Doula Questions and Answers

Question: Why do I need a doula if my partner will be there?

Question: I understood that doulas only support natural birth, what if I want an epidural?

Question: What is the difference between a doula and a midwife?

Question: I will have my mother/sister/friend at my birth, why would I need a doula?

Question: Why do I need a doula if I give birth in a hospital with nurses and doctors?

Question: How much does a doula cost?

Question: Why do I need a doula if my partner will be there?

Answer: A doula is not there to take the place of your partner, but rather to facilitate his support for you during labour. A doula is a professional trained to support a mother and her partner as a team. She is there to help him support her with what he has learned during prenatal classes or provide guidance if he has not been able to attend classes at all. This takes the pressure off of him and allows him to experience becoming a father knowing the mother is well supported by their doula and him together. Partners also differ in the amount of support they can provide, with some wanting to support fully and not knowing how best to do that and others who would prefer not to have the responsibility of being sole support. A doula provides the partner with guidance in comfort techniques and information on supporting her emotionally as well as about the clinical aspects of labour. A Doula does not replace a partner but rather enhances their support.

Question: I understood that doulas only support natural birth, what if I want an epidural?

Answer: A doula's role is to support a mother in the choices she has made and will make during labour and birth. She will help the mother find the benefits, risks and alternatives in making informed choices. Most doulas know that natural childbirth is the healthiest choice for mother and baby and that almost all women can achieve a natural birth experience if she so chooses. Doulas will also respect a mothers decision to accept medical intervention prior to or during childbirth as it is important for a mother to have a positive birth experience. Be sure to ask a doula her philosophy by asking questions when you interview her. Click here for a list of interview questions.

Question: What is the difference between a doula and a midwife?

Answer: Their care is actually complimentary. In a nutshell, a midwife is primary caregiver trained to provide all encompassing care for you and your baby during pregnancy and birth and the recovery period following birth of about 6 weeks to 2 months. Their role would parallel a medical doctor but with more training, knowledge and expertise in normal birth. An obstetrician is then one step above in that they specialize in high risk pregnancies, but may not necessarily have the same knowledge a midwife has of normal birth.
 
A doula on the other hand is a trained professional who provides physical, emotional and informational support during pregnancy birth and the immediate postpartum. A doula does not provide clinical support i.e. mother and fetal health checks like blood pressure, fetal heart rate and vaginal exams. This non-clinical support of women in labour has been shown through studies to have:
50% reduction in the cesarean rate
25% shorter labor
60% reduction in epidural requests
40% reduction in oxytocin use
30% reduction in analgesia use
40% reduction in forceps delivery

I would encourage you to have both. A midwife is often able to support similarly to a doula during labour. However if there is any complications and especially during the actual birth, your midwife is often not able to provide both the emotional and physical support while she is also getting ready for and delivering your baby. This is where a doula can really be of benefit to you, and the shared care of the additional support will provide you with a wonderful team to help you and your partner through this amazing experience.

Question: I will have my mother/sister/friend at my birth, why would I need a doula?

Answer: A mother can have anyone she wishes at her birth who will make her birth a more positive experience and who can be her advocate. This most commonly is her partner, but her mother, sister, another relative or a friend can be a wonderful addition to her birth team. Having a doula, who is a trained professional, is that she not only has the knowledge and skills to support you and your team effectively, she is not emotionally attached to you and can be more objective. She knows your wishes are what is important. She is also paid to be on call for you, will be there on very short notice for you without other obligations and will not limit her time with you if your labour is longer than expected.

Question: How much does a doula cost?

Answer: The average experienced, certified doula charges between $200 and $600 depending on your location and your doulas experience. Many doulas use a sliding scale based on your income. Also, for low income parents, there are many doulas who are working towards certification who either do not charge for their certifying births or ask only for their expenses to be covered.

Question: Why do I need a doula if I give birth in a hospital with nurses and doctors?

Answer: During labour you will likely not see your doctor unless there are complications. The doctor on call is in contact with your nurse during labour and usually arrive shortly before your baby is ready to be born. Nurses are invaluable during birth, providing the care and expertise they have been trained for. But in today’s hospitals nurses are very busy as they are doing more work in less hours than ever before. It is not uncommon for one nurse to be in charge of three or more mothers in various stages of labour, making their availability very limited. Getting to know your nurse takes a bit of time and during labour this can be quite difficult, especially if you are assigned to one who doesn’t agree with your birth plans. This coupled with shift changes, which can occur at the most inconvenient times for you and your partner can make an otherwise great birth marred by attitudes and disruptions. It is also well documented that disruptions, whether that be the arrival at the hospital, changes in shifts or attendance of your birth by another caregiver can slow and even stop labour. With only 6.1 %* of the nurses time devoted to supportive care, it soon becomes apparent that additional support is very beneficial. And that is the doula’s role, to provide that supportive care. Doulas are trained to provide the vital supportive care you need throughout your labor and in dealing with the disruptions common in hospitals, providing the continuity so vital in keeping your labour progressing.

Your Doula’s only responsibility is to you and she will remain with you at all times during your labour and birth. Your Doula will have met you and your partner several times before the birth, unlike the nurses at the hospital who will usually be meeting you for the first time. You will have chosen your Doula based on her personality and how well she matches your philosophy. Your Doula will work with your caregivers to strive for the best possible labour and birth experience.

*According to a study on nursing support during labour published in BIRTH Volume 23, Number 1, March 1996 the nurses’ time was divided like this:

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27.2% Off unit (breaks, meals, meetings)

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47.6% Not in room (charting, other patients, housekeeping, etc)

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3.8% Postpartum (dealing w/ postpartum women & babies)

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4.7% Indirect in room (charting, talking to partner, assisting w/procedures, etc)

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10.6% Direct in room (Dealing with IV, vital signs, inserting catheter, etc)

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6.1% Supportive care (direct non-medical care)

Of the 6.1% supportive care;

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50.5% Instruction & Information (coaching breathing, relaxation ideas, giving ice chips etc)

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5.8% Advocacy (listening to woman's requests, negotiate with other team members, etc)

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26.7% Physical (cold cloths, bathing or shower assistance, changing linen, massage, etc)

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17% Emotional ( reassurance, encouragement, keeping company etc)

 

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