How to Choose a Doula for Your Pregnancy and Childbirth

Pregnancy and childbirth are a very important time for you and your unborn child/ren. Having adequate support during your pregnancy and labor can remove a good deal of stress for you and help you to have a more peaceful birth experience.

What is a doula? A doula is a person who provides education and support for you during your pregnancy and labor. Some people will say that a doula is a labor coach, but truthfully, a doula does a lot more than merely coach you in the last few hours of your labor.

A midwife is someone that provides medical information, support and assists you in delivering your child. A midwife can also be a doula, but, unless a doula is medically certified as a midwife, a doula is not a midwife. A midwife is a medical position, a doula is not. I always tell people "Doula's coach. They don't catch!" It usually gets a laugh, and it is a way of explaining the difference quickly.

A doula does learn how to deliver a baby in an emergency situation, but this is not as a planned part of her experience. I have attended births where I was to have no part in the active part of delivery, but due to circumstances beyond the control of us who were present, I ended up being the person who assisted the infant into the world.

A good doula will answer questions for you. S/he will discuss what type of birth experience that you would like. S/he will discuss options that you may not be aware of. A good doula will work with you, your medical staff, and help to make your birth experience as close to what you would like as possible.

A good doula will also explain to you things that you need to consider, like the reality of having a completely pain free birth, or what could happen in an emergency delivery situation.

The doula will have loads of suggestions for you during your pregnancy, your labor, and your aftercare.

A good doula will also speak privately with only the mother to make sure that the birth experience that is being talked about is the one that she wants, not the one that she is only going along with to have less conflict.

Explaining different things that happen to you during your pregnancy is very helpful. One of my dearest friends who is a midwife loved it when we worked a birth together because we strongly believed that a birth needed to be as interference free as possible. When we were able to work as a team, it was truly wonderful because we would go to the pregnancy appointments together and make sure that the birth plan was being followed.

Now that you know the differences between midwives and doulas, you want to know how to choose a doula for you.

Ask questions. Ask lots of questions. Knowledge is power. Have a notebook to write things down, because you may get bombarded with information. I always distribute a binder with inserts that the pregnant woman and her support people can follow along with as I cover topics. It makes it much easier for everyone in the room, myself included. Not all doulas do this, so if yours does not, it does not make your doula inferior, it only means that her way is sharing information with clients is different than the way that I share information with clients.

Here are some questions I feel are important for my clients to know, as well as my answers, opinions or observations:

1. Who are you certified through? There are many certifying bodies in the world. Most of them will have an idea of what they believe, what they teach, and disciplines that they observe. It is a good idea to make sure that the doula you choose agrees with the birthing support process that you want to experience.
2. Are your doula's credentials current? Non-current credentials do not necessarily pose a problem. For some full time doulas, there is simply too heavy of a client base to be able to get time away from their work to retain certification. In other areas, doula certification is necessary to be allowed access in a hospital setting.
3. How long have you been a doula? Length of time as a doula does not mean that you will do a better or worse job than other doulas. It simply presents an idea of how much experience you have in working with pregnant women. Some doulas that I have been around have been at only one birth. Others have been to hundreds. Some experienced doulas are loving and compassionate. Others become very tired and it is simply a process of finishing a career and retiring. Make sure that the doula you choose is one that has an experience level you are comfortable with.
4. How long have you been a certified doula? There is a difference between being a doula and being a certified doula. A doula who is able to keep her certifications current may be very involved in the teaching role of your pregnancy, whereas one that is not current may be more experienced in the labor and delivery process.
5. What are your views on birth, the birthing process, aftercare and breastfeeding? If your views of childbirth are not the same as your doula, find a closer match. A client of mine wanted to have natural childbirth, but switched to me as a client at the last minute because her doula believed that all women would "cave in" at the last minute and have pain relief options. If you feel strongly about something, let your doula know so that you can discover whether or not you are a good match.
6. Do you have any children yourself? There are doulas who are wonderful women, able women and very competent as doulas, but they have never given birth. Yes, they are very supportive, but they can only offer textbook interpretations of what is going on in the labor process. This is a very individual decision of whether to use a doula who has never had a child.
7. If yes, did your birth experience go according to your birth plan, or your birth idea? Some of the best doulas in the world became a doula because of how horrible their experience was. They did not want anyone else to experience what they went through. Others experienced such a happy experience that they wanted every pregnant woman to be able to have as wonderful and rich an experience as they did.
8. Have you or a patient ever experienced a pregnancy loss such as miscarriage or stillbirth? If you are experiencing a pregnancy that may have a tragic end, knowing that you have a doula who has been through the same experience is something important to consider.

