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.
What is a Doula?
A doula is someone you hire to get 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). I am pretty sure you can certify. Many of them to internships with experienced doulas.
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 mangement
- Helping you make healthcare choices
- Encouraging you to keep going!
Mostly they’re you’re educated cheerleader.
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
Related Post: Placenta Encapsulation
Advantages of a doula
(benefits of a doula)
1. 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.
2. Doulas have a basic knowledge of labor and delivery. They might be helpful to take a basic prenatal class with. 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. Again, your labor nurse won’t be in the room all the time, and the doula can be.
She has hopefully seen many births and will be able to help you navigate your birth choices with a bit more ease.
3. Sometimes doulas are affiliated with physicians, so 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.
4. Doulas may decrease your chances of interventions. There is a study that backs them up on this. 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, often white and well off — etc). I’m not sure that I’ve seen a doula change anything, except for epidurals.
They are good at supporting you through the pain. They have great advice for finding a comfortable position or things you can do to take your mind off the pain. If you have a strong desire to go natural and your husband may not be that helpful in that instance, I would possibly consider a doula.
Disadvantages of a doula
(reasons not to hire a doula)
1. They get in your husband’s way. I really believe that God created labor to bring husband and wife together in the pain 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}
I liked to see my husband suffer a bit with me. 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!
2. 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.
We’re up to date on the most current info. My job is to KNOW labor. You’re already paying me. Ask me questions, let me help you understand. Ask your doctor questions, they’re not free either!
3. They vary SO 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.
4. They are 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.
Doula vs 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 masters in midwifery (plus, a bachelors 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, 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.
Is a doula necessary?
Absolutely not.
You WILL have a labor nurse who should be willing to answer quesitons and help guide you along your L&D path.
However, she won’t be in there constantly, and pain management isn’t really her job as she also has a lot of other things to be concerned about.
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.
If you are getting one, I would ask for SEVERAL references. Many Doulas are recently out of training and don’t actually have much experience of their own. I would also ask your MD if they have recommendations (as having your doula and your MD at odds is a very awkward situation).
Is a Doula a waste of money?
But my own personal opinion, after almost 14 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 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:
If you liked this post you might also like some other pregnancy posts:
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.
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When to call labor and delivery: Reasons to go to the hospital or call your doctor
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How Long Does an Epidural Last?
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Should You Hire a Doula? – Pros and Cons from an L&D Nurse
Read More
This post was originaally written in 2015, and has been updated since then.
Elise @frugalfarmwife.com says
I completely and totally agree with you on the best case scenario of the daddy being the doula/coach, BUT,I wish I’d had a doula with my first baby.
I didn’t realize how scared my husband was of the whole labor and delivery thing, and without going into a lot of detail, I think a doula would have made things go a lot better.
After baby number two though, hubby is well on his way to being a rockstar labor coach. 😉
Hilary says
Haha, my frind posted this on her FB page and someone commented they wish they had a doula on their first. I know delivery is hard for husbands. In some ways harder than it is for us, but I still like to see them suffer. 🙂
Lauren Tamm says
Great post! As a fellow nurse, I relate to all the pros and cons of having an additional “cook” in the room. I am currently in the process of deciding whether I will hire a doula or not. My husband is great and with my last labor he was supportive, but he really lacks knowledge about labor, progression, and advocating on my behalf. When I gave birth to my son, the nurses were SO BUSY. And as I nurse, I totally understood. It honestly didn’t bother me that they were only in the room when I rang the call bell to ask for help or support or to do a routine check. Because of this, however, they were not really available to offer frequent support during my labor. They weren’t their to encourage me to change positions, push through contractions, etc. My husband was supportive, but again he played a much more passive role looking for direction from me. I also think that sometimes when a nurse knows she is taking care of a nurse, she tends to lay off or lay low. I get that too. That may have been in play as well. This time I plan to deliver again at a naval hospital and I’ve already been forewarned that the nurses are typically quite busy and lack bedside manner at that particular hospital. I can’t really say for sure, since I’ve never actually been there. And personally, what someone would consider poor bedside manner is not what I would always consider poor bedside manner. My thought with the doula was that she would be able to better support me and coach me through a natural labor. I’m still on the fence. And truly the money is an issue because I don’t want to spend a lot of money on anything unless I truly believe it will be worth it. Even if we can easily afford it. Any additional thoughts? I would love to hear more.
