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Title: Doula  
Author: World Heritage Encyclopedia
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Subject: Childbirth, Natural childbirth, Perinatal assistant, Home birth, Birth attendant
Collection: Childbirth, Midwifery
Publisher: World Heritage Encyclopedia


A doula (left) with mother and child

A doula (), also known as a birth companion and post-birth supporter,[1] is a nonmedical person who assists a woman before, during, and/or after childbirth, as well as her spouse and/or family, by providing physical assistance and emotional support.[2] The provision of continuous support during labour is associated with improved maternal and fetal health and a variety of other benefits, including lower risk of induction and interventions and less need for pain relief. These benefits are particularly significant when continuous support is provided by someone who is not there as family/friend or as medical staff (i.e. a doula).[3] Additionally, a doula is sometimes hired to work with families beyond the postpartum stages, providing continued physical and emotional support, for as long as needed (sometimes, this support can be ongoing for several years).

These days most doulas will have completed some training to prepare them for the role. However, the title can be used by anyone. The goal of a doula is to ensure the mother and her partner feel safe and confident before, during, and after birth.[4] Doulas not trained by a formal organization (e.g. DONA) can be controversial within medical settings due to a lack of formal medical education when a discussion regarding medical interventions in labor versus pursuing natural childbirth without an epidural or caesarean section arises, however the role of the doula is not to offer medical advice.[5]

Sometimes the term doula can also refer to a non-medical person who assists critically ill elderly people.[2]


  • History and etymology 1
  • Types of support 2
    • Birth 2.1
    • Postpartum 2.2
    • Antepartum 2.3
    • Family life 2.4
    • Other 2.5
  • Medical aspects 3
  • Training and certification 4
  • See also 5
  • References 6
  • Further reading 7
  • External links 8

History and etymology

The term doula was first used in a 1969 anthropological study[6] conducted by Dana Raphael. Raphael suggested it was a widespread practice that a female of the same species be part of childbirth, and in human societies this was traditionally a role occupied by a family member or friend whose presence contributed to successful long-term breastfeeding. Raphael's derivation of the term is not clear, only describing it as coming from "Aristotle's time", and is defined as an Ancient Greek word δούλη meaning "female slave."[7] Marshall Klaus and John Kennell, who conducted clinical trials on the medical outcomes of doula-attended births, adopted the term to refer to a person providing labor support.[8]

In 1992, Doulas of North America (DONA), one of the first doula training and certifying organizations, was founded.[9] By 1994, DONA had certified 750 doulas and 10 years later that number reached 5,842 - the increase reflects the emerging popularity of the role.[9] Between 1992 and 2004, DONA has provided training to approximately 25,000 people.[5]

More recently, Childbirth International (CBI) has continued to add new content and courses to help train their students further. Their services have helped students and graduates in 102 countries across the globe. Founded by experienced doula, author and educator Nikki Macfarlane,[10] Childbirth International has grown to become the largest doula training organization offering more courses than any other. CBI have also developed a useful tool for helping mothers to find a doula quickly and easily in their area through their website Find A[11]

Types of support

The overall goal of a doula is for the mother to feel safe and comfortable, enhancing the goal of doctors and nurses which is to ensure a safe delivery for mother and child. Doulas have no clinical role, duties or decision making, deferring instead to nurses or doctors.[4]


A birth doula is also called a labor doula. The kinds of support provided during childbirth may include physical assistance and comfort (massage, maintaining a supporting posture or providing water), emotional support (providing company, encouragement or simply talking in a soothing tone of voice), and acting as an advocate for the woman undergoing childbirth (suggesting options or supporting the woman's decisions to a medical team).[2] Doulas may also be involved during pregnancy and after birth (postnatal care).[2]

Most doula-client relationships begin a few months before the baby is due.[12] Before the labor, the doula and the family can develop a relationship where the mother and her partner feel free to ask questions and express fears and concerns, and where the mother can take an active role in creating a birth plan.[12] Continuity of support by the same person is thought to be an important aspect of the relationship between doula and mother.[7] Doulas may be found in hospital- or community-based programs as well as private practice and may be reimbursed by insurance companies or out-of-pocket by clients.[2][4] Because insurance companies typically do not cover the cost of hiring a doula, they are more popular among middle- and upper-class parents.[5][13]


Postpartum doulas provide help and support in the first weeks after becoming a mother.[12] The same person often provides both birth doula and postpartum doula services. They may provide physical support, such as meal preparation and light household tidying, or fill in when a new mother needs a break.[12][14] They also provide emotional support and companionship by encouraging a mother when she might be feeling overwhelmed.[12][14]


An antepartum doula provides help and support to a mother who has been put on bed rest or is experiencing a high risk-pregnancy.[12] Emotional, physical and practical support can be provided by an antepartum doula in these circumstances.[12]

Family life

A family life doula provides help and support to an entire family. Occasionally confused with nannies, family life doulas are ongoing, long-term sources of support within a family structure. They fulfill tasks similar to those of postpartum doulas. Additionally, they care for children while providing emotional support, encouragement, companionship, and, if requested, guidance to new mothers. A family life doula can play a key role in lowering a family's stress so parents are able to focus on thriving in their careers while growing together as a parenting team at home.[15]


It has also been suggested that doulas or doula-like practitioners may have a role in caring for critically ill adults in geriatric care.[2]

