11. Selecting Your Birth Team

In the days before modern medicine and hospitals, laboring women would often be supported by other ‘wise women’ in their communities, who held and passed along the knowledge needed for the next generation to assist women during the process of labor and birth. These women were among the earliest ‘doulas’ – women whose sole role was to provide comfort, encouragement and wisdom during a woman’s labor and birth. The idea of the modern doula began to gain popularity from the studies of Dr. Marshall Klaus and John Kennel during the 1980s, which clearly showed the benefits of the presence of a doula during the labor process. DONA International was founded in 1992, and the role of the doula became a legitimate profession, with prospective doulas required to complete extensive training and assist in multiple births before becoming certified. In the past 20 years, one birth at a time, doulas have secured their role as an instrumental component in the birth team. People commonly think of doulas and midwives as having similar tasks, when in reality the midwife is a licensed care provider in charge of the mother and baby’s health while the doula’s focus is on supporting and promoting an environment of calmness and confidence in the mother.

As reported in many studies, the presence of a doula has many health benefits (less medical interventions, faster labors, easier breastfeeding) and the presence of a doula also highly increases birth satisfaction for the new mother. Doulas are not only for mothers planning an all-natural birth, but for mothers planning or investigating all kinds of birth choices. The doula movement is all about options, information and nonjudgmental support. Doulas are hired for all scenarios, including scheduled cesareans. In current maternity care, women often feel rushed during OB visits and sometimes are too self-conscious to share concerns, questions or fears with medical personnel. This is one of the gaps that doulas can fill.

One of the greatest benefits of hiring a doula is that doulas are well-read, informed and trained in medical terms, and understand routine hospital protocols along with the risks and benefits of various medical interventions. Doulas do NOT make medical decisions for their clients, but they do help clients to make informed decisions. In all up-to-date facilities across the country, doctors and nurses welcome the presence of a calming and professional doula. There is no role confusion; doulas are not there to take over the care of the woman, but to add to it. Doulas and nurses complement each other. During the process of hiring a doula, mothers should not feel shy to interview as many doulas as they feel they need to find their ‘match.’ An interview should be free of charge and commitment and usually last around one hour.

Some of the important points for a family to consider in hiring a doula are:

• How much experience does she have?
• How many births has she attended?
• Is she a mother herself?
• How many births does the doula take a month?

The answers to these questions may mean different things to different mothers-to-be. A mother may feel comfortable with a newer doula based on a personality match, and hiring the most experienced doula is not always the best fit for all families. The last question in the list is a very important one. Obviously, a doula willing to “book” 8 births in a typical month is much more likely to need to send a back-up doula to your birth than a doula who only schedules 3 births. A busy schedule may also affect when the doula joins a laboring woman, or how tired your doula is when she joins you for your birth.

• Is the doula certified?
• If so, by what organization?

DONA International is not the largest, but is by far the most respected doula organization worldwide. DONA has been training and certifying doulas for the past 22 years in 23 countries. If a doula is not certified, ask her to read and practice according to the DONA code of ethics and scope of practice, easily found at www.dona.org.

• How many prenatal visits will the doula provide prior to the birth? And after the birth? Not all doulas have a set schedule of visits, but the majority will do two prenatal meetings that last around 2 hours each, and one postpartum visit that lasts around 1 hour. The prenatal meetings can often substitute for a public birthing class.

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• When does the doula join the labor? Some doulas come when mothers first call; others come when labor is more established. Mothers should think about what they want and the doula should be willing to adjust to that, not the other way around.

• How much does a doula charge? This is a difficult question, as prices vary a lot. A more experienced doula will usually charge more, as will a doula with more services to provide (for example, prenatal yoga, nutrition help, or postpartum doula services – like doing laundry, watching the baby while you nap, or helping you and your newborn perfect your ‘latch’ for nursing.) In Los Angeles, doulas can charge anywhere between $500 and $3000. Some doulas work on a sliding scale, and most of the national organizations will help women to find doulas at no cost or low cost. The idea is that every woman that wants a doula should have one. Insurance companies are also starting to reimburse for doula services, so ask your insurance provider if a doula’s services are covered by your plan.

To find a doula in your area, please go to www.binibirth.com.

Need more guidance? Check out these workshops available through Berlin Wellness!

Ana Paula Markel is a childbirth educator, doula trainer, practicing doula and volunteer in international birth organizations. She is also the mother of four children. In 2008 Ana founded BINI Birth, a center in Los Angeles dedicated to the childbirth education field, doula training, parenting classes and green pregnancy retail.