Should we use a doula?

August 25, 2008 8:57 AM

Should we use a doula for our hospital birth?

It seems like using a doula is the thing to do now for hospital births and this is our first child and we won't have any family/friends around for support in labor. I've heard a lot of good reviews from friends and in pregnancy/parenting forums as well.

However, it is $600-1000. But, I am pretty sure that our insurance will cover some of it (looking into it now).

For those of you that have used a doula or explored it, anything that you can share would be helpful.

posted by k8t to health & fitness (41 answers total)

Here is a recent nytimes article about doulas.
posted by ikkyu2 at 9:05 AM on August 25, 2008

From a 5-year study of 420 pregnant women:
...among the women who did have a doula present, their group had a 12% lower C-section rate than the non-doula group. They also had an 11% lower rate of epidurals. Even more dramatic, if a woman with a doula had an induced labor, the need for a C-section dropped by 46%... Link to article
posted by junkbox at 9:07 AM on August 25, 2008 [1 favorite]

Absolutely. I have all the respect in the world for OBs and OB nurses, but it is really helpful to have someone at your labor who is entirely focused on making the experience a good one for you and your partner. It's also really nice to have someone who has been around this particular block a couple of times to act as your advocate in a way that people who are intimately and emotionally connected to the birth won't be able to do.

This is going to be one of the most intense physical and emotional events of your life. A thousand dollars is really not much, if you can afford it, to make it a positive time.

Good luck!
posted by LittleMissCranky at 9:12 AM on August 25, 2008

I had a post-partum doula and she was helpful. I have friends who say their doulas really made a difference. I wish I'd had a doula for my first birth, which lasted 56 hours and exhausted my husband to the point where he really could have used some help. (The second was a planned and medically mandated C-section, so I didn't have a doula.)

That being said, I don't know that the stats on C-sections and epidurals are all that meaningful. Many people who hire doulas are more interested in natural births, so it would follow that they'd have fewer interventions. It may even follow that they have doctors who are more interested in natural births. It would also follow that people who need to have C-sections might not hire doulas, since the need for support is different.

In our case, we decided not to hire a doula for the first birth, because we didn't want yet another person in the room. We didn't want someone intruding on our space. And many of the doulas I had researched seemed to disregard science. Although we're very much "granola" in many ways (cloth diapers, extended breastfeeding and so on), we preferred to have someone who trusted in medicine and science to a certain degree. *However*, my family doctor has a very strong midwife approach and I gave birth at a hospital where they go to great lengths to have natural births and family-oriented care. If you need a stronger advocate, a doula might be a good person to have around. And, if you have a labour anything like mine, you might be glad for the support.

Still, you could hire the doula for postpartum care and have more time to rest. Or you could put the money toward cleaning, meal preparation or diaper services. There are many trade offs.
posted by acoutu at 9:14 AM on August 25, 2008 [1 favorite]

We used a midwife for our home birth. In case we had to transfer to a hospital, the plan was that our midwife would then become our doula. We've had lots of friends use doulas in the hospital, and from what I hear it's overwhelmingly positive (one doctor was fiercely arguing for an immediate c-section, the doula intervened, the baby was delivered naturally without a problem other than a longer labor, which was inconvenient for the hospital staff).

If you have a birth plan (you have a birth plan, right?) then your doula can be there to attend to your every need, be your advocate, and help keep things as close to the plan as possible.

I believe that if you can afford it, you definitely won't regret the expense.
posted by spikeleemajortomdickandharryconnickjrmints at 9:15 AM on August 25, 2008 [2 favorites]

we used a doula and i'm so glad we did. i found her presence very reassuring and she made me a lot more physically comfortable than i think i would have otherwise been during labour.

i feel that the little things that our doula did made a big difference to my overall comfort and confidence level throughout labour - the massage, the peppermint essential oils for my nausea, the soothing background music, the cool washcloths and just the continual reassurance and reminder that i was doing great.

the doula took care of me throughout. after our son was born, and had nursed etc, my husband followed him up to the nursery where he was given a bath. our doula stayed with me and helped me to settle into my room and waited with me until my husband and son came to join me there.