Medical aspects

Continuous support during labour provided by doulas (along with variety of groups such as nurses, midwives, other hospital staff, partners, family or friends) have been associated with improved outcomes for both mothers and children.[3] There is research to support the beneficial effects of doulas on both maternal and newborn or infant health, including shorter delivery, fewer caesarean sections and complications, the use of fewer medications and fetal extraction tools, less time in neonatal intensive care units, positive psychological benefits for mothers, more satisfying birth experiences, and increased breastfeeding.[2] Cross-country research on the effects of doulas on child birth and postnatal care is complicated by the variety of settings, cultures and medical systems of individual countries and characteristics of patients.[2] These benefits appear to be contingent on the doula providing continuous rather than intermittent assistance, have some medical training and on the specific social and cultural setting within which their services are provided. Women with less education, lower incomes, less preparation for childbirth and those lacking social support may experience greater benefits from doula care than other groups.[2]

However, some medical institutions have banned doula participation citing that doulas can "cross the line" during delivery, endangering mother and child. Some doula clients have also found their doulas carried personal agendas into the birthing room that were contrary to their wishes and a risk to their health. Though the American College of Obstetricians and Gynecologists has no official position on doulas, during an interview the ACOG's chairwoman of the academy’s committee on obstetric practice Sarah Kilpatrick, stated while doulas may be helpful there are some who try to "interfere with the medical aspect of delivery." Doulas may also oppose the use of any infant formula, medications or medical interventions during childbirth, refusing work with mothers who decide to have an epidural or otherwise do not undertake natural childbirth.[5][16] Doulas acting beyond the role of social support and advocacy by providing medical advice should be addressed out of the presence of the patient, and professional associations have policies in place to address such issues.[4]

Training and certification

There is a lack of standardization and oversight of doulas, with multiple organizations providing different courses with varying requirements. There is no formal or universally recognized certification process or training requirements, and anyone can refer to themselves as a doula.[16] No academic credentials such as a college or university diploma, or high school equivalency are required.[5]

Being a doula does not specifically require any medical training, although it is not uncommon for doulas to have received certification or medical training of some kind.[5] In

External links

  • Klaus, MH; Kennell JH; Klaus PH (2002). The Doula Book: How A Trained Labor Companion Can Help You Have A Shorter, Easier, And Healthier Birth.  

Further reading

  1. ^
  2. ^ a b c d e f g h i j Balas, M. C.; Gale, M.; Kagan, S. H. (2004). "Delirium doulas: An innovative approach to enhance care for critically ill older adults". Critical care nurse 24 (4): 36–46.  
  3. ^ a b Hodnett, E. D.; Gates, S.; Hofmeyr, G. J.; Sakala, C.; Weston, J. (2011). Hodnett, Ellen D, ed. "Continuous support for women during childbirth". The Cochrane Library (2): CD003766.  
  4. ^ a b c d e f g Ballen, L. E.; Fulcher, A. J. (2006). "Nurses and Doulas: Complementary Roles to Provide Optimal Maternity Care". Journal of Obstetric, Gynecologic and Neonatal Nursing 35 (2): 304–311.  
  5. ^ a b c d e f g h Hwang, S (2004-01-19). "As 'Doulas' Enter Delivery Rooms, Conflicts Arise: Hired to Help in Childbirth, They Sometimes Clash With Doctors and Nurses".  
  6. ^ Perspectives on Biology and Medicine
  7. ^ a b Mander, R (2001). "The doula". Supportive care and midwifery.  
  8. ^ Klaus, MH; Kennell JH; Klaus PH (2002). The Doula Book: How A Trained Labor Companion Can Help You Have A Shorter, Easier, And Healthier Birth.  
  9. ^ a b Askren, Hana (2012-08-18). "Doula Comeback Tied to Gaps in Modern Birth Care". Womens eNews. Retrieved 2014-02-02. 
  10. ^ Nikki Macfarlane Founder of Childbirth International, Childbirth International, Retrieved on 2 July 2015.
  11. ^ Find A "Our pages answer your questions and gives you practical tips to help you decide what's right for you for your birth, and how to make it happen.", Childbirth International, | pages = [2] | Retrieved on 2 July 2015.
  12. ^ a b c d e f g "Having a Doula | American Pregnancy Association". Retrieved 2014-02-02. 
  13. ^ "Doulas, a Mom’s Best Friend During Labor, Grow in Popularity | Mission Loc@l". 2010-02-22. Retrieved 2014-02-02. 
  14. ^ a b "DONA International – What is a doula?". Retrieved 2014-02-02. 
  15. ^ "I'm Not A Nanny. I'm A Family Life Doula". 2014-07-13. Retrieved 2014-07-17. 
  16. ^ a b Paul, P (2008-03-02). "And the Doula Makes Four".  
  17. ^ Campbell, D.; Scott, K. D.; Klaus, M. H.; Falk, M. (2007). "Female Relatives or Friends Trained as Labor Doulas: Outcomes at 6 to 8 Weeks Postpartum". Birth 34 (3): 220–227.  


See also

Disputes between doctors, nurses and doulas have been described as a "turf battle",[4][5] though it is also recognized that doulas and nurses can occupy complementary roles that provide opportunities for mutual learning and assistance.[4] Some hospitals have created internal doula training programs to reduce conflict between doulas and medical staff.[5]

[4] Some doulas train through distance education.[17] Research also supports the use of female friends or relatives, after minimal training, as a low-cost alternative to professional doulas.[2]

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