If you think of other questions, write them down as well. When I was looking for a doula to work under in order to gain some more useful experience, one of the women I called explained that she only worked with women of her faith, because that way, they would have their faith in common. Another woman shared with me that she only did home births because of her hatred of hospitals.

Make sure that if your doula has a list of what she is firm about that her list and yours blend well.

Some healthcare providers do pay for some or all of a doula's services. Check with yours and see if they will. Sometimes, you pay the doula and get reimbursed by the insurance, other times, your doula will be paid directly. You never know until you ask.

Make sure that if your insurance covers the costs of your doula, you learn what paperwork that you will need to submit.

If you don't know where to find a good doula, you have several choices. Ask friends and family. Ask your midwife or doctor. Call birthing centers and hospitals. Doulas are everywhere, you just have to know where to look. I had a friend who found her doula by asking on her social network sites. It worked! In less than a week, she had met and interviewed 3 doulas, narrowing the field down by asking a lot of questions.

Don't be afraid to ask questions. I cannot emphasize that enough. You are delivering a baby, so you need your support person to not only be there for you, but to support your decisions for you in a compassionate but firm way.

Yes, being a doula is a noble profession. We all love what we do, and bringing babies into the world is very gratifying. However, gratification is not going to pay the bills, unless it is financial gratification.

Doulas all charge different amounts, prices are according to many factors. Region, workload, experience, these are all factors in creating a wonderful birth experience for you, the client.

Most doulas offer a payment plan of some sort, and most of the time, payment is expected in full before the delivery date. Why? Because it becomes more difficult to gather funding after the little bundle of joy arrives.

A good doula will show you what she offers. Some doulas offer different services based on your needs and the type of birth that it will be. (Hospital versus home, or vaginal versus Cesarean section are examples of differences in price points.) She will outline how long she will be there for, she will show you what can cause additional fees, and she will also show what things can happen that she is not responsible for but that she will still get to keep her fees. (Examples are c-section in which she is not allowed to be in the room, or you birthing en route to birth location)

Doulas still need to be paid for the services that have been rendered because of all of the pre-birth time that was spent with you preparing you for your birth experience. I once had a client who disputed with me the maximum amount of time that I would spend with her before requiring extra time. My overtime meter kicks in at 12 hours of active labor supported by me. She said that since she paid, I should be there from start to stop. We finally agreed on a rate in the event that she went into overtime. It was a good thing for her, because she was a long labor. 36 hours! Remember that while you are laboring, your doula is supporting you and not leaving your side. It is exhausting work, and we all need to be compensated.

After the birth, when you are all settled back at home or settled in your home without all of the support of family and friends, your doula may come by if you have set it up, for a postpartum visit. This can be to ensure that you and the baby are doing well, and to give you information about breast feeding, diapering, baby support groups in your area and more.

It is always nice if you have a nice letter of thanks written to your doula, as well as pictures of everyone, including the doula with your lovely bundle/s of joy. Doulas LOVE adding these wonderful and heartfelt sentiments to their books. It is a source of pride for them.

A small gift is welcome, too. If in doubt about what to get, I always suggest gift cards. They are the perfect size and everyone loves them!

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