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A doula (left) using comforting touch to help alleviate contractions during labor.

A doula (/ˈdlə/), also known as a birth companion, birth coach or post-birth supporter,[1] is a non-medical companion who supports a birthing woman by providing continuous care before, during, or after childbirth in the form of information, physical support, and emotional support. They also may provide support to the partner and family.[2] Unlike a midwife, doulas are not medical professionals and therefore cannot administer medication. Doulas are typically certified with some courses taking over a year to complete. Practical training is involved to become certified.[3] Support from a Doula may also reduce the woman's negative feelings about their experience.[4][5]

There is a movement to encourage certification, and provide documentation of it on consumer websites such as DoulaMatch where an individual can find certified doulas, childbirth educators, yoga instructors, and other birth-related professionals.[6] Doulas not trained by a formal organization can be controversial within medical settings due to a lack of formal medical education when a discussion regarding medical interventions in labor versus pursuing natural childbirth without an epidural or caesarean section arises; however, the role of the doula is not to offer medical advice.[7]


History and etymologyEdit

Doulas first emerged from the grassroots natural birth movement in the 1960s when women began desiring unmedicated, low-intervention births and began to have friends and childbirth educations provide them support during childbirth.[8] The term doula was first used in a 1969 anthropological study conducted by Dana Raphael, a protégée of Margaret Mead, with whom she cofounded the Human Lactation Center in Westport, Conn. in the 1970s.[9] Raphael suggested it was a widespread practice that a female of the same species be part of childbirth, and in human societies this was traditionally a role occupied by a family member or friend whose presence contributed to successful long-term breastfeeding.[9] Raphael derived the term from modern Greek (δούλα, doúla (pron. /ˈðula/), "servant-woman"), as told to her by an elderly Greek woman,[10] Eleni Rassias.[11] Raphael also describing it as coming from "Aristotle's time", an Ancient Greek word δούλη meaning "female slave".[12]

Dr Marshall Klaus and Dr John Kennell, who conducted clinical trials on the medical outcomes of doula-attended births, adopted the term to refer to a person providing labor support.[13] In 1992, Doulas of North America (later DONA International) was co-founded by Klaus, Kennell, Phyllis Klaus, Penny Simkin, and Annie Kennedy becoming the first organization to train and certify doulas.[14][15] The organization with the backing of the research of Kluas and Kennell helped to lend credibility and professionalize doulas.[16]

Due to the lobbying efforts of DONA International, the term doula was accepted into the American Heritage Dictionary and Oxford Dictionary in 2003, followed by Merriam Webster Dictionary in 2004.[17] In 2008, The Doula Project in New York City began working as abortion doulas and coined the term "full-spectrum doula" who support all pregnancy experiences and outcomes.[18]

Types of supportEdit

The overall goal of a doula is for the pregnant woman to feel safe, be informed and feel comfortable, enhancing the role of doctors and nurses which is to ensure safe delivery of the baby. Doulas have no clinical role, duties or decision-making.[6]


A birth doula is also called a labor doula. The kinds of support provided during childbirth may include physical assistance and comfort (massage, maintaining a supporting posture or providing water), emotional support (providing company, encouragement or simply talking in a soothing tone of voice), and acting as an advocate during childbirth (supporting the birthing woman's right to make decisions about their own body and baby to the medical team).[3][2]

Most doula-client relationships begin a few months before the baby is due. Before the labor, the doula and the family can develop a relationship where the pregnant woman and their support person (for example the father of the baby) feel free to ask questions and express fears and concerns, and create a birth plan.[12] The continuous care provided by doulas has been found to improve birth outcomes, reduce health disparities, and produce more satisfying birth outcomes.[19]

Doulas may be found in hospital, community-based programs as well as private practice, doula agencies and may be reimbursed by insurance companies or out-of-pocket by clients.[6][3][20] Because insurance companies typically do not cover the cost of hiring a doula, they are more popular among middle- and upper-class parents.[7][21] Since doula care has the potential to lower maternity costs and reduce health disparities, there is a push to cover doula services through Medicaid reimbursement programs. Three states, Oregon, Minnesota, and Wisconsin, have currently implemented reimbursement programs.[19] In 2019, New York State launched a doula pilot program for Medicaid reimbursement in Erie and Kings Counties.[22]


An antepartum doula provides help and support to someone who has been put on bed rest or is experiencing a high-risk pregnancy. Emotional, physical and practical support can be provided by an antepartum doula in these circumstances.


