Should I Hire A Doula? What You Need to Know About Getting a Birth Doula

Being pregnant for the second time—and the first time since becoming a doula—I’ve been thinking a lot about what I would tell myself as a first-time mom. One of the big questions I had during my first pregnancy was whether or not to hire a doula.

I remember not really understanding what a doula even was and why people hire one—I would have my husband there supporting me, after all, so why would I also need a doula?

The reality is that I had no idea what to expect, I didn’t educate myself properly, and I went into the birth without much planning or understanding. And certainly no doula. Let’s just say I spent my time doing a lot of anxious Google “researching” (read: spiraling) and not a whole lot of productive self-education. The outcome was about as dissatisfying as you might expect.

But you are different. You understand something that I did not the first time around. You’re taking the initiative and doing the research on whether or not to hire a doula, and this is such an important step in preparing for your birth.

You have come to the right place to get all of your doula-related questions answered and help you come up with the best answer for yourself. As someone who learned things the hard way and then spent years afterward immersed in research, education, and hands-on experience, I understand firsthand the many benefits people experience when they have a doula at their birth. And now I’m here to share that knowledge with you!

Believe it or not, though, I’m not interested in convincing you to hire a doula if it won’t actually serve you. My number one priority is to give you a realistic view of what a doula does and answer some of the most frequently asked questions about this topic. This way, you can decide for yourself what’s the right choice for you! So, without further ado, let’s jump in on why or why not you should hire a doula.

Here’s everything this post covers:

• What a Birth Doula Does
• What a Birth Doula Doesn’t Do
• Benefits of Birth Doula Support
• Will a Doula Take Over Your Partner’s Role?
• How Will Your Provider Feel About A Doula?
• Reasons Not to Hire a Doula
• What if You’re Planning a C-section or Epidural?
• Final Thoughts

Before we dive in, I just wanted to quickly mention that this post only covers birth doulas. There are several different types of doulas, like postpartum doulas, fertility doulas, death doulas, etc., which all deserve their own in-depth explanation and will not be covered here. Ok, that’s enough of an intro; let’s get on with the important stuff!

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What a Birth Doula Does

Before you determine whether or not you should hire a doula, it’s important to know exactly what their role entails.

Here is an overview of the main ways that a birth doula can support you through the childbearing process:

• Provides physical and emotional support to you during labor and delivery.
• Provides education to you and your partner prenatally.
• Helps you prepare for birth in a way that’s aligned with your goals and preferences.
• Provides emotional and educational support to the birth partner and other family members. This can include teaching your partner comfort measures, preparing older children for a new sibling, and offering resources to family members.
• Helps you advocate for yourself during your pregnancy, birth, and the immediate postpartum.
• Utilizes and shares evidence-based resources to help with informed decision-making.
• Assists you with birth planning and often postpartum planning.
• Provides you with referrals, such as mental health resources, lactation consultants, pelvic floor specialists, nannies, and housecleaners.
• Connects you with local community support networks, such as infant feeding support groups, new parents’ groups, and playgroups.

Every doula will do things a little bit differently, so it’s best to ask exactly what an individual doula’s care package looks like before signing on. This way, you can make sure you find someone that aligns with your goals and expectations.

What a Birth Doula Doesn’t Do

When deciding whether to hire a doula, it’s also crucial to understand what is not included in their role. This will ensure that you get the care and support you’re looking for from the right kind of professional. And that you don’t expect something from a doula that they aren’t able to provide safely.

• A doula is not a medical professional and cannot give any medical advice or clinical support. They aren’t a replacement for a midwife or physician and aren’t trained to help physically deliver your baby. A good doula will make it clear that you should not take medical advice from them and will direct you to your provider if you bring up any questions outside of their scope.
• A doula can’t make decisions on your behalf, but they can help support you (and your partner) in advocating for yourself. This can include helping you identify aspects of your care that are important to you and providing you with evidence-based resources and information. They can also teach you tools for decision-making under pressure and remind you of your previously discussed preferences, which can come in handy during labor.
• Doulas can’t guarantee a specific birth outcome. Even though having doula support can increase the likelihood of a positive birth outcome (more on that in the next section), they can’t guarantee that your birth will end up a certain way.
• Doulas aren’t super-humans! Even with the best intentions and planning, there is a small chance that the doula you hire will get sick or be suddenly unable to make it to your birth. Sometimes, births happen so fast that they don’t make it in time, and sometimes, the labor lasts an extra long time, and they may need to leave and come back or call in for backup. Most of the time, doulas are connected with others in the community who can back them up if the unforeseen happens, so you’re not left without doula support. If you hire a doula, this is another thing that would be good to discuss before the birth, just so you’re on the same page.

