Should You Hire a Doula? – Pros and Cons from an L&D Nurse

Should pregnant women hire a doula?  Using a doula has many pros and cons.  We’re going to talk the advantages and disadvantages of hiring a doula. Do you really need a doula or will they be a waste of money?

Truth is, I think this is so important I brought one of my favorite doula friends on a recent podcast to talk about what a doula can do for you!

First off, who am I and why should you even consider the information in this article:

Hi, I’m Hilary — many people know me as The Pregnancy Nurse 👩‍⚕️. I have been a nurse since 1997 and I have 20 years of OB nursing experience, I am also the curly head behind this website Pulling Curls and The Online Prenatal Class for Couples. 🩺​ After being at the bedside for 20 years I saw a LOT of doulas, both good and bad. I have also navigated the treacherous waters of social media and doulas.

I have worked with AMAZING doulas that I wanted to hug for all the support they provided the patient, they also made my job easier.

I have also worked with doulas that were not helpful and even some that made my job exceedingly harder (and also harder on the patients). I want to share with you how to decide if you need a doula and how to pick one that will work for you.

What is a Doula?

A birth doula is someone you hire to supoport you through labor — a labor coach.  Sometimes they teach prenatal classes or meet with you during your pregnancy to give you tips and tricks. There are actually many types of doulas. A doula is someone that can help you through lots of phases of life, there are even postpartum or death doulas..

Their services can vary pretty widely.  There is an organization for them called DONA International (there is more than that one, but it’s the one I’ve been most familiar with), where you can certify.  Many of them help you match internships with experienced doulas.

Doulas can be certified, but many aren’t. It isn’t regulated like an RN — which is a license vs a certificate. In fact, in my podcast I learned that some doulas would prefer not to certify (especially if they also work in a birth center).

It can be confusing to navigate the world of hiring a doula. The lack of regulation doesn’t help at all.

What do doulas do?

You can really boil it down to someone to support women in labor.  They’re very hands-on in helping you cope with the pain.

• Natural Pain management
• Helping you make healthcare choices (they should help you communicate with your team, not communicate for you)
• Encouragement & moral support to keep going!

Mostly they’re your educated cheerleader, as well as a translator that can help you know what is happening. They can be an extra pair of hands, an extra brain for ideas. The support of a doula can be REALLY helpful!

Another thing that doulas do is educate you. HOWEVER, you can totally do that on your own before baby. In fact, I 100% encourage you to.

It has NEVER been easier to get prepared on your own timeline with someone you can trust. In just three hours (or longer if you want to get more info The Online Prenatal Class for Couples can help you know what to expect! In fact, it guarantees you’ll feel more at ease about your upcoming birth.

And frankly, doula or no doula, make SURE you take a prenatal class in your third trimester (or before).

Pros and Cons of Doulas

Advantages of a doula

There are many benefits of having a doula — let’s talk about them!

Can be a support

If you are delivering alone, I would really recommend getting a doula.

There are women out there who don’t have a person to support them during the labor.  The reality is that I can’t be in your room all the time.  I have to pee, grab supplies, chart, and I may have another patient.  BUT, you could also grab a friend whom you love and trust.

I had a patient who hired a doula.  She didn’t want her mom in the room (the father wasn’t involved) and that doula was REALLY helpful.  The woman was a mess.  I had other patients, I couldn’t put this woman’s pieces back together.  Again, super helpful doula.  And this woman REALLY needed her as she had no other support system.

They have a basic knowledge of labor and delivery

With most things, this varies widely (and I mean WIDELY).

 If they are certified they should have some basic knowledge that is correct (although, there is no way to know how correct their knowledge is). Keep in mind that a LOT of your doula’s education will come from her own birth(s), her limited training, and any patients she has assisted.

It’s nice to have someone constantly at your side who has educated answers.  

She has hopefully seen many births and will be able to help you navigate your birth choices with a bit more ease.

Doulas can be especially helpful at home before you go to the hospital. They can answer questions and discuss what you’re feeling.

She is there just for you!

Your labor nurse won’t be in the room all the time and the doula can be. Their continuous support is easily one of the biggest perks to doula! This can both be physical (helping with pain management and labor support) and informational support in helping educate you on what to expect or to get your questions answered by the medical staff.

FYI, nurses can have up to 2 patients, we also often run into other rooms for emergencies, etc. You need to expect that your nurse won’t be in the room with you all the time.

Can be familiar with your provider

That means, they know how your doctor likes to do things and that could be helpful to educate you since sometimes the medical staff doesn’t have time (or aren’t great at communicating).

Your doula should be a support to the medical professionals around you, not making you question them. I find asking providers about doulas they prefer can help aid in this. Hospital staff may have doulas that they have found are better than others.

She can also provide support to you during things like IV’s or painful vaginal exams.

