Doulas: What They Do and Don’t Do
NEW YORK—Katja Schtock unexpectedly encountered an unusual and difficult birthing experience. Schtock didn’t go into labor until nearly 48 hours after her water ruptured. Fortunately, she had hired a doula to provide practical and emotional support every step of the way.
On March 16, 2015, Schtock finally delivered a healthy baby. But she thinks the birth experience and the outcome wouldn’t have been as good without her doula. She recalled how her doula gave moral support and affirmed her decision not to receive a vaginal exam too soon. Since it took so long for Schtock to go into labor, a vaginal exam could have caused an infection.
“When I was in the process of labor and couldn’t problem-solve, my doula was there to advocate for me and support me through decisions,” Schtock said of her doula, Emily Cohen-Moreira.
The extra support and advice from a doula allowed Schtock to be in control of her birthing experience, but Schtock is among a small number of women who take advantage of this service.
A doula is a nonmedical professional who is certified to give physical comfort and emotional support to a woman before, during, and after delivery. Doulas can provide essential information about birth and are on call 24 hours a day.
Although studies show doulas can greatly improve birth outcomes, not many women in the United States hire them.
According to the Second National U.S. Survey of Women’s Childbearing Experiences taken in 2006, only 3 percent of women said they used a doula during childbirth.
This is partly because there are some misconceptions about what doulas are and what kinds of services they provide.
How Doulas Impact Birth Outcomes
According to a 2013 study conducted by the University of Minnesota School of Public Health, the odds of a cesarean delivery were 40 percent lower for doula-supported births.
This is a particularly relevant finding since cesarean sections are currently alarmingly high in the United States.
The Center for Disease Control and Prevention estimates that 32 percent of U.S. babies are delivered by cesarean section. According to the World Health Organization (WHO), the ideal national rate for caesarean sections is 10 to 15 percent.
When medically justified, a caesarean section can prevent mother and infant mortality. However, there are no benefits to a caesarean delivery for women or infants who do not require the procedure. It can lead to infections and complicate future pregnancies.
A study in the Journal of Perinatal Education also found that mothers who hired doulas were four times less likely to give birth to a child with a low birth weight (LBW) and two times less likely to experience a birth complication involving themselves or their baby.
What Doulas Do
Doctors and nurses have many preoccupations in the delivery room. Amid the chaos of tracking charts and medications, doulas serve as an extra set of experienced eyes that solely focus on the mother.
Doulas can make deliveries smoother by suggesting different delivery positions.
“If a woman is comfortable, it can greatly help with delivery,” said Cohen-Moreira, a doula in the greater New York City area. “There are different positions they can try that doctors might not have time to think of.”
Cohen-Moreira recently advised one of her clients to try a position that shifted the pressure away from the cervix. The client was in labor, and this change in position helped her dilate more quickly.
If the baby is in a posture that makes birth difficult, Cohen-Moreira might advise the mother to get onto all fours in order to manipulate the baby’s position into a safer one for delivery.
For labor pains, a doula might suggest various coping methods such as a shower or a massage with lavender oil.
Doulas also help mothers think of questions and troubleshoot issues ahead of time that they might not necessarily think of themselves. For example, doulas can help them get the birthing facility to sign off on their preferences ahead of time—such as if a she wants to be allowed to eat a small meal in the event of a long labor.
There is a common misconception that doulas are synonymous with homebirth midwives. This is not true because doulas do not deliver babies or provide any other hands-on medical care.
Another misconception about doulas is that only the affluent can afford them.
It is true that doulas can be costly. Some insurance companies will reimburse for doula services, but most do not. However, some doulas are affordable. The price for doula services can range from $10,000 to free.
The Doula Project, a private organization based in New York City, provides support to women across all income levels. When they provide doula services for low-income women, they don’t charge these women a bill. Instead, they ask them to pay what they can.
Schtock’s doula, Cohen-Moreira, typically charges around $1,850 for two prenatal visits, the delivery, and lactation advice.
Fees can be tailored to the client’s needs. Second-time mothers may not need as much advice for postpartum care, so they usually get a less expensive package.
Another misconception about doulas is that they can prevent cesarean sections 100 percent of the time.
“There is a misconception a doula is some kind of a magic worker [and] we can make the outcomes different by sheer force,” said Vicki Bloom, a spokesperson for the Doula Project.
Doulas can certainly help improve many situations, but they cannot guarantee a perfect birth or prevent cesareans 100 percent of the time.
Schtock strongly feels that doulas are worth hiring. “From the nurturing … to the connection, to the moral support, to the information, she provided everything that I could have needed,” Schtock said.