What is a Doula?

A doula is a trained childbirth professional who provides support to a person or couple who is pregnant, undergoing labor, or has recently given birth. There are birthing doulas, prenatal doulas, full-spectrum doulas, pregnancy and infant loss doulas, postpartum doulas and more as this industry is evolving. The purpose of a birth doula is to help parents have a safe and positive birth experience.

What is the scope of a doula's practice?
A doula is not a medical professional. Doulas are not licensed or certified by the government or a regulatory agency. Consequently, the term "scope of practice" is not applicable to doulas. Like any citizen, a doula cannot do anything that is clearly considered the work of a midwife, obstetrician, nurse, or other licensed profession, which is against the law. This means that birth doulas individually define their own roles, which can vary widely. Some doulas choose to obtain certifications or memberships from private organizations, but this is completely optional. In this case, they often agree to a code of ethics or a defined and limited role that is dictated by this organization. For parents interviewing doulas, this is why it is important to ask if they follow the guidelines dictated by an outside organization and, if so, what they are. These are voluntary certifications and are not endorsed by any state or legal agency.

Labor doulas typically provide one, some, or all of these five main services:

  • Physical support

  • Emotional Support

  • Informative support

  • Positioning techniques

  • Advocacy

Physical Support
Physical support includes all of the comfort techniques that a doula may be adept at. These include massages, essential oils, facilitating a comfortable position by moving the bed, providing a stool or birthing ball, hip squeezes and counter-pressures, rebozo techniques, heating pads, relaxing music, tens of units, etc. It also usually includes offering food and hydration. Parents hiring a doula should be aware that some doulas limit their service to this area. This is fine, but it is important to ask.

Emotional Support
Emotional support is the encouragement, understanding, and reassurance that doulas give parents before, during, and after the birth of their child. Some doulas guide their clients through exercises to release fear, some may spend many months building a friendship with their clients, or may practice guided meditations before and during labor. Others specialize in working with people who have had prior birth trauma, emotional trauma, or sexual trauma, for which they typically have additional training.

Informative Support
Informational support involves providing clients with scientific information and education about interventions and options before birth and during labor. Some doulas are members of organizations or have specialized training that helps them provide the latest and most relevant research, such as Evidence Based Birth, Up to Date, and VBAC Facts. Many people assume that all doulas provide research information, but not all doulas.

Positional Techniques
Positioning techniques are not a widely adopted aspect of labor doula work, but that is changing, and it is one that many birthers already expect their doulas to be proficient in. Parents may have heard of back labor or situations where the baby is in a posterior position, which can affect her labor. Positioning techniques are used to help resolve positions that can lead to slow and difficult deliveries. Doulas who offer positional techniques train clients prenatally in optimal fetal positioning exercises. They may employ certain techniques during childbirth to help prevent or resolve "bad positions" and may use a Rebozo to lift and sieve the birthing person's belly.

Advocacy
Advocacy in the context of doula work means working to preserve the human rights of the person giving birth, this is in contrast to birth activism, which addressed issues that will affect many people who give birth. Advocacy in doula work is a broad spectrum:

  • Some doulas do not advocate at all for clients before, during, or after childbirth.

  • Some doulas can help educate parents to advocate for themselves or train the couple to do so.

  • Some doulas may advocate for parents and help them negotiate with providers before birth, but will not do so during labor.

  • Some doulas may remind a care provider of the birthing person's birth plan options, or will let the birthing person know if, for example, the provider is willing to perform an episiotomy without consent, but does not talk to the provider about the care of their clients.

  • Some doulas speak directly with the care provider inside or outside the delivery room to discuss the birthing person's options, the procedures offered, and the evidence of those procedures.

  • Some doulas may provide investigative evidence to care providers on behalf of their client.

  • Some doulas offer one type of advocacy exclusively, and others customize the type of advocacy they will provide to each client, based on what the client wants. Many parents feel strongly that they want their doula to speak for them, while others do not.

  • The doula should always inform the parents that the primary decision maker before, during, and after the birth is the person giving birth. For parents hiring a doula, be sure to ask specific, example-based questions to find out what kind of advocacy a potential doula is trained, experienced, or comfortable with.

For parents, it is important to first identify what is important to you in a doula. Then ask specific questions about whether your potential doula offers those services.