Usually, when I tell people that I’m a doula I get two questions. The first: How do you spell that? And the second: Isn’t that like a midwife?
The concept of doula, at least in the way I use it, is relatively new. The word itself comes from ancient Greek, meaning “helper” or “woman slave,” but it’s been adopted in the last 40 or so years to refer to someone who provides support to women during pregnancy and childbirth. The support a doula provides ranges from emotional cheerleading to massages and acupressure to aromatherapy and meditation. It runs a wide gamut of all things non-pharmacological, a unique service for women giving birth mostly in hospitals.
If you didn’t know anything about hospital births, you might be surprised to find out that women in labor have little to no access to pain mediation techniques that aren’t drugs like epidurals or opiates like Stadol. On top of that, you usually don’t get to move around, get in the shower, drink water, or do pretty much anything that might help you along during labor, besides lie still in bed.
That’s where I come in. As someone trained in a range of non-medical techniques for easing pain and moving the process along, a doula can be a serious advocate for a woman during labor and delivery. The doula is also unique in that she’s pretty much the only person in the room who is solely dedicated to the emotional and psychological well-being of the pregnant woman. She’s not worried about the baby at all, really. She’s just there to make sure mom has the best experience possible.
In a hospital environment where doctors are overworked and nurses often spend more time at the nurses’ station monitoring stats remotely than in the room with patients, a doula can be key. Doulas tap into skills that all of us possess—the ability to listen, assess someone’s needs and provide support. Because of that, there’s not a complicated training process that a midwife or doctor would have to go through—a typical doula training program is just a weekend long. Not including reading and birth time.
A doula doesn’t replace a midwife or an obstetrician, or a partner, best friend, or grandmother. The doula is there to provide ideas, support and even guidance to those who are supporting the laboring mom.
Which brings us to the third question people ask me: What made you want to become a doula?
Unlike many doulas who get into the work because of their own birth experience, I’m childless and was still in college when I started my training. It was actually an anthropology class and a documentary called “Born in the USA” that opened my eyes to how most babies in the U.S. are born. When I left class after watching that documentary, I knew my life had just been changed forever. I was riled up about the state of childbirth in our country and wanted to do something to change it.
Did you know that the Caesarean section rate in the U.S. is 31 percent? That’s twice what the World Health Organization recommends. Did you know that we rank 43rd in the world in maternal and fetal mortality, meaning that 42 other countries have fewer moms and babies dying than we do? That’s despite the fact that we spend more per capita on healthcare than anyone else in the world. If you thought it might be lack of access to services—think again. Ninety-eight percent of moms give birth in hospitals.
In that kind of climate, every bit of support helps. Doulas have been proven to lower intervention rates—in other words, our presence means fewer surgeries—and improve maternal satisfaction. We all want a good birthing experience.
Most doulas start building a relationship with their clients at the beginning of their pregnancy and work with them throughout the pregnancy as well as during the delivery itself. Because all my doula work has happened in a volunteer context, I haven’t had the opportunity to do that yet. I’ve met all of them once they are already in labor—not the ideal scenario. But even in that limited amount of time, I’ve seen the power of what working with a doula can do for a woman.
One mom I worked with, Susan, had chosen a nurse midwife for her hospital birth and knew she wanted an epidural, but hadn’t really figured out what to do during the rest of the birth. Her face lit up with surprise and delight when I told her about all these other things she could do to manage her pain. We walked together around her room, did breathing exercises, visualized what was happening as the baby moved down. She did an amazing job of working through each contraction. While she still chose to get the epidural, I could see that this knowledge, this sense of control, made a difference for her. That twinkle of self-confidence can really be a life-changing experience for a new parent.
Another woman I worked with didn’t have such an ideal birth experience. Rosa was a Spanish-speaking immigrant, giving birth for the first time in the U.S. I saw clearly how differently the staff at the public hospital treated her in comparison to how they treated the English-speaking white women with private insurance like Susan. Having me, a Spanish-speaking doula there, to explain things when the staff chose not to provided an extra level of comfort in a not-so-nurturing environment. Rosa ended up having a C-section—something she was hoping to avoid—but she and her baby were healthy and doing well when I went to visit them the following day.
It’s rough for me to see these distinctions—the way the hospital staff treat women based on race, language, immigration status or income. It’s tough to watch the cascade of interventions that can occur when doctors push one procedure, which leads to another, even when I think they aren’t necessary.
For me, being a doula is a form of activism. Some of that work happens outside of the birthing room—advocating for better access to midwives and out-of-hospital births. But in that room, I’m there to help the mom have the best possible experience. Collectively, all those good experiences I foster might just change the system as a whole. It’s a system that isn’t serving parents and children, and doulas are one way of trying to mend it.
By the way, doulas aren’t just working with childbirth. These days, there are doulas working across the spectrum of pregnancy—supporting folks during labors, miscarriages, adoptions, even abortions. Some doulas charge for their services, others do it as volunteers or work on a sliding scale.
Who doesn’t want that kind of support?