Postpartum doulas provide educational support and practical support in the home in the first weeks and months after childbirth or after adding an infant to the family. The same doula often provides both birth and postpartum services.[23] Their services include a mixture emotional support and practical help, such as infant care, breastfeeding support, information, advocacy and referral, partner support, sibling care, and household organization/work as the family adjusts to the addition of a new baby.[24] There is some evidence that postpartum doula support can increase breastfeeding and decrease postpartum depression.[2][25]

Other workers providing similar services are maternity nurses, newborn care specialists, and, historically, monthly nurses.


Full-spectrum doulas extend the role of a birth attendant and provide support for all reproductive experiences which connect the role to the larger reproductive justice movement. This can include support for abortion, miscarriage, stillbirth, queer family planning, adoption, and fertility as well as extending services to women, men, transgender and gender non-conforming individuals.[26][27][28] Full-spectrum doulas often identify as activists as well as service providers and emphasize the human rights of their clients in the hopes of ending social stereotypes.[28]


Death doulas care for critically ill adults in geriatric care,[3] and during death.[29]

Medical aspectsEdit

Continuous support during labor provided by doulas has been associated with improved outcomes for both birthing women and babies, including shorter delivery, fewer caesarean sections and complications, the use of fewer medications and fetal extraction tools, less time in neonatal intensive care units, positive psychological benefits, more satisfying birth experiences, and increased breastfeeding.[3] Cross-country research on the effects of doulas on childbirth and postnatal care is complicated by the variety of settings, cultures and medical systems of individual countries and characteristics of patients.[3] These benefits appear to be contingent on the doula's providing continuous rather than intermittent assistance, have some medical training and on the specific social and cultural setting within which their services are provided.[3] Doula care can help reduce health disparities of those with the greatest need including those with less education, lower incomes, less preparation for childbirth and those lacking social support .[3][19] Research also supports the effectiveness of female friends or relatives, after minimal training, as a low-cost alternative to professional doulas.[30]

Doulas can provide information about medications or medical interventions during childbirth and help the family decide if their practice fits the family's birth wishes such as those who decide to have an epidural or otherwise do not undertake natural childbirth.[7][31] Doulas acting beyond the role of social support and advocacy by providing medical advice, practicing outside their scope of practice may be acting as a traditional birth attendant.[6]

In March 2014, the ACOG put out a Consensus Statement titled "Safe Prevention of Primary Cesarean Delivery" in which it said, "Increasing [a woman's] access to non-medical interventions during labor, such as continuous labor support, also has been shown to reduce cesarean birth rates."[32] As more research has become available on the positive benefits of trained labor support provided by someone not employed by the hospital, in 2017 ACOG officially announced the need for all birthing individuals to have access to continuous labor support outside hospital staff, and said, "Evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support provided by support personnel, such as a doula, is associated with improved outcomes."[33][34] The official committee opinion put out by ACOG also offers other recommendations that allow birthing women more choice and access to more supportive care. Doulas could be utilized to help achieve many of these recommendations as they move towards better collaboration.[35]

In 2017 the United Kingdom's Royal College of Midwives published a position statement on doulas, which supports the choice of the individual to hire a doula for their birth as long as the doula does not provide medical care.[36]

