There are many modern names for a doula, including labor coach, birth assistant, and birth attendant. The roots of the word itself stems from a Greek word1 meaning “woman servant or caregiver.” Doulas are trained to provide emotional, physical and educational support for the mother during all parts of the birth, and are considered by many to be indispensable to women wanting to have a positive birth experience2.
Besides providing continuous support for the mother during labor, doulas may also provide pre and post natal assistance, as well as a plethora of other roles relating to birth. There are so many things that doulas are, that first it is easier to describe what doulas are not. First and foremost, doulas are not medical health care providers. While doulas will have a familiarity with birth specific medical procedures, their primary focus is of the emotional well being of the mother and baby, and they do not replace midwives or doctors in the birthing room. Doulas are not there to replace the partner. Doulas do not judge or push their personal agendas on births. Doulas are at births for the sole purpose of making your birth the best experience it can be for you!

Why choose a doula to begin with? Studies3 show that women whose births were attended by doulas were more likely to have spontaneous vaginal births and less likely to have any pain medication, epidurals, negative feelings about childbirth, vacuum or forceps-assisted birth, and cesarean births. In addition, labor time was decreased by an average of 40 minutes and their babies were less likely to have low Apgar scores4 at birth. Doulas exist not just to make birth more enjoyable for the mother, but also to make births smoother, shorter and less painful.

In addition to birth specific teachings, many doulas have other skills and wisdom sets that can be applied to birth, such as:

Birth Consultant:

A doula will help you prepare for all the different ways your birth may progress, and will help you to sort out your preferences for various interventions, pain relief options, emergency situations, and more. She will help you create a unique and clear “birth plan,” stating your personal preferences for your birth. Many women go into the labor room uninformed of the many options they have, and may become overwhelmed and confused during the intensity of labor. Sorting all of the details out before your birth begins means that you will feel much more in control during the birth itself.

Birth Advocate:

Your doula wants you to have the birth you want! She will work with you, your partner, your midwife or doctor, and anyone else involved in the birth so that your birth can run as smoothly as possible. The nuances of being your birth advocate may range from gently asking your loud sister to please talk on her cell phone outside, to reminding the hospital staff: “Please refrain from speaking to the mother during contractions” and “No, she does not want an epidural now. We will let you know if we change our mind. Thank you!” Your doula will do everything in her power to gently (or sometimes firmly) keep the birth on your terms. The role of birth advocate will vary greatly from the home to the hospital. In a hospital setting the role of birth advocate will most likely include explaining your birth plan to the changing medical staff, and explaining requested procedures to you and your birth partner.

Birth Coordinator:

Your doctor or midwife is there to make sure you are medically and physically sound; your partner is there to support you and experience this transition with you, and your friends and family are there to support as well. Everyone in your team has various roles to fill, and your doula will help each of them support you in the best way possible. Imagine your doula as an “event planner” of sorts for your birth: making sure all the details are taken care of so you can focus on your journey.

Labor Coach:

Supporting the mother through labor is its own job! A good doula knows various labor positions, pain relief methods, as well as visualization techniques to keep the mother’s strength up. It can be easier to lose sight of both the end result of birth (the baby!) and of appreciating and honoring the process. When it gets rough, a doula will help you keep your journey in perspective. Having continuous support by a knowledgeable and loving companion is proven to greatly improve the labor experience. Just like a sports coach or trainer, she will keep you focused and inspired during the long and intense birth process.

Physical Labor Support:

The doula’s job is physical as well as mental. Holding up a laboring mother is no easy task! She, along with your partner and/or midwife, will guide you through various labor positions, massage you, rub you, comb your hair, and do everything to support your physical comfort.

