Choosing a Labor/Birth Doula: The Ultimate Guide
The months (or years) spent preparing to welcome a new baby often pale in comparison to the day(s) spent working to bring the baby into the world through labor and birth. These days will go down in your personal history as some of the most important and life-changing. It stands to reason that choosing the people who will participate in this beautiful work should take some thought and consideration. You'll choose a medical care provider and decide between a midwife & an OB/GYN. You'll choose whether to birth at home, in a free standing birth center, or in a hospital, so you'll come into contact with any number of these sites' staff. One of the options I hope you consider is a professional support person or persons in the form of labor or birth doula. If you’re reading this article on Your Birth Team's site, you’re likely to know what a birth doula is and how she/he/they can support your parenting journey. But just in case you don’t and are curious, click here.
Like anything else on the internet, my suggestions are merely that-not a set protocol. While I hope my article makes you think critically about the interview process so that you can find the doula who fits your needs best, there are inevitably things I couldn't write about here that you might keep in mind. For instance, there are male doulas; there are perfectly lovely doulas who never certify with an organization; and there are plenty of childbirth educators in the world who doula on the side but don't call it that. It’s very likely that there’s a doula/doulas closer to you than you realize, no matter where you live. If you take the time to figure out what you want and need from a labor or birth doula before hiring, all parties are bound to have a wonderful experience and fond memories at the end of the day.
Don't Act Like A Hiring Manager
Like any potential employer should, take the hiring process seriously. However, you’re hiring someone to step into your home and your life for a day or two (not including time spent in your home pre- or post-natal). You’re hiring someone who will see you at your most vulnerable; you could be naked in front of this person; you could scream at this person; you could cry with this person; you could sleep in the same room as this person. For the sake of your sanity, you need to make sure you’re going to be comfortable with the person you hire to be on your birth team. So get the logistics situated first, but then hone in on whether or not you are personally comfortable with that person(s).
Gettin' Cozy
Let’s talk comfort levels, shall we? I’m referring to the symbiotic exchange between a laboring woman, her partner, and her doula. For one person, being comfortable might mean hiring a birth doula who can clearly understand, respect, and keep in mind the personal boundaries you have set up because…“there is NO WAY anyone should see me naked in birth and if one step is made toward my lower half I will kick that person out.” For another, being comfortable could mean hiring a birth doula who commits to always answering her phone no matter what and dedicates an entire month of on-call time to you alone so you don’t have to worry about her missing your birth due to a scheduling conflict. Yes, those are extremes on a graduated scale of needs, and you’ll most likely fall somewhere in the middle there with yours. But, the extremes are real issues for many families that should be taken into account and respected when possible.
Food for Thought
So, before you go inviting a handful of doulas to your home for interviews, sit down with your birthing partner(s) and figure out what it is you want out of the experience. Why are you hiring a doula? What do you want your doula to actually do during your labor and birth? What are your boundaries? Do you envision a doula who will run out to grab food to keep everyone’s energy up? Would you be more comfortable with a doula that shared your ethnic background? Would you prefer a doula who identifies as LGBTQ? Would you prefer to work with a solo doula, a set of doulas in a partnership, or a group of doulas who work independtly but backup for each other when needed?
Know Your Options
If you live in a metropolitan area or its outlying cities, chances are good that you’ll have a variety of personalities to choose from. No matter where you’re located, though, there are online directories to help you find your doula choices. There are international directories from trainig organizations like DONA, Birthing From Within, & CAPPA or nation-wide directories like Doulamatch.net in the states & Doula UK on the other side of the Atlantic. Searches can even be broken down into states or regions, as seen in Southern California's DASC and Utah's UDA. I'm sure other region-centric directories exist and google should be of some help there.
So you've identified the pool of applicants in your area. Now what? My suggestion is to set a short list of must-haves in your doula and then call and have a short chat about your musts.
Some of the basics to plot out before you contact a doula could include availability, cost, & level of experience desired. However, if you know you'd like to hire someone who serves a specific population, you could definitely start there.