Motivations and challengesEdit

In 2010, a survey of professional Canadian doulas found that the common motivations for doula work include "desire to support women in childbirth, personal interest, and a wish to share their own positive birth experience with others" but didn't see the work as a means to create steady income.[37] Doulas of color also found motivation in providing care for their racial, ethnic and cultural communities so as to provide culturally competent care.[38] Volunteer doulas often saw doula work as a way to "help others, to establish a practice as an employed doula, and to have a route into nursing or midwifery."[39]

A 2004 study of North American doulas identified challenges to doula work such as lack of support from clinicians, balancing doula work with family and other work obligations, and being on call.[40] Volunteer doulas also found challenges in individuals' poor understanding of the doulas role, lack of clear boundaries, and complex socio-economic issues.[39]

In the UK, the National Health Service and promotion of midwifery for low-risk pregnancies provide a continuity of care not available to North American pregnant individuals, but still are seeing an upswing in doulas. This pattern has been suggested to be a result of the lack of midwives available and a move to provide doulas to individuals at greater risk for poor outcomes.[39]

Training and certificationEdit

There is no law requiring doulas to become certified, however certification can benefit professional doulas by providing structured education prior to entry into the field, access to a mentor, opportunities for networking, and client confidence.[41] In North America, training generally takes the form of a two- to three-day seminar, and some experience with childbirth.[42] Trainees may have hands-on practice with various techniques used during childbirth, including maternal positions and movements, relaxation and breathing exercises and other measures that could be used for comfort. Certification can occur through organizations at various levels (local, national or international) and some require positive evaluations from medical professionals. Certification may also require, in addition to attending a training course, time spent working or learning about maternity care and childbirth classes and possibly a written exam.[3] Some doulas train through distance education.[6]

Major doula organizations that offer certification programs include Birth Works, Birthing from Within, Childbirth and Postpartum Professional Association (CAPPA), DONA International, International Childbirth Education Association (ICEA), and Hypnobirthing.[43] Because of the lack of standardization, doula organizations provide different courses with varying requirements and anyone can refer to themselves as a doula.[31], an online referral page for doulas, has offered a list of items that students should look for as they begin looking for training. Amy Gilliland, a researcher on doula care and culture, also lists some qualities a training program should have.[44] Some theorists have stated that it may take college-level work or more in-depth online education in order to provide some of the communication skills that may be necessary.[45] Being a doula does not specifically require any medical training, although it is common for doulas to have received medical training of some kind.[7]

Disputes between doctors, nurses and doulas have sometimes been described as a "turf battle,"[7] though it is also recognized that doulas and nurses can occupy complementary roles that provide opportunities for mutual learning and assistance.[6] Some hospitals have created internal doula training programs to reduce conflict between doulas and medical staff.[7][46]

