what is a doula?
The idea of a doula is both old and new. Doula is an old Greek word, but its use to describe birth and postpartum assistants originated in America in the 1970s. Families have started to hire doulas to support the birthing person only in the last few decades; but at the same time, women have been supporting other women through birth and early parenthood for all of human history.
what does a birth doula do?
In our modern context, we now usually give birth under the care of doctors or midwives. These medical providers are there to guard the health of parent and baby. A doula is not a medical provider, and she is not really there for parent and baby: she is there for the pregnant person. It may seem like a small distinction, but in reality it is an incredibly important difference.
During a birth, doctors, midwives, and nurses go about their jobs, sometimes caring for other patients, and always attending to different aspects of the labor's progress and its physiological effects on parent and baby. Family may be present as well, offering encouragement and support, but also experiencing their own powerful emotions—amazement, worry, exhaustion, joy, anticipation, fear, exhilaration—as they watch their loved one labor and birth. A doula is the only person in the room who is there just for the pregnant person.
The doula is knowledgeable about pregnancy, labor, and birth, and is skilled in emotional support and pain management techniques. The doula also is an excellent communicator, and can help the pregnant person and their family navigate their birth experience as it unfolds, sometimes slowly, sometimes quickly. Birth is unpredictable; the doula is there to help the birthing person identify their choices in each moment and support them in making and trusting in those choices.
Unfortunately, in Greek, doula means a female servant. But when she teaches new doulas, Thérèse Hak-Kuhn, Director of toLabor, tells a story that I love. She has had several clients and students from Ethiopia. They explained to her that in Amharic, there is a word, dula, which means "walking stick." That, Thérèse says, is how she prefers to think about our work; and I agree. As a doula I am your walking stick: you have to make the journey with your own strength, but I can go along with you, adding my strength to yours and holding you up when you need to rest.
what does a postpartum doula do?
In an article that I love, one mother reflects that she misses "how intensely people cared for me when I was in labor. I'm a mom and a therapist, after all. The majority of my life is spent taking care of other people. Even though I am happy to be independent and strong, it was so nice to have people taking care of me." After giving birth, a family goes home to find their new normal. Friends and family will come by to visit and bring food; but eventually, that tapers off.
In the meantime, parents are learning how to be parents to a new baby: how to feed baby, how to get baby to sleep, how to hold and clean and interact with baby. And baby, of course, is figuring out how to be a person: how to sleep, eat, see, feel, smell, learn, move, and more. While all this is happening, parents still have to figure out how to feed and clothe and bathe and rest themselves, often while returning to a daily routine and a work schedule, often while caring for older children, and always while rediscovering their relationship to one another and to the rest of their lives.
Sometimes all of this goes very smoothly. Different parts of it can be challenging. A doula is knowledgeable about all of it, and sensitive to the needs of the particular family. She can provide information about and assistance with feeding, and if needed, can offer referrals to a lactation specialist. A doula can educate families about infant sleep patterns and safe practices, and offer strategies when baby is really wearing them down. A doula can hold baby while mom takes a shower, or do a little laundry when it's been a particularly bad night. She can do a little cooking and help strategize a meal plan. A doula can give suggestions and offer resources if older children are having difficulty adjusting. She can educate family members on the signs of perinatal mood disorders, and give appropriate referrals if they crop up. A doula can be a nonjudgmental ear for parents when they are struggling. A doula is there to help the transition from birth to new life go as smoothly as possible.
what are the benefits of having a doula?
Numerous studies show the benefits of the kind of care a doula provides, including improved health outcomes for parents and babies, shorter labors, increased satisfaction with birth experiences, and lower rates of medical interventions such as cesarean section and episiotomy. In the postpartum period, doulas have been shown to lessen likelihood of mood disorders in new parents and to improve nursing outcomes. I share articles about this from time to time on my facebook page.
why do you say "pregnant person," "birthing person" and "parent" in your writing?
Very simply, I want to make sure that everyone who is pregnant and everyone who gives birth and everyone who nurses and parents a child to feel safe and supported. And when you are talking to a broad audience (like on the internet) or to someone you don't know well yet, you don't know what might make them question whether you can give them the care they need. For instance, common language like "mom and dad" can feel exclusive to families in which there are two moms, for instance, or in which there are no moms.
Even "mom" can feel unwelcoming to a pregnant person who does not think of themselves as a "mom." Most people that become pregnant are women, but not everyone that gives birth is a woman. At the core of my commitment to birth work is trusting pregnant people, and that includes trusting them to know who they are.
Doula work is about birth, yes. But for me, the fact that birth happens is secondary to the fact that there is a person in front of me who has asked me to listen to and care for them. I can't do that if I have pre-established expectations, assumptions, or judgments about them. This quotation from midwife Cora Beitel says it all for me.
As humans we are categorizing all the time—we are looking for people that we understand because we’ve seen someone else like them. But it’s really helpful to crack open those assumptions and ask, who are you? Is there anything I need to know about you that would allow me to be a better care provider to you? When you ask those questions, you get really good answers. And as midwives, we value taking time with people.