You're having a baby, and we are here to help, journalistically speaking. LAist has already made you a real talk postpartum guide for the other side of childbirth, but first you have to deliver the being growing inside your body, perhaps even during a pandemic.
Some people put together a birth plan for the occasion, with detailed preferences from birthing ball to breastfeeding.
Sometimes those birth plans include the services of doula, but not everyone knows what a doula does — and not all doulas do the same thing.
OK, But What Exactly Is A Doula?
Broadly, doulas provide expecting and new mothers or birthing people with educational, emotional and physical support before, during and after a baby is born.
Doulas are non-medical birth workers. They are not doctors or midwives. They don't deliver babies and they do not make medical decisions on a client's behalf or tell them what to do.
Think of them more like coaches or advocates for pregnant people and their partners as they approach their due date, while they're giving birth and during the postpartum phase.
"The purpose is that the clients are educated, empowered and inspired to make informed decisions for a healthy birth outcome," says Compton doula Bethany Benson.
Doulas have existed in one form or another since ancient times. Before hospitals and modern medical care, a woman typically was assisted by family members while she gave birth at home. The word doula comes from a Greek word for female helper, but today it’s not just women doing this work.
I Already Have Questions
We did too. There's a lot to consider. How do you interview a doula? How do you know they're qualified? Will insurance cover their services? What exactly are their services? What are the advantages? Are there any disadvantages? Also, how do I find one?
LAist readers sent us more than a dozen questions, and we spoke with 20+ California doulas to get answers.
Do Doulas Have Any Effect On Birth Experiences?
LAist reader Anne Buster told us that working with a doula when her sons were born created a better birth environment. She asked, "Do statistics back this up?" "Better" is a subjective term, but there is data about birth outcomes:
- A 2016 study of Medicaid-funded births found women who worked with a doula were less likely to have a preterm birth or cesarean section (this could also save health insurers nearly $1,000 per birth).
- A 2017 review of more than two dozen studies around the world found that women who received "continuous support" (like what a doula provides) during labor were less likely to have a cesarean section and could use fewer pain medications.
- The American College of Obstetricians and Gynecologists said in 2014 that "published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula."
Doulas are also increasingly viewed as key to efforts to reverse birth disparities experienced by women of color. In Los Angeles County, African American infants die at three times the rate for white infants and new Black mothers die at disproportionately high rates.
"The data are showing doula support during pregnancy and during the labor and delivery period can help to sort of mitigate some of these risks," says Rachel Hardeman, a University of Minnesota researcher who specializes in reproductive health equity. "I think we should be careful to understand that this is one piece of this bigger puzzle."
What Does Doula Support Look Like?
The doulas LAist spoke with say they support people with a variety of birth plans including cesarean sections, vaginal birth after cesarean (VBAC), hospital and home births.
“We don't try to force you to have your baby out in the woods without medication,” says Los Angeles doula Michelle Sanders. “If you want all the medication, tell me that and I will go down the list of all the medications and interventions with you so that you know what they are."
Long Beach doula Stevie Merino emphasizes she wants to provide non-judgmental support to clients.
"I'm not going to project what I want for you, onto you," Merino says.
Some doulas work with clients who are navigating a pregnancy loss including miscarriage and still birth. Other doulas work with those seeking an abortion. One term for someone that does it all is a “full spectrum” doula.
Each doula will have their own areas of expertise and their own way of doing things, but here are some examples of what to expect from a doula when you're expecting.
Doulas have prenatal meetings virtually, at the client's home, or wherever they're comfortable. Those meetings vary in length from an hour to several hours. It also might be more than one meeting.
Possible agenda items:
- Creating a birth plan
- Stretches or exercises
- Dietary and nutritional information
- Attending doctor's appointments
- Childbirth and infant care education
- Coaching for a partner, family member or friend on how to support the mom
- Herbal or essential oil treatments
- Pain management techniques
- Questions about birth, including those related to anatomy and physiology
- Navigating birth as an LGBTQ+ person
- Ways families can prepare for postpartum—including physical healing, breast or chest feeding, and self-care strategies
Many doulas LAist talked to also frequently communicate with their clients via text to help answer questions before and after birth.
There is a calm and patience, with knowledge, that a partner can't have. And a dedication and intimacy that the doctor, or in my case, the midwife, doesn't engage in.
Birthing Support, IRL Or Virtual
Doulas are on-call in the time leading up to labor. Most also have a trusted back-up doula in case they're not able to attend the birth. During the pandemic some doulas have switched to offering virtual support when they cannot be physically present.
During labor doulas can offer:
- Guided visualizations
- Help with positioning the mother
- Photography and documentation of the birth process
Sara Lutz hired a doula to help with the birth of her third and fourth children. "When we hit some rough patches with the pushing stage… she was the one holding me up and moving my dreadfully tired body into the positions my baby needed me in."