our doula did a follow up visit to our home a few days after the birth to check up on us. she checked on how my son was nursing and helped to make some adjustments to his latch that made me more comfortable. she also showed me how to bathe my son. it was much easier for me to grasp what i was being taught in the comfort of my own home rather than reading it in a book or being told it at the hospital.

personally, i feel like it was money well spent.
posted by netsirk at 9:20 AM on August 25, 2008 [1 favorite]

I've done a huge amount of research and doulas are very important for ensuring that the doctors and nurses respect your birth plan, and gain your full consent for ALL medical procedures.

If you don't have a birth plan, ask your doula to sit with you before your birth and make one.

I would also ask her if she can help you get a good breastfeeding relationship going, and if she knows any lactation consultants in case you have a few extra questions.

Happy birth!
posted by sondrialiac at 9:23 AM on August 25, 2008 [1 favorite]

To answer some questions: we're at a hospital that is pretty family-centric.

We don't have a birth plan yet (this isn't happening til early November and we just got back to the U.S., so I haven't even seen my American ObGyn yet). But we'd like to avoid a C-section, obviously. We haven't made up our minds about pain control yet, but we're not opposed to it.

We're also pretty concerned about "crunchy" things generally (using cloth diapers, trying to bf as long as is possible), but we are also pro-science. Thanks for the tip, acoutu, on that being a sticking point with some doulas.
posted by k8t at 9:24 AM on August 25, 2008

acoutu, in that study the women were split up and either assigned doulas, or not. They did not choose whether or not to have a doula.
posted by sondrialiac at 9:33 AM on August 25, 2008 [1 favorite]

My wife, who is a strong advocate of natural childbirth (having gone through three), found that NYT article that ikkyu2 linked to incredibly biased, as did I. If you want to know about some of the worst, most unprofessional doulas working today, that article is all you need. "Doulas: Why Hospitals Hate Them and Why They Hate Fathers. More on page B2!"

But if you want to learn about what doulas actually offer to women and their families, you'll need to do much more additional research. The posts above are a good start.

Also, congratulations.
posted by hhc5 at 9:34 AM on August 25, 2008 [2 favorites]

Whatever works to make you less afraid, DO IT. There are two kinds of muscles in the uturus, and if you're scared, the muscles holding your baby in activate, making labor MUCH longer and MUCH more painful. I knew I needed an experienced, knowledgeable guardian to feel safe in a hospital setting, and that my partner couldn't fit that role very well. (She's studying to be a nurse so is overly respectful of hospital people.)

I had a doula I loved, she fit my needs perfectly. This was my first child, I'm not particularly fit or energetic, and I had my baby in six hours with no drugs, no nothing. Partner held me, squatted with me, helped me get off the toilet, into the shower or bed, and was very participative, but was not in charge. Doula and I were. She kept the nurses and doctor away until I absolutely needed him, and even then, the baby came so fast that he was unable to get his gloves on in time to catch the baby.

The main thing is to find a doula you really click with, and to spend plenty of time with them pre-birth so that you do have total confidence in her. Then make sure she knows your birth plan, listens, and is practical and experienced enough to help you make the right decisions when you're in the middle of most surreal experience of your life.

About the $$ - everyone I've read at mothering.com etc says that it's totally worth it, and I'd have to say for me it was, as well. I have nothing but positive memories of my entire birth experience, and my kid had a healthy, non-drugged, peaceful hospital birth. I'd probably give my doula double what she asked, now that I've been through it. She is 80 and really determined to retire, but if I have another one, I'll have to drag her out of retirement to help me again.
posted by pomegranate at 9:34 AM on August 25, 2008

I never used a doula but I found that a well respected mid-wife who is known by the nursing staff in the maternity ward is key. My mid-wife who was committed to natural birth but not opposed to pain relief (and suggested a number of natural interventions that I am convinced made medical interventions unnecessary) and who provided follow-up care, including breast feeding advice was crucial to three wonderful birthing experiences. My midwife was there throughout labor and it was obvious that the nursing staff knew and respected her. I know one person who used a doula and found her to be very much sidelined by a hospital staff who hadn't worked with her before.
posted by bluesky43 at 9:39 AM on August 25, 2008 [1 favorite]

We're using a doula. Our due date isn't until the end of next month, but she's already been very helpful: just knowing that somebody knowledgeable will be there with us through the whole process (nurses come and go, and the doctor you want may or may not be on duty, and is only there for the actual delivery anyway) is a good thing to know. I also like that we'll have someone there who can give us an instant second opinion if any drastic decisions have to be made.

