Do You Need A Doula?

If you want an easier, more peaceful birth, the answer may be yes.


Wouldn't it be great if someone you trust volunteered to be on hand — even sleep on your couch — in case you went into labor in the middle of the night? What if that same person offered to walk in the woods with you in the last weeks of your pregnancy or adjusted her vacation plans to be with you during your baby's birth?

My doula (pronounced doo-lah), Sue Ann Higgens, did all this and more when I was expecting my first child.

Greek for a woman who helps women, a doula is not trained to deliver babies, but rather lends support to women and their families, providing encouragement and information through late pregnancy, labor and birth.

A Proven Benefit: Constant Support

Although there are no official statistics, experts in childbirth education estimate that in the United States, 1 percent of births are overseen by doulas. And they say the numbers are rising as evidence of the benefits adds up. "More hospitals are opening their doors to doulas because they know women want that kind of support," says Maureen Corry, M.P.H., executive director of the Maternity Center Association in New York City, a nonprofit organization devoted to improving maternity care. "There are no known risks to the mother or baby in having a doula — and lots of benefits."

A scientific review involving six studies of more than 2,000 women found that with the continuous support of a trained doula, epidural use decreased by 60 percent. Also, the number of Cesarean sections dropped by 50 percent, oxytocin use for labor induction decreased by 40 percent, forceps use by 40 percent, and the average length of labor by 25 percent.

"We think that anxiety can slow or stop contractions," says John H. Kennell, M.D., professor of pediatrics at Case Western Reserve University in Cleveland and one of the researchers involved in the review. "The doula's experience and knowledge help set the mother [and her partner] at ease."

Postpartum advantages are adding up as well: Research by Kennell and others suggests that doula-supported mothers breastfeed more successfully and suffer from less postpartum anxiety and depression than new moms without such support.

The Making of a Doula

Labor-doula trainees typically attend a workshop led by experienced doulas. They learn about the labor process and about techniques for pain relief and effective communication with a laboring woman, her partner and hospital staff, says Penny Simpkin, P.T., a childbirth educator and co-founder of Doulas of North America. A doula also must attend three to 10 births in order to be certified.

Postpartum doulas — who help women after delivery — learn how to prepare family meals, care for newborns and provide lactation support.

Typically, labor doulas meet with the expecting parents at least twice before contractions start to answer questions and discuss the birth plan. A few weeks before the due date, most labor doulas are on call; they often check in with the family after delivery to talk about the birth. Fees for such a package range from $150 to $1,000.

For $300, my doula, Sue Ann, promised two prenatal visits, support from the first contraction to the last, and two postpartum visits. My husband, Craig, and I got much more. During prenatal visits, we talked about our hopes for the birth. Sue Ann taught us how to practice labor positions that use gravity, such as dancing, rocking and squatting, and she helped us make a list of what to bring to the hospital.

She answered all my questions. "Is it good or bad for the baby to move during a contraction?" (Good.) "Will I be able to tell if my water breaks while I'm swimming?" (Yes.) "What time of day am I most likely to go into labor?" (Many mammals go into labor in the middle of the night, when quiet breeds a sense of safety.) Sue Ann lent us videos on nursing, labor and baby care, as well as copies of useful articles. She accompanied us to two doctor's appointments and, when I was overdue, to the hospital for an application of prostaglandin gel to prepare my cervix for induction.

The Power of the Doula

At one point, I became frustrated when my due date passed without incident. Sue Ann suggested that I massage my belly to reconnect with my baby. "Rub gently downward," she said. "Think about how you can't wait to meet him." With those simple, reassuring words, she helped me refocus my attention on the beauty, mystery and spirituality of childbirth.

Her presence sustained my husband and me through the 23 hours I was in the delivery room. In that time, my doctor came and left three times, and the nursing shift changed three times. Sue Ann was nearby from start to finish. As contractions became more intense, she offered options: Do you want to try dancing or squatting or spending time in the hot tub?

When it was time to push, Craig stood on one side with Sue Ann on the other, holding and rubbing my legs and coaching me to breathe in, hold and push. She positioned a mirror so that I could see my son crowning. And when Cobi slipped out, she stepped back to let Craig and me welcome him.

Sue Ann eased our transition from hospital to home by keeping in touch with us via phone, and cooking us a homemade dinner of rice-and-bean enchiladas and oatmeal-raisin cookies. As our doula, she guided us through late pregnancy to early parenthood, offering the steady hand of someone who has passed that way before.