Preparing to give birth can present a mind-boggling number 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 work with 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. But these birth professionals provide vital services to families before, during, and after a baby’s birth.
What Is a Doula?
A doula is a trained professional who provides both emotional and practical support during pregnancy, labor, and birth. Many doulas offer services during 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?
Many doulas are trained as nurses, midwives, or childcare professionals. However, there’s no specific medical training is required to become one.
With or without a medical background, though, doulas are birth professionals. They are trained to support birthing parents and their partners. Doulas provide 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.”
The Need for 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. This could be difficult previous birth, poor interactions with medical professionals, loss of a loved one, or traumatic life events like sexual assault.
“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.”
When Sencer 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. For others, she would help them feel safe if a hospital environment was a scary or emotional place.
However, many patients who don’t have a medical provider offering that level of one-on-one attention. When that happens, a doula can fill that supportive and protective role.
Interested in working with a doula? Find local doulas and night nurses in Charlottesville and Central Virginia. Plus, find prenatal support classes for Charlottesville parents.
Pregnancy and Birth Support with Doulas
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. 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.
A doula will often be present with the mother for the entire labor and delivery process. They are with the mother from home to hospital or birth center. The medical team focuses on the safe delivery of the baby. But 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. This can mean a variety of things, such as making sure her client stays hydrated and comfortable. Or it can include literal support, such as helping the client move through different birthing positions.
Importantly, doulas are used to working in medical settings and collaborating with doctors and nurses. This means they can also often serve as intermediaries between the parents and the medical team.
The Role of Postpartum Doulas
Many doulas also offer postpartum services. Others are exclusively postpartum doulas. They will visit new parents in their homes to check on the mother and baby. Postpartum doulas can offer:
- Advice and resources for recovery
- Tips and strategies for baby care
- Breastfeeding support
- Childcare while parents sleep
- Light housekeeping, 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.
What Is A Community Doula?
Another type of doula is known as a community doula. These professionals are doulas who come from the same racial or cultural community as the patients they serve.
Community doulas 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. Community doulas may also support mothers from communities that have traditionally been underserved by the medical community, such as Black, indigenous, low-income, or LBGTQ populations.
Even when the language or background is not a barrier, a doula can help:
- Explain medical terminology that parents don’t understand
- Enforce boundaries around birth interventions
- 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.”
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. She became a 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. This photo essay explores 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 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 explores the intersections of Black womanhood, memory and healing. It has been featured in the Library of Congress, Virginia Quarterly Review, and Zeke Magazine. Mayo’s accolades include the prestigious Julia Margaret Cameron Award for “Women Seeing Women” and international recognition in fine art circles.
What Are the Benefits of Hiring A Doula?
The benefits of working with a doula are only just being studied more widely by the medical community. However, the results already show the incredible value they 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
- Reduced disparities in health outcomes between economic and racial groups.
Another study, published in The Lancet in 2022, found even more specific benefits. Women who received doula care during birth were 52.9% less likely to have a cesarean delivery. They were also 57.5% less likely to experience postpartum depression or postpartum anxiety.
The United States has the highest rates of maternal mortality in the developed world, especially for women of color and those living in poverty. This means that 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.
How Much Does It Cost to Hire a Doula?
“Not all families can afford a doula, and the cost is rarely covered by insurance,” says Cox.
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. More than 40 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.
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. Additionally, Medicaid provides payments to incentivize postpartum visits.
Many doulas also offer free or reduced cost care for low-income patients or mothers from marginalized communities. Or, they may offer their fees on a sliding scale based on patients’ income.
Ultimately, 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.”
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
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KATHARINE PALJUG is a freelance writer and novelist who lives in Charlottesville with two busy kids. She is a big fan of public libraries, homemade muffins, and inclusive spaces for queer families.