Birth Assistant:

Doulas can also act as you and your partner’s personal assistant during birth. Births can be long laborious processes, and not everything stalls just because you are in labor! Although we stress multiple times that doulas are there to provide continuous labor support, in some situations a doula may be more valuable helping out in other ways. For example you may ask your doula in some cases to walk your dog, water your plants, or keep the lighting in your birth room at the same hue as the sun rises or sets. She may become good friends with your mother on the phone as she calls her hourly to keep her informed of your progress. She may spend an hour away from you as she helps your toddler daughter get ready for bed and fall asleep. A good doula has no ego, and knows that there is no task beneath her if having it done brings you a sense of calmness.

Birth Cheerleader:

Your doula’s role may simply to be your biggest cheerleader during your birth. Nothing you can do can phase her. She will hold your hand as your body convulses and wipe up vomit, urine, or defecations without blinking. You can scream, cry, laugh, and curse, and she will still tell you that you are a champion. She is your biggest fan, and she will cheer you until your final push.

A doula may take on a different role for different women, depending on their specific needs. Most birth doulas will provide the following services during and before labor:

Massage Therapists:

While all doulas should be comfortable with intimate touch and pressure points, it is common to find doulas that are also trained and licensed massage therapists. Many of these doulas will offer a series of massages as part of their prenatal and/or postnatal care packages. Receiving intimate touch from your doula prior to the birth can be a wonderful way to bond with her, and for her to learn how you prefer to be touched (or not to be!).

Acupuncturists:

Acupuncture is an ancient technique that can be used in conjunction with birth to, among other things, calm the mind, strengthen energy and induce contractions5. Training to be an acupuncturist is a long and vigorous journey, and while there are few doulas who are also acupuncturists (it is more likely your acupuncturist is a doula than your doula is an acupuncturist!), many are familiar with energy points and may have a birth knowledgeable acupuncturist to refer you to.

Chiropractors:

Chiropractors specialize in alignment, and as your body changes during your pregnancy, it is very possible for your body to go out of alignment, which can result in pain and a more difficult birth. The most common thing a chiropractor will assist with in pregnant women is pelvic alignment, which, in some cases, can help shift a breech baby into optimal fetal positioning6. Like acupuncture, chiropractors are so specialized that it is unlikely your doula will be a chiropractor, but your chiropractor may be a birth expert.

Nutritionist/Chef:

Some doulas may specialize in nutrition and will be able to advise you about what foods and herbs can best benefit you during and after your pregnancy. She can recommend certain food and/or herbal combinations to combat various ailments, both physical and emotional, that can arise during pregnancy and after birth. Nutritionists vary immensely from USDA trained to holistically inclined, so make sure that their philosophies align with yours. Your doula may include cooking in her birth packages. Having nutritious home cooked meals or shakes before, during or after the birth is a wonderful thing to not to have to worry about.

Birth Photographer

At the very least your doula will be able to help snap a few photos of you (with consent of course) during late pregnancy, during labor, and with your baby after the birth. However many doulas go above and beyond and have the camera equipment and know-how to create beautiful maternity and newborn family portraits as well. Some doulas are also able to make you a body cast of your pregnant belly.

Reiki/Energy Workers

Some doulas have additional training in energy field work such as reiki, crystal healing, sound healing, aromatherapy etc. Be warned that during the birth process some things you think you like (sounds and smells) may repulse you without reason! Some of these therapies may be more beneficial during the pregnancy than during the birth.

Many doulas have additional areas of expertise and/or certification in specialized birth care:

Postpartum Doulas:

The fourth trimester can be the most difficult for new parents, and many doulas specialize in this period. Your postpartum doula may be the same as your birth doula, or may be a different woman. She can help you with newborn care, family adjustment, breastfeeding, meal preparation, education, companionship and more. Many birth doulas will include these services in their birth package, make sure to inquire.

Lactation Consultants:

Many doulas are also experts in lactation, and some are board certified Lactation Consultants7. Breastfeeding surprises many new parents, as some babies are able to latch on instantaneously while others can cause great turmoil in their difficulty to breastfeed. Lactation consultants can help with common breastfeeding problems such as latching difficulties, painful breastfeeding, and low milk production; as well as other issues related to breastfeeding.

