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01

Doulas: Before, During, and After Birth

Author // Jan S. Mallak, Certified Doula

A doula is a woman experienced in childbirth who is specially trained to provide various kinds of support for the mother before, during, and/or after the birth. The term comes from ancient Greece, where a female servant called “the doula” attended the expectant lady of the household.

A movement to bring back this age-old tradition began in 1992 when Doulas of North America was founded. Since then, several other organizations have emerged or expanded to offer doula training and certification: International Childbirth Education Association (ICEA), Childbirth and Postpartum Professional Association (CAPPA), and Association of Labor Assistants and Childbirth educators (ALACE). All can be found on the internet and offer a wealth of information regarding what a doula is, how to locate one, what costs are involved, and how to find the right “fit.”


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There are three types of doulas: antepartum (before), birth (during) and postpartum (after). The antepartum doula is the newest kind of doula who can assist the high-risk mother while still pregnant, for example. The woman may be restricted to bed rest for medical reasons and therefore unable to care for herself or others. The antepartum doula can provide mother/child care, do light housekeeping, run short errands and prepare nutritious meals. She educates the mother about pregnancy, birth, or postpartum and provides her with local resources and referrals. Doulas often have a list of complimentary care providers for women to consider during pregnancy and beyond such as massage, chiropractic care, yoga, exercise, acupuncture, etc. She can recommend a variety of area childbirth classes including private lessons if a mom is on bed rest. The doula can also lend an ear to help the mother deal with the additional fears associated with a highrisk pregnancy and possible outcomes. And she helps keep the family on track so their lives can flow more smoothly even if mom is “out of commission.”

Sometimes an antepartum doula is called in to help an expectant mother shop or set up for the baby. Maybe the mom simply has no family in the area and needs assistance with some of the basics associated with preparing for a new baby. Having an experienced woman’s guidance and companionship can be very instructive and reassuring for the mother-to-be.

A postpartum doula does much the same as the antepartum doula, but after the baby comes. Her roles are similar but helping the family transition into their new life with the baby is now the focus. Education often takes the form of “on the job training” since the baby has specific, immediate needs that have to be met. Bathing, dressing, changing, swaddling, feeding, burping and entertaining the baby are some of those immediate needs. And, not everyone feels very accomplished in those areas. The doula steps in to educate, guide, and facilitate the family’s comfort and confidence with their new roles.

Breastfeeding is on the rise, so assistance with nursing is another function of the postpartum doula. Many women lack breastfeeding role models or reliable resources; having an experienced and knowledgeable guide is a valuable benefit for them. Helping the baby latch on well from the beginning seems to really contribute towards early breastfeeding confidence and success. Follow-up and suggestions on almost a daily basis from a doula help the mother maintain her self-belief.

Postpartum depression is also on the rise so having someone around who knows how to prevent, recognize, or deal with postpartum mood disorders can literally save lives. Sometimes a woman’s birth experience can influence her mental state. A debriefing afterwards can be very therapeutic. Doulas are trained to be good listeners, assess a woman’s well being and refer if warranted. No medical care, advice, or interpretations is ever provided by any type of doula. Doulas identify red flags and provide expert resources and referrals, which are integral to their duties. Sometimes the father experiences a postpartum depression of sorts due to little sleep, improper nutrition, new roles and responsibilities, worry, etc. The doula is there to help the whole family with all the new adjustments and challenges and can address these issues as well.

A birth doula is quite different from the other two types of doulas. She specifically helps a woman prepare for the birth, deal with it, and recover from it. She provides five types of support: physical (like a personal handmaiden), emotional (like a trusted friend), informational (like a walking textbook), mediatorial (like a nurturing protector), and spiritual (having a special woman-to-woman connection). Because every woman’s response to labor is different, the doula must be able to meet her clients’ particular needs. Meeting before the birth, working on a birth vision jointly (like a birth plan), going to an appointment together, attending the birth, helping with bonding and nursing and visiting afterwards creates a trust relationship that develops over time. When the mother develops this comfort with the doula and confidence in the birthing process she tends to have a safe, satisfying, and successful birth. The “wrap-around care” that a doula offers is not provided by any other member of her birth team—it is a truly a unique and special relationship.

Research since 1980 shows that there are many benefits to having doulas: shorter labors, less interventions used, fewer cesarean deliveries, more satisfying birth experiences, more successful breastfeeding, and decreased postpartum depression to name a few. Even though a doula can dramatically reduce the cost associated with births, insurance companies do not routinely cover their fee. Some couples participate in a tax-free employee benefit plan at work which reimburses for medical expenses not usually covered by traditional health insurance. Doula fees are sometimes paid in that case. It’s worth contacting an insurance company or employer to investigate this possibility.

Some worry that the doula might take away from the partner’s role at the birth. In fact, research shows the opposite: dads are more involved because the doula guides, suggests, and models roles for them to follow. She helps them find their comfort level and watches over their well-being, too. After all, he needs to be the rock for the family when everyone disappears after the birth. It is critical for the doula to safeguard dad’s stamina and ability to function as a new parent. She also gives him the opportunity to take a break or eat a hot meal or go for a brisk walk, guilt free. This removes the total responsibility of the mom’s labor support off his shoulders. And he gets to be in the first family photos instead of taking them…that’s a real bonus! Lastly, a doula is fond of her client but does not love her so she doesn’t get swept away emotionally like a family member might. This caring detachment is a real plus when facts need to be gathered or difficult decisions need to be made.

Others wonder why a doula is needed if staff is there. Medical staff work in shifts and go on breaks, so caregivers change often. They also have more than one patient so they go room to room. Also, the staff does not know the parents like a doula does. Some births take place at the client’s home so there is no staff on duty at all.

Some question why a doula would be necessary if using a midwife. Even though their roles overlap, the midwife is still in charge of the medical care whereas the doula’s job is strictly one of “social” support. Midwives need breaks too, for sleep or to eat to be medically ready. But a doula can perform her duties half asleep and hungry and still be effective! Since doulas and midwives tend to have similar birth philosophies, working in alliance for the client’s benefit is especially advantageous.

Giving birth is a rite of passage for a woman so pregnancy, delivery, and postpartum should be a special time for the mother. By hiring a doula to assist during this unique phase in a woman’s life, she can truly feel well-educated, supported and assisted. This combination leads to feeling empowered and confident. After all, generations of women have been helping other women to prepare for and to deal with being a new mother. Why shouldn’t modern women consider taking advantage of a tried and true system that has worked for thousands of years?



Pathways Issue 19 CoverThis article appeared in Pathways to Family Wellness magazine, Issue #19.

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