Essential reads & resources

Doulas are a unique profession perfectly suited to support pregnant people. Understand what doulas are, why they exist, and how they might help you and your family in a hospital or virtual setting - once you feel clear on your options, come meet the doulas, expert coaches and childbirth educators ready to serve you, here at Seven Starling!

What is a Doula and what services do they offer?

• What is a doula?
• What is a doula’s role and training?
• A brief history of doulas
• What can a doula do for me?
• The health benefits of having a doula
• A doula’s process - how it works!

When to hire a Doula

What are Virtual Doula Services?

• Remote doula support
• Doula help during COVID-19
• Virtual childbirth education

Virtual Birth and Postpartum Services at Seven Starling

• Our team of expert Doulas
• Evidenced-based learning
• Group-based model
• 100% virtual and convenient
• Month-to-month support through your family’s first year

What is a doula?

A doula is an essential member of your team, providing non-medical care in the form of evidence-based education, hands-on labor techniques, emotional support and assistance navigating the health care system.

The word “doula” is Greek in origin, and refers to a person in a position of service who cared for “the lady of the house” - today, a doula is a service professional for a person or family, or may work as an employee or volunteer at a birth center or hospital.

What does a Doula do?

There are a few different ways that doulas work to serve pregnant people, couples trying to conceive, and new parents. For this reason, you might be asking yourself “what does a doula do?” Doula care is used by all kinds of people to support prenatal health, birth outcomes and postpartum success - keep reading to learn the primary services, benefits and details of doula care.

What is a doula’s role and training?

Doulas come in many forms with unique sets of skills, philosophies and backgrounds. Since doulas are not medical providers or therapists, and different clients desire different things from the doula(s) they work with, there is not one certifying organization for doulas. While there are many things a doula can do, their scope of practice does not include:

• Diagnosing medical or mental health conditions
• Treating medical or other health conditions
• Interrupting medical care
• Giving medical advice
• Prescribing medications or treatments
• Applying medication or treatment
• Speaking on behalf of their client
• Making decisions on behalf of a client or baby

In order to learn and master their scope, most doulas receive intensive training or go through an apprenticeship model to learn from a senior doula before serving families on their own. Training usually includes 16-32+ hours of learning with an instructor, book reading and reports, and attending a number of births or assisting another doula before becoming certified. Trainers are usually expert doulas, childbirth educators, and sometimes health care providers, with years of experience supporting families in pregnancy, birth and postpartum.

A brief history of doulas

Doulas became a profession in the United States because many birthing people were isolated from spouses, family or support people, as recently as the 1960’s. From the Victorian era through the mid-1900’s, deliveries that had long taken place in the home, under the skillful care of midwives, were slowly moved into hospitals, first as an experiment, then as a means of delivering (and billing) more care to upper-class women who came to associate medications and new technologies used by (usually male) obstetricians with status and comfort.

Bigoted ideas about female anatomy, race and sexuality strongly influenced these early hospital systems and obstetrics in general, with Black, Indigenous and immigrant poor or enslaved women bearing the brunt of systemic problems. What was learned through the bodies and experiences of more vulnerable populations was then marketed to wealthier, mostly White women seeking pain relief, convenience, or other possibilities of industrial era approaches.

Today, efforts to address preventable disparities in health outcomes point to this history of maternity care in the United States, and the ways it is intertwined with the injustices of racism. We have come a long way, but valid concerns about today’s patient rights, autonomy and respect are seeded in practices of only a generation or two ago.

That system sometimes led to improved access to high-tech services, for example if a Cesarean section was necessary - it also meant many patients were subjected to misguided hospital practices of the time. These included:

• Use of heavy narcotic medications in inducing “twilight sleep” during labor
• Physical restraints
• Impractical or injurious uses of forceps or other tools
• Withholding food or water from patients
• Lack of consent for procedures
• Separating newborns from their recovering parents.

By the 1960’s and 1970’s, in response to this crisis and with the Civil Rights movement and women’s equality efforts of the same era, doulas, primarily women, started serving other women who wanted to have:

• Trusted support from a non-medical person
• A friendly, confident and calm face in the birth room
• Help understanding medical procedures or communicating with staff about options
• Help or protection from disrespect, sexist practices, or infant separation
• Assistance to spouses or new fathers in feeling confident, supportive and informed

What can a doula do for me? An overview of doula services

Great reasons to work with a doula are written right into their job description. A birth doula usually provides support for someone prenatally and during their labor and birth, and a postpartum doula usually focuses on the parent-baby pair after birth - some doulas do both! There are also doulas who specialize in supporting someone experiencing pregnancy loss, and there is even a niche for fertility processes like IVF.

In either case, a doula can provide the following doula services for you and your family, no matter where you are in your journey:

Physical support may include:

• Comforting touch, such as massage or acupressure
• Helping a laboring person to eat a meal, preparing tea, etc.
• Fostering a calm environment
• Assisting someone who wants to use hydrotherapy, different labor positions, and other childbirth techniques.
• Pregnancy nutrition help
• Demonstrating infant care techniques
• Practice labor prep with a partner
• Help with home chores while a birthing person is in recovery.