Hilary says
If you have a TON of references that they were INSANELY helpful, I might consider it. BUT you’re going to be more prepared this time. Saving the cash might make you just as happy. 😉
Lauren Tamm says
Cool. Thanks for your feedback!
Hilary says
Hope it was helpful!
Angie says
I’m biased against doulas. The woman that taught my labor class with my first was a doula, as she loved to tell us, and was a HORRIBLE PERSON! She wanted to scare the class out of any kind of assistance or drugs or even the hospital if possible. She had us close our eyes then brought out an epidural needle and had us open our eyes again. She said, “If you want some strange man, in a profession that has the highest rates of suicide in the world, to stick this thing in your spine, then go ahead.” Then told us how its basically just as effective to bounce on a ball in the shower anyway.
Then during my labor with E, another crazy doula saw me in the waiting room and had her class surround me and kept referring to me as “An actual laboring mother!” then followed me, uninvited, upstairs to the maternity floor and kept rubbing my back telling me I could do this. She’s lucky her nose still points outward!
I’m sure there are wonderful ladies out there who just want to help women through the experience of childbirth, like many women have through the ages. But its not for me 🙂 Then again, I’m not doing that again anyway, so whatevs!
Hilary says
Woah, and here I thought you never hated anyone… when I find out you’re doula-cist. 🙂 I think some are great, and most really aren’t.
Saira says
Love the article & thanks for sharing on this week’s Mom Blog Party! For us, the doula was for my husband! He was with me all the way through but he needed a 2nd opinion from time to time & she gave him the confidence he needed to help me through labor. Good thing too – our 1st daughter would have been born at home if the doula hadn’t made the call that it was time to go to the hospital (hospital kept telling him “it’s your first baby – you have time”)… 2nd baby was born at home intentionally but without a doula & in hindsight I wish we would have had one the 2nd time too! Here is more about our fertility journey.
Hilary says
Yeah, that makes sense. I’m glad it worked out! 🙂
Heather says
I’m so bummed about this and all your other posts about the childbirth process =(
If I had read these things, I would have felt MORE scared about the birthing process with my 2nd and 3rd children. I had HORRIBLE nurses who talked down to me, much like you did in this post (I went to nursing school, I know more!). Honestly? I don’t care how many years you went to school for, YOU don’t know MY body any better than I do!
I educated myself after my traumatic birth with my first (the classic intervention cascade that typically happens). I had a great induction (later discovered completely unnecessary) that was fine until I hit 7 cm and the impatient nurses talked me into iv drugs. I wasn’t that uncomfortable at all. I hit 8 cm and felt pressure and wanted to start practice pushing. I had a nurse get in my face and tell me to ignore it. After two hours, I begged her to let me try since I had stalled out. She told me “if you push before 10 cm you will kill your baby” So I fought it, ended up with an epidural and baby was born 43 minutes later.
I refused a hospital birth with my third but my husband, bless his soul, felt that the hospital was the only place to ‘safely’ have a baby. I said I would only do it with a doula, a midwife of my choosing and following my birth plan to a t. The first sentence of it stated “Thank you for witnessing my birth. I intend to have a natural birth so if you have not witnessed one, please find me a nurse who has” Yes, that’s your job, witnessing. Not telling us what to do or play the dead mom dead baby card. Yes, I fired my first midwife at 32 weeks because she decided I wasn’t making the right choices. I opted to refuse a test that’s not recommended for every mother out there and instead chose to treat me like I had the issue the test looked for.
I had an amazing birth experience. My birth plan was actually followed and no one checked me for dilation except for the midwife upon her arrival and that was the only time my entire pregnancy. Because it’s completely pointless. I also didn’t wear the belts to monitor baby’s heartbeat. Again, pointless in a natural birth. Instead we used a doppler every half hour to check on baby. Water broke on it’s own. I labored, and pushed, in hands and knees. It was the only comfortable position after laboring up to 8 cm on a birthing ball. Oh, and I started practice pushing at 8 cm and bearing down when my body told me to. Which we don’t know how far dilated we really were but the midwife suspected it was earlier than 10 cm. My body knew what it was doing. I didn’t have to listen to anyone.