Doulas can also help keep track of their client’s birth plan.
"They are the eyes and ears, knowing what a mother needs and wants, when I was so deep in labor, that I couldn't have spoken for myself," wrote Marisa Davis. "There is a calm and patience, with knowledge, that a partner can't have. And a dedication and intimacy that the doctor, or in my case, the midwife, doesn't engage in."
But births don't always go according to plan. Sometimes families have to make unexpected decisions, like whether to have a c-section, episiotomy or induce labor.
Cyndi Whitwell, who has been a doula for more than 30 years in Sacramento, asks doctors to give her clients five minutes to consider any major changes.
"It's really helping them take a step back, take a breath and examine their options and decide what's best for them," Whitwell says.
Hospital Birth In A Pandemic
Having a baby is one of an infinite number of once-routine activities that was changed by the pandemic.
“Birth is uncertainty, but now we add even more uncertainty on top of it,” perinatal care specialist Mikaela Lynn says.
Hospitals changed their policies to follow the guidance of the Centers for Disease Control and Prevention, the California and local departments of public health and other organizations.
“Safety is the priority,” says Cedars-Sinai Medical Center Executive Director of Women and Children’s Services Michelle Souza.
Doulas and hospital staff say it’s important to ask hospitals about their visitation and COVID-19 policies as your due date approaches because during the pandemic they’ve changed from day to day.
A group of California birth workers and other advocates created a list of useful questions including:
- How many people can come with me for labor support? Can they come and go? Do they have to wear a mask or any other special protective gear? Do you provide the mask/equipment?
- How have your policies changed because of COVID? Do you expect any more facility changes?
- What is your COVID-19 testing policy?
- If I am found to have COVID-19, what will change regarding my care?
Earlier in the pandemic, hospital restrictions eliminated or limited visitors during birth. Now many hospitals allow for at least one visitor and a doula, but still have additional guidelines. There might also be different policies when it comes to visitors during prenatal appointments.
“Visitation in the hospitals, we know it's different and it probably will be different for a long time,” Souza says.
For example, hospitals may require visitors and doulas to provide proof of COVID-19 vaccination or a negative COVID-19 test. Doulas may also have to provide some proof of certification from a training organization (more on why that’s complicated below.)
“We want doulas to be present,” Souza says. “We want their collaboration during this birth experience.”
Even if your doula isn't able to be physically present at the birth, ask the hospital about accommodating virtual support by phone or video chat— don’t forget to pack the charger.
A Little More On Collaborating With The Hospital Birthing Team
Hospitals are not always welcome places during childbirth. A 2019 study found one in six women reported mistreatment during childbirth ranging from verbal abuse to ignored requests for help. The rates were higher for Black, Indigenous and Latino women. Other studies have found these perceptions of poor treatment are tied to disparities in care.
LAist has talked to doulas who’ve described sometimes contentious interactions with physicians and health care workers, but we also talked to hospital staff who say they want to work with doulas.
“I always encourage my colleagues to never ever look down on a patient who comes in with a birth plan,” says Emanate Health nurse and doula Nancy Lomen. “If they have a doula, think of that doula as just part of the team.”
Not all medical staff might know what a doula is or the role they play in birth. Emanate Health Director of Labor and Delivery Judy Chacon encourages patients to share their birth plans with physicians ahead of time, even if it’s not the one they ultimately deliver their baby with.
“We can always have this available for the physician that's going to be delivering this patient and try to make it where it's a collaborative effort to meet the needs of the patient,” Chacon says.
You did it! There's a baby.
Doulas can return to your home to answer any questions you might have about breastfeeding, baby's health, your healing body, mental health — and they might even stock your freezer with padsicles.
Some doulas are exclusively postpartum-focused.
A doula might also just stop by to watch the baby and provide a little relief — maybe long enough for you to even take an uninterrupted shower!
"My doula has visited me several times, brought food, washed dishes, checked on the baby, binded my belly and ensured that I was doing well mentally and emotionally (postpartum anxiety and depression, not here!)," mom La Mikia Castillo told us. "I am so grateful for her support during this critical stage as I transition into motherhood with a newborn."
Other postpartum services doulas can offer include placenta encapsulation (arranged ahead of time), sleep consultation and help with breastfeeding.
When the spotlight shifts to the baby— how much they weigh, what they’re eating, if everyone can hold them— doulas focus on the person who gave birth.
Lynn said they’re the ones asking “How’s your bleeding? Have you been able to poo? Have you been able to pee?... How are you eating? How are your boobs feeling? How is your body feeling?”
And then springing into action with help where needed. Doulas can be the “resource of resources.”
“There's a lot of different things to navigate,” Lynn says. “Some of my work is supporting those folks and helping them find the resources they need and deserve.