Emotional support looks a little different for everyone, but it could include:

• Verbal encouragement, reminding you of your strengths
• Helping you navigate communication with your partner or family
• Helping to identify and celebrate your goals
• Holding space for your feelings after a medical experience
• “Continuity of care” - their presence with you through each step of your journey, makes them someone who is familiar to you and familiar with you and your story

Informational support that doulas provide will depend on their exact background, but a skilled doula should be able to:

• Help you find evidence-based information about your options
• Help explain medical procedures
• Guide you and your support team through the various stages of pregnancy, labor and postpartum
• Share holistic techniques like movement, breathing, relaxation and general wellness tips
• Offer comprehensive labor preparation, certified childbirth education
• Offer insight, resources and referrals on additional topics such as breastfeeding, pelvic floor preventative health, and newborn care basics

Advocacy support means helping you to be an effective communicator and decision maker in collaborating with your medical care team. Doula styles of advocacy vary because it is not a doula’s job to speak directly for their client, but it is their job to help their client be fully informed and feel empowered in their choices. As a medical patient, even if you aren’t sick, you are the decider when it comes to your care. A skilled doula can help you to remember that by:

• Helping you to understand and develop a birth preferences plan
• Debrief with you before or after medical appointments
• Facilitating communication with your medical staff
• Helping you to ask questions or find more information
• Compassionately accompanying you through a challenge
• Bearing witness and helping your partner, family or primary support person to directly assist and advocate with you
• Assist you in documenting or communicating postpartum requests, feedback or important information between your family and your health care providers

The health benefits of having access to doula services

There is a lot happening in a large clinical setting - while everyone has the goal to keep babies and parents safe, there is also the matter of operating a facility and business.  In fact, researchers are exploring how hospital design itself is a primary determinant of birth outcomes, regardless of client health and provider types.

With only so many rooms or beds, hospitals must receive and discharge clients within a certain window of time. Every medication or procedure used must be documented and categorized for insurance billing, and staff must manage the competing demands of long shifts, oversight requirements, multiple patient requests, liability protocols and various approaches to providing care. Very rarely is the medical professional who delivered prenatal care available to meet with their client and help them deliver their baby when the time comes. With these competing pressures - not to mention the emotional vulnerability of having a baby, it makes sense to have an experienced support person solely dedicated to your experience, questions and well-being.

Generally, and in the research measuring the impact of doula services, a doula is most effective as a third party, separate from the pregnant person’s immediate family, friends, or medical staff. This is considered important because of the special relationship of service and advocacy a doula provides to their client - a relationship that might be influenced by a hospital employer or pre-existing personal relationship.

Some of the well-measured benefits of having a birth doula include:

• About a 40% reduction in risk of Cesarean
• About a 15% increase in likelihood of a vaginal birth
• Decrease of 10% or more in use of pain relief medications
• Shorter lengths of labor
• Better Apgar scores for newborns and fewer NICU admissions
• Increased rates of client experience satisfaction
• Increased rates of successful of breastfeeding

A doula’s process - how it works!

Depending on when you hire a doula, you may meet them right away, throughout your pregnancy, or just in the weeks leading up to your birth. In a postpartum arrangement, you might work with the same doula who attended your birth, or someone who meets you towards the end of pregnancy, or right after birth. Occasionally, through volunteer programs or last minute decisions, you might not meet your doula until you are in labor, but most professionals prefer to connect ahead of time.

Some doulas have unique processes that they have created to offer you a mix of skills and appropriate support. If interviewing doulas, ask them for specifics of how they will work with you. Otherwise, these are the basics of how a doula can work with you and your family.

• Phone call, screening or interview. There is a doula out there for everyone who wants one, and some people will feel like a better “fit” than others. Many doulas have a website or printed brochure you can look at before discussing your goals, your pregnancy, and your doula’s services. An initial screening serves to help you get a sense of the doula’s personality and style, helps them to understand your needs, and provides an opportunity to discuss limitations, pricing, extras, and expectations.
• Prenatal visits. The length and frequency of these appointments vary, depending on your doula’s service and the amount of time you have together. The purpose of these visits is to become familiar with your doula, practice labor techniques with your team, learn information about your options, and to help you to prepare and plan for birth and beyond while feeling supported. Very commonly, a birth doula will meet with an individual or family two or three times before attending them in labor, and sometimes more.
• On-call labor support. The details vary, but most families who hire a doula arrange for their doula to be with them during labor. Sometimes a doula will join a laboring person at their home, or they might assist you in getting to the hospital or meet you there. In either setting, a doula should be accessible, available and ready to provide the agreed upon services for labor, birth, and the immediate postpartum period, starting about two weeks before your estimated due date. If they aren’t available or if they need a break, they should have back-up coverage.
• Postpartum visits. Most birth doulas provide at least one postpartum check-in, and many provide multiple visits or incorporate a postpartum check-up, closing meeting, or newborn care and feeding session into their package. Alternatively, when you hire a doula specifically as a postpartum support person, they will likely have a number of hours or visits they can provide based on your health, your needs, and your preferences. Postpartum recovery is a sensitive and unique time during which a doula’s care can be not only uplifting, but provide serious benefits to your health, safety and confidence as a new parent.

