Preparing to give birth can sometimes present you with a mind-boggling amount of choices. Obstetrician or midwife? Home birth, birthing center, or hospital? Breastfeeding or formula? Do you need to sign up for birth classes? How many? Does your partner need to come? As you work through your decisions, you may find yourself asked one that never occurred to you: Are you going to have a doula? If you’re like the majority of people in the United States, you might never have heard the word “doula” before becoming pregnant. So, what is a doula, and what exactly do they do?
What Is a Doula?
A doula is a trained professional who provides both emotional and practical support during pregnancy, labor, birth and often the postpartum period as well.
*The main role of a doula is to support the decisions of the pregnant woman, throughout pregnancy as well as through labor and delivery,” says Kelly Cox, a Charlottesville doula and founder of Share the Drop, a web app connecting mothers with excess breastmilk with mothers who need it. “Doulas serve as a resource for parents-to-be and offer both emotional and physical support during labor,” says Cox.
What Training Does A Doula Have?
A doula often doesn’t have specific medical training, such as being a nurse or a nurse-midwife. While some nurses and nurse midwives may also be doulas, no specific medical training is required to become one. With or without medical training, doulas are birth professionals. They are trained to support birthing parents and their partners, providing the care, advocacy, and information that will help you feel safe and strong during your birth. *There are birth doulas, there are postpartum doulas, there are doulas that just talk on the phone,” says Claudia Sencer. Sencer, a recently retired Nurse Practitioner Certified Nurse Midwife, brought over 40 years of experience to her work. “In its best concept, [it is] a one-on-one relationship with somebody who can carry you through your experience of birth.”
Pregnancy, Birth & Postpartum Support
Most doulas will start working with clients during pregnancy, offering support and guidance in the lead up to birth. Because doulas have seen many pregnancies and births, they can offer vital information and emotional support to help parents feel calm and prepared. *During pregnancy, I am available for my clients and their partners to help them research options and available resources,” says Cox. “I help them develop a birth plan that works for them, and I often have the pregnant woman doing prenatal yoga with me weekly so I can stay up to date with how she is doing.”
A doula generally becomes “on call’ in the weeks before a client’s due date. Once the client goes into labor, one of the biggest supports that a doula provides is that of presence. “[In] hospitals right now, there’s nobody who’s sitting with a patient,” says Sencer. “The nurses have three or four patients at a time…We need people who are nurturing to provide bedside care, and I think this is where doulas have stepped in.”
A doula will often be present with the mother for the entire labor and delivery process, moving with the mother from home to hospital or birth center. While the medical team focuses on the safe delivery of the baby, the doula’s role during delivery is to focus on the person giving birth. This can take a variety of forms.
“I am as hands on during labor as the client needs,” says Cox, noting that she provides a lot of physical support, making sure she stays hydrated and helping with changing positions on a regular basis.” Because doulas are used to working in medical settings and collaborating with doctors and nurses, they also often serve as intermediaries between the parents and the medical team.
What Is A Community Doula?
Community doulas, who come from the same racial or cultural community as the patients they serve, can act as figurative or literal translators between families and the medical team. They may facilitate communication between hospital staff and patients who speak no or little English; they may also support mothers from communities that have traditionally been underserved by the medical community, such as Black, indigenous or low-income populations.
Even when the language or background is not a barrier, doulas can help explain medical terminology that parents don’t understand; enforce boundaries around birth interventions; and advocate for parents if they feel overwhelmed or are unsure about communicating with medical professionals. “I am not as emotionally tied to the process as their partners, so I can focus on keeping the process moving along smoothly,” Cox explains. “Partners are allowed to just be a partner, and I try to stay out of the way so they can enjoy the experience together.” Some doulas also offer postpartum services. They will visit new parents in their homes to check on the mother and baby, offer advice and resources for postpartum recovery, and answer questions about baby care.
Some postpartum doulas may be certified to assist with breastfeeding struggles, and others might help out with housekeeping needs such as meal preparation or laundry. “Having a constant cheerleader in your corner can help with those early weeks of parenting when parents often feel like they are tackling the unknown,” explains Cox.
Birth Support & Advocacy
Birth can be a beautiful and empowering experience. But it can also be emotional, overwhelming and even scary. For some, this fear comes because of the unknowns of a first-time pregnancy. For others, it might come from other life events: a difficult previous birth, poor interactions with medical professionals, loss of a loved one, sexual assault or other kinds of traumatic life events.
“I think the biggest gap that I saw in care for pregnant women is understanding the impact of prior life experiences on birth,” Sencer says. “If you’ve had significant trauma in your life, on a physical, emotional or social plane, that hasn’t been resolved and worked through, it has a tendency to show up in labor.”
Sencer notes that when she was practicing as a midwife, she would often work with patients to understand and resolve the fears that could get in the way of labor, or to help them feel safe if a hospital environment was a scary or emotional place. For patients who don’t have a medical provider offering that level of one-on-one attention, a doula can fill that supportive and protective role.
