A doula, or professional childbirth assistant, is a woman employed by a pregnant woman and her partner to provide continuous psychological and physical support for the woman during labor, delivery and the immediate postpartum period.   A doula works with a laboring woman’s physician or midwife, using her expertise to help a woman focus and accomplish the hard work of labor.  She provides emotional support, helping her client to acknowledge and overcome the psychological barriers that can cause labor to stall.  She is a resource for the laboring woman’s physical comfort; she helps a woman find the most comfortable positions for labor and delivery, provides soothing massage, and assists with hydrotherapy. 

A doula can be a tremendous asset for a woman giving birth in a hospital setting, in which obstetricians and nurses are often too busy to provide continuous personal care.  Like an obstetrician or midwife, a doula meets with her client before the birth and establishes a close relationship, built on the trust that when the woman goes into labor, she can count on her doula to be there for her labor and delivery.   The doula also supports the father or partner, if he is present at the birth, by making it possible for him to attend to his basic needs (using the bathroom, eating, sleeping) while not leaving the woman alone.

A doula may join a couple at their home prior to the birth to assist the couple in laboring at home as long as possible, after which she will accompany them to the hospital; other couples may prefer to have their doula join them at the hospital or birthing center.  For couples who choose home birth, it is usually the case that a midwife will bring at least one assistant with her to serve as a doula.

Research demonstrates that the presence of a support person during labor decreased the risk of cesarean section and other medical interventions, such as forceps, vacuum extraction and epidural anesthesia.  See The Doula’s Contribution to Modern Maternity Care from Doulas of North America, one of the larger doula-certifying organization.

Doulas are valuable whether or not an unmedicated birth is planned. If a medicalized birth becomes necessary a doula can help a mother understand her choices and minimize interventions, if that is her goal.  For example, after the successful external version of my baby from breech to vertex, there was a chance that our consulting perinatologist would recommend labor induction.  I was grateful to know in the back of my mind that I had a doula who would support me in birthing without an epidural, and who had been-there-done-that with other women.

What to Look For in Your Doula

The doula's role is to be whatever you want her to be.  Do you like massage, or do you like your space?  Do you need verbal affirmations, or do you cope best with pain by focusing internally?  Although your doula should ask you these questions in advance, many of these things will not be resolved for you until labor begins, and your answers may change over the course of your labor.  Your doula should follow your cues and give you emotional support and/or physical comfort measures that match your needs at each moment.

It is important to feel that you and your doula have “chemistry.”  All doulas offer introductory face-to-face meetings free of charge where you can ask questions and get a sense of whether or not the two of you connect.  This connection is vitally important.  Also, a doula should have a backup plan in place to assure that you will have support in case of emergency.

The fee for doula services varies widely.  In 2005 in Manhattan, it was $500-2000, depending on the experience and additional skills (massage therapist, hypnobirthing training, etc.) of the doula.  If your budget is tight, many doulas work on a sliding scale.  You can also try to find a doula-in-training who might attend your birth for free or a nominal fee.  Considering that a doula is on-call 24-7 prior to your birth and may spend as much as 24 hours with you, with little chance to rest, almost any fee is a bargain.

You do not need to use a professional doula, although you may choose to do so in order to avail yourself of her skill set.  You can invite a close friend, sister or mother to provide labor support.  Having an extra set of loving hands is really the most important benefit of a doula.  If you choose to go this route, I highly recommend that your partner and support people read The Birth Partner by Penny Simkin.

Birth Doulas and Postpartum Doulas
           
Until now, I have been using the term “doula” to refer to a birth doula providing continuous labor support.  Postpartum doulas are female caregivers who assist families after the birth of a new baby.  A doula cares for the mother, facilitates nursing, and helps with housework, meal preparation, and child care, enabling the parents to focus on bonding with their new baby.   A woman who has just given birth needs extra support to facilitate healing, especially if her body is healing from a cesarean birth or from tearing during a vaginal birth.  Trust me, just going to the bathroom can be an ordeal in the first several days! 

A postpartum doula fills a void that was traditionally filled by extended family and social clan.  If you have friends or family members who can play this role for you, wonderful.   For more information, or to find a DONA-certified postpartum doula, see www.dona.org.  Sometimes, one doula has certification as both a birth and postpartum doula.

Whatever you decide about hiring a doula, make sure to line up your own support people to help you and your partner during and after your birth, as well as for the first couple of weeks at home.  If you give birth in a hospital, do not count on hospital staff to fill this role, and don’t assume that you won’t need help after your birth.
           
Recommended reading:

• The Doula Advantage: Your Complete Guide to Having an Empowered and Positive Birth with the Help of a Professional Childbirth Assistant by Rachel Gurevich
  
  
• What is a doula? from the website of Supported Birth
  
  
• Partners and untrained labor support people should read The Birth Partner: Everything You Need to Know to Help a Woman Through Childbirth by Penny Simkin.  This book is the best overview I have seen of the l birth process, and will prove to be an invaluable resource before, during and after birth.
  
  
• The website of DONA, Doulas of North America, a large doula-training organization.  In particular, see The Doula’s Contribution to Modern Maternity Care.
  
  
• A wonderful collection of handouts for clients and doulas from Birth Empowerment Support Team doula services in Los Angeles.
  
  
• The Doula Book: How a Trained Labor Companion Can Help You Have a Shorter, Easier, and Healthier Birth by Marshall H. Klaus, John H. Kennell, Phyllis H. Klaus

Though I am not currently practicing, I was trained and certified as a birth doula by Supported Birth in 2002.  My doula contract perhaps best conveys my personal philosophy about what to look for in a birth doula.   

If you are a Shomer-Shabbat Jewish woman who is a doula, or if you are interested in having a Shomer-Shabbat woman as your doula, you may want to read my halakhic analysis.