What Does a Doula Really Do?

Recipe

May 4

Forget the stethoscope, fetal monitors, blood pressure cuffs, and gloves. You won’t need them to be a doula. What you DO need is a warm heart, a calm presence, and sometimes a strong back! Being a doula is about so much more than tools; it’s about people, connection, and making a difference. Let’s break it down.

What Does a Doula Do?

Google “What does a doula do?” and you’ll find thousands of pages all defining the role as, “A doula provides physical, emotional, and informational support to the laboring woman and her partner.” While true, this definition often oversimplifies what doulas do on a day-to-day basis.

Let’s dive into a real-life example that goes beyond the textbook definition. Here is one client’s journey with her doula, from start to finish (shared with permission, of course!).

The hiring process
Amy contacted me via email on October 22nd. She was looking for a doula for her second baby. Her first birth involved an induction, a difficult labor, and an epidural that didn’t work well. After learning more about the birth process, Amy decided she wanted a different experience this time and opted for a birth center. Knowing epidurals weren’t available there, she decided to hire a doula for support.

Amy found me through my website but made her final decision after her midwives recommended me. She called, asked about my packages, and by the end of the day, I had a signed contract and payment via my website.

Because Amy had already experienced birth, she chose a package with one prenatal visit, but I offered her a spot in one of my childbirth education classes as a bonus. This allowed her to get additional information and gave us extra time to connect before her due date.

The prenatal visit
We scheduled our visit for early December at Amy’s home. I arrived with my birth planning cards, pelvis, doll, placenta model, and comfort measure tools. Amy and her husband welcomed me warmly, and we discussed her previous birth experience and her hopes for this one.

We talked about:

Fears and concerns.
When to call me during labor.
Comfort measures and labor positions.
A mini-birth plan and preparation activities.

By the end of the visit, Amy felt confident and ready for her birth. She knew I’d be on call for her from 36 weeks onward, and that I was her go-to for any questions or concerns.

The birth day
Amy was nearing her 42nd week of pregnancy, and her midwives decided to try and get labor going so they wouldn’t have to transfer her out for a hospital induction. Amy and I had discussed it earlier the previous week, and I knew that this was the plan for this day. Her midwife instructed her to drink castor oil that morning, and for the next two hours I got humorous texts about how awful castor oil is.. (I’ll spare you the details :)

The midwife had her come to the birth center around noon and I decided to meet them there. The plan was to get the breastpump going to stimulate contractions, and I would provide some acupressure that may help as well. The castor oil had already got some contractions going, but Amy was not in labor yet. The contractions slowly started coming, and after the 2nd dose of an herbal concoction that was provided by her midwife, and some belly sifting and tummy tucks by me, contractions quickly picked up from every 15 minutes to every 2-5 minutes. It was looking like labor was underway!

3:00 pm: Because contractions were not intense, the midwives thought it might be a good idea for Amy to go home and try to continue to labor there for a while. I knew Amy pretty well, and I knew that driving an hour away was going to make her feel uncomfortable. We discussed the possibility of getting a hotel closer to the birth center, but as Amy’s brow furrowed more and more with the contractions, I suggested that they talk to the midwife about just staying there. They felt the most comfortable with this option, and the midwife reluctantly let her stay. For the next three hours, I did what a typical doula does. I gave counter pressure on her back, rubbed her back and hips, suggested various labor positions, and even discussed getting some rest. I encouraged her to drink fluids, and encouraged Amy’s husband to help with various comfort measures. Around 9 pm Amy’s water broke, and things got intense very quickly. Contractions were coming 2 minutes apart, and it was clear that she was entering transition. I got my station set up with a bowl of cold water and wet washcloths, vomit bags, peppermint oil, and gloves in case bodily fluids started going everywhere.