Availability
This one is almost completely straight forward. Contact doulas, ask if they’re available to take a birth client around your estimated due date, and include whether or not you’re a first, second, or 6th time mama. If the doula says yes, go a step further by asking how many clients are on her calendar for the same month. You could also ask what the situation looks like if your doula was sick, at someone else's birth, had to go out of town at the last minute, etc.
Some doulas make their entire livelihood attending births, so they’re going to take on as many births as possible and pay a backup if and when they inevitably miss a birth due to two mamas in labor. Others only take on 1 or 2 clients a month because they do other things (postpartum doula, office day job, etc.) to offset the limited number of birth clients. Ultimately, if you’re uncomfortable with the number of clients a doula takes on per month, you shouldn’t sign up with her/them. It’ll just breed resentment if they have to cancel prenatal appointments for others’ births or miss your birth entirely because another mama went into labor first.
Cost
If you haven't given any thought to how much you and your family can invest to have a doula present at your birth, check out these resources for a breakdown and explanation of doula fees before you make a decision.
Let's say that you've given it consideration (please do) and decide that you have $500 set aside to compensate a doula for her time and services to your family. You start to call around to doulas in your area, but find that the highest rated/most recommended doulas all charge over $1,000, which is very common in metropolitan areas. In this situation, you have 3 options:
1) You think on it some more and decide to up your budget to match the going rate of experienced doulas in your area.
2) You ask if they ever work on an income-based sliding fee scale and figure out if the fee for your income bracket works for you.
3) You seek out doulas who charge less, but possibly have less experience in the field. If you go with option number 3, ask the original doulas you contacted for referrals to doulas with lower fees. Some will even post to forums or Facebook groups they’re a part of to help you find a doula who does fall within your decided budget!
What about free doula services?
I always caution families in seeking out doula services completely free of charge. Unless you literally have nothing in the bank to offer and no skill or service you could trade with, I suggest you search instead for a low-cost doula. At the very least, provide for your doula’s out of pocket expenses like gas to and from you and food while with you.
There are doulas who will offer birth services free and clear when they’re starting out. They do so to build up a knowledge base, to get recommendations and feedback for improvement, and to feel less pressure in the first few birth experiences they’re active in. While this all sounds swell, if your doula lives in a 1 bedroom apartment and shows up to support you and your partner in your beautiful 3-bedroom home for what could be days, you bet your bum she's going to be at least a little peeved and that will affect your relationship.
Another possible scenario-you could sign up with a free doula who doesn’t end up showing up to your birth because something that paid came up. That doula would suck and would pretty much be banned from doula groups everywhere if others found out that’s why she missed a birth. But she could also simply say she’s sick and no one would be any wiser. And there’d be no backup doula in place because very few people are willing to be on call for someone else’s doula gig for a guaranteed $0 paycheck. This is definitely a “you get what you pay for” type of situation that's no good for anyone; for the sake of transparency and honesty, I want you to walk into free doula situations fully aware that this is a possible outcome.
I do have one caveat to this section: If you are truly in need and can prove it via income tax returns or participation in a program like Food Stamps or WIC, you are bound to find a wonderful doula who will provide excellent care out of the goodness of her heart. I still suggest you barter, trade, offer a letter of recommendation, or have your partner/family members take photos of your doula in action if at all possible to show your doula you value her time and energy!
Level of Experience
This one is a little trickier for parents to navigate because there are many different ways to categorize experience.
To start, I want to suggest that parents never assume anything about a doula's background. If I've learned anything in this industry, it's that doulas and parent educators come from all walks of life (some more surprising than others). A doula who is 25 may have been supporting families for a decade before you meet her if she knew a midwife growing up. And a woman who is 60 might never have experienced birth or parenting before feeling called to this work.
I also want to put it out there that while giving birth and providing birth support are two different things, I'm an advocate of "counting it all" when considering what experiences impact a doula's career and offerings. There are amazing doulas on both sides of the parenting line. An OB/GYN who is male would have no personal birthing experience to draw from, yet may be absolutely wonderful as a provider. Just as a mother of three who has never attended a birth as a support person may just be the right fit for your family. Ultimately it should matter less what types of births your doula has or hasn’t had herself and more how she envisions helping you through yours.
