"Nicola was not only vital to my experience but also - if not more so - to my husband!"
Mothers Mate - Doula Services UK

What is a Doula?

Doula (DOO-lă) comes from the Greek meaning "in service of", it also came to mean a favoured female servant whose duties probably included attending the lady of the house at birth. Nowadays, Doula is used as a term for a person who attends and assists mothers-to-be during birth. Their role covers many things:-

  • They work alongside the partners, families, doctors, midwives and nurses looking after the woman in labour.
  • They understand the birth process and assist during the labour.
  • They provide non-medical care for the mother and partner, easing the transition from home to hospital/birth centre and back home again.
  • They are there during the birth to facilitate treatment and offer encouragement.
  • Their role includes educating the new parents before, during and after the birth.

In the States they can be found in hospitals, birthing centres home births, in the UK whilst some are affiliated with hospitals and birthing centres most are employed by agencies or freelance. They work in co-operation with the families OB/GYN, nurses, midwives, partners of labouring women.

A Doula is also sometimes referred to as a Childbirth Assistant, or Labour Support Person or Birth Coach.

Why haven't I heard of this before?

It's not surprising that not many of heard of Doulas before. Doulas have been working in the States for 10-15 years and are only just really gaining acceptance. Several studies have now shown the benefits of having a Doula alongside a mother during labour.

In the past, a woman's own mother would provide support before, during and after the birth, however in this modern world distance and other responsibilities or problems prevent this.

Why would I want to have a Doula?

The prospect of having a new baby can be both exciting and daunting, as well as overwhelming and exhausting. Many new mothers focus on the pregnancy and forthcoming birth and give little thought to the changes that will come to their lives after the birth. The Doula's role is to help ease this transition both on a practical and emotional basis. The service a Doula provides can be invaluable for all parents whether first time, experienced, adoptive or parents of multiple births.

What other services does a Doula offer?

Many Doulas offer other services along with professional labour support, such as:

  • Quality childbirth education (even for moms on bed rest since they are done in your home!)

  • Birth plan counselling

  • Photographing or videotaping your birth

  • Breast feeding support

  • Post-partum Doula care

  • And more

What else can I expect of my Doula?

The Doula's role is vary varied and depends on the needs of the new parents. Generally, the services needed are agreed between the new parents and the Doula during her initial Ante Natal visits. Here are just a few things she might be expected to do after the birth:-

  • Preparing meals for the family

  • Light housekeeping

  • Running small errands,

  • Taking care of the other children in the family

  • Screening calls and visitors

  • Taking care of the baby so Mom can rest

  • Teaching new parents how to look after their baby

  • Answering any questions, however silly they may seem

  • Providing assistance and guidance with breast feeding

  • Listening to the birth story - as many times as the new parents tell it!

A Doula adheres to a set of standards and provides emotional, educational and physical support prenatally and continually during labour and birth. Doulas do NO clinical tasks and intertwines her care with the wisdom of nurses, midwives and physicians. Doulas may be trained in the use of massage, breathing techniques, relaxation, accupuncture, hydrotherapy, aromatherapy, physiologic positioning to enhance labour as well as the anatomy and physiology of the childbirth process.

Twenty years of research and a multi-clinical trial study show that Doulas can have a significant impact on the birth process. It is important to point out, however, that if a birthing facility has taken steps to reduce the caesarean section rate, then the first percentage value may not be precise.

What Does A Doula NOT Do?

A Doula cannot speak for her client, but is there to provide support and information when making decisions about the labour and birth. A Doula does not perform any clinical tasks such as vaginal exams and a Doula does not deliver babies. A Doula works with the medial team, not against them, her role is to work to create a calm situation and not a confrontational one.

Does the Doula have special training?

In the UK at the moment there are no special qualifications required to become a Doula, but generally a Doula:-

  • Is a mother herself

  • Provides references

  • Is insured

  • Is certified in infant/child/adult CPR

  • Has completed various birth/childcare training programs

  • Has been thoroughly screened including a nationwide criminal background check

What Is The Difference Between Doulas, Labour& Delivery Nurses, Midwives and Monitrices?

  • A Doula is there to provide emotional, educational and physical support.

  • A Labour/Delivery nurse will tend to the mother's clinical considerations during labour and birth.

  • A Midwife is a Nurse with specialists skills/qualifications which allow her to prescribe medications and deliver babies.

  • A Monitrice is a nurse or midwife who has received additional training in specialist clinical skills such as taking foetal heart tones, blood pressure checks and vaginal exams.

How Much Do The Services Of The Doula Cost?

The cost for a Doula varies depending on the services provided and expertise of the Doula Some Doulas can offer additional services such as breast feeding counselling, baby massage and post birth support. An average of £250 to £1,000.00 is not unusual depending on where you live and what services are being provided. A more experienced Doula is likely to charge more than a less experienced one, but after all it is that experience you are paying for.