Benefits of Birth Doula Support

People choose to hire a doula because of the many evidence-based benefits that the right kind of support can offer the birthing person and their family.

I won’t go too deep on everything here because this topic really deserves its own write-up. For the purposes of deciding whether or not to hire a doula, here is an overview that covers the basics of evidence-based benefits of having a doula.

Doula support is associated with the following:

• a lower risk of cesarean and vacuum- or forceps-assisted birth,
• a lower risk of interventions, like labor augmentation,
• a lower likelihood of needing pain medication,
• higher satisfaction with the birth experience,
• higher APGAR scores for the baby at birth,
• a shorter labor, and
• a lower likelihood of developing postpartum depression.

For more on the evidence supporting the benefits of having a doula, I recommend checking out this article by Evidence Based Birth. It’s an excellent article that dives deep into the research and the reasoning behind how doula support can help improve outcomes to such a significant extent.

Will a Doula Take Over My Partner’s Role?

This is a common question I get when I tell people I’m a doula. And I get why; I had the same thought when I was expecting my first.

The answer? No, a doula’s job is not to replace the partner. Since we already covered what a doula does in earlier sections, let’s take a look at the ways that a doula can also benefit you by supporting your partner during birth.

• Prenatally, a doula can help prepare your partner with how to support you physically and emotionally when it’s baby time.
• During labor, a doula can help remind your partner of comfort measures they may have reviewed beforehand. This could look like helping your partner with hand placement so they can best physically support you, reminding them to regularly offer you sips of water, and having them take over the hands-on support role, relieving them when they start getting fatigued so you don’t have to go without continuous support.
• Another way a doula can help support your partner is by reminding them to care for their basic needs–eating, drinking, resting, etc. Especially during a longer labor, it can be difficult for the partner to remember to do this for themselves, or they may feel guilty stepping away to care for themselves while you need their support. But it’s in everyone’s best interest for your partner to have their basic needs met so they can best support you.
• While birth can be unpredictable, doulas can often tell when things are shifting–either into the more intense phase of labor (called transition) or if you’re really close to actually birthing your baby. So they can often relieve your partner at a good time, but make sure they make it back to support you through the parts when you need them most.

Although a doula’s role is not to replace a partner, there are plenty of situations where a birthing person might want a doula to be the primary birth support person during their labor. Common reasons for this include being a single parent, having a partner who can’t be there in person, or having a partner with a disability that makes it harder for them to provide hands-on support.

I will add that evidence on birth support suggests that the presence of both a birth partner AND a birth support person who is not a friend or family member (e.g., a doula) is correlated with the most benefit. So, if you are looking to hire a doula as your primary support person, having another trusted friend or family member present, too, might be something to consider.

Whatever your situation, a doula has a unique and important role in providing support during birth and can benefit both you and your partner.

How Will My Provider Feel About a Doula?

As we previously discussed, doula support is correlated with improved outcomes, including increased satisfaction with the birth and lower intervention rates. In fact, the American College of Obstetricians and Gynecologists (ACOG) has issued a committee opinion that is favorable of doula support and points to the improved satisfaction and outcomes seen when doulas are present.

As a doula, I have encountered providers with a wide range of attitudes toward birth doulas. Providers who are up-to-date on the evidence and committed to patient autonomy and improved outcomes will ideally use this knowledge to inform their attitude toward doulas.

However, you won’t know how your provider will feel about you having a doula without talking to them about it first. Even if you are working with a group practice and you don’t know which provider will be attending your birth, it’s a good idea to get a feel for how the practice or labor and delivery staff feel about doulas.

I recommend this not because I think your provider’s opinion should inform your decision about whether or not to hire a doula. It’s actually a really good way to see if your provider will be supportive of things that doulas represent, such as self-advocacy and empowerment. Even if you don’t ultimately want to hire a doula, it may not be the best choice to go with a provider whom you know is unsupportive of this kind of support during birth.

Ultimately, you won’t know the answer until you have this conversation with your doctor or midwife, and it’s a good idea to do so! While some providers and facilities may not be super doula-friendly, many love having doulas present. I’ll finish off this section by sharing one OB’s account of why she chose to have a doula at her birth.

Reasons Not to Hire a Doula

While I believe every pregnant person deserves to have access to a doula, actually having one is not the right choice for everyone.

As stated at the beginning of this post, my objective is not to convince you to hire a doula for your birth. There are certainly some very valid reasons not to hire a doula, and there are great alternatives for birth support if you decide not to. The important thing is that you have a solid support plan, not that it includes the presence of a trained doula.