Doulas may decrease your chances of interventions.

There are a lot of studies that show doulas can help lower birth risks and interventions in expectant mothers. There is even an ACOG article that says (ACOG is the professional organization for US OB’s):

Evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support provided by support personnel, such as a doula, is associated with improved birth outcomes for women in labor.

ACOG Approaches to Limit Intervention During Labor and Birth

That all being said, in my experience, I see a variety of reasons for the decreased interventions (they tend to have clients with good prenatal care, higher socio-economic statuses — etc).

Here are some good things doulas can do:

• Find a comfortable position (sometimes helping prop you up with physical support as well).
• Use position changes to help baby into the vaginal birth canal & prevent cesarean births — different positions can be a HUGE help to you and hospital staff.
• “Natural” pain management techniques (breathing, hypnosis).
• Massage or other pressure.
• Help your partner provide you relief.
• Provide stress relief during hard labor.
• Talk to you about your birthing process so you know what to expect next.
• They can also help you labor at home (using tools like heating pads) to decrease your hospitalization time.
• Explain what’s going on so that you’re not caught off guard (but I would 100% also recommend taking a prenatal class).
• Doulas may also help you adjust to your postpartum period or the new baby.

And, because they help you to relax that can help decrease your overall labor time.

** As I have said, a great doula is such a win. However, you have to remember that in the vast majority of cases people who use doulas are more well-off because they can afford a doula (they are not part of routine hospital births). Hence, I take the studies with a bit of grain of salt. Correlation does not mean causation.

Disadvantages of a doula

There are also many con’s to hiring a doula — let’s talk about those:

Doulas can get in your partner’s way.

I really believe that God created labor to bring those parents together in the pain/effort that culminates the start of their lifelong parenting journey.

If you want your husband playing candy crush in the chair while she does the hard work, by all means, hire a doula. {note: sarcasm font — not every delivery is like that — but I have certainly seen husbands hire doulas, so they could check out}. BTW, I have a post on my best tips for dads in labor.

I love seeing supportive husbands.  It shows me that that woman will have the support in her next journey, raising the child.  If you and your husband really want to prepare for this — I have the answer!

How much do they REALLY know?

Yes, they have a basic understanding of labor, but my job is to know ALL about labor.  It’s what I do, it’s my job.  I go to classes, I went to five years of nursing school, I discuss it with doctors when we’re at the nurse’s station, we read articles.

I am ACLS, BLS, NRP and AWHONN fetal monitoring certified and do a lot of continuing education.

Nurses are up to date on the most current info.  My job is to KNOW labor and especially the complications of labor.

You’re already paying your nurse.  Ask him/her questions, let them help you understand.

Ask your doctor questions — you’re paying for them to educate you as well!

Their Skill/Knowledge Varies Widely

Again, I don’t mind doulas (I really don’t, you might guess otherwise with this article) but sometimes you get ones who are so early in their practice that they aren’t helpful to the patient and they’re in your way or questioning you.

To me, It’s super annoying.  New doulas are not helpful.  In fact, I often find them a deterrent.  It takes more of my time to correct them or to talk through misinformation.

There are a few I’ve worked with who are WONDERFUL.  I’d say if you’re looking for one, I’d get a LOT of references and ask how much they felt the doula helped.  I’d ask the doula how many deliveries they’ve been to.

Experience is the most important thing in finding a good doula.

Doulas May Not Want to Support YOUR Birth

If you switch to an epidural or use pain medication mid-labor — will your doula be upset and be unable to support you? What about going to a c-section — will they support you in that choice as well?

Some doulas only want to support home birthers or people birthing the way they think is best. So, when you interview your doula, ask how they support in a variety of ways! This is REALLY important, because no amount of doula support can help someone have the perfect birth they are hoping for — mother nature has the ultimate call.

They Can Be Expensive

A good doula is expensive.  And, if they’re not expensive, they probably aren’t that good.  This is their job.  They make money doing it.

In reality, I think good doulas probably make more for a labor than I do.

It’s hard work.  A good doula earns her money.

I guess you just need to ask if you could use that money more efficiently in your child’s college fund.  I know for many parents the money isn’t the issue, so this won’t matter.  BUT, if money is tight, I think it’s time to step back and re-evaluate your finances.

Doulas CAN NOT GIVE MEDICAL ADVICE.

In no way, shape or form can a doula give medical advice. They are not trained, medically, and should only support you through communication and basic education to get the information you need to make choices. They also are not trained in any medical procedures (including vaginal exams).

Let me repeat: Doulas are not trained in medical care.

Many doulas say that they can prevent cesarean section, but in no way can your doula promise that. They can help, and there is a LOT you can do to try to avoid one — but it can not be guaranteed. No doula can promise better outcomes just for your birth.

Real quick– back to my first dis-advantage — let’s talk about supportive partners.