Most Doulas will require a deposit, usually around a quarter of the agreed fee, once a contract for services has been agreed. The remainder of the agreed fee for the birth will be due two weeks prior to your due date. Payment terms for Post Birth services will be agreed when the contract is first made. Most Doulas will be willing to work with the families on this if discussed and agreed in advance.

Will Women Who Choose to have an Epidural Still Benefit From having a Doula?

The role of the Doula is to provide care and support for women during labour and birth, regardless of what type of medication they choose or indeed how they decide to give birth. As Doula is experienced in the process of giving birth, having her there can provide additional support for all the parties involved. A Doula is there to give you the information needed to make the best decisions for yourself and your baby, this doesn't stop just because you have an Epidural or have chosen to have a caesarean. There are no guarantees that the medication you take will take away all your pain, so a Doula can be there to provide additional care and can also provide support and relief breaks for your partner. Having a Doula there to help if you are looking for an unmediated birth can be of great help, they can often assist clients to the 7-8 cm stage without any pain relief and can then aid you in your decision whether or not to take any medication or to continue through the natural birth process. Most Doulas believe in natural birth, they are aware of the problems that can occur in a medicated birth, but it is not their purpose to push their ideals upon you, they are there to support you through the whole birth experience based upon your choices and decisions.

Is it worth hiring a Doula if I may have a repeat caesarean section?

As mentioned about a Doula can still provide essential emotional and information support and she can help in other ways. If your first caesarean was unplanned she can help you ask the right questions, to determine the pros and cons as to whether a repeat c-section is really necessary. She can help you relax as a spinal or epidural is administered, helping to ensure you remain relatively unrestrained so you can touch your baby as soon as it is brought to you. If the medication starts to wear off, she can again help you with various relaxation techniques to help provide some pain relief. If your partner leaves the operating room to go with the baby to the nursery, she will stay with you whilst surgery is completed, as an otherwise quite lonely and depressing point in time. After surgery she can act as a liaison between you in recovery and your partner with your baby in the nursery.

Isn't the Doula supplanting the position of the partner?

The presence of a Doula can actually help to bring a couple closer. She doesn't just look after the labouring mother, but also looks after the needs of the partner, whether it be as straightforward as providing food and drink or providing emotional and information support and reassurance. Having the Doula there allows the partner to participate as much or as little as they are comfortable with. If they prefer to just witness the birth, the Doula can be there during the labour to provide additional support to the mother. If they chose to participate fully, the Doula can supplement his support of his partner by helping to comfort and reassure her. During longer labours she can provide the partner with a break if needed. Whilst a Doula is knowledgeable about labour, birth, and maternity care, the partner knows his partner's personality intimately.

Nowadays it is expected that the father becomes the principle birth coach, even though they have little experience of the birth process. It can be frustrating to them to find that the comfort methods they have been taught do not appear to work. A Doula can offer advice to the father at the appropriate time to enable him to butter utilize his support skills. It is not unusual for a father to become a spectator as they become overwhelmed with the situation, they start to feel inadequate and insecure because their lack of knowledge and experience is making them more of a liability than a help to the mother. Having a Doula present can provide the father with the reassurance and information they need, to bolster their confidence so they the emotional support their partner requires.

I want this to be a special/romantic time between my partner and I, we really don't want a stranger there, why would I use a Doula?

By the time you come to give birth the Doula will feel more like a close family friend than a stranger. She will have met you several times before and talked through with you all your fears and concerns and helped you to make your preferences clear, perhaps by drawing up a Birth Plan. She can help you and your partner through the process and help ensure that the medical staff who do doubt will most be strangers, know your preferences. She can help to ensure that any medication provided is in accordance with your wishes. A Doula can help your birth be very special to your and your partner by becoming an integral part of your support team, providing knowledge and comfort when needed, relieving stress from yourself and your partner.

What about other family, won't it get confusing with a lot of people?

A new baby is exciting for the whole family and close friends, who of whom would like to help and "be there" for you. However, this can sometimes be more traumatic than helpful putting the mother in a stressful position as she feels a need to look after everyone or worse have to act as a mediator between family members. A Doula can co-ordinate the efforts of this extra group of supporters by given them jobs to do, making them feel useful, helping them to act as a team and if need be acting as a buffer between you and your partner and everyone else.

Are There Liability Considerations With Doulas?

As Doula's do not perform any clinical tasks there is no need to worry about liability.

Won't the nurses do most of this for us?
Why would we need someone there is she will be there for us?
What about my doctor, where will he/she be?