6:05 pm: Amy started giving little tiny pushes, and I went and notified the midwives that she wanted she was starting to push, and that Amy had been asking if she could get into the tub yet. They came in and started drawing the water, and getting the room set up for the birth. I applied cold washcloths to Amy’s head and gave her words of comfort and affirmation, (and did the same for Amy’s husband as he was starting to feel a little nervous). Within 15 minutes of Amy entering the now full tub of warm water, she began pushing in earnest. The midwives did most of the coaching, while I held Amy’s hand and kept the washcloth from falling off her forehead. I gave Amy’s husband the task of pouring water over Amy’s belly which she thought was really helpful. We had talked during the prenatal visit about the possibility of Amy’s husband catching baby, but he wasn’t sure he would want to do that. In the moment of Amy’s baby crowning, I whispered in his ear “would you like to catch your baby?” He nodded yes, and then asked the midwives if he could help, and they guided him in the next few steps as the baby slithered his way out into the water. Amy’s husband pulled him out from the water and placed the baby on Amy’s chest. They both laughed and cried at the same time.

A few minutes later, we got Amy out of the tub and I helped the midwife dry her off. After the placenta was delivered, and Amy was settled in, I helped the baby latch to Amy’s breast for the first time. I gave her some quick breastfeeding tips and then snuck off for a few minutes so that Amy and her husband could have some bonding time. A few minutes later, I could tell they were doing well on their own and told them that I was going to leave. I congratulated them on their new baby and told them to be sure and call me in the next few days, especially if they were having trouble with breastfeeding. (I am also a breastfeeding counselor, so I like to add this into my doula packages).

The postpartum visit
Eight days later, Amy emailed me to schedule her postpartum visit. Breastfeeding was going well, and she didn’t have many questions, but she wanted to reflect on the birth. We chatted, reviewed swaddling techniques, and I reminded her that I was always just an email away.

A little bit more about doulas...
When you are a doula, you will find that your support may look slightly different for each family. Some births are very long, and some are very short. Sometimes you are holding a vomit bag, and doing counter pressure at the same time, and sometimes you do hardly anything. One thing you may notice is that a doula does not do anything medical. No vaginal exams, no monitoring fetal heart tones, or taking vitals. This is up to the other care providers.

The doula is often with the client longer than the midwife, nurses, or doctors, because she often offers to come to the client’s home and labor there until it’s time to go to the birthplace. You will be that person in the room that will know a little bit of the medical side but will also be deeply invested in supporting the family and helping them achieve their birth goals - whatever they may be. Nurses do not have the time to be with laboring mothers anywhere near the time new parents expect. A doula provides continuous labor support.

Doulas also help with comfort measures, so that a mother can go unmedicated as long as she wishes. We have some tricks up our sleeves that the other support person may not have learned (or may not remember) from childbirth class. Doulas are there to provide suggestions when things vary from the path of normal. They may be able to guide the laboring woman into positions that will help rotate a baby into an optimum position, provide alternatives to inductions, and birth argumentation, and reduce the chances of having a cesarean in the process.

A doula can support a woman through any type of birth. It doesn’t matter if it’s an elective cesarean or a birth with all of the bells and whistles. Most women choose to hire a doula to get through her birth with the least amount of interventions possible. Birth is hard work for everyone involved. Sometimes a partner can be stressed under this pressure. It’s not easy to see someone work so hard! A doula and the partner work right along with the mother as she labors. They work together to ease the mother’s pain, while the doula keeps dad looking calm, cool, and collected. She is there to let them know when things are normal, and help explain the situation when things are not.

Studies show that when women receive continuous support from a doula, they are more likely to have spontaneous vaginal births, less likely to have pain medication, vacuum or forceps-assisted births, negative feelings about childbirth, and their chances of having a cesarean were reduced! In addition, their labors were shorter, Pitocin augmentation was used less, and their babies were less likely to have low Apgar scores at birth and had less risk of needing to go to the NICU.

The studies also showed that the best results occurred when women had continuous labor support from a doula– and not someone from the mother's social network, or someone provided by the hospital staff. --2012, Hodnett et al.

The cesarean rates have climbed to nearly 32% in the United States, and with that our rates for maternal and neonatal mortality rates have not seen much improvement. When we can help reduce the cesarean rate, we can make an impact on the lives around us.

Why Doulas Matter

Studies show that having a doula leads to:

Fewer cesareans.
Shorter labors.
Less need for pain medication or interventions.
Better outcomes for moms and babies.

When you support a family as a doula, you’re making a tangible difference in their lives. You’re not just helping them through birth; you’re empowering them for parenthood.