For contrast, another couple we know had a really bad experience -- just a bad match of personalities, I think: the couple wanted specific "what should we do right now?" advice during the labor, but the doula was all touchy-feely "what do you feel like doing now?" And as acoutu describes, some of them are pretty heavily biased against "medicalized" birthing; you don't want to be arguing with the person you've hired to be your advocate.

So shop around. It doesn't cost anything to meet with a doula and talk it over; you'll get a sense pretty quickly of whether your personalities and opinions mesh enough that you'll want that person with you on the big day or not.

Oh, and congratulations!
posted by ook at 9:41 AM on August 25, 2008

A friend of mine is a doula, and instead of cash people have given her goods (when they can) in exchange for her services - a couple of cases of wine, for example.....just a data point.
posted by tristeza at 9:45 AM on August 25, 2008

Bluesky43 said, "I know one person who used a doula and found her to be very much sidelined by a hospital staff who hadn't worked with her before."

Yeah that is a very big deal: my doula was so well known that as soon as the nurses saw her, they said, "Go get New Nurse, she's never worked with before." They then used my birth as a teaching experience for New Nurse on how doula's work with the birthing mom's body to move the baby down the birth canal. I think they stayed out of my way solely because of the doula.
We birthed at a public hospital because it has a good reputation for mom-lead births, and because my doula is so well respected there. No flat-screen TVs or wood floors, but we checked out within 18 hours of having her anyway, so who cares?
posted by pomegranate at 9:46 AM on August 25, 2008 [1 favorite]

We are not using a doula, but we are also (hopefully, assuming that our meeting tomorrow night goes well) using a very family/natural childbirth-oriented birthing center and there are midwives at my ob office that I will be seeing. We will have a birth plan (part of the process at the center) and I'm feeling very comfortable that their approach and our approach are going to be very similar.

If I didn't feel that way, I would be more likely to have a doula present (and one of my sisters-in-law was ready to offer her services). So I agree with others: evaluate the atmosphere you'll be giving birth in and whether you are comfortable with it and your role in it and make sure that you and the doula are also on that same page.
posted by stefnet at 9:51 AM on August 25, 2008

We had a doula for the birth of our son - she was also a RN so we were comfortable she'd be 'scientific' in her approach. It was such a relief to me since our son was born 6 weeks early - after rushing my wife to the hospital I had a shoulder I could literally cry on while they prepped my wife for the C-section as well as have her stay with my wife while I went with my son to the ICU.
posted by Twicketface at 10:10 AM on August 25, 2008 [2 favorites]

I really wish I had had a doula for my first baby. My husband didn't know what the hell was going on, I had a really long labor, and I was basically freaked out and the nurses were too busy to help me manage my experience. It must be said that going into the whole thing I thought I was prepared for everything, and I really thought I was. I took a class, watched videos, read books educated my support people, but none of them had been through a birth, and that, I believe is ESSENTIAL.

Go for it, you are worth it. This experience is worth it. If you play your cards right you can draw strength from the potential power of this experience and we can all use that.

Good Luck :)
posted by vermontlife at 10:24 AM on August 25, 2008 [2 favorites]

My mother is a doula so I might be a bit biased but my first answer is always yes! Unless you are in a specialized birthing center that caters to families and making sure mom is comfortable or unless you are having a midwife deliver your baby at home.