Nurses are normally very supportive, but remember you will not be their only patient. It is likely that there will be at least one other other couple also needing their time and attention. When the nurse is with you their time will be taken up making assessing how you are and your baby are doing, there is little time for anything other than informational support. It is unlikely that the nurse will be trained in alternative methods of pain relief and are more likely to suggest the use of medication instead. If you have a long labour you may see several different nurses as shifts change, a Doula will be there with you throughout the whole process, from start to finish. Your doctor may also change along the way as shifts change, they will be managing several patients and are likely only to be by your side for the final moments of the birth.

If you are interested in using a Doula here are some pertinent questions to ask

  • What training has she had, is she certified?

  • What experience does she have with birth, personally and as a Doula eg how many births can she attended?

  • What types of births has she witnessed (Caesarean, epidural, intervention free, VBAC, teen birth, etc.)?

  • What is her philosophy about childbirth and supporting women and their partners through labour?

  • Will she meet with you to discuss birth plans and her role you supporting you through childbirth?

  • Can we call her at anytime with questions or concerns before and after the birth?

  • What care providers have she worked with?

  • In what hospitals have she attended births?

  • When will she meet you once labour has started, at home or at the hospital?

  • Will she meet with you after the birth to review the labour and answer questions?

  • Does she work with one or more backup Doulas, for instance what happens if she is already attending a client when you go into labour?

  • What is her fee? Is any part of the fee refundable if she is unable to attend the birth?

  • Can she provide references? (Be sure to check the references.)

  • When you meet the Doula (and it is a good idea for both you and your partner to meet her), pay particular attention to your personal perceptions of the Doula

    • Is she kind, warm and enthusiastic?

    • Is she knowledgeable?

    • Does she communicate well?

    • Is she a good listener?

    • Is she comfortable with your choices or does she seem to have her own agenda?

    • Do you feel comfortable with her?

  • You may want to interview more than one Doula and make a comparison to help you find a Doula who is right for you as the bottom line is whether you and your partner like her and feel you can comfortably work together.

Would a Doula be offended if asked to leave so we can have some private time?

No, a Doula would never be offended by such a request as it will only serve to make the whole experience better for you, it is probably essential for your and your partner to have a few moments alone during this miraculous process. After the birth she will be ready to take a step backward whilst you celebrate with friends and family but will be ready to respond to your needs if required.

What if I have a midwife or am giving birth at a birthing centre or at home?

A Doula can still provide a valuable service, including personal childbirth education and labour support. Not all midwives provide labour support and this is a very good question to ask her when interviewing a midwife. Some midwives prefer to attend you later in labour or may prefer not to provide physical labour support. The best way to determine how your midwife will be is to ask former clients and see how well they felt supported during labour There are never too many extra hands at a birth! So even with a supportive midwife, you may still benefit from a doula's services. Ask your midwife/midwives how they feel about Doulas

Are a doula's services covered by health insurance?

At this time only a few insurance companies cover Doula services, but the numbers are increasing gradually as providers are beginning to recognize the benefits of both improving parental satisfaction and bottom line savings when parents employ a Doula for their birth. Factors that may increase your chances of reimbursement include:

  • Using a certified Doula

  • Submitting a doctor or midwife's referral or prescription for Doula services

  • Submitting well documented statistics of Doulas influence upon birth outcomes

  • Actually achieving a low intervention, low cost birth

  • Submitting a superbill for Doula services complete with diagnosis and treatment codes

  • Resubmitting with more documentation if first claim is denied

You talked about a Birth Plan earlier, exactly what is it?

A birth plan is a list of the decisions you have made about medication and the labour prior to the birth, such as, no epidural or no pain medication unless absolutely necessary. Basically it's a list of do's and don'ts list for your labour which the hospital staff are asked to adhere to. The Doula will does everything she can to help you and your partner manage your labour and the birth according to your wishes.

What does a Doula bring to the hospital which might help me in labour?

A Doula's bag's is usually full of useful tools such as birthing balls, hot and cold compresses, massage tools and lotions, music of different styles and a few snacks for both you and your partner. These are just a sample of things that a Doula may have with her.

How far along should I be before contacting a Doula?

The sooner the better, but generally anywhere from 6 - 9 months pregnant. The more time you have to spend getting to know your Doula prior to birth, the better for both you and your Doula

A Doula can help you with many issues to do with pregnancy and birth such as:
  • Childbirth
  • Breastfeeding
  • Home births
  • Birth plans
  • Baby massage
  • Post birth
You have probably already heard the term Doula and are interested in finding out what a Doula can do for you. Please do have a good look around the site; we hope we have covered all your questions and concerns. If you need any further information please contact Nicola Wilson (more details on contacts page).
Mothers Mate - Doula Services UK Material on this site is the copyright of Nicola Wilson / Mothers Mate 2007
Copyright 2007 - © Nicola Wilson/Mothers Mate. All right reserved.