Tips & Tools: Labor Support
How can I find labor support specialists or doulas in my area?
How can I choose the right labor support specialist or doula for me?
What questions should I ask when interviewing a doula?
What if I want to work with a doula, and cost is an issue?
Do I need a childbirth education class if I am planning to have a doula?
How can my partner prepare for supporting me in labor?
What should I consider when choosing a family member or friend to provide labor support?
How can I choose a caregiver and birth setting that value labor support?
There are many ways of finding and learning about local doulas. You can:
- get information and recommendations from area childbirth educators, maternity nurses, midwives, doctors, breastfeeding counselors, and others who may be familiar with doulas and women who have worked them
- contact a doula trainer in your area
- talk with new moms in your area who may have worked with doulas
- search online for doulas in your area (see Resources for a list of online doula referral sites)
- check with local hospitals -- a small and growing number offer doula services.
If you decide that you would like to have doula care during your labor and birth, we encourage you to meet with several doulas to help you find the right person. You can begin by gathering some basic information by phone about doulas in your area, such as their availability, experience, services, and charges. You may also be able to find much of this information online from websites of doulas or from sites that let you search for doulas in your area (See the Resources: Labor Support page for links to these sites.) Then, you and your partner, if you have one, can meet with those who sound like good possibilities. These inquiries will help you select a doula. They're also a great way to learn about maternity care options in your community and to help clarify your own maternity needs and preferences.
Have a list of questions with you. (See below for questions that you may wish to print out.) This can help you:
When you speak and meet with a doula, ask yourself how you feel about the experience:
- organize your thoughts and questions
- be sure that you get all of your questions answered
- compare the responses of different doulas.
This person will be working intimately with you and your family through one of the most important times of your life. It is worth the effort to take the time to choose carefully.
- Does she seem knowledgeable?
- Is she a good listener?
- Does she respect my vision for my maternity care and birth?
- Is her personality a good match for me, and for my partner?
This website provides a list of questions to ask to get to know doulas, their policies, and styles of practice. Think about what is important to you, and be sure to add any other questions or concerns that you may have.
You can download a pdf version of these questions with space for making notes, and take it with you when you interview doulas.
Doula services may cost several hundred dollars, and few insurance policies cover doula care. If you would like to work with a doula and are concerned about the costs, you can explore a number of possibilities:
Most doulas will strongly recommend learning as much as you can about labor and birth. They may recommend books or videos and many will refer clients to a childbirth education class. More and more, doulas are becoming certified to teach childbirth education classes. They may include the class in the cost of their labor support services or offer them separately for an additional fee.
- Check with your insurance carrier to see if doula services are covered. If there is no policy, you may be able to show them evidence about benefits of doula care (see Resources) and influence coverage for you or for other women in the future. If the initial response is "no," further inquiry or a formal letter directed to someone with more responsibility may turn up a favorable reply. Due to well established benefits of continuous labor support, authors of the most recent and largest review of effects of this type of care call for insurance coverage.
- Doula trainees often attend births at no cost in order to gain experience.
- Some experienced doulas offer some services at no or reduced costs.
- Experienced doulas may be willing to barter for their services or to set up a schedule for payments at a rate that you can afford.
- Some hospitals or communities have volunteer doula services. See the Resources page for a link to a list of such programs. You can also check the hospitals and birth centers in your community to see if any have a doula program and whether you are eligible.
- You can ask your friends and relatives to give the services of a doula as a baby shower gift.
- Consider whether you have a friend or relative who could commit to providing labor support for you. They may be willing to learn more about the best ways to support you by reading or watching videos (see Resources). (As discussed on the Best Evidence: Labor Support page, research suggests that such companions reduce the likelihood that you will be dissatisfied with your childbirth experience, but do not seem to reduce the likelihood that you will have various obstetric interventions.)
If your doula does not offer childbirth education classes or you choose to take them with another instructor, here are some things you may want to look for:
You can get help finding childbirth educators in your community on the Resources: Labor Pain page.
- independent educator: An employee of a hospital, clinic, or private practice may focus on her employer's preferred policies and practices. An independent educator may feel freer to present all of your options and discuss disadvantages of standard practices. Chances are good that classes located in a community center or an educator's home or offered through a childbirth education organization are taught by an independent educator.
- certified educator: Certification by a national organization ensures that the educator has met some standard for skill and knowledge.
- enough time per class and number of classes: It takes time to learn new skills and information, get questions answered, and explore issues. Classes with at least 6 to 8 sessions may be more helpful to you than those with fewer sessions.
- small classes: Class size should allow for good discussion, individual attention and help, and comfort with intimate or sensitive topics.
Your partner, if you have one, can prepare for his or her role in supporting you in labor and birth by:
The following questions may help clarify whether you want to invite a specific friend or family member to provide labor support:
- talking openly about their hopes, expectations, and fears and listening to you express yours
- learning as much about labor and birth as possible by reading, watching videos, coming to prenatal visits, or attending childbirth education classes with you. The Resources page has books and videos for labor support companions
- practicing relaxation techniques and comforting touch before labor begins
- making a plan for support and household help after the birth, to enable you to get the rest and care you need to recover from birth and get off to a good start with breastfeeding
- Are her thoughts and feelings about birth similar to mine?
- Can I be myself around this person without worrying what she may think? Would I feel comfortable having her present during the intimate time of labor and birth? Does my partner feel the same way?
- Is she able to commit to making herself available whenever I go into labor, and staying with me until I give birth?
- Is she interested in learning more about ways to support women in labor?
This website provides in-depth support for choosing a maternity caregiver and choosing a birth setting. If you want to put arrangements for labor support in place, you may want to explore the following questions when making these decisions:
- your maternity caregiver: Would the caregiver be able to stay with you through labor and provide supportive care? What are the caregiver's experiences with and attitudes toward working with doulas?
- nursing resources during labor: How many laboring women does each nurse care for (nurse-to-patient ratio)? Will a nurse stay with you throughout labor? Do the nurses have any special training, skills, or commitment to providing supportive care to laboring women?
- institutional policies: Are there any institutional policies about who or how many people may be with you? What are the staff's experience with and attitudes toward doulas? Are there any circumstances in which your doula would not be permitted to be present? Does the facility have its own program for making doulas available?
- institutional resources: Apart from pain medications, what is available to provide comfort during labor? What about tubs, showers, birth balls, hot and cold packs, rocking chairs, options for moving about? Are there enough (tubs, for example) to go around? Does staff have training in non-drug methods of providing pain relief? Does the setting encourage use of these resources or freely provide them according to women's preferences?
Most recent page update: 11/16/2012
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