A doula (with your birth plan) can have the uncomfortable or more stern conversations with your doctor or nurse so that you don't have to stress about things. For example, our local hospital mandates an IV but many moms don't want that, your doula can make sure that happens for you without you getting involved. She is also knowledgeable about births, complications, and options and can give you advice that your doctor can't or won't because most doctors (and hospitals) jump to c-section quickly. If you have any special requests or restrictions (I don't want so-and-so in the room) a doula can handle those for you. One time my mom was the doula for an orthodox jewish couple who, of course, went into labor on the sabbath which severly limited what the dad could help with, that was a situation made for a doula.

Don't be afraid to ask for references and to call them. Also, ask how many births she has attended and in which hospitals. Ask about her experiences with the staff at those hospitals. You want someone who the hospital staff knows and who can work well with them, that will increase your chances of everything going smoothly.
posted by magnetsphere at 10:28 AM on August 25, 2008

Could you compromise by getting one that isn't an "advocate" against your doctor, but is there to comfort you and otherwise help out?
posted by phrontist at 10:34 AM on August 25, 2008

Also, something else to think about is you might (if you wanted to, of course) be able to switch care to a nurse-midwife---this would, at least in my experience (2 kids) make the doula unnecessary, since the midwife will stay with you all the time during labor (at least, mine did). I found the working with a midwife experience to be fantastic, and I switched care from an OB to the midwife at I think 24 weeks (in my first pregnancy, because the OB seemed to be implying "you're petite, therefore C-section).
posted by leahwrenn at 10:39 AM on August 25, 2008

My due date is just under two weeks away, and we went back and forth about the whole doula thing. In the end we decided not to have one. I will say that at our (quite crunchy, but IMO pro-science and balanced) CB classes, the instructor did say that most of the people in her previous classes that had a doula were incredibly happy that they did.

My own personal opinion, for what it's worth, is that it comes down to the level of trust you have in your health care provider. I have a wonderful midwife who is also very pro-science (I do neuroendocrinology research, so this is very important to me) and with whom I have discussed all the ins and outs of what might happen during the labor. IMO, my job, during labor is to focus on that, and the decisions about care are in her hands. But that's because I trust her implicitly, and she knows our wishes regarding interventions and why and when we would or wouldn't want specific ones. If you don't trust that your midwife or ob-gyn is there for you, and you feel like you need someone to stand up for your rights then a doula might be a good idea.

This is the same reason I don't have a birth plan. It's all been discussed and noted by my midwife anyway. And personally, I think having a birth plan is setting yourself up for disappointment, because you can't plan a birth. All JMO of course.
posted by gaspode at 10:54 AM on August 25, 2008 [1 favorite]

The role of a doula as outlined in their professional organization's scope of practice is to provide non-clinical support through the labor and/or post partum experience, and that this support should be responsive to their client's need regardless of what model of care they ascribe to (so a good doula should be willing to support her client's use of pain management in labor, or through a c-section). This is all made clear through DONA, the professional organization.

The studies that suggest that a doula's presence support birth outcomes with less intervention also suggest that it is not because a doula prevents care, but because the laboring women has constant, unfatigued support (which in current healthcare models, is sometimes not the default case). Postpartum doulas are often excellent front line caregivers in alerting medical professionals of birth and newborn complications like depression and jaundice--especially in communities where new mothers are not provided with follow-up visits from a healthcare provider.

Look for CERTIFIED (via DONA) doulas, who have been through training to learn about their scope of practice, ask for references, and do not hesitate to ask your healthcare provider or labor and delivery nurses at your hospital for references. I am bit alarmed by the article ikkyu2 linked to, as it does not seem balanced, and anecdotally (to be fair) is not what I see in the vast majority of instances. Doulas who step outside their scope of practice and start providing clinical advice are the rare horror stories and would be acting in direct opposition to the certification training and certification hours they received. Certainly, a doula will explain to a laboring mother and her other support what the healthcare providers are planning to do, or would like to do, but ONLY as away to make sure the patient's consent is informed and that questions are answered. An experienced, certified doula with good references should not be telling the patient what to do or directing care.