See alsoEdit


  1. ^ "What is a doula?". Doula UK. Archived from the original on 2014-12-07. Retrieved 2014-12-04.
  2. ^ a b c "Evidence on: Doulas". Evidence Based Birth®. 2017-08-14. Retrieved 2019-03-30.
  3. ^ a b c d e f g h i Balas MC, Gale M, Kagan SH (August 2004). "Delirium doulas: an innovative approach to enhance care for critically ill older adults". Critical Care Nurse. 24 (4): 36–46. PMID 15341233.
  4. ^ Ollove M (2017-08-17). "Cities Enlist 'Doulas' To Reduce Infant Mortality". Huffington Post. Retrieved 2018-01-23.
  5. ^ Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa, RK, Cuthbert A (2017). "Continuous support for women during childbirth". The Cochrane Database of Systematic Reviews. 7 (7): CD003766. doi:10.1002/14651858.CD003766.pub6. PMID 28681500.
  6. ^ a b c d e f Ballen LE, Fulcher AJ (2006). "Nurses and doulas: complementary roles to provide optimal maternity care". Journal of Obstetric, Gynecologic, and Neonatal Nursing. 35 (2): 304–11. doi:10.1111/j.1552-6909.2006.00041.x. PMID 16620259.
  7. ^ a b c d e f Hwang S (2004-01-19). "As 'Doulas' Enter Delivery Rooms, Conflicts Arise: Hired to Help in Childbirth, They Sometimes Clash With Doctors and Nurses". The Wall Street Journal.
  8. ^ Torres JM (July 2013). "Breast milk and labour support: lactation consultants' and doulas' strategies for navigating the medical context of maternity care". Sociology of Health & Illness. 35 (6): 924–38. doi:10.1111/1467-9566.12010. PMID 23398567.
  9. ^ a b Roberts S (February 19, 2016). "Dana Raphael, Proponent of Breast-Feeding and Use of Doulas, Dies at 90". The New York Times. Retrieved January 17, 2017.
  10. ^ Jones M (December 21, 2016). "Dana Raphael Opened Up the Mysteries of Nursing". NYT Magazine. Retrieved January 17, 2017.
  11. ^ Raphael D (1973). The Tender Gift: Breastfeeding.
  12. ^ a b Mander R (2001). "The doula". Supportive care and midwifery. John Wiley & Sons. pp. 113–33. ISBN 978-0632054251.
  13. ^ Klaus MH, Kennell JH, Klaus PH (2002). The Doula Book: How A Trained Labor Companion Can Help You Have A Shorter, Easier, And Healthier Birth. Da Capo Press. p. 4. ISBN 978-0738206097.
  14. ^ Torres JM (July 2013). "Breast milk and labour support: lactation consultants' and doulas' strategies for navigating the medical context of maternity care". Sociology of Health & Illness. 35 (6): 924–38. doi:10.1111/1467-9566.12010. PMID 23398567.
  15. ^ "History of DONA International". DONA International. Retrieved 2019-04-09.
  16. ^ Simonds W, Rothman BK, Norman BM (2013-10-23). Laboring On: Birth in Transition in the United States. Routledge. ISBN 9781135939984.
  17. ^ "History of DONA International". DONA International. Retrieved 2019-04-09.
  18. ^ Mahoney M, Mitchell L (2016-10-17). The Doulas: Radical Care for Pregnant People. The Feminist Press at CUNY. ISBN 9781558619494.
  19. ^ a b c Strauss N, Giessler K, McAllister E (2015). "How Doula Care Can Advance the Goals of the Affordable Care Act: A Snapshot From New York City". The Journal of Perinatal Education. 24 (1): 8–15. doi:10.1891/1058-1243.24.1.8. PMC 4720857. PMID 26937157.
  20. ^ "Career Choices for Becoming a Doula". Become a Doula with ProDoula. Retrieved 2016-04-18.
  21. ^ "Doulas, a Mom's Best Friend During Labor, Grow in Popularity". 2010-02-22. Retrieved 2014-02-02.
  22. ^ "New York State Doula Pilot Program". Retrieved 2019-03-30.
  23. ^ "DONA International – What is a doula?". Retrieved 2014-02-02.
  24. ^ Gjerdingen DK, McGovern P, Pratt R, Johnson L, Crow S (January 2013). "Postpartum doula and peer telephone support for postpartum depression: a pilot randomized controlled trial". Journal of Primary Care & Community Health. 4 (1): 36–43. doi:10.1177/2150131912451598. PMID 23799688.
