What does a doula do?
The doula has three primary functions to her role as a labor assistant: physical, informational, and emotional support. A doula provides physical support through massage, counterpressure, positioning, breathing, relaxation, movement, and other ways to help ease the mother’s physical discomfort. A doula contributes informational support by empowering the mother to make her own decisions. She does this by assisting the mother in gathering information about the course of labor and her options, including risks and benefits. Perhaps the most important part of a doula’s role is emotional support — reassurance, encouragement, and comfort.

Does a doula take over the father’s role?
No. Even with the assistance of a doula, the woman’s partner continues to play an essential and irreplaceable role in providing support for the laboring woman. The partner’s intimate knowledge of the woman and love for the unborn child, in combination with the doula’s training and experience, make a perfect support team for the laboring mother. Also, no matter how good the childbirth preparation class, most fathers have little or no experience with birth. The doula can help reassure, support and guide the father, too. In fact, the doula can enable the partner to participate at a level at which he feels comfortable.

How does a doula interact with the maternity team?
A doula’s work also complements the work of the medical team. Doctors, nurses and midwives are primarily responsible for the medical health needs of the mother and baby. A doula helps ensure that the mother’s non-medical needs are also met. And, while medical staff may change from shift to shift, a doula provides continuous care throughout labor and delivery, and often for several hours postpartum.

What are the benefits of having a doula?
Research shows that childbirth goes more smoothly with a doula present: labor is 25 percent shorter, the need for cesarean section is reduced by half, and the need for epidural anesthesia is reduced by 60 percent. A recent study also shows improved bonding between mothers and infants when a doula is present for labor and delivery.

But, what if I want an epidural?
A common misperception about doulas is that they discourage the use of pain medication. While most doulas value the benefits of natural childbirth, they do not project their values or judgments onto the laboring woman. It is not the role of the doula to discourage the mother from her choices. While many women feel less need for pain medications when a doula is present, a doula can also help maximize the benefits of pain medications while minimizing some of the undesirable side effects. The doula’s primary goal is to help the woman have a safe and satisfying birth.

Exactly what services does a doula offer?
While doulas are employed by hospitals in some areas, most doulas are employed directly by the parents. In that case, a doula usually has telephone contact and at least one prenatal visit with the couple to establish a relationship. A doula may also help draft a birth plan and attend prenatal appointments. A postpartum visit to review the birth is typically included in the doula’s services.

How much does a doula cost?
The fees for a doula’s services vary widely from state to state. Most doulas charge a flat fee for their services, although some charge on a sliding scale. In North Carolina, the average fee for a doula’s services is around $300. Of course, fees vary depending on the services provided, the doula’s experience, and any other special circumstances.

How are doulas trained?
Doula training covers the anatomy and physiology of labor, as well as techniques for providing physical and emotional support to women in childbirth. Certification through one of the international doula organizations usually requires observation of a series of childbirth classes, background reading, a written exam or essay, and positive evaluations from doctors, nurses, midwives, and clients.

How do I find a doula?
To locate a doula, ask for recommendations from your health care provider, talk to other mothers, or contact one of the following international, non-profit doula organizations for a referral list. DONA (Doulas of North America) can be reached at (206) 324-5440 or on the Internet at http://www.dona.com. ALACE (Association of Labor Assistants and Childbirth Educators) can be reached at 1-888-222-5223.

For additional information on doulas, read Mothering the Mother : How a Doula Can Help You Have a Shorter, Easier, and Healthier Birth, available through Amazon.com.