No. A doula can actually bring a couple closer together. The doula makes sure that the father’s need are met so that he can meet the needs of the laboring mother. By having a doula, he can participate at his own comfort level without having to remember “everything” that he and mom learned in childbirth class. Studies show that fathers also experience fear and tension during the mother’s labor. A doula’s presence and knowledge can break the fear-tension-pain cycle for the mother and father. Many times fathers worry that they are not doing enough or the right thing. A doula helps him to care for and support his partner by giving suggestions, providing encouragement or giving needed breaks during a long labor. One study showed that 60% of fathers that have taken childbirth education classes become mostly a spectator, as they become overwhelmed with the surroundings and events. The feeling of insecurity and lack of knowledge of what is happening takes its toll on both parents.

A doula has accompanied other couples through the birth experience and gained the knowledge needed to help each couple achieve their desired birth experience. Remember that a doula would never want to replace the father’s role. And realistically speaking, how could she? The birth experience is his birth experience as well.
Is it worth hiring a doula if I am going to have a cesarean section or if I am planning a vaginal birth after cesarean section (“VBAC”)?

One of the most important roles of the doula is to help the mother achieve the birth experience that she most desires. In that sense, doulas help to give mothers the support (emotional and physical) that they need when they need it most. Having a doula present especially for a VBAC can serve many purposes. That doula can help the mother “reframe” her cesarean birth experience to make it a more positive experience so that the mother can then enjoy this birth experience and enter into this labor free of the negative emotions that she may associate with her cesarean section or prior birth experience. That’s a benefit of the doula and mother working together during pregnancy AND labor. By identifying and reframing negative emotions early on, the mother can face this pregnancy, labor and birth free of those emotions. Often times, that in and of itself is enough support to empower the mother to successfully VBAC and achieve the birth that she most desires.

It is also emotionally comforting for women to have another woman with her if she knows that she is going to have a cesarean section. Having a doula present for an unanticipated cesarean section is invaluable. If the cesarean section was not anticipated, that means that during the labor for some reason, the cesarean section has now become the means of birth. Many women feel unprepared for this surgery and benefit from information (risks and benefits based on the situation at hand), alternatives and support. The doula has experience with the emotions that a woman experiences before, during and following a cesarean section. The woman still requires support for a cesarean birth which the doula will provide. The doula knows the surgical procedure of a cesarean section and can let the mother know that what is happening during the surgery is normal. The doula can stay with the mother while the partner goes to the nursery with the baby or she will go to the nursery with the baby to take pictures and let mom know that the baby is doing fine while the partner stays with the mother in the operating and recovery room. If the baby is not doing well, the doula can support the mother and partner emotionally.

Following the surgery, the doula can assist the mother by supporting her with relaxation techniques such as breathing and massage and can initiate and support breastfeeding following the birth.
Why would we need someone besides the nurses and our doctor/midwife to be there for us during labor?

Nurses are usually very supportive; however, it is unusual for you to be her only patient. She usually has the responsibility of at least one other couple to support as well. Often times, the time she does spend in your room is used to assess and chart your well being and that of your baby, with very little time left for actual hands-on support. Some nurses are not trained in alternative techniques for comfort and pain relief and are more likely to suggest medication use instead of trying tried and true non-medicated suggestions. Even if a mother knows that she wants medication during her labor she may want to wait until she is in active labor so that she does not “knock-out” the surges (contractions) of early labor before her labor pattern is established thus increasing her chances of receiving pitocin to re-establish or augment her labor surges. Often times, a mother who is planning to have medication during her labor does not want that medication during early labor because she wants to spend early labor in the comfort of her own home, with her doula, where she can eat and drink. Many times, the surges of early labor do not, in the mother’s opinion, necessitate the need for pain medication during that time. For that reason, tried and true comfort measures work wonderfully during early labor instead of pain medication.

Generally speaking, a nurse spends less than 10% of the time providing actual supportive care during an average labor, and only a small percent of that is physical support rather than verbal/instructional support.

Even wonderfully supportive nurses change shifts. During a long labor you may see several nurses, but your doula stays with you through all of those changes. Even your caregiver may not be the same one that was on call when you started! You doctor of midwife will only be called in occasionally and may not show up until the mother’s final pushes that bring your baby into the world.
How does a doula work with a midwife if I am planning a home or birth center birth?
Your doula may or may not provide constant labor support. Find out from her if this is included in her services. A doula can still provide a valuable service, including personal childbirth education and labor support. Most times, the midwife and doula work wonderfully together to support one common goal- the desires of the birthing woman. The doula and midwife make an empowering team for the mother and her partner! Therefore, even with a supportive midwife, you may still benefit from a doula’s services.
What kind of training does a doula have?

There are several certifying and training organizations for women wanting to become a doula. At this time, the doula profession does not have any state regulation or mandate and does not require training or certification. There are many wonderful practicing doulas that have chosen not to certify with any of the current organizations. If a doula does decide to become certified then there are several organizations that do that. They also provide referrals to doulas who are members in their organization.

The requirements differ from organization to organization, but basic training includes completing required pertinent reading , attendance at a workshop for a specific number of hours, good evaluations from a minimum number of births and an audit of a full series of childbirth education classes.

A woman usually becomes a doula because she has a passion and respect for the birth process and women. The most important attributes of a good doula is a warm and caring heart, a willingness to work with birthing women, a professional attitude and hands on experience. Many excellent doulas have done this work for years before certification and training were available. It is important to ask a potential doula about her training/experience. You should also feel comfortable with her skill level and personality. Ask the doula for references from past clients so that you have an ideal of her skill level and experience. While certification is optional, it gives parents a reliable way to verify skills/training.
How are doulas paid?

Most doulas who own a doula company require a deposit upon the signing of the agreement for services with the balance due before or at the clients 38th week of pregnancy. In the event the client cancels the contract for some reason, the deposit will probably not be refundable since the doula commits herself to be available for a specified time period (usually 2 weeks before and 2 weeks after the client’s due date). Doulas may charge by the hour during the labor or one set fee for a package of services. Most doulas charge one set fee for the labor no matter how long or short so that the mother does not feel that she is “on the clock” and must hurry to give birth for payment purposes.

There are some hospitals that provide doulas to a laboring couple once the woman is admitted for birth. With most hospital based doula programs, the couple and doula may or may not have met prior to meeting at the hospital. Either the hospital will pay the doula and the mother pays the hospital for this service or the mother and doula will contract a fee for service independent of the hospital.
Do health insurance companies pay for doula services?
Only a few insurance companies cover doula services, but the numbers are increasing gradually as providers are beginning to recognize the benefits of both improving parental satisfaction and bottom line savings when parents employ a doula for their birth. Insurance companies are more likely to pay for in-home postpartum services if the OB writes a prescription for home health care. Also, if a doula provides doula services in tandem with another reimbursable service, such as a registered nurse providing doula and/or monitrice and nursing services, or a doula who is also a childbirth educator providing doula services and childbirth education, insurance companies may reimburse for the nursing portion of the care or the childbirth education service.
Factors that may increase your chances of reimbursement include:

• Using a certified doula and submitting the doula’s credentials with the claim to the company.
• Submitting a doctor or midwife’s referral or prescription for doula services.
• Submitting well documented statistics of the doula’s influence.
• Actually achieving a low intervention, low cost birth.
• Submitting a bill/invoice for doula services complete with diagnosis and treatment codes.
• Resubmitting with more documentation if the first claim is denied.
• Talking to a person at the company to explain what you do if your services are denied payment.

For more information or to answer your questions, please call us at 440-552-6963