Also, you mentioned in another post that our c-section rate is 30% but you didn’t mention that that’s above the rate recommended by the WHO. It’s twice the recommended rate. And you only mentioned the national rate. Plenty of states, and hospitals, are way above that. Please include more non biased info in your posts.
Looking at your birth plan post: Sure, YOU have to follow ‘hospital policy’ but WE do not have to. It’s called not consenting. Episiotomy? You’re kidding right? Those are outdated.
Again, I’m just super bummed that I saw all these posts after I started following you due to other things that I agreed with. I”m guessing the name “Ina May” makes you cringe? =( =(
Hilary says
Wow, that’s a long comment! I can tell you’re super passionate about l&d! I try to make it clear that all of my labor posts are from a labor nurse’s point of view. I am on the same page as you for many interventions…. but in reality this comes down to picking the right doctor or midwife. my hands are tied in many ways.
I agree you know your body best, better than a doula.
We’ll probably have to agree to disagree on some things. I would encourage you not to push before you’re complete or close to it. You can make your cervix tear or it can swell prolonging labor. Again, just a personal experience of seeing that happen.
I love birth plans and I love moms who stand up for themselves and listen when it’s really important. The truth is I can only stand up so much on my end. If you have another I hope it’s a great experience!
Heather says
You state we will probably have to agree to disagree which, to me, means you don’t agree with any or all of my statements about episiotomy, cervical checks or the monitoring belts. Which in turn means you HAVEN’T been reading up to date things =(
http://www.evidencebasedbirth.com, http://www.birthwithoutfearblog.com and http://www.bloomspokane.org are great resources. For laughs and giggles, you may want to pop on over to http://www.myobsaidwhat.com as there’s great posts on what nurses say too
I intend on becoming a doula some day when my kids are old enough for me to be on call and working for up to 48+ hours at a time. I intend on only signing contracts with my mamas after they’ve talked to other doulas to ensure we are the right fit. I do not intend on interfere with mom and dads relationship during the process as a doulas primary roles are to help mom THROUGH the birth process AND guide dad through it too, often showing him how to help mom. We are also there to give dad a break so he can eat or go to the bathroom among other things.
Hilary says
Heather, I can’t actually remember the last time I saw an episiotomy, it’s probably been a year as the physicians I work with RARELY do them, but I have certainly seen times that it was necessary. For various reasons, not all of them baby health. Some women have such poor nutrition their tissue just starts to fall apart which makes it almost impossible to sew up. That’s right, I’ve seen that.
Am I wrong, have you delivered babies?
We aren’t allowed to doppler every half an hour, that’s not our policy. I also think it is VERY difficult to get an accurate picture of the baby with a doppler. We do have a telemetry monitor that goes underwater, I think it’s great (although they can’t use the jetted tub with it as it interferes with the ultrasound).
Let me be clear. I’ve been in HUNDEREDS of deliveries. You have no idea how much can go wrong and you have no idea how dumb many pregnant people are. I have had drug addicted patients climbing the curtains. I have had patients seize. I’ve had blood literally pouring off my patient’s bed. This blog is written by a labor and delivery nurse of almost 14 years. I am up to date, I do it all the time, and we will have to disagree on this one.
Katie says
It’s interesting how differently a person can feel after reading a post. I’ve found all of Hilary’s posts on labor and delivery to be really enlightening and encouraging – in fact, it’s one of the reasons I subscribe to her blog. I’m very passionate about pregnancy and the birthing process, and I think to tell her she’s not up to date on things is somewhat rude. I believe she knows more about the birthing process than probably anyone, and if I could, I’d have her be one of the RNs around next time I give birth!
