Embracing the Doula Difference

The role of a doula, rooted in ancient practices that vary across cultures—from Latin America's "cuarentena" and China's "zuo yue zi," to Nigeria's omugwo—has evolved into that of a professional who offers emotional, physical, and informational support to new mothers. They play a vital role in supporting the mother and the family post-birth, just as seen in many traditional customs, thus providing a bridge between cultural tradition and contemporary medical systems for new parents.

Despite the growing popularity of doula services, only 6% of births in the U.S. benefit from doula support. This low percentage stems from several factors: many families cannot afford doula services, insurance coverage is often insufficient (for instance, about 35% of millennial moms would have wanted doula support), and the number of available doulas—approximately 9,000—to support the 3.6 million births each year is simply not enough. Yet, perhaps the most significant barrier is the lack of awareness about the role of a doula and the immense support they can provide to expectant mothers.

In my own journey to becoming a birth and postpartum doula, I have encountered numerous questions from friends and family—many of whom have experienced childbirth themselves—about the difference between a doula and a midwife. For some, the concept of a doula was entirely new. So, let's clarify what a doula is and how their support can be a game-changer for both the birthing and postpartum experience.

Within the doula community, the role is typically defined as the “one who mothers the mother”. Many cultures have embraced this ancient concept for years. In Latin American cultures, the "cuarentena" is a 40-day period where new mothers rest at home, avoiding household chores and focusing on bonding with their baby, supported by the women in their family. In Chinese postpartum tradition, "zuo yue zi" involves a new mother's month-long rest at home. A confinement nanny, or "pui yuet," helps by preparing herbal remedies, nutritious food, assisting with the newborn, and offering motherhood tips. Nigeria has its own omugwo tradition, where a relative supports the new mother and baby for 40 days post-birth, handling household tasks to let the new mother focus on recovery and bonding with her newborn. 

A modern day doula is therefore a trained professional who, whether for payment or as a volunteer, delivers a range of such support services – emotional, physical, and educational, to new parents within the community. It is important to note that doulas are non-clinical professionals (unlike midwives) and can therefore not provide any medical advice or recommendations. 

So can doulas actually shape care outcomes? Various randomized controlled trials have suggested that the involvement of doulas in continuous labor support leads to:

  • Lower cesarean delivery rates
  • Lower rates of epidural administration 
  • Better 5-minute Apgar scores
  • Improved rates of breast-feeding initiation 
  • Higher rates of positive childbirth experiences 
  • Lower postpartum depression rates
  • Improved adoption of infant safety including back-sleeping for infants and appropriate car seat use

One might ask, how exactly do doulas contribute to these positive outcomes? Here are five key ways in which doulas assist parents through the childbirth and postpartum stages.

  1. Knowledge transfer and preparation for birth: Doulas provide expectant parents with comprehensive information about childbirth and postpartum processes, equip them with strategies for effective labor management, and offer guidance on creating birth plans that align with their preferences. Preparation might include teaching breathing techniques, providing insights into the stages of labor, and helping the parents discuss potential interventions or complications with their medical team (note: doulas are not medical professionals and therefore cannot provide medical advice themselves).
  2. Emotional and physical support during birth: During labor, doulas offer continuous emotional reassurance and comfort to the birthing parent, helping to create a calm and supportive environment. Physically, they may assist with pain-relief techniques such as massage, positioning, and movement, as well as encourage hydration and rest when needed.
  3. Advocacy for the birthing parent: A doula can serve as an advocate for the birthing parent's wishes, ensuring that their voice is heard and considered by the healthcare team. They help facilitate communication between the birthing parent and medical professionals and can provide reassurance and information when decisions about interventions must be made. Looking at the data around doula involvement “those who met with a doula two times or more reduced the odds of C-section by nearly 20%. For those who met with a doula two or more times and have had a prior C-section, the impact was even greater: more than 60% of these moms saw reduced odds of C-section.”
  4. Create room for partner involvement: Doulas work to enhance the partner's role in the birth process, helping them to engage at their comfort level. By guiding partners in how they can offer support, doulas enable them to take on a meaningful role, thus supporting both the birthing parent and the partner in a shared positive birth experience.
  5. Postpartum support: Following birth, doulas continue to assist families with the transition into parenthood. They offer support with infant feeding, emotional and physical recovery from childbirth, newborn care techniques, and overall adjustment to the new family dynamics. This support encourages healing and bonding within the family unit. For example, rates of breastfeeding initiation in the doula-assisted group of mothers was found to be significantly higher than rates of breastfeeding initiation in the non doula group (79.4% in the doula group vs. 67.2 in the non doula group).”

The positive impact that doulas have on birth outcomes is well-documented, yet numerous women encounter challenges in securing the right doula support. These challenges range from navigating complex matching processes to contending with ambiguous pricing structures, often resulting in significant out-of-pocket expenses. At Cradle & Coos, our mission addresses these exact concerns. We are committed to providing expectant parents with seamless access to a full spectrum of maternal care services, covering both birth preparation and postpartum needs. Our approach prioritizes easing the financial strain on new families by ensuring cost transparency, simplifying the use of FSA/HSA, upskilling partners and other caregivers to bridge gaps, providing flexible payment options, and facilitating insurance coverage.

To learn more about how we can support your journey or to join us in our mission, please contact us at info at cradleandcoos.com.

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