Doula comes from the ancient Greeks who selected a special “hand maiden” to attend the lady of the house during childbearing. Today, it refers to “a woman experienced in childbirth who provides continuous physical, emotional, and informational support to the mother before, during and just after childbirth” (Klaus, Kennell and Klaus – Mothering the Mother).
Although centuries old, the benefits of this one-on-one care have only recently been documented in several separate controlled studies. Since 1980, varying research has proven that the presence of a doula results in a significant decrease (30-60%) in interventions (drugs, forceps and cesareans) and in labor being shortened by 25% overall.
The studies also show an increase in a woman’s positive feelings about herself, labor and the baby. This leads to more successful breast-feeding, fewer neonatal problems and decreased postpartum depression.
With staff shift changes, breaks, clinical responsibilities and shared care, the doula can offer the consistency shown to be so beneficial. A strange environment, unfamiliar technology and the pain/uncertainty often associated with birth can be stressful and frightening for the mother. This is where the role of the doula to promote comfort and relieve anxiety can have such a positive impact.
Therefore, doulas can reduce the cost of maternity care while improving outcomes. These findings should be of particular interest to insurance companies and health maintenance organizations.
Expectant mothers should contact their carriers regarding coverage or reimbursement if contemplating the services of a doula. The fee for a doula usually ranges from $250 to $500 and covers prenatal and postpartum contact as well as attendance at the birth.
Some mothers are “bargaining” for doulas by agreeing to pay for her services themselves if an epidural or cesarean occurs, for instance. Many companies offer a benefit plan of pre-tax dollars which employees may elect to put aside and use towards medical expenses not normally covered by health insurance. Doula services may qualify for reimbursement in such a plan.
Expect to sign a contract and pay a deposit to assure her presence (or a qualified substitute) at the birth. Some doulas also charge for miscellaneous costs such as parking, meals, beeper rental, babysitting and film, plus developing. With an epidural often costing $1500, the immediate savings is clear when considering modern day, skyrocketing health care costs. According to Doulas of North America (DONA), founded by Penny Simkin in 1992, a doula recognizes birth as a key life experience that the mother will remember all her life. Through her understanding of the physiology and psychology of birth, a doula can assist the woman to better accomplish her planned goals.
By providing constant support, comfort measures, an objective viewpoint and mediation with clinical care providers, a doula can nurture and protect the woman’s memory of her birth experience. DONA, ICEA (International Childbirth Education Association), ALACE (Association for Labor Assistants and Childbirth Educators), and other organizations offer training and certification because of their strong desire to provide qualified, professional doulas as the newest member of the birth team.
It is important to realize that a doula does not provide medical care, advice or interpretations. However, she is an essential member of the working alliance that better ensures a healthy baby and satisfying experience. Sometimes a doula is referred to as a labor partner/companion, birth assistant or even a secondary coach.
A monitrice, on the other hand, is a doula who also provides some medical care such as taking blood pressures, monitoring fetal heart tones and doing internal exams. A monitrice is generally an RN whereas a doula need not be medically credentialed. Her passion for birth and the desire to be in service to women combined with her knowledge and experience makes for a highly motivated and qualified attendant.
Many doulas are also childbirth educators who offer private or group classes. Expanding your relationship on that level would be valuable. There also seems to be a movement in the area of postpartum doula services for women who want assistance at home after the baby’s arrival.
When selecting a doula, an in-depth interview to discuss preferences and to assess mutual comfort is suggested. Ask about training, certifications, number of births attended and personal philosophy about births. Inquire about fees and what kind of services can be expected. Some doulas go to a childbirth class or a doctor’s/midwife’s appointment with their client. Many take photos and keep a birth journal that they share with the new family. Others provide a gift or a hot meal during a postpartum visit. And, a good doula should always be willing to furnish a satisfied client list for referrals if requested.
The mother and her chosen partner are totally involved physically and emotionally during the birth so it just makes good sense to employ a doula to provide additional support.
Perhaps more childbearing women will consider this popular option when trying to provide their baby with the safest entrance into this world in a truly satisfying way.
Editorial provided by Jan S. Mallak, 2LAS, ICCE, CD (DONA), Founder/Coordinator of “Heart & Hands” Doula Service in Export, Pennsylvania.