I'll get right to the point: yes, in my professional and personal opinion, doulas are well worth their fees and the energy invested in finding and engaging with. But you probably knew I'd say that. This is, after all, a blog by Lamaze -- the leading organization educating and empowering families in birth!
But you probably want more information. To determine if a doula is worth it to you, let's look at what a doula provides that cannot be provided for free -- or at least, not typically with the same coverage and depth.
Personalized attention - A doula is hired by you, answers to you, and when the time comes, supports only you. One of the hallmarks of doula care is continuous one-on-one support.
Your nurse, midwife, OB, etc. cannot match a doula's level of support in terms of the amount of time spent with you during labor and birth. They are often responsible for many families at a time. A doula stays with you, and only you, from the time you agree they will join you in labor, until the first 2-3 hours after birth.
During your labor and birth, a doula's sole responsibility is to support and encourage you (as well as your partner, though to a lesser extent), even if that means your doula steps back to quietly observe in between providing more hands-on support.
Your partner or selected birth support person (friend, family member) may be able to provide continuous one-on-one support, and their intimate knowledge of you will of course supersede that of a doula, but they lack knowledge about the ins-and-outs of birth (see below). Many people find that their partner and doula make a great team, providing abundant support while giving each other the ability to take a short break when needed.
Knowledge of physiologic labor and birth - Physiologic refers to processes that are normal for the human body. A doula knows birth, and while a nurse, midwife, OB, etc. also are intimately informed about the process of labor and birth, they cannot be with you continuously (as mentioned above) and can be limited in their knowledge of the wide range of coping skills, especially non-pharmacologic (prescribed drugs) pain relief options.
And, while your partner or selected birth support person will likely be by your side most of the time, they are not trained in or as experienced in supporting someone during labor and birth, like a doula.
A doula's in-depth knowledge about labor and birth will provide you the information you need when it comes to coping, risks/benefits of procedures, when to ask questions, how to make informed decisions, general knowledge on what's happening and why, and initial help with breastfeeding.
A doula's only agenda is you - As mentioned earlier, a doula works for you and only you. Yes, doulas are often bound to a code of ethics as detailed in their certification, but otherwise they do not have to adhere to policies and procedures written by insurance agencies, hospital administrators, and the like.
Care providers, especially those who work in the hospital setting, are required to follow the institution's policies for liability purposes. This may mean that certain procedures and rules are applied as a measure of course (routine, for liability) and not based on best evidence for birth. A doula is trained and encouraged to follow measures and techniques used in accordance with the best evidence for healthy outcomes in labor and birth.
Equipped to deal with the emotions - Birth is truly one of life's emotional roller coasters. Too often, people try to rush in and "fix" upsetting emotions, in a misguided attempt at help. But emotions can't be fixed-- they can only be experienced and supported, or stifled/shut down, the latter of which is damaging in the long run. A doula is well-trained in the language of emotions and how to support someone experiencing the range of emotions during labor and birth. A doula will hold space for you to cry, express frustration and disappointment (without judgement), anger, and beyond.
The "is a doula worth it" question comes down to what you think you'll want and need out of labor that can't be found elsewhere. I would argue that anyone will benefit tremendously from having all of the above needs met during labor and birth. What do you think?
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