Should Doulas Be a Part of Your Labor, Delivery, and Post-Partum Team?
As many of you know, my brother is preparing to have a baby with his long-time friend and future platonic co-parent, Ashley. They are wondering if they should hire a doula. A doula, as defined by the doula credentialing organization DONA, “is a trained professional who provides continuous physical, emotional and informational support to their client before, during and shortly after childbirth to help them achieve the healthiest, most satisfying experience possible.” That sounds amazing.
But the question about whether to hire a doula took me to my own experiences with patients and their doulas. Some were positive and some were not: I saw doulas advocate and support for single mothers, parents with little family or community, and couples who just wanted extra hands on deck. I also had patients whose doulas recommended waiting when OBs needed to induce labor for conditions like maternal hypertension, or focused so much on breastfeeding that babies were dehydrated, or pressured them against vaccination.
Nevertheless, like any good scientist, before giving Raman and Ashley a definitive answer, I looked into the science. The impact of doulas on vaginal births, healthy birth weights, breastfeeding, and maternal satisfaction have in fact been measured, and, especially in black communities or other groups that face healthcare disparities, doulas can improve all these measures. Medicaid and some insurances even cover doulas as part of birthing teams.
My advice on hiring a doula:
Please note that the following input on doulas is rooted in science but coming entirely from a pediatrician’s perspective and experiences. For your own decision, please discuss with you doctors and healthcare team.
Be Clear: Delineate exactly what you are looking for in a doula. For me, this would look like emotional support and physical support, meaning I want a doula who provides light housekeeping or chores as part of her service. I also want a doula to know where I stand on potentially controversial topics, like vaccines. Most importantly, share your goals. Many women set goals like vaginally delivering or breastfeeding exclusively. While these are nice outcomes, the overall health of the mother and child should come first. A good doula would help support your vision and advocate for you while making sure you are hearing medical input. As stated by American College of Obstetrics Gynecology (ACOG), doulas are not trained in medical advice giving but they are trained in active listening.
Review Costs and Duration of Doula Care: Before considering a doula, make sure your version of doula care fits your budget. Doulas can range in cost and care coverage (pre-hospital, labor and delivery, and/or post-partum support). Ashley tells me she was quoted $4300 solely for labor and delivery doula services.
In hospital emotional support and advocacy is ideal but, personally, I would want a doula who offers post-partum assistance once you come home with the baby. This is especially important for parents with minimal social support or single parent homes.
Find a Trained and Reliable Doula. This is probably the hardest part of finding a doula. There are many certifications out there, including DONA ICEA, and NDCB. When asked about doulas, I recommend finding a certified doula with at least three glowing references. As a bonus, I would try and find one who is supportive of or a member of ACOG, ensuring alignment with evidence-based practice.
Takeaways:
- Before all else, know the costs.
- Be aligned on the role of your doula: a doula is a one-on-one support provider and advocate, not someone trained in medicine. Personally, I would want my doula to reinforce my decisions, including the decisions to vaccinate myself during pregnancy and my baby after birth.
- Double check training and references.
- And did I recommend a doula for Ashley? Yes, I did! I think the emotional support for her will be a great asset, especially since her family is not nearby.
To read more about the platonic co-parenting journey of my brother and Ashley, get a glimpse into Ashley’s pre-pregnancy self-care here, or read here to learn why and how Raman quit vaping, or learn more about growing your baby’s microbiome before and after birth here.
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References:
Ramey-Collier, Khaila et al. “Doula Care: A Review of Outcomes and Impact on Birth Experience.” Obstetrical & gynecological survey vol. 78,2 (2023): 124-127. doi:10.1097/OGX.0000000000001103
Sobczak, Alexandria et al. “The Effect of Doulas on Maternal and Birth Outcomes: A Scoping Review.” Cureus vol. 15,5 e39451. 24 May. 2023, doi:10.7759/cureus.39451
Kozhimannil, Katy B et al. “Doula care supports near-universal breastfeeding initiation among diverse, low-income women.” Journal of midwifery & women’s health vol. 58,4 (2013): 378-82. doi:10.1111/jmwh.12065
ACOG Committee Opinion No. 766: Approaches to Limit Intervention During Labor and Birth. Obstetrics & Gynecology 133(2):p e164-e173, February 2019. | DOI: 10.1097/AOG.0000000000003074
https://www.acog.org/education-and-events/webinars/navigating-doulas-role-in-maternal-vaccinations
