How Doulas Can Help Moms and Families During and After Childbirth

According to the nonprofit doula organization, DONA International (DONA.org), “From the beginning of time, people have been cared for and nurtured during pregnancy, birth and postpartum. Family, friends and neighbors from the community would rally around the new family to help guide them through their tender early weeks and months with a new baby.”

Doulas bring a nonmedical approach to birth and are trained to provide continuous, one-on-one care and physical and emotional support during labor. They may also provide information and support to families before or during birth and into the postpartum period. In Birth Ambassadors: Doulas and the Re-Emergence of Woman-Supported Birth in America, authors Christine H. Morton and Elayne Clift define a doula as “a special companion who supports women during pregnancy, labor and birth.”

Some services doulas provide include:

• Birth planning and education
• Breastfeeding help
• Mental health support
• Health care navigation
• Support during labor and birth
• Postpartum support
• Connection to local resources

Researchers who combined the results of 26 trials with more than 15,000 people across 17 countries, in both high-income and middle-income settings, found that the best results occurred when a birthing person had continuous labor support from a trained doula, NOT someone who was a staff member at the hospital and or part of their social network. This type of overall, continuous support during birth leads to a:

• 39% decrease in the risk of Cesarean
• 15% increase in the likelihood of a spontaneous vaginal birth
• 10% decrease in the use of any medications for pain relief
• Decreased labor duration by an average of 41 minutes
• 38% decrease in the baby’s risk of a low five-minute Apgar score
• 31% decrease in the risk of being dissatisfied with the birth experience

Siskiyou County doula Chelsy Marriott helps guide and comfort a laboring mother, easing her labor and creating a peaceful birthing experience. Photo By Belle Âme Photography.

Doulas stay focused on mom and baby

Most mothers agree that labor and delivery nurses are angels in scrubs. Unfortunately, demands on nurses are intense. A doula is an asset, even with one-on-one nursing care. In labor and delivery, there are really two patients: you and your baby. Nurses must update charts, consult physicians and monitor the baby. A doula stays focused on you, start-to-finish.

According to Ann Fulcher, CLE, CD, program manager for the Hearts and Hands Volunteer Doula Program at the University of California, San Diego, the hallmark of doula care is “the continuous presence of an experienced woman who has no clinical responsibilities and so is free to focus on the whole family’s personal needs all the way through the birth experience. Doulas support women with epidurals as well as those who choose to forgo drugs, encouraging each to make their own choices. They work with both doctors’ and midwives’ patients and see normal as well as high-risk births.”

Doula attended labors are shorter, safer and less stressful

Long, drawn out labor can be physically and emotionally challenging, even if a woman is medicated and ‘comfortable’,” says Fulcher. “Shorter labors are more effective.” Mothers are also less likely to receive epidural anesthesia, forceps delivery or a cesarean, she says.

Doula-supported mothers report less distress during labor, and these emotional benefits pay off physically. When you’re stressed the body releases adrenaline, activating the fight-or-flight response. “In simplest terms, adrenaline suppresses oxytocin, the hormone that makes labor happen,” says Fulcher. If a mother is anxious, scared or angry, stress hormones may cause labor to stall. “That’s where the doula’s informational and emotional support comes in,” says Fulcher. Doulas are useful even for medicated labor and surgical deliveries.

“One-third of women will perceive their birth as traumatic and 4% of them will develop PTSD,” says local Siskiyou County doula, Chelsy Marriott CD/PCD(DONA), CLC. “Doula support can be protective against traumatic birth experiences. The perinatal time is a key time in a woman’s life where her brain is more vulnerable to trauma but also primed for healing. Positive experiences and improved parent-infant bonding can have a long-lasting impact that can affect generations.”

Doulas help postpartum

In addition to birth doulas, there are also postpartum doulas, who assist new parents and their newborns at home. They provide a steady source of emotional and physical recovery from childbirth, education on newborn care, coping skills for the parent(s) and information and support on lactation and breastfeeding.

Doulas promote equity and protection for Black, Indigenous and other people of color

Increased stress due to racism can negatively impact pregnancy outcomes, according to a 2005 American Psychological Association Report “Explaining Disproportionately High Rates of Adverse Birth Outcomes Among African Americans: The Impact of Stress, Racism and Related Factors in Pregnancy.”

According to the organization, Evidenced-Based Birth, access to continuous labor support from a doula or other labor support professional is especially vital for Black, Indigenous and birthing families of color. A 2022 analysis of responses from 1,977 women in the 2018 Listening to Mothers in California Survey found that women of color who received Medi-Cal insurance and had a doula present with them during birth were more likely to report experiencing respectful care during labor and birth than those who did not.

Doula care is now covered by Medi-Cal

Those with Medi-Cal insurance or a Medi-Cal Managed Care Plan can get Doula services completely covered.

Chelsy Marriott, a contracted doula with Medi-Cal, says, “This insurance benefit makes doula services available to a much larger number of individuals. The improved health and mental well-being of parents and infants will be far reaching.”

The Medi-Cal doula benefit includes up to nine perinatal visits, complete support during labor and delivery, and postpartum support including home visitation. This full-spectrum doula support covers all pregnancy outcomes including miscarriage, abortion and stillbirths. Doula services can be provided virtually or in-person with locations in any setting. Eligibility requirements entail a current pregnancy or being pregnant within the last 12 months.

You can find a Medi-Cal contracted doula in in your county at dhcs.ca.gov/services/medi-cal/Documents/Doula-Directory.xlsx

More information about the doula Medi-Cal benefit can be found at dhcs.ca.gov/provgovpart/Pages/Doula-Services-Members.aspx

Finding the right doula for you

If you are wondering if a particular doula may be a good fit for you, here are some questions to consider: What is their training and philosophy? What are they passionate about? How experienced are they? What is their approach to soothing strategies? What is their personality like? What are their fees and availability like?

Many local doulas are present on social media and web searches or found via word-of-mouth. For doulas covered by insurance, contacting your insurance for a list of their contracted doulas is another option. You can also try DoulaMatch.net or search a doula organization directory such as dona.org.