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

Doulas can help you if you have your heart set on a “natural birth” (without an epidural). Doulas are a good option to advocate for you (especially if you have a hard time fighting for yourself) and helping you feel supported. Should you hire a doula?  Using a doula has many pros and cons.  We’re going to talk the advantages and disadvantages of hiring a doula and if you really need one, or if they will be a waste of money.

In fact, I thought this was so important, I brought in one of my favorite doula friends on a recent podcast to talk about what a doula can do for you!

What is a Doula?

A 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 even postpartum doulas to help you transition to your new life.

Their services vary pretty widely.  There is an organization for them called DONA (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.

As a labor nurse since 2001, I have met and worked with many doulas.  I am going mainly off my experience with them for almost 20 years in the field.

Before you write a nasty note in the comments:

As a nurse for 20 years I have seen a LOT of doulas. A good doula is worth her weight in gold. Patients and nurses LOVE them. They are helpful and know a lot of shortcuts to helping moms have their best birth. BUT, the truth is most doulas are not good doulas. I’ve seen a LOT of bad ones, and I feel like people look to save money, and instead just waste it.

A good doula is worth their weight in gold. I’ve just seen a lot of bad doulas over 20 years.

Hilary Erickson

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.

• Pain management
• Helping you make healthcare choices
• Encouraging you to keep going!

Mostly they’re your educated cheerleader, as well as a translator that can help you know what is happening.

I think most Doula’s hearts are in a lovely place.  They really are working to empower women and show them that they can have a wonderful labor.  I think that is great.

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 a doula, 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.

 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).

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 and 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. This is easily one of the biggest perks to doula!

FYI, nurses can have up to 2 patients, and we also often run into other rooms for emergencies, etc.

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 your doctor doesn’t have time.

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. 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 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, are likely college graduates, well off — etc).  I’m not sure that I’ve seen a doula change anything, except for epidurals, if a patient has a strong desire to go natural.

They are good at supporting you through the pain.  Some things doulas do to help with pain/stress

• Find a comfortable position
• Take your mind off the pain
• Massage or other pressure
• Help your spouse provide you relief.
• Provide stress relief during hard labor
• 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)

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 care). Hence, I take the studies with a bit of grain of salt. Correlation does not mean causation.

Disadvantages of a doula

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

Doulas can get in your husband/partner’s way.

I really believe that God created labor to bring husband and wife together in the pain/effort that culminates their start in parenthood.

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 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 me.  Ask me questions, let me help you understand.

Ask your doctor questions, they’re not free either!

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 how many deliveries they’ve been to.

Experience is going to be key in finding a good doula.

Doulas May Want to Support YOUR Birth

If you switch to an epidural mid-labor — will your doula be upset and be unable to support you? What about going to a c-section?

Some 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!

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.

Real quick — let’s talk about supportive partners.

If you’re looking to have a partner who supports you more during labor, I have a course I totally recommend. It’s done in the privacy of your own home on your own timeline, and is meant to be done AS A COUPLE! Be SURE to check it out — you can even save 10% with code PC10.

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 really do the work of a doula, but they may also have several patients, so again — 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 account for that.

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 are uncomfortable with your provider, and for some reason are unable to switch

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, and I’ve 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 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 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.