April 19, 2019
Doula giving a pregnant woman a massage.
Ask the Experts

Should I Hire a Doula?

by Jeanine Barone  

Q: I have been hearing more about doulas for childbirth and even for the postpartum period. What exactly do they do, and is there research to support having one?

A: A doula is a person—nearly always a woman, but occasionally a man—who works as a professional birth attendant, providing emotional and physical support to the mother during pregnancy, labor, and in some cases after the birth. Other terms sometimes used to describe a doula include birth coach, labor coach, birth assistant, and birth companion. (The word doula is an ancient Greek term that translates literally to “female servant.”)

A doula’s duties can include helping the pregnant mother to actively prepare for giving birth; providing physical comfort measures during labor (such as massage, counterpressure, or heat and cold, or helping the mother to move into different positions); serving as an advocate for the mother during labor and delivery; providing breastfeeding support; and helping ease the family’s transition at home after the baby arrives—for example, assisting with newborn care, watching older siblings so the parents can rest or tend to the baby, doing light housework, or planning and preparing meals.

A doula can also provide critical emotional support and encouragement to the new mother as she recovers physically and mentally from childbirth.

Doulas do not provide medical advice or administer medications, and they aren’t trained as medical professionals, as midwives and nurses are. But they often work alongside these professionals in the birthing setting, whether that’s a birthing center, a hospital, or at home. About 6 percent of birthing mothers in the U.S. used a doula in 2012, up from 3 percent in 2006, according to the National Partnership for Women and Families, a nonprofit group. (More recent national data aren’t available.)

Research on doulas

Several studies have found that having a doula present during delivery significantly decreases the rate of cesarean delivery, or C-section. In one study, published in 2013 in the American Journal of Public Health, researchers compared records from a national sample of almost 280,000 women insured by Medicaid who gave birth nationwide and a smaller group of 1,079 women in Minneapolis, also Medicaid recipients, who received doula support during pregnancy and labor. (Minnesota is one of only a few states that allow Medicaid reimbursement for doula services.) They found that the women who had a doula were 41 percent less likely to have a C-section compared with the women who gave birth without a doula (22 percent vs 32 percent, respectively).

A subsequent study, led by some of the same investigators and published in 2016 in Birth, looked at more than 67,000 Medicaid-funded births, all in the Midwest, between 2010 and 2014. It found that women who received services from a community doula organization (about 1,900 women) had lower rates of both preterm birth and C-section compared with the roughly 65,000 who didn’t have those services (4.7 vs. 6.3 percent for preterm birth; 20 percent vs. 34 percent for C-sections).

According to DONA International, a nonprofit organization that certifies doulas, a professional doula may help a woman lower her C-section risk in several ways. Those include helping her to weigh the benefits and risks of induced labor, lowering the need for pain medication during labor, helping to create a calm and comfortable birthing environment, and assisting with movement or postures that can position the baby well for birth.

Other research points to the benefits of having continual, one-on-one support—whether from a doula or another person—during the whole of the childbirth process. In an analysis by the Cochrane Collaboration in 2017, for example, researchers examined more than two dozen studies in 17 countries, involving more than 15,000 women who gave birth in a hospital. It found that those who had continual support during labor and delivery—from a doula, midwife, nurse, or other person (usually a woman)—were more likely to have a vaginal delivery (vs. a C-section), were less likely to use pain medication, and had shorter labor on average compared with women who did not have such support.

Finding a doula

If you’re considering working with a doula, check with your hospital or birth center to see if they have a doula program. You can also ask for a recommendation from your obstetrician, midwife, childbirth educator, or women in your family or social network. There is no formal licensing for doulas, but several organizations offer certification for birth and postpartum doulas: DONA International, CAPPA (Childbirth and Postpartum Professional Association), and the International Childbirth Education Association. Each site offers an online directory of its member doulas.

Before signing a contract, you should ask about the doula’s experience, training, and certification, and see if you can speak with some of her previous clients. It’s also wise to meet in person to see if it feels like a good fit.

Some insurance plans cover doula services; check with your provider. Doula services are also reimbursable by flexible spending accounts (FSA) or health savings accounts (HSA), though you may need a letter of medical necessity.

Also see Breastfeeding Reduces Diabetes Risk.