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Value of a Doula

Some time ago, I was in a mum's group I’m a part of, I saw a comment from a mum that said “I looked into hiring a doula but their fee was £xxx and she didn’t seem to offer much”. I’ll admit this comment was a little disheartening to me. However, it made me realize that the general public and even sometimes the families that hire us do not understand the true value behind the care we provide.


You see, there’s so much more that goes into the work a doula provides than holding a hand and giving encouragement to the birthing mum (although those things hold great value in themselves). Those that choose the career path of being a doula dedicate their life to this work. They pour hours and upon hours into educating themselves on all things birth and babies. We have a deep knowledge of the birth process. And for most we never stop educating ourselves. It is a continuous learning process so that we can provide our clients with the most up to date research and information.


Prior to a mom giving birth a doula will spend anywhere from 3-6 hours with her client and the family doing light childbirth education, talking about her birth desires, processing through any fears she has, teaching coping techniques, giving nutritional advice, talking about ways to prepare her body physically and mentally for birth, etc. We are also available 24/7 to our clients via our phone.

I myself have spent hours on the phone with clients in addition to our prenatals just working through concerns and other emotional issues. As a doula we go “on-call” 2 weeks prior to a women’s due date and remain on call until her baby is born. However, if we have more than one client on our schedule for the month (which most doulas do) this puts us on a never ending “on-call” status. I’m not sure most understand all this entails. Being “on-call” for a doula means that we must ALWAYS have our phones on us. When we have a client in the window of her due date we hesitate going far from home, we must have “on-call” childcare because we must be able to leave with a moments notice. This may also mean that we miss our kids School Trips, Festivals, important events as well as our morning with our kids. I’ve left my little one upset at the door begging me not to leave. I may be at a birth 4 hours or I may be at a birth for 45 hours.


I’ve held a woman’s body weight while they squat or given continuous counter pressure for hours on end. I’ve held women as they cry and as they rejoice. I’ve coached them through some of the hardest decisions in their life. This lifestyle is not for the faint of heart. The women who choose to become a doula have such a deep passion for birth, women and babies.


The sacrifice we make to be ever present for our clients doesn’t come without consequence. There’s a reason the divorce rate among birth workers is so high. We pour so much of ourselves into our work. And you must understand that when things don’t go as planned at a birth we don’t just go home and move on with life. Those difficult births can take a huge emotional toll on us. Also, our relationship with our doula clients doesn’t end after they have their baby. We then offer postpartum support.


Most doulas visit with their client at least once after the birth and provide continuous phone support for breastfeeding issues, emotional support, etc. So the next time you think to yourself “that doulas fee seems a little high” or “is a doula worth the money” I can assure you that a doulas fee is well worth all the support that comes with it and the sacrifice that doula makes for your birth. 

Evidence

"In 2017, Bohren et al. published an updated Cochrane review on the use of continuous support for women during childbirth. They combined the results of 26 trials that included more than 15,000 people. The birthing people in these studies were randomized to either receive continuous, one-on-one support during labor or “usual care.” The Cochrane reviewers stated that the overall quality of the evidence is low-quality, according to the GRADE systems for assessing evidence. In the GRADE system, the quality of evidence for each outcome is graded as one of four levels: high, moderate, low, or very low. A rating of high would be considered great evidence, where the authors are very confident that the true effect of doulas is very close to the effect seen in the study results. On the other hand, a rating of very low means that they have very little confidence in the findings, and that the true effect of doulas is likely to be very different than what was seen in the study results. The middle ratings aren’t great, but they aren’t weak either. Since it is not possible to blind participants or care providers to continuous labor support, the quality of the evidence for doulas received a lower grade."

Rebecca Dekker

PhD, RN