Bearing Witness, A Photography Exhibit
When Benita Mayo learned about the maternal healthcare crisis for Black women in the U.S., she decided to do something about it. Mayo, who had been splitting her time between her day job in insurance and her passion for landscape photography, took on a third title: community doula with Birth Sisters of Charlottesville. Birth Sisters is a women of color community based doula collective
When her first client volunteered to open her home, Mayo brought her camera to the woman’s labor and delivery. The images she captured that day became the foundation of Bearing Witness, a photo essay about the challenges Black women face while giving birth and the difference that doula care can make.
Mayo hopes to expand the series by traveling south, all the way to the Mississippi Delta, to share more women’s stories. “I want people to know that this issue exists,” says Mayo. “And I want them to know that it’s not all doom and gloom, that there is a solution to this crisis. I want them to know what a community doula is.”
Of sharing her photographs, she adds, “It’s been a wonderful, joyous ride. And I’m honored to be part of the conversation.”
About Photographer Benita Mayo: Benita Mayo is an award-winning visual artist based in Charlottesville, Virginia, and a resident artist at the McGuffey Art Center. Her evocative work—featured in the Library of Congress, Virginia Quarterly Review and Zeke Magazine—explores the intersections of Black womanhood, memory and healing, earning her the prestigious Julia Margaret Cameron Award for “Women Seeing Women” and international recognition in fine art circles.
Benefits of Hiring A Doula
The benefits of working with a doula are only just being studied more widely by the medical community, but the results already indicate the incredible value they can provide to both families and the medical community. In 2016, The Journal of Perinatal Education noted that births attended by a doula resulted in:
- Higher maternal engagement with hospital care,
- Increased satisfaction with birth care,
- Higher Apgar scores for infants,
- Shorter labor,
- Increased breastfeeding success,
- Lower likelihood of postpartum depression,
- And reduced disparities in health outcomes between economic and racial groups.
- Another study, published in The Lancet in 2022, found even more specific benefits finding that women who received doula care during birth were 52.9% less likely to have a cesarean delivery and 57.5% less likely to experience postpartum depression or postpartum anxiety.
At a time when the United States has the highest rates of maternal mortality in the developed world, especially for women of color and those living in poverty, doulas can, literally, save lives. Unfortunately, though doulas can provide vital emotional and practical support to new parents and babies, cost is one of the biggest barriers that prevents families from using their services.
Costs of Hiring A Doula
“Not all families can afford a doula, and the cost is rarely covered by insurance,” says Cox, noting that the typical cost for a doula is often between $1500 and $2500 per pregnancy; this can prevent doulas from being able to work with the patients who most need their services.
“Doulas are trained and highly skilled, often spend a lot of time on call, and clearly are worth the cost,” Cox adds. “Yet it still remains an additional thing to budget for.”
Right now, doulas are present at fewer than 10% of births in the United States. But that number could grow as state programs begin to cover some of these costs for families. Around the country, 43 states and Washington, D.C., offer or are in the process of implementing Medicaid coverage for doula services. Some states have also introduced legislation to mandate coverage for doula care through private insurance.
Becoming A Doula in Virginia
In Virginia, state-certified community doulas can become qualified as providers through Virginia’s Medicaid program. Once doulas have been certified in the program, Virginia’s Medicaid services reimburse $859 for up to 8 prenatal/postpartum visits and labor support, as well as providing additional payments to incentivize postpartum visits. Learn more about local health resources.
Many doulas themselves are also working to make care more affordable and accessible to patients of all backgrounds by offering free or reduced cost care for low-income patients or mothers from marginalized communities. Others may offer their fees on a sliding scale based on patients’ income.
Ultimately, as you prepare to give birth, whether or not you want to work with a doula is a personal decision. The most important thing to keep in mind, says Sencer, is remembering that every birth is a unique experience and process.
“There’s no right way to birth,” she says. “It’s what works for the individual woman. It’s having a sense of agency in your own care.”
Looking for support in the toddler years? Read on for more great resources from CharlottesvilleFamily including mini day camps for little ones, Mommy & Me Classes, early learning tips, local health professionals, helping young children to understand the word “No” and more!
Resources To Guide You Through Pregnancy & Beyond:
Charlottesville’s Favorite Pediatricians
Preparing For Birth
Sleep Training Guide
Teething Tips
Your Guide to Different Pregancy Care Providers
A Pediatrician’s Guide to Baby Proofing
Water Safety for Babies & Toddlers
Charlottesville Prenatal Support Classes
Charlottesville Doulas & Night Nurses
Mommy & Me Classes
Diaper Bag Checklist
KATHARINE PALJUG is a freelance writer and novelist. She lives in Charlottesville with two busy kids and more books than she has time to read. Find her on Instagram as @katharinewrites.