Here's another way to look at this: a non-parent doula who has years of experience under her belt has a much wider array of birth experiences to draw from than a doula who has three children of her own but just trained as a professional support person. She also is able to provide practical benefits that doulas who have children might not offer. On the flip side of that, though, a doula with children of her own can empathize and understand moments of early parenthood from a perspective that the childless doula might not be able to. She might have a grace about her that others lack.
Parent or non-parent, you’ll ultimately want to make sure that your doula has experience supporting people with an open mind, willing hands, and a personality that fits with your goals. If you’re going for a very Bradley experience, hiring a doula who takes charge in labor could be a mistake that leads to your partner feeling useless. Similarly, if you aim for a quiet and calm Hypnobirthing experience in childbirth, you’ll want to be sure you find a doula who understands the principles behind the programs and discuss her role throughout. I know doulas who attend any type of birth free of their own agendas, but I’ve met doulas who only support mamas who are aiming for natural births. In the case of a client who wants to schedule a C-section in advance, hiring a doula who has supported or experienced this type of birth before would be recommended because she’ll probably be less judgmental, overwhelmed, or underprepared for helping you right after birth.
Rounding out my guidance on choosing a doula for your birth, I’d like to discuss the interviewing and selection process. By this point in your search, you’ve probably done quite a bit of work narrowing down the candidates (or you’ve ignored all of the above and just dove in head first by calling a bunch of people). The interview, then, is the next logical step.
Where to Meet Potential Doulas
Many doulas, like Your Birth Team, prefer to meet in clients’ homes for interviews so they get a feel for the space they’ll be working in and so that clients are as relaxed and comfortable as possible. While you may be new to the process, the doulas you interview will probably have been on dozens, if not hundreds, of interviews. It can be nerve-wracking meeting a new person in a new place to talk about very personal things. If the thought of interviewing causes you any anxiety, I suggest requesting a meeting in your home to at least help ease your mind and remove the driving aspect.
Do be aware that there are doulas who prefer to meet in public places for interviews; the reasons range from saving gas and time (after all, they don’t know if they’re going to be hired) to being safety-conscious.
How Long the Interview Should Be
Wherever you meet for the interview, please allow for approximately one hour to discuss your needs and get to know each other a bit. Under thirty minutes will probably not be enough time to get a good feel for the doula and vice versa. Over an hour, though, would be unfair to the doula as the interview is (usually) unpaid. Plus, if you are interviewing a handful of doulas, you’re going to want to be efficient with each so that you don’t exhaust your (usually) minuscule reserve of pregnant energy.
What You Should Ask
Doulas are independent business owners, and the time we spend setting up appointments, driving to and from them, and interacting with potential clients is valuable and does add up. Respecting your interviewees’ time and energy is the first step to creating a positive working relationship. Keeping the number of predetermined interview questions to a minimum helps, and won’t affect you negatively if you choose a doula who you feel comfortable communicating with long-term.
By all means, ask as many questions as you feel are necessary to understand the type of person the doula is. Just know that if you have three pages of typed questions and expect your interviewee to stay for 2 hours while you ask them all, you'll probably be disappointed with the interview outcome.
There are TONS of sample questions and lists out there that families can print and use for inspiration in interviews. A few of these resources can be found here, here, & here. But these are just general suggestions at the end of the day and I know I prefer it when clients ask us questions that are individual to their personal needs and wishes. Having a conversation is so much more helpful when trying to get to know someone!
I’d like to offer up some “insteads” because I believe there are more efficient ways to get the information that matters most than the general questions the helpful internet peoples provide.
Instead of…"How many births have you attended?"
Ask…"What experiences brought you to working with parents and how do you think those experiences would shape your time with me/us?
