Choosing a Birth Doula?

Many families ask me the following questions about choosing a birth doula: Do we need one? How do we pick one? And who do you recommend?  I suppose as we are a postpartum doula group that doesn’t offer labor support, we are in the category of being fans without being biased towards our own offerings.

Here are some of my guidelines for answering the birth doula questions:

Do we need one?

The biggest question here is what you really want from your birth. Are you birthing at home, in a birth center, or in a hospital?

Homebirth and birth center midwives often have assistants or apprentices that can sometimes act as your doula and many of them do births in teams, so a labor doula isn’t always needed. However, some of them welcome doulas at the birth and appreciate the emotional support that doulas can provide as they care for more of the physical/clinical concerns around the birth. If you birth in the hospital, even though you often have one nurse assigned to one patient during labor, the role of a nurse and a doula are very different. Nurses used to provide many aspects of doula care, but now their time is buried between charting, running all the equipment used in a hospital birth, and carrying out the orders from the doctors or midwives. Certainly nurses can be a huge source of emotional support, but their work also runs in 12 hour shifts, and you are likely to get a few different nurses during your labor process—this usually is not a good continuum of care for the laboring mother.

Do you have women in your family that have experienced birth who can be present with you to meet your needs during labor? Sometimes mothers, sisters, and other female relatives or friends can be great doulas, trained or not. It is important that they know your desires for your birth and are operating on your agenda, not their past experiences or biases.

The main reason I see a lot of women hiring birth doulas is to avoid some of the interventions that make birth more difficult and often surgical. Yes, the Cesarean rate is still way too high by anthropological standards (over 30% in some hospitals in PDX) and having a doula at your birth reduces the chance of a cesarean by 50%. It also reduces many other often unnecessary interventions. Unless you have the doula role covered by other professionals (not your doctor or midwife, they rarely will sit with you throughout labor) or other family members/friends who you confidently feel can meet your needs in a calm way, I would recommend you look into getting a birth doula. I have had one birth with a doula, and one birth without a doula, and I will tell you it does make a big difference!

How do I pick one?

Here again, the question to you is: what do you want from your birth? Are you looking for a medication/intervention free birth? Do you have a Cesarean planned where your partner might be torn in different directions as you and the baby could be separated after surgery? Are you looking to delay an epidural for as long as possible? Are there concerns about your family members wanting to help but your gut tells you that they might not be the best person for the job?

All of these are great reasons to have a birth doula, but I would recommend different people based on the circumstances!

The beauty of the doula is that she should be there for you. Your needs/desires should be at the top of her list. If your doula has an agenda about “saving birth” or “changing the system,” you also need to feel strongly about this before going into labor as you don’t want to be caught in the middle of a conflict between your healthcare team and your doula. The best recommendation I have for choosing a doula is to talk to several on the phone, get a feel for their care, and then interview at least 3. You should follow your instincts when making decisions about who to have at your birth. You will likely be naked with this person, and make funny sounds and have this strange primal behavior—you need to feel VERY comfortable with whomever you chose. If you have a twinge of hesitation, move on. There are hundreds of birth doulas just in the Portland, Ore. area, and you are bound to find one that meets your needs perfectly.

Do you want a student doula (one with less experience but also charges little to nothing) or an experienced doula (where the fees can range from $300 to $800, depending on the package that your doula has to offer)?

Is this your first birth? I would probably recommend an experienced doula that can reassure you when you have questions (as there are MANY the first time around). If this is a subsequent birth, then it depends on your first experience and what you are looking for this time. The studies on doulas report that having a woman quietly staying with you throughout labor can reduce interventions and empower you in many ways, even when she doesn’t have a bag full of tricks that help you cope with labor and work together with your partner. I have met many women who want to be “good patients” who prefer to follow what the doctor decides about their birth. These women would benefit from a quiet doula that can help fill in the gaps of knowledge when the primary caregiver is busy doing other things.

Families who are looking for more of an advocate to their care will want a doula with a lot of experience, a strong knowledge base, and a good ability to read you in stressful situations.

And finally, whom do I recommend?

Yes, I do have a favorites list, but even within that list, there are variations based on the client’s needs. And there are so many wonderful doulas that aren’t listed as well. I would probably recommend looking at http://bsnnorthwest.org/ first for their list of caring doulas. There are many doulas listed there who have received rave reviews for the past several years and some new doulas who are getting involved with the community of birth supporters and can offer services for low or no cost.

You can also contact http://www.birthingway.edu and look for their list of trained and/or certified birth doulas, as they are a local midwifery college and have a long list of women looking to do births at low cost for experience. Many women check out http://www.dona.org, http://www.cappa.net, or http://www.icea.org to find their list of certified or trained doulas. This does insure that your doula has gone through the initial training requirements, but these are often overwhelming lists to work from with the numerous options.

Most women tell me that their birth doula was invaluable during their birth. I have heard a few stories reporting otherwise though, and I would want to caution you against compromising your goals.  Also make sure to budget for help after the baby arrives. Many women tell me that the help of a lactation consultant, postpartum doula, home-chef or a postpartum massage was as helpful, or even more helpful, as the services a birth doula provides.

I hope this has helped you figure out what would be best for you as you plan for your birth. As I am certainly a fan of birth doulas, I hope you find someone who is a perfect fit for you and that you have a great birth! Birth and early postpartum is a time that women remember for the rest of their lives, so it pays to have really wonderful people surrounding you to help you make the best memories!