Grief and Loss Doulas:

Some doulas have taken special classes and certifications to be able to provide special support for mothers dealing with loss. These doulas may focus solely on postmortem counseling and care, or may also offer doula services for stillborn births. Besides the emotional support associated with the loss, it can be very difficult to cope with the physical realities of leaving the hospital empty handed with a body still in post-partum. Many of these doulas have experienced loss themselves, and want to support others going through what they experienced. They want you to know you are not alone. Please don’t hesitate to seek support8 through this difficult process.

Teen Birth Doulas:

Teen pregnancies are most often unplanned, and are usually associated with confusion. Having someone to talk to and give advice is invaluable to these young women going through immense changes. While each situation is unique, teen pregnancies can involve such other complications as homelessness, estrangement from parents, estrangement from the partner, and the like. Teen birth doulas are more than just doulas, they are also mentors. There has also been an emergence of teens training as doulas to assist other teen births9. These doulas take on the role of peer as well as mentor.

Placenta Experts:

Love it or hate it, we believe that all women should be able to consume their placenta10 if they choose, and having someone to safely prepare it for them is important. Many doulas offer placenta preparation packages on top of their birth packages, and have experience in the various ways placentas can be consumed (most often they are dehydrated and encapsulated, but they can also be blended into smoothies, or cooked with other food).

And sometimes doulas can come in other forms, such as:

Long Distance Doulas:

For some families, having a doula present physically is simply not possible, but they still want the continuous labor support a doula provides. Some doulas specialize in distance care, meaning all communication is done by phone and video. We strongly believe having a doula in any form is better than not having a doula at all, and urge parents in rural environments or special circumstances to not rule out this option.

Midwives/RNs:

Some doulas come from a medical background and are able to fill various roles in the birth room. Sometimes midwives will work in pairs, so they can alter roles as medical provider and doula. Some midwives will have an apprentice who will take on the role of doula. Never assume that a doctor, RN, or MD has doula training and agrees with doula-principles, but there are always exceptions, and depending on your circumstances, you may just stumble upon an unexpected doula in your medical team.

Friend/Mother/Partner:

Studies show that having ANY continuous labor support by another female results in higher overall satisfaction and less interventions with the birth11, and that these figures are consequently increased with a woman trained in birth companionship. What this means is that having a professional doula is always recommended, there is no reason why a close friend or relative that has a natural propensity towards care and shows a strong desire to support you in your labor cannot step up to the plate. And while most partners of laboring women are going through their own emotional roller coasters, and welcome the support of a doula in the birth room, there are always exceptions… perhaps your partner is a woman or has significant experience with birth themselves (male doulas do exist12 you know). Whatever the reason you choose someone in your inner circle instead of a professional, part of owning your birth and choosing a doula is trusting your intuition.

We hope this helps you understand exactly what a doula is, does, and can be. We wish you nothing but understanding, compassion and empowerment during your birth experience.

All photographs by Britt Fohrman. 


  1. http://www.dona.org/mothers/ 

  2. http://www.bellybelly.com.au/pregnancy/doulas-what-is-a-doula#.Uw1O5kKSzqY 

  3. evidencebasedbirth.com/the-evidence-for-doulas/ 

  4. http://www.nlm.nih.gov/medlineplus/ency/article/003402.htm 

  5. http://www.bellybelly.com.au/birth/acupuncture-natural-labour-induction#.UxScGc4l-cE 

  6. http://themotherbabycenter.org/blog/2013/04/seeing-a-chiropractor-during-and-after-pregnancy/ 

  7. http://www.ilca.org/i4a/pages/index.cfm?pageid=1 

  8. http://www.marchofdimes.com/ 

  9. http://www.examiner.com/article/teen-doulas-help-teen-moms-through-pregnancy-and-childbirth 

  10. http://placentabenefits.info/ 

  11. https://www.childbirthconnection.org/article.asp?ck=10272 

  12. http://blogs.babycenter.com/mom_stories/12052013-male-doulas-is-childbirth-womens-work/