What Is A Doula?
In the ancient Greek, the word doula means servant - usually the most favored female servant in the ancient Greek household who would be honored by attending the lady of the house during the birth of her child. Today, the word doula means a woman who has received training by one of several international organizations and attends women and their families during birth.

What Does A Doula Do?
A doula adheres to a set of standards and provides emotional, educational and physical support prenatally and continually during labor and birth. Doulas do NO clinical tasks and intertwines her care with the wisdom of nurses, midwives and physicians. Doulas may be trained in the use of massage, breathing techniques, relaxation, acupressure, hydrotherapy, aromatherapy, physiologic positioning to enhance labor as well as the anatomy and physiology of the childbirth process.

Twenty years of research and a multi-clinical trial study show that doulas can have a significant impact on the birth process. It is important to point out, however, that if a birthing facility has taken steps to reduce the cesarean section rate, then the first percentage value may not be precise.

• 50% reduction in the cesarean rate
• 25% shorter labor
• 60% reduction in epidural requests
• 40% reduction in oxytocin (pitocin) use
• 30% reduction in analgesia use
• 40% reduction in forceps delivery
  Excerpted from Mothering the Mother: How a Doula Can Help You Have a Shorter Easier and Healthier Birth, Klaus, Kennell, and Klaus (1993).

What Does A Doula NOT Do?
A doula does not speak for her client(s) but empowers the client to make informed decisions about labor and birth. A doula does not work against the better health wisdom for her client nor does she encourage or participate in creating a confrontational environment, either prenatally or during labor/birth. A doula does NO clinical tasks such as vaginal exams, monitoring/interpreting fetal heart rates or recommending certain modes of treatment. Doulas do not deliver babies.

What Is The Difference Between Doulas, Labor & Delivery Nurses, Midwives and Monitrices?
A doula provides emotional, educational and physical support. A labor & delivery nurse tends to the clinical considerations during labor and birth in a hospital or birth center setting. A nurse may also study further to be a midwife (certified nurse midwife) or a monitrice. A midwife may practice with other midwives or with a physician or group of physicians and can prescribe medications and deliver babies. A monitrice (may be a nurse or midwife) is someone who has received professional training for clinical skills (fetal heart tones, blood pressure checks, and vaginal exams).

Will The Doula Take The Place Of The Partner or Husband?
The doula can actually bring the couple closer. By making sure that the partner's needs are met (food, drink, occasional back rubs, and reassurance), the woman and partner can work more closely together. The doula allows for the partner to participate at his own comfort level. Some husbands prefer to be there only to witness the birth of their child and to share this experience with the woman they love. They may not want to play an active role and do not want to be responsible for the woman's comfort and emotional security. The doula can fill in and allow the partner to participate as he wishes, without leaving the woman's needs unmet. When the husband chooses to be the major source of emotional support, the doula can supplement his or her efforts by running errands, making suggestions for comfort measures, and offering words of reassurance and comfort. During a long tiring labor, she can give the husband a break for a brief rest or change of scene. While the doula probably knows more than the husband about birth, hospitals, and maternity care, the husband knows more about the woman's personality.

Do Women Who Choose Epidural Anesthesia Still Benefit From Doula Service?
There is a myth that doulas only provide care for those interested in natural childbirth/unmedicated births. Far from the truth! Doulas provide care for women with and without medication, women who have vaginal births, unaccompanied teen mothers, women who have disabilities, women who plan cesarean sections, women who have unplanned cesarean sections or women who are planning a TOLAC (trial of labor after cesarean) or VBAC (vaginal birth after cesarean). Since the core of the doula's belief is to make this the very best birth experience for a woman, the doula can be a benefit regardless of the special circumstances surrounding a birth.

How Much Do The Services Of The Doula Cost?
The cost of doula varies with geography and with the extended expertise of the doula. Extended expertise of doulas may include training as a certified lactation consultant, childbirth educator, nurse, or perinatal exercise specialist. Doulas who have been practicing for many years and have extensive experience may charge more.

What Kind Of Training Do Doulas Receive?
There are several organizations that provide doula training: DONA, ALACE, Childbirth Enhancement Foundation, Lamaze International and ICEA. A doula trainee does not have to be married nor should she have had children to be compassionate during labor/birth. Just as each educational institution in the U.S. varies, so does the training differ between these organizations and even between the trainers in each organization. General pre-requisites include reading a certain number of books, attending childbirth classes (she may even be a certified childbirth educator) and having a heart for women and birth, attending a lengthy workshop, acting as a doula for a certain number of births as a trainee, and making a formal application to the organization either in an essay or exam format. Perinatal Education Associates, Inc. provides DONA approved trainings.

Are There Liability Considerations With Doulas?
Typically, there are no liability considerations with doulas since they perform no invasive clinical tasks. Doulas may be contacted by legal representatives in a malpractice case to testify, however their testimony would be more subjective than objective since it is not within their scope to have clinical expertise. However, doulas who practice outside their scope may encounter liability situations. There are companies who do provide liability insurance for doulas who request it.