Commonly Asked Questions about Doulas
Are doulas the same as midwives?
No. Midwives, like obstetricians and family physicians who practice obstetrics, are responsible for the physical well-being of mother and baby. Midwives are medical care providers. Doulas, in contrast, have no medical responsibilities. The doula scope of practice includes providing physical (i.e., comfort), emotional and informational support to the laboring woman and her partner. Doulas do not take vital signs, do cervical checks, or provide medical advice. For more information, see DONA-certified doula's scope of practice and code of ethics.
What is the difference between a birth doula & a postpartum doula?
According to the DONA website, a birth doula:
What factors should I consider when hiring a doula?
Every individual has different needs. However, we suggest considering the following factors when deciding which doula to hire for your birth team. (NOTE: These are not listed in any particular order.)
1. Personality fit. You will share one of the most intimate experiences of your life with your doula, so she should be someone whose personality "meshes" well with yours. You should feel comfortable with her and confident in her abilities. Take the time to get to know her over coffee or lunch before determining whether you will hire her. Imagine her at your birth. There are many doulas in our community; thus, many different personalities. With the right research, you will surely find one with whom you fit well!
2. Experience. Ask your doula about her training and prior experience with birth. The number of births she has attended as a doula is one type of experience, but it is not the only birth-related experience that is important. Some doulas are childbirth educators, postpartum doulas, or breastfeeding educators; some have given birth to their own children; some have academic or prior work experience that serves them well in the labor & delivery room. When you interview potential doulas, be sure to ask about the experiences they believe make them a good doula.
3. Availability. You might interview a doula you think would be a perfect fit for you; however she will be out of town the week before your due date. You have a few options in a situation like this: hire the woman as your primary doula, and a back-up doula you feel equally comfortable with; hire two doulas to "share" call with each other; or opt not to hire that doula and select someone who is available for your entire on-call period.
4. Cost. While we do not think that cost should be the primary factor you consider, we understand that it is an issue for some families. Know that doulas working toward certification often offer their services at reduced rates, and even experienced doulas offer flexible payment plans, barter, etc. Do not hesitate to talk to a doula you are interested in about her fee structure. (See more on doula fees below.)
Why do the fees doulas charge vary so much?
Many doulas who are working toward certification offer services at a reduced rate. With experience, fees typically rise to meet the competitive rate for the particular geographic location. On the Palouse, doula fees range from $0-$650. In contrast, in the Seattle area, doulas often earn $1000+ per birth. The Uma Center has a scholarship fund designed to help low-income families hire doulas.
Also consider that having a doula at your birth lowers intervention rates of all kinds, including epidurals and c-sections. Many couples feel they actually save money by hiring a doula. As doulas, we recognize the importance of your birth experience. Most people say meeting their baby for the first time is the most memorable moment of their lives. As a culture, why do we spend thousands of dollars on our weddings and question if we should spend an extra $600 on our birth experience?
I'm planning to have an epidural. Why should I hire a doula?
Many women decide to hire a doula because they know that continuous support during labor reduces epidural rates, among other benefits. However, regardless of how you choose to labor and birth (induced/not induced, with or without medication, vaginal or caesarean birth), your doula's role remains the same: to help you have the most positive and empowering birth experience possible.
Women who labor with an epidural benefit greatly from a doula's knowledge of how to keep labor progressing when the mother's movement is limited. She will recommend labor and pushing positions that are safe for women with an epidural, and she, along with other members of the birth team, will help support you in different positions.
Most care providers also recommend that labor be well-established before getting an epidural. A doula will help you relax and remain as comfortable as possible during that time before you get an epidural. It is also important to remember that epidurals do not always work. If you plan to labor with an epidural and it does not provide the expected pain relief, having a doula to help you cope will be important.
Labor is inherently unpredictable, and birth plans often change during labor. If you are faced with unanticipated decisions about medical interventions, your doula will help you readjust your birth plan to accommodate any new situation that arises.