SO many moms get educated themselves, but when I created my class I knew that partners needed the support as well. The Online Prenatal Class for Couples is created to NOT overwhelm partners. It gives you the option to deep dive into things you’re hoping to get more info about and you can just watch the main videos with your partner. It really gives both people whatever experience they’re hoping for.

I love what M. Moyle said:

“I’m a family physician who previously worked in Labor and Delivery. I’m pregnant with my first and wanted to include my husband in understanding what to expect. Hilary’s course is concise, medically accurate, and practical. Highly recommend”

People love all the experience, how quick it is to get JUST the right info on your own schedule and I keep it simple and understandable.  I think you’ll love it — I even guarantee it.

What is the Difference Between a Doula and a Midwife?

There are different types of midwives.  In the hospital, only Certified Nurse Midwives (CNM) are allowed to practice.

In Arizona within a few years, that person has to have a doctorate of nursing along with a master’s in midwifery (plus, a bachelor’s in nursing, and most practiced as L&D nurses before they became midwives).  So, essentially — you could also call them doctor. 🙂

There are also lay midwives who go through other training.  I’m not familiar with them/that training, so I can’t comment on that.

BUT, Certified nurse-midwives are AWESOME.  They often do the work of a doula – in helping with positioning and pain management techinques. However, they may also have several patients — they may not be able to be in your room all the time either.

The midwife will also deliver your baby (as long as things go according to plan).

I want to be very clear that doulas should not, nor are they trained, to do any medical intervention at all.

Certified Nurse-Midwives can do many of the things that doctors can do, and are great for a low-intervention labor (read: not high risk).

Is a doula necessary?

Absolutely not.

You WILL have a labor nurse who should be willing to answer questions and help guide you along your L&D path.

However, she won’t be in there constantly, and hands-on natural pain management isn’t really her job as she is consumed by many other things (but is a willing teacher to your support team).

If you want 1 on 1 involvement, a doula might be your best choice.

Should I hire a doula?

I think if you feel like your husband might get overwhelmed, you’re wanting to go natural, or you lack trust in your MD (and are unable to change) it might be a good plan.

I 100% think you need to talk it through with your partner.  It is just as much their delivery as yours.  If the thought of having a stranger there bothers them, you need to take that into account.

People who should consider a doula:

• If you have your heart set on a “natural birth”.
• Hoping to not get an epidural or can’t for a medical reason.
• You aren’t a strong advocate for yourself, and neither is your partner (you could also consider a good family member).
• You are uncomfortable with your provider, and for some reason are unable to switch.
• You strongly desire 1 on 1 support through the entirety of your birth.

Tips if you are hiring a doula:

1. Get references.  I would ask for SEVERAL references.  Many doulas are recently out of training and don’t actually have much experience of their own. 
2. Only hire a doula who is prepared to be flexible and support you no matter the choices you make during your labor.
3. Talk to your provider. I would also ask your MD if they have recommendations (as having your doula and your MD at odds is a very awkward situation).
4. Decide what services you’ll need — many doulas provide care before delivery and after delivery — and clearly, all those services cost extra.  

Things to consider in your doula:

• Training
• Certification(s)
• Experience
• Hours of availability (and what do you do if she can’t come)
• What types of services they provide
• How comfortable you feel with her (if she’s a good fit with you!)
• The cost

Sidenote:  Many doulas offer placental encapsulation, but if they’re pushing it you might want to steer clear of them as it is strongly discouraged anymore.

Birth Doula FAQ’s

Is a Doula a waste of money?

They CAN be. I’ve also seen some 100% be SO helpful and really make the birth extra special.

But my own personal opinion, after almost 20 years as a labor and delivery nurse.  In a perfect world – the people who were there when the baby was conceived should be there when the baby comes out.  Plus a doctor and 2 nurses.  Possibly a mom, if that’s important to you.

I also really thought this Salon article of a women who didn’t appreciate her doula to be an eye-opener (because a lot of people end-up feeling this way but don’t talk about it — I find).

I think you should only become pregnant if you feel like the other person empowers and supports you.  Of course, this is in a perfect world.  And most babies aren’t born into a perfect world.

I really think you need to weigh the doula negatives with the positives and decide what works best for your family.

Do I really need a doula?

I thought this video was really great.  She seems like a wonderful doula.  She’s honest about what she can do and how she supports.  Hopefully, she gives you some ideas if you want to doula or not.

I hope, if you’re pregnant, you have a wonderful labor and delivery experience — grab my birth plan template (which is in my free birth prep kit below) to get centered on what you’d prefer on your delivery day:

Hilary is a labor and delivery nurse who has worked in various medical fields over the past 18 years.  Please don’t take any advice you read on this blog over something your doctor tells you.  Trust your doctor, or find a new one. 

This post was originaally written in 2015, and has been updated since then.