In my area, the labor and delivery staff and local OB/GYNS and midwives welcome good doulas as it supports their time to provide good care to all of their patients. The NY Times linked article also undermined Lactation Consultants, which I find puzzling--as they are a legally defined profession that must pass boards and do thousands of clinical hours and carry malpractice insurance (the article made it seem like they are some sort of hippie-derived fake profession that would deliberately starve a baby in favor of the all-holy breastmilk. I am working towards taking my LC boards, and I have more than once created a supplemental feeding plan that includes formula). There are certainly poor care providers in every discipline--research and ask for a variety of references, and if you're unhappy, move to someone else.

Full disclosure: I am working towards my LC clinical hours, am a certified postpartum doula, and this fall I begin school at a major research university to become a pediatric nurse practitioner, so I support a full-spectrum of care models.
posted by rumposinc at 11:12 AM on August 25, 2008 [3 favorites]

We are pretty un-hippy, and we used a duola. We didn't have local family, and found her helpful beforehand and during the birth. She kept an eye on the doctor (who was new to the hospital) and was good about prompting us to ask for the things were wanted and had decided on beforehand, but was getting lost in the moment (e.g. letting the cord pulse out, etc..). She was also helpful to take pictures after the birth (not as serious but nice to have)

I would recommend it.
posted by bottlebrushtree at 11:30 AM on August 25, 2008

I would recommend one as well. I didn't actually use one for any of my four births simply because in Ontario midwives are free (and mothers always get two midwives, one for the baby and one for the mother - but for some reason I always get three or four) so I felt the midwives were performing a doula-like role in keeping me educated and supporting me and my husband emotionally as well as physically during the pregnancy, birth and post-partum.

I have heard complaints of mis-matched personalities though, so research the person you choose. I would actually recommend popping into the L&D ward of your hospital as ask for recommendations from the nurses. They've seen them all and will have opinions that may help you.
posted by saucysault at 12:02 PM on August 25, 2008

well, doctors and nurses are there for a reason, and I hear a lot of bad stories re: doulas who get confrontational and all with doctors and staff and it gets pretty stressful (they have of course the right to have very strong opinions about their work). hospital + doula is after all a bit of a hybrid, so to speak. a classic hospital setting or a midwife for a home birth seem to make more sense to me and a lot of people (parents, doctors) I've discussed this with. good luck.
posted by matteo at 1:00 PM on August 25, 2008

I hear a lot of bad stories about doctors and nurses trying their damnest to override the patient's wishes re: meds and C-sections. Midwives and doulas are willing to stand up for what the patient wants. Of course doctors and nurses find this "interference" confrontational and irritating, but it doesn't mean the midwife shouldn't be there. The patient shouldn't be having to fight two battles- giving birth is plenty.
posted by small_ruminant at 1:34 PM on August 25, 2008

My two cents, from the other side of the doctor-patient relationship:

My one experience on the OB team working with the doula was a negative one (again, my n=1). We had a baby with very concerning heart rate fluctuations (decelerations) despite multiple adjustments, and the doula continually told the mom to refuse a c-section. It made the atmosphere not a pleasant one--a doula with no clinical training or experience telling a mother to refuse a c-section when the doctors and nurses were seeing heart rate changes that can indicate lack of oxygen to the baby.

For the good of you and your child, please please go with someone with some basic clinical training, who isn't completely anti-establishment and anti-doctor--it's why you give birth in a hospital to begin with, and why maternal death rates are so much lower than they used to be in the rest of human history.
posted by gramcracker at 1:47 PM on August 25, 2008 [1 favorite]

My best friend flew in from the US to serve as my doula in the UK for the birth of my second child. It was worth every penny to pay for her flight, lodging and lost wages while she was my doula. It was a great comfort to have someone who served as my advocate at every level including the surgical room. The medical staff had to get used to her presence but I am glad that I had her because I was in no shape to be an effective advocate regarding medical procedures. She allowed my husband to be stress free because he could trust her with medical information and split second decisions. My main regret was that I did not have the sense to spend the money and have a doula for my first birth because that one was kind of rough and led to a c-section.