Hilary says
Katie, that is sweet of you to say. I try to make it clear that my posts come from a place of a l&d nurse… 🙂
Martha says
How sad you are a labor nurse..well..positive energy your way
Gaela A Fisher says
I was really disappointed to read your blog. I am a certified labor doula. I have also been a nurse for 24 years, I worked in L&D, Postpartum and New Born Nursery. I guest speak at the University Nursing program to teach nursing students about doula care. I am certified through CAPPA. The first thing I do when I go into a new facility is to let the nurse know that I am not there to do her job or to interfere with what she’s doing. Hopefully, I will save her a lot of trips to answer call lights to bring ice, unhook monitors so that the patient can use the bathroom, etc. Also, I do not get in dad’s way or replace him. Dad and I are a team. I allow dad to be the very best that he can be. Dad doesn’t have to try to remember everything he learned in childbirth class because he has me as a backup. Dad can be there in the supportive, loving manner that he would like to be. I try my best to fit myself into the dynamics of the couple. Sometimes that means sitting at the side and just offering tips to a very hands on dad to allowing dad to hold his wife’s hand and stroke her head or to work with me to support mom. I have more than a “basic knowledge” of labor. My certifying agency requires me to recertify every three years. That requires that I write a research paper on evidence based information, read several new books on different fields of childbirth and to pass a test on doula support. I also have a strict scope of practice that I follow. I spend a lot of time with my clients before birth. The nurse may spend an entire shift with the patient, but I have spent many hours with her. I have a relationship of trust that I have worked hard to develop. I help to educate them on the pros and cons of interventions, I help them to cope with their fears and I educate them ahead of time as to comfort measures that we may use in the birth room and possibilities of things that can happen that may not be in their “plan”. Not only do I know how to change mom’s position for comfort, but I also know how to position her to turn an OP baby. I know how to get a slow labor going and I have a very solid relationship with my client by the time she actually goes into labor. I may stay with mom as long as 42 hours. The nurse will leave at the end of her shift, providers go on and off call, but I am there with mom and dad through it all. As far as the expense of a doula? By the time you figure in interviews, prenatal visits, emails, phone calls, text messages and labor, I make less than minimum wage. Yes, I get paid, but I don’t know of many doulas who are getting rich. I leave my family for many hours at time, I’m on call 24/7 for 4 weeks. My life is dedicated to my client until 3 weeks after she gives birth. I educate my clients to know that medical interventions are tools that are available when needed. I teach them that their bodies are not broken and that they were created to birth their child. Do we cut down on epidurals? Yes. Are we against them? No, they are a wonderful tool when needed. Do we cut down on c section rates? Absolutely! And if you don’t think that a c section is traumatic to mom, explain why 75% of my clients are VBAC moms? It sounds as if you have had some bad experiences with doulas and I just really hate that you have. When I left a hospital birth today, both the nurse and the midwife thanked me for all the help and knowledge that I brought into a difficult birth (I was 36 hours without sleep by the time I left). I have also had nurses ask me to teach them what I do so that they can help moms and help to cut down on the number of surgical births! The US is #2 in the world for c sections. We are also #49 for maternal safety. My suggestion to your readers is that if you want to hire a doula, hire a certified doula that follows a strict scope of practice. Get references. Meet with several doulas to make sure that you’re a good fit and that your doula can support you in the way that you need to be supported. I have had many clients who are L&D nurses (I was hired by one on the spot 2 births ago) and also have assisted with physician’s wives in birth. Yes, most of my clients are well educated, professional women that want to be pro active in their birth, but I also do pro bono work for underpriviledged couples. If you want to know if you should hire a doula, ask other couples who have had a certified doula how they changed their birth.
Hilary says
I think it is hard to find a REALLY well educated Doula. You sound like a Doula dream. I just have found some that wanted to play more midwife or SO many just starting out that just stood there and took pictures. As I said in my article, I had 2 doulas (because it took 2) save my bacon one day. They were wonderful. I just depends, I completely agree with your last statement to find a GOOD one, if you’re going to use one!
Christina says
More recent research has shown that labour is shorter in duration when a woman is present at the birth.
Men are wonderful supports during labour and it can be a huge bonding experience for moms & dads to be together in the delivery room. However, traditionally women have been the ones helping other women through labour.