Why are some doulas certified & others are not?
There are no state licensing requirements for doulas, however several professional organizations certify doulas in this country. DONA International is the oldest and largest of these organizations, offering approved trainings, professional development opportunities, and an annual conference. Doulas wishing to certify must complete an in-person training; observe childbirth and breastfeeding classes; complete a lactation education course and a required reading list; and attend at least 3 births in the role of doula and receive positive evaluations from physicians, nurses, and clients. DONA-certified doulas must also adhere to a clear scope of practice and code of ethics.
Certification, however, is voluntary. Some doulas choose to certify, while others opt out of certification, often for financial reasons or due to the limited scope of practice. When you interview doulas, ask whether they are certified or working toward certification, and if they aren't certified, what their reasons are. Find certified doulas in our community here.
What am I paying for when I hire a doula?
Some couples feel that hiring a doula is a "luxury" they cannot afford. Others question why some doulas charge fees up to $650 in our community when, in their view, their clients might only be in labor 5-10 hours. So, what are you paying for when you hire a birth doula?
1. Her expertise. Doulas, particularly those who are certified, can demonstrate that they have a solid understanding of the physiology of childbirth, emotional and psychological aspects of pregnancy and birth, common medical interventions and the evidence either supporting or refuting them, non-pharmaceutical strategies for coping with labor pain, and the normal process of breastfeeding. Moreover, doulas have hands-on experience working with women and their partners during labor. The typical person has only experienced the birth of his or her own children, if any at all. Doulas have the benefit of having participated in a variety of birth experiences.
2. Time spent with you. Most doulas spend anywhere from 4 to 10 hours with clients prenatally. The average length of labor for a first-time mother is 24 hours. Postpartum visits add another 2-4 hours of face-to-face time. Factor in phone, email and text message support and travel time, and most doulas charging a competitive fee earn an hourly rate of less than $20/hour.
3. On-call time. Being on-call for clients means that unless other arrangements have been made, your doula will stay close to home so that she can reach you within 90 minutes after you call her in labor. Being on-call means that your doula has a charged cell phone on and with her 24 hours a day, 7 days a week, no matter what she's doing. It means that she is ready to leave wherever she is if you go into labor – that she's planned ahead to be sure her own children (if she has any) are taken care of, and that she's well-fed and well-rested. Being on-call means that she says ‘no’ to spontaneous opportunities to travel for pleasure or for work. A doula's life is planned around her clients for one month around each one’s due date. Personal sacrifice is a big part of our job as doulas.
4. A portion of her business expenses. These include (but certainly aren't limited to): advertising, cell phone service, office supplies, photocopying, mileage & automobile wear-and-tear, professional membership fees, self-employment taxes, labor support tools, food while away from home, books and videos, and continuing education.
As my doula trainer so eloquently says on her website, "Nobody's getting rich off of doing doula work." (S. Muza, www.sharonmuza.com). Doulas provide their services out of a true love of women and childbirth, and a commitment to serving them. Doulas should earn a respectable wage, don't you think?
Will a doula replace my partner?
Some husbands fear that a doula will take his place as the primary support person at the birth. Doulas do just the opposite! An experienced doula will help your partner be your best supporter. Fathers and doulas make a great team. Doulas have knowledge and experience of the birth process, comfort measures, and medical procedures; and fathers have unbounded love for mothers and their babies, the desire to be an important part of the birth process, and the physical strength to carry out many important comfort measures. During prenatal visits, your doula will discuss with you how your partner wishes to be involved in the birth process, and she will do all she can to support that.
How do local doctors & nurses feel about having a doula on your birth team?
Local, experienced doulas have taken great care to establish a positive and professional relationship with doctors in Moscow, Pullman, and Lewiston. One major factor in this is their adherence to DONA's scope of practice and code of ethics. Most care providers in our area have had positive experiences with doulas and will feel reassured that you are in good hands. If your doula is not certified by a professional organization, ask her about her prior experience working with members of the medical care profession locally.