I think the main thing is to find a doula that works well with YOU. Someone who you feel trust and comfort with a very important event in your life.
posted by jadepearl at 1:53 PM on August 25, 2008

Ask any potential doula, as well as hospital and other caregivers, about their infection rate. Ask about Apgar scores, compared to babies w/ no doula present.
posted by theora55 at 2:38 PM on August 25, 2008

At the simplest level, you can look on having a doula as having an extra pair of hands committed to your birth experience. While the world is filled with outstanding L&D nurses, they are there for a shift and not for a labour. It's often as simple as that.

You say you have no family and few friends in town. In a long labour, you're going to really want someone other than Non-Birthing Parent around to apply counter pressure and back rubs, for example - labour can be physically demanding for more people than just you, even though you obviously win that sweepstakes. Someone to go to the cafeteria for your husband or pass out snacks when they're needed is nice. Plus, someone with a little more emotional distance than you or your husband has can sometimes be useful when decisions need to be made and nobody has slept in 28 hours.

And I know you're not all woo-woo, but you might want to give some thought to the gender dynamics of your birth. Birth is pretty intensely female and there's something to be said for having someone who's BTDT and very much wants to help you BTDT too. Traditionally that's been your mum (or his mum, or both mums or all the mums from 10 miles around, or...) but today it's more likely to be a doula. That's modern life for you.

All of that said, as with anything else, do as many interviews as you can and get references. The doula is responsible for helping you have the best birth you can, and you are responsible for making sure you get the best doula you can hire.
posted by DarlingBri at 4:18 PM on August 25, 2008 [3 favorites]

While I was pregnant, I was planning on using a volunteer doula (our hospital has a relationship with a service) during my birth, and a postpartum doula (who we paid) for after. I met with the volunteer doula once, she seemed very young and had not attended many births. We didn't develop any kind of relationship during my pregnancy, and when I went into labor I didn't call her. It ended up that I was started on pitocin right away which made my contractions too painful for me to cope with - once I was on the epidural the doula would have been completely irrelevant.

I can't speak highly enough of postpartum doula services - especially when they came from 10pm until 6am. They helped me a lot with many things.
posted by pinky at 4:53 PM on August 25, 2008

First and foremost, as the father of a now-five-month-old, congrats and good luck with the birth and first few months! It's the ride of a lifetime.

I trained in a very-much academic hospital, and there weren't a ton of doulas present at births, but when one was present there was no consistency in terms of whether they were good, bad, helpful, interfering, or anything else. As is the case with any instance of enlisting someone's help with decisions as close to you as childbirth and health care, the devil's in the detail of finding someone who (a) you can trust implicitly and unreservedly, and (b) you can feel comfortable is not overstepping his or her role in the process you're asking them to help with. So before asking the question, "Should we use a doula?", you should ask, "What are the things I'd like to get assistance with during the birth of my kiddo?", and then see if a doula (or midwife, or even an ardently-defensive spouse or best friend!) is the answer to those things.

pomegranite: There are two kinds of muscles in the uturus, and if you're scared, the muscles holding your baby in activate, making labor MUCH longer and MUCH more painful.

I'd love to see your source on this one; it's just not true, and is the sort of thing promulgated by the peri-medical folks that surround birth. The uterus is made up of a single type of muscle -- smooth muscle -- "organized" in random interdigitated bundles, and that muscle doesn't seem to have any consistent reaction to the kind of stress you're talking about.

rumposinc, with all due respect, what you've outlined is very much the ideal role that doulas are supposed to have, as per DONA, but you can read comment after comment in this very thread that there are oodles of doulas who frequently take on much more, and much more in the way of clinical involvement. (Pomegranite's "kept the doctors and nurses away", magnetsphere's experience is that they help prevent IV fluids from being administered, gramcracker watched one persistently push against a mom getting a C-section, etc. etc.)

