What Do Doulas Do -- And How Can I Find One In LA?
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 human creature that's growing inside your body.
Some people put together a birth plan for the occasion, which lays out a woman's 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 with educational, emotional, and advocating 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.
Think of them more like coaches or advocates for pregnant women 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," wrote Compton doula Bethany Benson.
I ALREADY HAVE QUESTIONS
We did too. There's a lot to consider here. Like, how do I 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 like this, and we spoke with 20 California doulas to get answers.
BUT FIRST, A VERY BRIEF HISTORY
Doulas have existed in one form or another since ancient times. Before hospitals and modern medical care, women typically were assisted by family members while she gave birth at home. The word doula comes from a Greek word for female helper.
DO DOULAS HAVE ANY AFFECT 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," said Rachel Hardeman, a University of Minnesota researcher who specializes in reproductive health equity. "I think we should be careful to understand that like, this is one piece of this bigger puzzle."
THE BIRTH PLANS
The doulas LAist spoke with said they support women with a variety of birth plans, including hospital births, cesarean sections, vaginal birth after cesarean (VBAC), medicated births and non-medicated births.
In other words, said Los Angeles doula Michelle Sanders, "we don't try to force you to have your baby out in the woods without medication. 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," she said.
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.
VISITS BEFORE THE BIG DAY
Doulas have prenatal meetings 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:
- Help create a plan for birth
- Suggest stretches or exercises
- Give dietary information
- Attend doctor's appointments
- Provide childbirth and infant care education
- Coach a partner, family member or friend on how to support the mom
- Create herbal or essential oil treatments
- Offer pain management techniques
- Generally answer questions about birth, including those related to anatomy and physiology
- Suggest ways families can prepare for postpartum -- including physical healing, breastfeeding, 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.
IN THE ROOM DURING THE BIRTH
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 labor doulas can offer:
- Guided visualizations
- Help with positioning the mother
- Taking photos and document the birth process
- Advocacy for the wishes of the birth plan
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 in 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 said.
You did it! There's a baby.
Doulas can return to your home to answer any questions you might have about breastfeeding, your baby's health, your healing body, mental health -- and they might even stock you 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!)," new 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:
- Placenta encapsulation (though this would need to be arranged ahead of time)
- Sleep consulting
- Emotional and other support through stillbirths and miscarriages
Several of the doulas LAist talked to say they stay in touch with clients as their babies grow up.
HOW TO FIND A DOULA IN L.A. (or anywhere, really)
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:
Kindred Space: doula support, midwifery, childbirth education classes, lactation consulting support groups, birthworker training.
Long Beach Birthworkers of Color Collective: doula services on a sliding scale, doula trainings.
Village Birth: childbirth education classes, doula services, support groups.
Bini Birth: doula services, childbirth education classes, doula trainings.
Bundle of Joy: doula services, childbirth education classes.
Los Angeles Birth Partners: doula services, childbirth education, lactation consultations.
Joy in Birthing Foundation: pro bono doula services for low-income families, doula training.
Baby Brilliance: doula, childbirth education, newborn care specialist services and referrals.
The Birth Co-op: childbirth education, doula services and referrals.
Childbirth and Postpartum Professional Association (CAPPA): doula, childbirth and lactation training, certification, doula and educator directory.
WHAT TO ASK WHEN DECIDING WHO 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 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?
Interview several doulas (three is a good number) and 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 judgement 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 at ease?
- Can you imagine being vulnerable in front of them?
"Each doula has a different personality and skill set," said 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."
IS THERE ANY SORT OF DOULA CERTIFICATION?
Well, yes and no.
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.
Doula Stevie Merino 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.
She co-founded the Birthworkers of Color Collective, which offers a three-day doula training in Long Beach.
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 said they take a variety of payments:
- Credit Card
- Barter for goods or services
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, L.A. Care Health Plan and Kaiser Permanente told us they do not cover doula services.
"At this time, doulas are not considered essential to maternity care and therefore not covered by Blue Shield of California," said a spokesman via email.
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."
A spokesperson for for L.A. Care Health Plan said the organization is "currently researching the benefits of doula services, including the feasibility of making them available to targeted members."
UnitedHealthCare does not cover doula services, but a spokesperson said people with a health savings account could apply those funds to paying for a doula.
Some doulas work through a non-profit 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.
The L.A. County Department of Public Health is currently piloting a program that provides free doula services to African American women in parts of the county with the largest numbers of black infant deaths.
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.
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."
"I have two children and we worked with the same (amazing) doula for both births," wrote Jessica Yarger. "She acted as a guide through the birth process, an advocate in the hospital, a support for my spouse, was an educated impartial sounding board when decisions had to be made, and helped me at all times stay in tune with my body. She reminded me over and over that my body was built for birthing."
"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."
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.
And 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, just knowing what to expect and how to have the right frame of mind to be able to help my wife," he said.
Despite their success, the Escobars did not have a doula when their daughter was born a few years later. One factor was cost.
"It's like a luxury, when I really don't think it should be considered a luxury," Elizabeth said.
UPDATE, Jan. 23, 2 p.m.: This guide was updated to include additional doula service organizations.