Several of the doulas LAist talked to say they stay in touch with clients as their babies grow up.
“I'm very big on creating community,” Merino says. “Doula work doesn't just end after the baby is born, or after whatever happens with the pregnancy.”
Is There Any Sort of Doula Certification?
There are local and national organizations that certify doulas. Usually the certifications require several days of training in areas like childbirth education, attending births, breastfeeding, and providing physical and emotional support. Programs can also require continuing education and recertification after a certain number of years.
Some doula trainings do not offer a certificate, and some doulas might choose not to seek a program that does.
Long Beach Doula Stevie Merino co-founded the Birthworkers of Color Collective and says there are questions within the birthworker community about who are considered the gatekeepers of birthing information and as a result, who is able to offer services.
How Much Does This Cost?
Each doula sets their own rate for attending the birth and prenatal and postpartum visits. That range in Los Angeles is typically from a few hundred to a few thousand dollars.
Doulas who responded to our question about this say they take a variety of payments:
- Credit Card
- Barter for goods or services
“Even if you think you can not afford it, ask for a sliding scale,” wrote doula Sarah Pinder. “Many of us offer and insist on it.”
Some doulas work through a nonprofit organization or independently to provide free or low-cost services to low-income families. In addition to typical doula services, these community-based doulas can offer referrals to other resources.
For example, the L.A. County Department of Public Health has a program that provides free doula services to Black women in parts of the county with the largest numbers of Black infant deaths.
Is Health Insurance Going To Pay For Any Of This?
This was the most frequent question we received.
LAist reached out to several of California's largest health care insurers.
Blue Shield of California, Kaiser Permanente and UnitedHealthCare told us they do not currently cover doula services.
Marianna Volodarskiy, regional clinical director for Kaiser Permanente Southern California, wrote the company is aware of the increasing interest in doula services and research on their benefits. "We continue to monitor for evidence validating this information."
UnitedHealthCare spokesperson said while the organization doesn’t does not cover doula services, people with a health savings account could apply those funds to paying for a doula.
Medi-Cal is scheduled to cover full spectrum doula services for low-income Californians starting on Jan. 1, 2023, though the rollout has already been delayed twice.
L.A. Care Health Plan is preparing to implement doula services on the same timeline.
“That means doula care not just for prenatal postpartum labor and delivery but also doula care for abortion care, miscarriage and abortion care, miscarriage and stillbirth,” says Amy Chen, a senior attorney with the National Health Law Program in Los Angeles.
The benefit is scheduled to start next January. In the meantime there’s a lot the state still has to figure out from how much to reimburse doulas for their services to who qualifies as a doula. You can find out more, including how to participate in stakeholder meetings by emailing DoulaBenefit@dhcs.ca.gov.
Where to Find A Doula in L.A. / Resources
You can look for a doula through local and national registries. Many doulas may also have their own websites and social media accounts.
Here are some Southern California resources. Many also offer support virtually:
Baby Brilliance: doula, childbirth education, newborn care specialist services and referrals.
Beauty For Ashes Maternal Wellness: a nonprofit focusing on perinatal support for BIPOC birthing people, pregnant and parenting teens and doula mentorship.
Bini Birth: doula services, childbirth education classes, doula trainings.
The Birth Co-op: childbirth education, doula services and referrals.
Birthing People's Bill of Rights: a guide to advocating for yourself in hospital and health care settings during the pandemic, created by California birth workers, legal experts and maternal and child health advocates.
Birthworkers of Color Collective: support for birth workers and doula training based in Long Beach.
Bundle of Joy: doula services, childbirth education classes.
The Cradle Company: a pregnancy and postpartum resource center that offers doula services, baby care classes, lactation and pediatric sleep consultation in Southern California with several locations including Pasadena and Newport Beach.
Joy in Birthing Foundation: pro bono doula services for low-income families, doula training.
These resources were recommended by California birth workers and families. Have a suggestion? Email email@example.com.
Kindred Space LA: birth center, doula support, midwifery, childbirth education classes, lactation consulting support groups and birth worker training based in South L.A.
LOOM: pregnancy, postpartum, sexual and reproductive health education.
Los Angeles Birth Partners: birth and postpartum doula services, referrals childbirth and newborn education, lactation education and consultations.
Long Beach Birthworkers of Color Collective: doula services on a sliding scale, doula trainings.
The Pump Station: doula referrals, parent-and-me classes, lactation education and support based in Santa Monica.
Village Birth: childbirth education classes, doula services and support groups.
Childbirth and Postpartum Professional Association (CAPPA): doula, childbirth and lactation training, certification, doula and educator directory.
March of Dimes made a template for creating a birth plan during the COVID-19 pandemic. It’s available in 14 languages including English, Spanish, Korean, Armenian, Tagalog, simplified and traditional Chinese.
