hired for much less if cost is an issue over the experience of a seasoned doula. Outside Toronto and the GTA, fees are much lower. Whatever the cost, birth doulas are worth their weight in gold – just ask anyone who has had a one!
Postpartum doulas provide care for mom and baby at home after the birth. They may help mom with breastfeeding, teach her how to properly bathe and diaper baby, do light housework, run errands, cook light meals or stay overnight to bring baby to mom for feeding and then care for baby throughout the night while moms get some much-needed rest. These doulas typically charge by the hour and they will have to discuss and agree in writing on what services the postpartum doula will provide, either long-term or on an “as-needed” basis.
It is important to interview two or three (or more) doulas for either birth or postpartum support to ensure your doula meets YOUR criteria for what you want in a doula. Do you all get along? It is vitally important that your partner is onboard and feels comfortable with the doula, since you will be spending hours together in close quarters and under some stressful circumstances. Does your potential doula support your vision for your birth? Can she answer all the questions you have in a way you understand?
Does she have the knowledge of what happens in labour and birth or during the postpartum period, that you would expect of a professional? Do you share the same moral or religious views? If the answer is yes to all the above questions, then she is probably the right doula for you. Many doulas work with payment plans to make it easier for birthing moms to have a doula by her side. Ask your doula what payment options are available or if she works on a sliding scale depending on your income.
Where can one find a birth or postpartum doula?
Google is an excellent source to start with. Google birth or labour doulas in your area or surrounding areas. You can go to certifying organizations’ websites where there is usually a current listing of their certified doulas. Organizations such as CAPPA International, DONA, ICEA and many others have doula training and certifying programs, so those would be great sites to visit. You may also ask friends and relatives if they’ve had a doula, and ask how did they like her then get a referral. Word-of-mouth is a great way to find a doula that’s right for you!