  25. ^ "Overdue: Medicaid and Private Insurance Coverage of Doula Care to Strengthen Maternal and Infant Health" (PDF). National Partnership for Women and Families. January 2016.
  26. ^ Chor J, Goyal V, Roston A, Keith L, Patel A (April 2012). "Doulas as facilitators: the expanded role of doulas into abortion care". The Journal of Family Planning and Reproductive Health Care. 38 (2): 123–4. doi:10.1136/jfprhc-2011-100278. PMID 22454010.
  27. ^ "A Call for "Full Spectrum" Doulas". Birth Arts International. 2015-08-19. Retrieved 2019-03-30.
  28. ^ a b Mahoney M, Mitchell L (2016-10-17). The Doulas: Radical Care for Pregnant People. The Feminist Press at CUNY. ISBN 9781558619494.
  29. ^ Slevin D (2016-04-10). "Doulas For The Dying". Huffington Post. Retrieved 2016-04-11.
  30. ^ Campbell D, Scott KD, Klaus MH, Falk M (September 2007). "Female relatives or friends trained as labor doulas: outcomes at 6 to 8 weeks postpartum". Birth. 34 (3): 220–7. doi:10.1111/j.1523-536X.2007.00174.x. PMID 17718872.
  31. ^ a b Paul P (2008-03-02). "And the Doula Makes Four". The New York Times. Retrieved 2012-03-22.
  32. ^ American College of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine (March 2014). "Obstetric care consensus no. 1: safe prevention of the primary cesarean delivery". Obstetrics and Gynecology. 123 (3): 693–711. doi:10.1097/01.AOG.0000444441.04111.1d. PMID 24553167.
  33. ^ Kozhimannil KB, Hardeman RR, Attanasio LB, Blauer-Peterson C, O'Brien M (April 2013). "Doula care, birth outcomes, and costs among Medicaid beneficiaries". American Journal of Public Health. 103 (4): e113–21. doi:10.2105/AJPH.2012.301201. PMC 3617571. PMID 23409910.
  34. ^ Committee on Obstetric Practice; American College of Obstetricians and Gynecologists (February 2017). "Committee Opinion No. 687: Approaches to Limit Intervention During Labor and Birth". Obstetrics and Gynecology. 129 (2): e20–e28. doi:10.1097/AOG.0000000000001905. PMID 28121831.
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  37. ^ Eftekhary S, Klein MC, Xu SY (July 2010). "The life of a Canadian doula: successes, confusion, and conflict". Journal of Obstetrics and Gynaecology Canada : JOGC = Journal d'Obstetrique et Gynecologie du Canada : JOGC. 32 (7): 642–9. doi:10.1016/S1701-2163(16)34567-4. PMID 20707952.
  38. ^ Hardeman RR, Kozhimannil KB (November 2016). "Motivations for Entering the Doula Profession: Perspectives From Women of Color". Journal of Midwifery & Women's Health. 61 (6): 773–780. doi:10.1111/jmwh.12497. PMC 5143171. PMID 27862907.
  39. ^ a b c Spiby H, Mcleish J, Green J, Darwin Z (September 2016). "'The greatest feeling you get, knowing you have made a big difference': survey findings on the motivation and experiences of trained volunteer doulas in England". BMC Pregnancy and Childbirth. 16 (1): 289. doi:10.1186/s12884-016-1086-6. PMC 5041283. PMID 27680500.
  40. ^ Lantz PM, Low LK, Watson RL (December 2004). "Doulas' views on the rewards and challenges of their work". International Journal of Childbirth Education. 19 (4): 31.
  41. ^ Simonds, Wendy; Rothman, Barbara Katz; Norman, Bari Meltzer (2013-10-23). Laboring On: Birth in Transition in the United States. Routledge. ISBN 9781135939984.
  42. ^ "Doula Training Become A Doula". ProDoula. Retrieved 2016-04-18.
  43. ^ "Childbirth Education and Doula Organizations | Transforming Maternity Care". Retrieved 2019-04-01.
  44. ^ Leavitt R (2017-06-13). "What Makes the Best Doula Training Program?". New Beginnings Doula Training. Retrieved 2018-07-08.
  45. ^ Meadow SL (December 2015). "Defining the doula's role: fostering relational autonomy". Health Expectations. 18 (6): 3057–68. doi:10.1111/hex.12290. PMC 5810740. PMID 25327532.
  46. ^ "Hospital "Credentialing" For Doulas? Yea or Nay?". Become a Doula with ProDoula. 2015-10-24. Retrieved 2016-04-18.

Further readingEdit

External linksEdit

00:08, 12 January 2018 (UTC)