When to hire a Doula

For anyone interested in supporting their health, easing stress, and taking the reins on decisions about their pregnancy and parenting, a doula is a wonderful resource. Whether you are a first time parent or you already have children, you deserve support that helps you feel informed, empowered, and capable. If hiring a doula sounds right for you, click here for a deeper dive on hiring a doula, considerations and questions to ask, and resources to get started.

What are Virtual Doula Services?

While birth doulas are an evidence-based addition to any family’s journey, and have been shown over recent decades to improve health outcomes as well as client satisfaction, the Internet era and COVID-19 have put new demands on birthing people and those who serve them. Doulas are no exception, and some have shifted their services to continue helping clients in new restrictive scenarios. While the virtual aspects of doula support have yet to be studied in-depth, we do know that some of the benefits translate across all types of contact. Read on for more details about virtual access to quality doulas from the convenience of your home or device-based access.

Remote doula support

In less populated areas, rural regions with fewer medical facilities, or towns with older demographics, there may not be many doulas around. Nonetheless, a pregnant person can still benefit from the emotional support, personalized education, and assistance navigating complicated health care systems that a doula provides- the question is, how? While most types of jobs occur on-site, there have always been some professions that serve clients remotely. Doulas are one of those groups. Even if your local hospital setting has restrictions on visitors, or if you are concerned about minimizing COVID-19 exposure risk, many doula gifts can be accessed remotely!

Today’s doulas are particularly well-equipped to provide remote support, and thanks to tablets, laptops, wireless internet and video conferencing, they can visually guide laboring and support people in some of the physical techniques of labor. Even before these tools helped birth professionals to reach clients far away, doulas sometimes used phone calls, printed resources sent in the mail, and even recorded audio tapes or videos to provide education, social support, encouragement and organizational help to families they couldn’t see in person.

Doula help during COVID-19

Doulas share a legacy of adapting care to meet the holistic needs of diverse families. The SARS-CoV-2 pandemic is no exception. During COVID-19, doulas have rallied their skills, imagination and collaborative spirit to support pregnant and postpartum people amidst social distancing, travel and visitation restrictions, and rapidly changing knowledge about safety and risk.

With the remote capacities described above and by leaning into community tools for health advocacy, patient safety and reproductive equity, doulas have served American families with renewed approaches and impressive dedication since March 2020, when the virus first reached concerning levels nationwide. That service has included many innovations, redefinitions and partnerships, leading to:

• Increased quality of online health, pregnancy and childbirth learning
• Collective organizing for informed choice among parents and birthing people
• Socially distanced and affordable options for labor preparation classes
• Creative solutions for safe, convenient access to:
• Expert advice
• Shared experiences and compassionate solidarity
• Collaboration between parents and professionals

Virtual childbirth education

If you’ve read any of our content on childbirth preparation and preparing for labor, you know that there is a LOT a pregnant person or partner can learn when it comes to pregnancy, childbirth, postpartum processes and infant care. Some of this knowledge can be gleaned from books and films, while the internet can be an overwhelming source of information, some of it of better quality than others.

A professional childbirth educator is skilled in conveying complex topics in simple ways, with respect for your feelings, fears and hopes. They might cover topics like prenatal screenings, labor symptoms and techniques, making informed medical decisions, and feeding your baby. Quality instruction usually includes information that isn’t covered in hospital tours or classes, and often includes tips from experienced parents and medical practitioners.

Childbirth education can take place over a series of sessions, a longer workshop, or in shorter bite-sized pieces. A small or private class allows time for your personal questions, and a group setting has the benefit of social connection, additional perspectives and unique opportunities for learning through discussion. Thankfully, the bulk of this content can be learned online and across multiple mediums, with graphics, written tips, and discussion to help you integrate new knowledge.

Selected Sources

• ‍Continuous support for women during childbirth. Bohren  MA, Hofmeyr  GJ, Sakala  C, Fukuzawa  RK, Cuthbert  A. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub6. Accessed 18 March 2021.‍
• “Evidence on: Doulas”, Evidence-Based Birth ®. Updated on May 4, 2019 by Rebecca Dekker, PhD, RN. Originally published on March 27, 2013.‍
• Optimizing Postpartum Care. ACOG Committee Opinion, Number 736, May 2018.‍
• "Twilight Sleep". Pollesche, Jessica. Embryo Project Encyclopedia (2018-05-16). ISSN: 1940-5030 http://embryo.asu.edu/handle/10776/13061.