Here are some reasons people may not hire a doula for their birth:

• You feel confident without an additional support person. Maybe you have a solid support team with a trusted midwife and birth assistant, your best friend is great with their hands and always knows what to say, and your partner is confident in their ability to support you, too. If you feel like you will be supported fully, that’s great!
• Your number of visitors is limited. Most hospital policies I’ve encountered will allow a certain number of visitors to be with you while you’re laboring in addition to a doula, and they may allow more people in the room for the actual delivery. There may be some hold-over lower visitor numbers from the pandemic, but they are likely more relaxed now. To be safe, it’s best to check your facility’s policy before you make this decision based on the number of support people you plan to have.
• It’s not in your budget, or you can’t find a doula you align with. I’m working on a whole post about what to do if you can’t afford a doula that goes into strategies for finding free, affordable doula support, as well as information for your chosen support person/people to help them better support you in labor. If you’d like to be notified when the post is published, please sign up for my email list!
• You want to keep the number of people at your birth to a minimum. Plenty of people want to give birth with as few people in the room as possible, regardless of the benefits extra support can offer. It’s a totally valid decision, but only you can know if it’s right for you. I would also suggest doing some introspection about your why and weighing the pros and cons of having an extra support person focused on you.
• You just don’t want to! Only you can know how comfortable you are with your birth support plan, and if it does not include a doula, then there is absolutely no requirement to have one. What matters is that you feel supported and make your own decisions, doula or not.

Do You Need a Doula if You’re Planning on an Epidural or a C-Section?

Regardless of how you plan to birth your baby, it will be a new, intense, and life-changing experience, and one for which you deserve all the support. Doulas provide support that improves birth experiences and outcomes whether you have an epidural, cesarean, or unmedicated vaginal birth.

Let’s focus for a moment on how birth satisfaction is improved, regardless of delivery method. In my view, it usually comes down to a sense of autonomy, control, and decision-making. All of these things are big factors in the case of epidurals and c-sections too.

If the birthing person feels supported and empowered in making their own decisions, they are more likely to end up feeling satisfied and positive about their birth. The presence of a doula can help you plan for this beforehand and make informed decisions in the moment so you can adequately advocate for yourself.

In the case of a planned c-section, this could look like asking for a clear drape to view the baby coming out, preferences on immediate skin-to-skin or attempting to latch the baby in the OR, or even wanting some essential oils to calm any anxiety and distract from unfamiliar smells and sensations.

For an epidural, this could include regular position changes in bed to help your baby descend, helping you get into an alternative epidural-friendly birthing position, or supporting you through any breakthrough pain or discomfort during the birth.

It’s also worth mentioning that sometimes even our best-laid plans fail. People sometimes end up going into labor naturally before the date of their planned cesarean or induction. Epidurals, while usually very effective, are not instant and not always 100% pain-relieving. Certain conditions (like severe scoliosis) can make it tough for an epidural to be effective, and sometimes, labor progresses faster than the epidural can be administered.

This is all just to say that it’s a good idea to be prepared for laboring without pain medication, even if it’s in your plan. Being prepared for the “what if” scenarios and having a doula to rely on for support throughout can be the difference between a stressful change of events and an empowering birth. It can be invaluable to have someone to ask questions to and support you during these events, whether planned or not.

As a doula, I’ve supported people with and without epidurals and with both vaginal and cesarean births. In each of these births, I have been able to offer significant, ongoing, personalized support throughout. Many of the important aspects that doulas can help with, like advocacy, body positioning, and support through unknown and physically uncomfortable experiences, are relevant in these scenarios as well, and there are many ways doulas are able to be supportive through each.

Final Thoughts

In summary, doulas have many benefits and can improve birth outcomes and satisfaction. There is evidence to support these improved outcomes, and a good provider will be in favor of you hiring a doula if that’s what you want. You can still greatly benefit from doula support even if you’re planning a C-section or epidural, and they aren’t there to replace your partner at your birth.

That said, a doula is also not the right choice for everyone. You should first consider your personal feelings about how you want to be supported during your birth and make your decision from there.

Hopefully, this post has shed some light on whether or not to hire a doula for your birth! But if you’re still not sure what to decide, you can interview a few local doulas to see if they would be a good fit, ask friends or acquaintances about whether or not they had a doula (or would for their next birth), talk it over with your partner, and do some introspection about what adequate and empowering support looks like for you.

Best of luck with your decision and your birth! If you need more information about how to find a doula, how your partner can best support you in labor, or any other pregnancy, birth, or postpartum-related content, please check back soon or sign up for my email list to be notified of new posts. I love sharing important, helpful information like this with people like you, and have a ton of related content in the works.