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What Is A Doula?

From the beginning of time, women have been having support during labor. Female family members and friends, midwives, nurses and their partners. A birth doula is no different. They are a non-medically trained professional who provides physical and emotional support to the birthing person and their partner. They are trained to connect families with evidence-based resources so they can make informed decisions about their births. Doulas do not give medical advice, but serve as a bridge of communication between the client and their provider, so that they can find their voice to advocate for their birth preferences and care.


History

Evidence of doulas date back to prehistoric cave drawings, stone carvings and statues. Historically, women have been attended and supported by other women during childbirth. However, in hospitals worldwide, continuous support during labour has become the exception rather than the routine. In the 1960's, doula became a term used in the US with the grassroots natural birth movement. Meaning "female servant/slave" in Greek, DONA International adopted the term and became the first organization to train and certify doulas in 1992. The term became accepted in dictionaries in the early 2000's.


Qualifications

A doula does not have to be certified to be a support person. I know a few women who have attended and supported so many births, they could be a midwife if they only had the medical schooling. However, if you think one day hospitals, the state, etc won't require doulas to be certified, then you are mistaken. Doulas receive training from different organizations that vary in content, requirements, and duration. There are no universally accepted standards for doula certification and doulas are not licensed, but some organizations are looked at more favorably. If you look at the NYS Doula Pilot Program to provide Medicaid coverage, the listed doulas received their training from 3 different organizations. The link is listed below.


Pros & Cons

A birth doula providing continuous support during childbirth may improve a number of outcomes including:

-decreased need for pain medication during labor

-reduced length of labor

-increased likelihood of a vaginal birth (rather than cesarean)

-increased birth satisfaction of birthing person

-increased likelihood of successful breastfeeding

-may decrease the risk of developing postpartum depression

-babies have better APGAR scores

-BETTER BIRTH OUTCOMES!


While there are many benefits, the cons tend to be subjective:

-they are an added expense

-they may get in the way of your partner

-they may be unhelpful

-they do not have medical training


I could argue all of these cons because I honestly think having a doula was the reason I had such an amazing birth experience. Hiring Malissa was invaluable to my experience becoming a mother and I look at her as an investment. She was never in the way of my partner. She was actually able to show him a lot of comfort measures during our prenatal visits that he was able to do during labor to help with pain. I didn't have to use any pain medication (even though a few contractions made me contemplate it!), I was able to have a vaginal birth, and I even advocated to leave the hospital a day early because we were doing so well! She may not have had medical training, but her experience supporting low intervention births sets her apart from the medical model. After birthing my daughter, my nurse told me that most birthing people will end up getting some sort of pain medication, so to have a doula who is trained in non-medical comfort measures was a benefit to me.


Cost

Depending on the state you live in and the type of insurance you have, doula support is covered completely or partially by your insurance company. If it is not covered, you may also write a letter to your insurance company explaining why you felt the need for a doula and how you believe the doula was beneficial to your health. You should get a reply within 4 weeks, and whether or not they cover this birth, they may cover them in the future. So, keep advocating for doula support!

Some doulas accept health insurance, whereas others are out of pocket. However, imagine this: some people actually go to college specifically for medical billing. I did not. So unfortunately I do not currently accept insurance.

You can expect the cost of a doula to be anywhere from $500-5,000, with the typical cost of $1500 in Buffalo, NY. You should receive a number of prenatal visits, 24/7 on-call in person labor support 2 weeks before and 2 weeks after your due date, and a number of postpartum visits.


In Conclusion

Doulas are a great resource whether this is your first pregnancy or your tenth. If you are considered low risk (there's no such thing as no risk) the likelihood of having your birth preferences are higher. But even if you are high risk, a doula can help support you during your pregnancy right up until birth, and a postpartum doula is invaluable in the weeks after you meet your baby.

You do not have to have a home birth to find value in a doula. However, most out of hospital birthing centers require you to have one. (This should tell you something!) In a hospital setting, nurses change every 12 hours with the typical first time birth lasting 17 hours! The research says continuous labor support is beneficial. And if you are anything like me, the birth of my daughter was the first time I ever had to go to the hospital, or get an IV, or receive stitches! It's already an uncomfortable place, so having someone in your corner that can help you navigate the most significant event in your life can't do more harm than good.


Evidence Based Resources:

Make sure whenever making a medical decision, that you have evidence based information. I strive to always supply resources from credible sources (such as systemic reviews, clinical trials, and places such as the Cochrane Review, ACOG & Mayo Clinic). Google is not your best friend when making medical decisions for you and your baby's care.


Some resources pertaining to this blog "What Is A Doula?":

https://evidencebasedbirth.com/ebb-229-evidence-on-doulas-community-based-models-the-pandemic-and-reimbursement-with-the-research-team/


(https://pubmed.ncbi.nlm.nih.gov/23076901/)


https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/02/approaches-to-limit-intervention-during-labor-and-birth


https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/expert-answers/doula/faq-20057910


https://www.cochrane.org/CD003766/PREG_continuous-support-women-during-childbirth


https://www.health.ny.gov/health_care/medicaid/redesign/doulapilot/index.htm


https://www.holisticallyloved.com/blog/2014/9/14/insurance-paying-for-a-doula


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