You’ve probably heard of doulas—they have become increasingly popular over the past few years. But if you’re expecting, you may be wondering: What exactly is a doula, and why should I hire one? 

Below, we’ll answer both of those questions and share what doulas actually do, so you can decide for yourself whether doula care is right for you.

What Is a Doula?

Until about a century ago, giving birth was a community event in the United States, attended by midwives and other female helpers. When birth moved from home to hospital and was attended by physicians, the type of continuous personal support provided by midwives and other members of the birthing person’s community was lost. 

However, that kind of support during birth is incredibly important—a fact increasingly supported by research. A recent Cochrane Review on Continuous Labor Support highlights how continuous care can enhance physiological labor processes and includes emotional, informational, and physical support through comfort measures. The review recommends that all birthing people have continuous support during labor.

This is exactly the type of support doulas provide. The state of Oregon defines a doula as: “A birth companion who provides personal, nonmedical support to birthing people and families throughout a person’s pregnancy, childbirth, and postpartum experience.”

Why Consider Hiring a Doula?

In the past, doulas were often viewed as a luxury service—accessible primarily to wealthy, private-pay clients or those planning a home birth. Media portrayals sometimes depict doulas as wacky, comedic, or unconventional, which can leave expecting families unsure whether having a doula is right for them. 

However, when you ask someone who has had the support of a doula during birth, they are very likely to recommend that friends or relatives seek one out when expecting. People from all backgrounds and birth settings can benefit from doula care.

High rates of satisfaction 

Doulas are the most highly rated provider type by patients, according to the Listening to Mothers in California study. The majority of birthing people surveyed stated that they would have a doula at their birth again and reported a high rate of satisfaction with the care they received from their doula.

Doulas go where their clients go

Some questions that often come up in discussions on whether to hire a doula revolve around planned birth location. Having a planned home birth? A planned cesarean birth? No matter the situation, a doula can provide specialized, individualized care to you and your support team.

And just as importantly, your doula can go with you, even if you transfer care. For example, if you have a planned home birth and end up being transferred to the hospital, your doula will be able to stay with you, providing continuous, familiar support.

Doulas support the birthing person and the support team

What about displacing partners or family members? Despite what some people may assume, doulas provide support to the birthing person, the birth partner, and the whole support team. Most people aren’t trained to support a person in labor, unless they take a childbirth education course or hospital birth class. Doulas can educate the birthing person’s support people so they know what to do in the moment and feel more confident in their role, no matter their preferred level of involvement. 

Ask a birth partner what they thought of having a doula on their birth team, and they’ll most likely gush about how they felt supported, too, and how they were grateful for an extra set of hands—and for being able to take bathroom and snack breaks without guilt.

Doulas provide non-judgemental, specialized care

Doulas provide support that is unique to each client. Unlike family members, who may wish for you to give birth in a certain way, a doula supports your choice and doesn’t try to influence your decisions. Having a doula is a benefit, as they are experts in birth who want to help you have the most positive experience possible.

When you hire a doula, you’ll have prenatal visits with them, where you discuss your goals, questions, and fears. Your doula will get to know you and your family, and they’ll provide you with a nonjudgemental listening ear, resources, and evidence-based information specific to your pregnancy. 

Doulas provide:

• Comfort measures during your labor (like cool compresses, hip squeezes, therapeutic touch, keeping you hydrated, and more)
• Choices for labor (such as suggestions for different labor and pushing positions)
• Unbiased information and resources
• Encouragement without judgment or expectation

Doulas help you navigate the healthcare system

Many people don’t realize that a doula can also help you with decision-making and encourage autonomy. Your doula won’t speak for you, but they can help you practice and develop confidence and self-advocacy skills. 

For example, your doula may make sure you understand your rights during your birth, discuss with you how to write a birth plan, and remind you that your consent can be revoked at any time and that you are allowed to interview different providers to find the right fit. Additionally, when medical procedures and jargon become confusing, your doula can help you understand what’s going on.

If you’re thinking about hiring a doula, reach out to doulas to interview. Just like anyone else, doulas have their own unique perspectives, backgrounds, and personalities. There are doulas who specialize in supporting people through VBAC (vaginal birth after cesarean), for example, or working with people in addiction recovery or with teen parents. Many people describe finding a doula that they “click with,” and when they do, it’s a special type of relationship.

What Makes a Community-Based Doula Different?

Community-based doulas are doulas who are embedded in and actively a part of their communities. They are often from the same cultural or linguistic background as their clients, and provide care that goes beyond “conventional” doula care. They provide more intensive and extended care in pregnancy, labor, and postpartum. Community-based doulas often serve low-income, high-risk and birthing people of color. In other words: They look and sound like and can relate to their clients. 

This heart-centered work is proven to benefit birthing families through higher breastfeeding rates and decreased cesarean rates. Other benefits highlighted by organizations like HealthConnect One who study the impacts of community based doulas include:

• Decreased epidural use
• Fewer medical interventions
• Increased skin to skin contact after birth
• Increased parent-child interaction
• More positive birth experiences
• Improved parenting skills
• Lower medical costs

Community-based doulas are peers who bridge language and cultural barriers to pregnancy care and education. This type of care centers equity and reproductive justice and uplifts inclusivity.

In Oregon, community-based doulas are often THW (Traditional Health Worker) doulas, or doulas who provide support to Medicaid priority populations.

Did you know that Oregon was the first state to implement a medicaid reimbursement program to provide doula care to families that would otherwise be unable to access it? HB3311 (House Bill 3311) passed in 2011 to ensure families in Oregon had access to doula services and care. The Oregon Health Authority wanted to “explore options for providing or utilizing doulas in the state medical assistance program to improve birth outcomes for women who face a disproportionately greater risk of poor birth outcomes.”

How You Can Support the Community Doula Program

The Community Doula Program was built on the model of community-based, THW doula care in order to address maternal health disparities across Western Oregon. Since 2018, the CDP has matched experienced THW community doulas to clients that are culturally and linguistically aligned. The CDP also supports the doulas in the program with professional development, training, and continued education, and operates as a hub, providing crucial client matching and medicaid billing services.The program operates as a NPO (nonprofit organization) and relies on grant funding and financial donations in order to do this important work in the community.

Support the CDP by contacting them for doula support if you have OHP Medicaid insurance! If you’re not expecting, other ways to support the program include telling people about the CDP and letting them know that Medicaid families can have the benefit of doula support at no cost. And if you can, donate to the program.

Enjoy this video that highlights the important work of the Community Doula Program.