Menu
Births—painful, messy, unpredictable—have been a part of humanity since time immemorial. And in the U.S., where preventable complications and maternal deaths are surprisingly high, more people seem to be seeking out doulas for additional care during pregnancy and childbirth, says Natalia Richey, acting chief midwife in the department of obstetrics and gynecology at Massachusetts General Hospital.
Some research suggests that the care of a doula can benefit both mother and baby. But what does a birth doula do? Although neither a midwife nor a doctor, a professional doula can provide emotional and physical support to women during pregnancy and throughout the birth process.
Here’s what you should know if you’re considering doula care.
Midwives and doulas tend to have some overlapping duties. But there’s one key difference: Midwives provide medical care, doulas don’t.
Midwives: Their primary job is to maintain the physical health of a woman and her baby during labor. Certified midwives like Richey are also trained nurses, but most midwives have completed medical training. This can vary by state law.
Doulas: Unlike midwives, doulas don’t perform medical tasks. Their primary job is to help laboring women feel comfortable and calm using a variety of methods, including recommending comfort measures and optimal positions for labor and pushing.
“Many women hire doulas when they’re planning an unmedicated birth,” says Richey. “Doulas are really good at knowing what techniques—like walking, showering, massage, or aromatherapy—can help a woman with pain. It’s like having a coach.”
Note that doula training varies widely. There are no formal rules requiring licensing or certification, but many doulas seek certification with the more than 100 independent organizations that offer some type of doula training and certification, according to the National Health Law Program.
Private insurers often do not cover doula care, which can cost several thousand dollars if arranged privately.
However, some employers — including Walmart — help pay for doula care. And some hospital systems, particularly in low-income or medically underserved areas, offer doula programs aimed at improving maternal care during and after pregnancy. Others may arrange doula support for people with limited resources who would otherwise be alone during the later stages of pregnancy and childbirth.
As of February 2023, 10 states and the District of Columbia offered doula services in Medicaid. Other states are in the process of adopting such coverage. Most states that offer doula care in Medicaid require that doulas be trained or certified by a recognized organization.
A 2023 analysis in the journal Cureus reviewed 16 individual studies conducted over 22 years. It found that support from a doula was associated with better birth outcomes, such as fewer cesarean sections and preterm births and shorter labors.
In addition, emotional support from doulas was associated with less anxiety and stress in laboring mothers. Among low-income women, support from a doula improved breastfeeding success.
“It’s impressive,” says Richey. “I think these improved outcomes are due to having an expert in the birth process who is not a medical professional but is just there for you moment to moment.”
Care arrangements vary. Doulas typically meet with women every few months during pregnancy to discuss their goals for the birth (such as avoiding pain medication) and to build a relationship with both the expectant mother and her spouse or partner.
Like birth doulas, doulas are on call 24/7 to support clients who are in labor or whose labor is being induced. Doulas stay with them throughout the birth process.
“Having someone there who has been through many births, who can support themsupport and advocate for them can be a great comfort,” says Richey.
That can be especially important for women with limited resources, especially those who would otherwise be alone in the later stages of pregnancy and birth. “Doulas remind women that they are OK and that they can get through this process – all the things that many of us take for granted,” says Richey.
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut elit tellus, luctus nec ullamcorper mattis, pulvinar dapibus leo.
This usually goes smoothly, Richey says. If a hospital arranges a doula for a woman, members of the OB/GYN team might meet with the doula a few times before the birth. A privately hired doula, on the other hand, typically doesn’t meet the larger OB/GYN team until the woman arrives at the hospital to deliver.
If everyone sticks to their assigned role, things go smoothly. For a doula, that might mean suggesting non-pharmacological methods to reduce pain and encourage labor to progress. Boundaries are important, though, if medical intervention is necessary.
“For example, if the baby’s heart rate is low, the expertise needs to be left to the midwife or doctor,” Richey explains.
Richey suggests starting by asking yourself:
What are my hopes and goals for the birth process? Could a doula improve my ability to achieve these?
What do I envision my support team to be like during birth? Do I have a partner, mother, or friend I want there? Would a doula be an asset to the support I already have?
Do I have friends or family members who have used doulas in the past? What was their impression of the experience? Can they recommend a doula?
When contacting a doula to explore your options, ask about:
her training and certification
how many births she has assisted with
how she believes she can help you during pregnancy and labor
how she will work with your partner or spouse and the medical team
whether she will provide postpartum support—if so, what type of support and for how long?
“Take the time to meet with any doula you are considering and make sure she is a good fit for you,” advises Richey, “because she is someone who will be there for you during one of the most vulnerable times of your life. Having someone there who you don’t feel safe and comfortable with can significantly impact the birth.”