The Reason… As discussed above. age does not necessarily equate to experience level in the doula world. Lots of women get trained after they have had their own children; many more train after they help their daughters in labor. So, a middle aged woman might come off as having wisdom, but actually may lack hands-on experience with laboring women and their families as she may have just trained professionally. An older doula could also have been in the business for years and whoop all other doulas in the knowledge/experience/expertise/presence game. Either way, this question is pertinent.
I’m only 25 and haven't given birth; this may seem young in numbers & experience at first sight, but I have a college degree related to families and children, 5 years’ experience as a doula, 5 years' experience serving homeless families so I have a wealth of knowledge related to trauma, pregnancy loss, domestic violence, etc. and have a completely nonjudgemental approach. In total, I have helped a 200+ families in some capacity during pregnancy, birth, or in the first year postpartum. Plus, I’ve done a number of trainings and certifications, read dozens of related books and articles, and gathered loads of information to help my clients along the way. All this to say, I know a ton of amazing doulas in my area and none of them have the exact same things to offer, and I don't have what they have to offer.
Instead of… "When do you go on call?"
Ask… "When you go on call around our due date, what changes do you make to your life?"
The Reason… Typically, doulas are on call for a month around your due date. What varies is decisions like attending or skipping Girls Night at the bar every Friday or whether or not a weekend workshop will be scheduled and attended during your on-call time. The second question will probably lead to answers involving alcohol/recreational drug use, childcare for doulas with children, vacations, and more.
Instead of… "When will you join me in labor?"
Ask… "How much notice do you need before you can join me in labor?"
The Reason… Depending on your doula’s lifestyle and location, it could take over an hour for her to be ready to jump in the car. If your doula has children, childcare has to be figured out. If your doula lives 30 minutes from you but has a day job an hour away and has to wait for backup to relieve her there before meeting you, you’re going to have to call pretty early on in labor.
Instead of… "Where do you live?"
Ask… "Where do you spend the majority of your time?" or "How long does it take you to get to my home?"
The Reason… Like most people who work outside the home, many doulas don’t spend that much time in their actual residences, so asking that won’t really tell you much about them or about the distance they’ll be traveling to get to you. Most doulas are driving all over the place because they have interviews, prenatal appointments, and possibly a birth all in the same day.
I strongly believe it is advantageous to clients if they hire someone who spends a majority of their time in their relative area (20-30 miles), but this matters a lot less with first time mamas than 2nd, 3rd, or 19th time mamas as you have much more time in labor on average the first go around.
Also, keep in mind that the distance from a doula's home to yours doesn't necessarily correlate with the length of time it will take her to get to you once in labor. Like I mentioned above, this time frame depends on many factors including traffic (especially if you live in a metropolitan area) childcare arrangements (family down the street vs. daycare in another city?), day job status (immediately able to leave vs. the need to wait for backup?), mode of transportation (train, bus, car?) and more.
Instead of… "How many visits does your fee include?"
Ask… "What will we do at the prenatal & postpartum visits?"
The Reason… Generally, birth doulas include 2 prenatals and 1 postpartum visit to clients. You can request additional appointments, and your doula would most likely charge an additional fee per visit or per hour. If you want more one-on-one support postpartum, consider hiring a doula who includes 2 postpartum visits instead of one or ask your chosen birth doula how much she would charge for extra visits.
Despite there being some possible difference in the number of visits provided by doulas, I believe it’s far more important to ask what the doula will actually do during visits.
Prenatal Appointments: Are you just visiting and getting to know each other? Is your doula going to attend an appointment with your care provider so he/she is familiar with her? Will you spend time practicing labor positions and comfort techniques? Can she help you create a birth plan?
Postpartum Visits: Will you be reflecting on your birthing experience with her for an hour? Is your doula willing to help out around the house or with an older sibling during the postpartum visit(s)? Can she give you tips and tricks to heal in the postpartum period? How about offering breastfeeding support? Does she do a postpartum depression assessment or teach partners in the home to do it?
I hope this guide helps you and your family in your search for a doula, whether here in Orange County or abroad in another country! Thank you so much for reading.