So in the end, it again comes down to a soon-to-be mother deciding what her own goals are for her birth, and then deciding whether they mesh with those of the person she enlists for help during the birth. But with that said, I would also remind soon-to-be mothers that they've also enlisted the help of the obstetrician (or midwife, or other medical equivalent), and those folks have a ton of training as to how to make the process move along at the right pace to keep everyone healthy. Setting up dyads of doctor vs. doula or whatever isn't productive to anyone.
posted by delfuego at 5:49 PM on August 25, 2008 [1 favorite]

So... everyone's getting a doula; you should too? :) I have a differing perspective.

I gave birth three months ago. I ended up being in the hospital for a week prior to my baby's birth because I had pre-eclampsia. Since I was in the hospital, I became very familiar with the entire Labor & Delivery nursing staff. I was assertive in my wishes, and I did the communicating with the staff.

I had a voice in my birth "experience" but the "experience" was not about me; it was about my baby surviving as long as she could in utero and then surviving birth. Giving birth is not all about the mom. And if you have complications like pre-eclampsia, gestational diabetes, placenta problems, etc., it's even less about the mom. I hate that I felt like a baby incubator for my entire hospitalization until my baby's birth, but it's the truth and the perinatologists would be the first to tell you that.

When you are thinking about getting a doula, think about this: Are you a naturally assertive person? Would you be OK with advocating for yourself? Are you OK with yourself changing your mind halfway through? Giving birth is such an unpredictable process--you are going to surprise yourself. Give yourself some leeway and don't be too hard on yourself if things don't go perfectly to plan (written birth plans are a joke) and you have to get a C-section or you decide you want an epidural. Is your husband/partner going to be OK with yet another party in the birthing room? Are YOU going to be OK with it?

Would anything have changed had I engaged a doula? Not very likely.
posted by FergieBelle at 8:07 PM on August 25, 2008 [1 favorite]

I had a doula. Labour day, I was induced for pre-eclampsia and she came to the hospital with us. I had a high pain tolerance so I was not feeling pain even though I was on a pitocin drip for a good 4 hours. They cranked up the pitocin some more and started the monitor. I started puking like I was in transition, but I was only 7 cm. I was sectioned for failure to descend less than 3 hours from when the "real work" of labour started. She even felt that the section was a good idea.

Was my doula necessary? No, she was not. Did she improve my outcome? No. I would have done just as well (and saved my $750) with the very supportive labour nurse at the hospital.
posted by crazycanuck at 8:44 PM on August 25, 2008

I've forked out the dough for a doula for my wife on three separate births and never regretted it one instance....though I suppose it depends on the doula. A doula is experienced at comforting a woman during childbirth in a way which no man can. If Mom is not going for a natural birth, I wouldn't think a doula would be as beneficial, but she is a godsend if Mom is fighting the pains of natural childbirth. Be aware that different hospitals have different policies about who attends a birth, but there should be nothing wrong with the doula standing near Mom's ear and encouraging her along the way...and offering whatever form of comfort and support she is able. Birth is SO much more emotional than you think and if Mom is going for a natural childbirth, she is going to want an authoritative voice she can trust during those times of doubt.
posted by keith0718 at 2:58 AM on August 26, 2008

Important things to note (obligatory disclosure, I am a birth doula):

DONA was mentioned more than once in this thread, but it is not the only organization which provides training and certification for doulas in the U.S. and while there is some considerable difference between the various certifying bodies, there is also a great deal of overlap. Off of the top of my head, I can also note ICTC, ALACE, CBI, CAPPA, BFI, ICEA and BAI as some of the certifying bodies. (I'm affiliated with CBI and ICTC.) You can make yourself nuts researching the differences between these organizations and what they mean to you as the birthing mother, but the more important thing is to ask the doulas that you interview about their training, experience and philosophy.

Along those lines, it is as important to have a strong rapport with your doula as it is to have a relationship with your clinical care provider. You should be meeting with your doula at least two or three times during your pregnancy, and you should be completely comfortable with this person and you should come to an understanding with this person about your vision, priorities and expectations for birth and his/her role therein.

If cost is a concern, there are doulas who provide their services on a sliding fee basis, or even free, for those with a lower income or who are reliant upon medical assistance programs. Visit Bellywomen.net to find doulas who offer cost rollbacks under such circumstances. (More than 1,200 across the U.S.)

