Whether you need a doula to participate in your antenatal care, your labour, your birth, or your postpartum care is a matter of personal choice. Some doulas are also trained to support women (and sometimes their whole families) in the wake of an abortion or losing a baby as a result of miscarriage or some other reason. It is important to note that doulas are not medically qualified to oversee labour and birth or to help you manage perinatal mental health problems. They are not trained in clinical tasks, nor are they lactation consultants, nurses, or able to diagnose pregnancy or postpartum problems unless they have additional medical qualifications. So, now that you know what they can’t do, you may be wondering...

What is the point of a doula in pregnancy?

Doulas can provide the experience, knowledge, and guidance to support both you and your baby’s father, who will need to take breaks and have things explained to them that cannot always be accommodated by a doctor or midwife caring for you. Different doulas will have different skill sets, so proper research on anyone you want to employ is essential. The following are some things they can offer:

Emotional support for you and your family
Support your labour and childbirth education.
Help with self-advocacy in clinical environments
Specialist support for coping with high-risk and complex pregnancies
Help with writing your birth plan
Help with labour and birth breathing, positions, and natural pain relief techniques.
Breastfeeding and newborn care support: Some doulas are trained to help you and your partner adapt to your “new normal” after your baby is born, including helping with establishing feeding and sleeping routines.
Preventing “obstetric violence”: “obstetric violence” is a rather controversial term that has emerged in the media and among anti-birth intervention advocates as the number of inductions, assisted deliveries, and caesarean sections has increased in the last two decades. Broadly, it refers to any situation in which a pregnant mother believes her perspective was ignored or disregarded by professionals during her care, though it can also be used to refer to specific episodes of abusive or neglectful behaviour towards her. As doulas act to amplify women's voices and educate them about their options in pregnancy, labour, and birth, they can be said to reduce a mum’s risk of obstetric violence.

What is the evidence for doula support?

More formal research is needed to fully capture the benefits of doula support, but we do have evidence that they can:

Decrease your risk of having pharmacological pain relief where you don’t want it.
Decrease your risk of medical intervention (though this is situational, some medical intervention may be vital to the health and wellbeing of you and/or your baby, and a doula will usually support this).
Decrease your risk of having a caesarean section
Help you feel more calm and confident in labour and birth.
Make breastfeeding success more likely.
Make the postpartum period easier for you and your partner to handle.

It is important to note that historically there was a strong tradition of providing what we now call doula support among minorities (e.g., African-American birth attendants in the American South), and the lack of adequate recognition and recording of their efforts means there may be a great deal more evidence that we do not have.

We must also acknowledge that the loss of community in our increasingly peripatetic world may be making doulas more necessary. A woman may simply want someone of her race, religion, or background to be in the delivery room when a member of her family can’t. A mother, sister, or friend can sometimes play a doula-like role, but this isn’t a gift afforded to women in every pregnancy, especially if she is giving birth far from her own birthplace.

Can’t the people giving me clinical care do all the things a doula does?

They can; the difference is typically that they have less time and many other concerns, especially if they are hospital or midwife-led unit employees rather than hired by you as private healthcare professionals. Hiring a doula is usually cheaper than hiring a private midwife or obstetrician, though obviously they have far fewer skills. It’s all about what you need to feel comfortable and supported throughout your pregnancy, labour, birth, and postpartum period.

How do I know a doula is legitimate?

Ask about their certification and experience, and check them out with reputable doula accreditation providers where you are in the world. If they are not certified, ask why not. Online reviews are nice but can often be faked or unhelpful. Membership with an industry body can show commitment to professional standards but also be paid for rather than given based on merit, so look for additional credentials. Asking about insurance is also a good idea, as insurance companies generally won’t work with someone who is not certified. You can also ask your obstetrician or midwife for a recommendation.

For more advice on taking care of yourself in pregnancy, labour, and birth, check out Unii’s Ultimate Antenatal Classes, with prenatal video episodes taught by senior NHS midwives, an award-winning obstetrician and gynaecologist, and six other leading healthcare experts. Now available at unii.com.

Antenatal Class Questions: Do I really need a doula?

Are doulas worth it? What can they do that a midwife can't?