What To Ask When Deciding Which Doula To Hire
First, ask yourself some questions:
- What do you want out of your experience with a doula?
- Is your doula's personal background a factor?
- Do you want to work with someone who can support you in breastfeeding or who provides a specific service?
- Are there family or cultural traditions that you want to include in your birth plan?
- How much can you afford to pay?
Consider interviewing several doulas (three is a good number). You might ask questions like: What is your experience? What services do you offer?
"Find someone who you like to talk to and you feel comfortable with, someone who inspires you and makes you feel confident and trusting in yourself!" wrote doula Rebecca Belenky. "Most people feel a lot of judgment from others during pregnancy and parenting, you should not feel judgment from your doula as well."
Orange County doulas Marlee and Megan Malone-Franklin suggest asking about a doula's journey to birth work and how they approach working with partners and care providers.
Then, back to the personal questions: Does the doula make you feel safe? Can you imagine being vulnerable in front of them?
Do we have a connection? Do you feel safe with me? Do you feel like you can be vulnerable? You are inviting another person into some of the most intimate moments of your life.
"Each doula has a different personality and skill set," wrote Darla Burns, a doula from Santa Clarita. "Who could you imagine being in that intimate space when you are in pain? Who would comfort you the best? It's not just about experience and price, there has to be a connection with the doula."
Merino often says this in her potential client interviews: “If it's not a strong Yes, it's probably a No.”
“So often during pregnancy, we don't get to choose a lot of things,” Merino says. “And so the things that we can choose, like who is going to be supporting us, it should be a choice that feels good.”
Can I Hear Some Real Life Stories Of What It’s Like?
Yes! Many of the people who wrote us back said we could share their stories. The overall takeaway was that their doulas helped keep them calm, advocated for their health and provided a valuable source of information.
Giving Birth In A Pandemic Can Be Isolating. It Doesn't Have To Be
In early 2020, then-Alhambra couple Sheila Thomas and Charles Lyles knew the birth of their second child would be different because of coronavirus.
Thomas, a licensed clinical psychologist, said she sought out a doula because she was among those who experienced postpartum anxiety when her first son was born.
Her mind raced with uncontrolled thoughts like "I'm the only one who could keep this baby alive. Nobody else will be able to keep this baby alive. So that means that I have to stay awake — all the time. I cannot sleep. There will be no sleeping because I'm the only one. All other people, they might let him die. For real. They probably want him to die."
"Honestly, like it goes that bad," Thomas said.
During a routine prenatal visit on May 7, several days before her due date, a doctor told Thomas labor would have to be induced that day because her amniotic fluid was low.
"And then I flipped out," Thomas said. "[I said], let me call the doula who can listen to what it is you're saying, and then tell me later when my mind is clear."
Once at the hospital her birth plan went into action — it asked that the hospital staff get her permission before touching her body and performing procedures.
The plan also called for music.
Thomas had planned to listen to a playlist of '90s R&B, but in the moment the song that felt right was Juvenile's "Back That Thang Up" — the uncensored version.
Thomas danced in her light blue hospital gown, IV trailing from her left hand, and Cowan laughed with them over FaceTime.
When the pain intensified, Cowan guided Lyles as he used his hands to massage his wife's sacrum and glute muscles.
"She inspired me to do it, to help her out, which helped me feel like I was actually being useful," Lyles said.
Their son Ezra was born at 9:36 p.m. on May 7, 2020 about an hour after the hospital room dance party.
When we talked later that month, the network of support surrounding Thomas included her husband, family, a therapist, public health programs, and her doula, who, for now, is a text message or phone call away.
"I still have thoughts like I'm the only one that can keep them alive, but now I can say that's unrealistic," Thomas said. "There's other people here."
An Empowered Orange County Father
Orange County dad Jose Escobar says he was skeptical about his wife Elizabeth's desire to have a doula when she was pregnant with their son in 2016.
But as they worked through their doula's "birth boot camp" program, he started to change his mind.
"The knowledge, methods and preparedness they provide was so valuable for us to feel confident during pregnancy and feel more ready during labor," he said.
When Elizabeth was diagnosed with gestational diabetes, their doula accompanied her to her appointments with a dietician. When their plan to have their baby at a birthing center went out the window during a 33-hour labor, their doula followed them to the hospital, too.
"I get there and I'm being bombarded with just like, nurses and there was like, student nurses or student doctors and all just kind of stuff," Elizabeth said. Their doula was a buffer.
Jose said he felt empowered to have a role in the birth of their son whether it was coaching Elizabeth through breathing exercises or helping manage pain.
"That was major for me,” he said, “just knowing what to expect and how to have the right frame of mind to be able to help my wife."