Another pro of having a doula is that Dad gets to be involved with the birth as much as he wants to. If you find a doula who does photography then Dad has one less thing to worry about and can enjoy the birth of his child and be in the pictures!
Hilary says
Haha your first sentance made me laugh. I mean if there were only men…. but I get what you mean.
I do think Doulas can be extremely helpful, but in my opinion, as a bystander watching Doulas I think it tends to separate the dad from the process. Just a personal opinion as someone watching from the outside.:)
Becky says
I had a Doula with my first child partly because the nurses at the hospital talked down to me and told me I would change my mind about getting an epidural. My doula believed in me and that made me so much less fearful of the whole process. Also, it was invaluable to have her come to my home in early labor to check the baby’s heart rate and tell us all was o.k. That made my husband a lot less nervous and allowed me to stay home for the first 19 hours of labor. Had I been in the hospital all that time, I’m sure they would have sent me down intervention road!
Hilary says
Huh, I didn’t know doulas were allowed to check a heart rate. It sounds like she was really helpful to you! I’m glad!
Laura @ Little Bits of Granola says
I love how you always look at both sides!
I tried to have a doula with my second baby (a VBAC), but she did not answer when I called her from the hospital, dilated 5 cm. When she did finally call me back, I was pushing (didn’t answer, for obvious reasons). Everything went just great without her. The nurses were absolutely fantastic.
I totally agree with you that it is better for the husband (or baby-daddy) to be the mom’s main supporter. My desire was for our doula to be there to help both of us (not just me). My husband didn’t have a clue how to help/comfort/advocate for me even though he badly wanted to, and I was not able to help him help me. So our hope was that a doula would be there for him too. We have been so lucky that our hospital has such wonderful nurses. They did so much for all three of us (me, hubby, and baby) that we felt fully supported and ultimately a doula would have been unnecessary.
Sara says
As a doula I’m shocked by this. I’m
Sorry this has been your experience but so much about this is inaccurate. First Dona is only one of many certifying orgs. I’d encourage you to look into Prodoula.
Doulas are not just ” labor coaches” In fact we don’t coach labor at all. We support the family dad included emotionally and physically. Many dads love doulas because we take the pressure off. You have to realize that we meet with this family prior and discuss how they would like us to support. So your observation is just the labor. What if the family wanted dad to be able to relax ? The births I’ve attended my dads and I work as a team to support the mom. But sometimes they want to nap and having a doula can help with that.
We are not another cook in the kitchen because we are not medical staff. We are soley there for the families support.
nurses and doulas can actually be a great team. I’ve seen it, I e experienced it and many nurses I e worked with agree. And doctors. Actually I’ve been a doula for nurses.
I’d really encourage you to expand your thinking on this. The right doula who practices within her scope should not interfere with anyone!
Hilary says
I lovea great doula, we can truly be a team, but they are awfully rare, but precious. 🙂
Allison says
Well said Sara. This article was disappointing. I’m sorry you’ve had such poor experiences with a Doula, but good Doulas are not rare. Unfortunately the few who do practice out of scope or cause problems give the rest a bad name. I hope you can expand your research on this topic and get to work more positively with Doulas in the future.
As a nurse and Doula myself, I see your arguments, but there is so much on the other side your missing here. It can be easy to get stuck in the medical side of things when that’s your job and you do it well! Best wishes.
Hilary Erickson says
Unfortunately, I find that people look for a doula on their price range, which is usually a brand new doula who really isn’t very helpful and is sometimes even un-helpful. Just my experience but a great doula is worth their weight in gold. I just don’t find them often, and I would guess they cost a lot (as they should).
Mom of Six says
I totally agree with this article! My husband was way more helpful than any woman- mom, midwife or nurse- I’ve ever had attend one of my labors. I should mention I’ve had three unmedicated labors, two of them homebirths. I’ve also had 1 c-sec. And 2 other hospital births, my most recent with an epidural I do not regret at all 🙂 I enjoy your birth related articles. Keep up the good work. Btw, the nurses at the hospital have always been kind to me.
Hilary Erickson says
Awh, thank you!