Also, you can consider a doula who has fulfilled all of the requirements of training but is in the process of attending what's known as "certification births." In order to complete certification, all of the major organizations require a doula to submit reviews from the mothers (and occasionally medical staff) involved in a number (3-12) births, and because the doula is not completely certified and since remuneration comes in the form of the review, a doula in this situation can provide you with a trained, experienced birth attendant, usually for no cost other than incurred expenses such as parking at the hospital.
posted by Dreama at 3:00 AM on August 26, 2008 [1 favorite]

keith0718: A doula is experienced at comforting a woman during childbirth in a way which no man can.

Huh? Care to elaborate on that? Does this mean that there can't be male doulas? This is just a weird statement.
posted by delfuego at 8:45 AM on August 26, 2008

delfuego, I think keith0718 is referring to a woman that has personal experience with childbirth (as most doulas do). A lot of what people know about childbirth is though a male lens (if I believed Hollywood I would never have had children) so a woman who knows exactly what transition feels like is invaluable. Can a man be a doula? Well, I guess so, but he just wouldn't have the personal experience than many woman need to relate to when they are in labour (am I supposed to feel like this? is this normal? is this thing coming out my vagina supposed to?). If the labour is difficult or draining, a doula can reassure the woman she knows exactly what it is like and she can make it through just like the doula did. If you were learning to rock-climb would you think someone with personal experience (I read books and climbed a mountain!) had more accurate and believable information than someone that just had abstract knowledge (I read books about climbing a mountain)?

Also, comfort from a female doula while exposing your vagina to whomever walks in the room and feeling emotionally vulnerable eliminates any sexual tension a woman may feel towards or coming from a male doula. This is also why many women will only go to a female ob/gyn.
posted by saucysault at 1:29 PM on August 26, 2008

Saucysault, no doubt that some folks might (probably do) generally feel more comfortable with female gyn-related caregivers; I just would challenge the notion that doulas comfort "in a way which no man can." (Also note that the perspective you voice would also mean that doulas must be women who've given birth, and if you wanted to nitpick, must have given birth in the exact way as the women she's caring for; otherwise, she wouldn't be able to reassure the woman that "she knows exactly what it is like", etc. Again, I'd challenge this.)

OK, enough of my derail; I just wanted to make sure that the notion that only women can assist other women giving birth didn't go unchallenged. Millions, nay billions, of soon-to-be-fathers have served the role that doulas now serve, with successful results...
posted by delfuego at 1:41 PM on August 26, 2008

I do not believe "billions of soon-to-be fathers" have served the role that doulas now serve. (Fathers have been a very recent addition to the delivery room, mostly in western society and are not universal there). Billions of women have supported each other during labour however.
A doula does not have to have given birth in the exact same way because although the child-birth may be different, it is the labour that takes the most time, follows a pattern and has a distinct physical and emotional feeling that men biologically can not experience. Your focus on the "birth" rather than the much more difficult and longer labour is interesting because it is part of the medical establishment's view of that the delivery is the only important part of the process and the only part worthy of sustained medical attention.
A father CAN be a support in labour but as many people upthread mentioned, the doula is there to support the father as well (a factor in reducing male post-natal depression). She also has experience and education to bring that a father simply doesn't. I know MANY women (without doulas) that ended up expending emotional and physical energy during labour on the father and found him to be a hindrance (but of course, afterwards they always massage his ego on how great he was as he brags to his friends about participating - see comments). It is not a new idea that fathers-to-be in the labour room can actually have negative outcomes with regards to c-section rates and use of medication. There is a lot of research confirming the good things about men supporting their partners; however, that role is not being a doula, and expecting men to take on such a role without training or experience is unfair to men, increases their stress which further stresses the labouring mother. Women without midwives/doulas often praise their spouse's support because they do not have anything to compare it with (except being alone in the hospital room while scared and in pain).
posted by saucysault at 3:40 PM on August 26, 2008 [6 favorites]