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Why Include a Doula, When I Already Have A Doctor? | What is a Doula?

There is so much that is unpredictable with childbirth. It’s important to create a supportive team to assist you along the way.  Many people choose to include a doula for pregnancy and birth. But, what is a doula and why include one in your birth plan when you already have a doctor?

Below you will find information and firsthand experiences about including a birth doula. Sarah Walton (owner of Bright Heart Birth Services, birth and postpartum doula, Placenta Encapsulation Specialist & Co-Owner of “Biggest Little Baby”) provides professional feedback and advice. 

What is a Doula?

A doula is a person who offers judgment-free, non-medical support to birthing individuals and their partners before, during, and after childbirth.  Doulas provide information/resources, physical assistance, and emotional support. 

Think of your doula as the ULTIMATE FRIEND (cue Friends theme song). She’ll be there for you….when the “rain” starts to fall (aka your water breaking). She’ll be there for you….like she’s been there before (Braxton Hicks or false labor? She’s there, and will be back when it’s really go time!). 

Your doula is your birthing guide, and there to make everything easier.

“The benefits of having a doula on your team range from a decrease in medical intervention rates to an increase in positive and empowering experiences,” said Walton.  “I like to describe birth doulas as professional birth guides and coaches. Someone to help you and your partner through the unknown path and encourage and support you through overtime. So much of what we do changes based on the individual family we are supporting. Doulas are hired to support everything from unmedicated home birth to a planned cesarean section, knowing that there are many valid, important, and special ways to have a baby.”

See a complete list of doulas in Reno, Sparks, Carson City, and Tahoe.

Image by Eden Rose Photography

Preparing for Childbirth

There is so much to think about, consider, and plan for when expecting. My husband and I attended the suggested First Time Parent Classes offered by the hospital, we read all the books and downloaded all of the apps.  

We knew what to expect, but the biggest thing about giving birth is… to.expect the unexpected! It can be so overwhelming, especially the birthing process! 

Extra Support

I had heard that doulas offer great support before, during, and after birth for mom, baby and the rest of the family. But beyond that, I was really unsure why to include a doula, when I already had a doctor, and planned to give birth in the hospital.

My husband and I were interested in extra support helping prepare for baby, answering questions about the birthing process, and assisting us to acclimate once baby arrived.  

Making your Voice Heard

I had an obstetrician I trusted to deliver my daughter safely. However, I didn’t trust that he would listen to, or adhere to, the birth plan my husband and I had in mind. 

We wanted to ensure that decisions and procedures were explained clearly to us while in the hospital, and we were not confident the busy medical staff would be able to put these fears to rest. 

Doulas Don’t Deliver

Doulas are not medically trained, and cannot deliver babies. An obstetrician or midwife is still responsible for your medical care during labor.

“A midwife or doctor’s job is to take care of you, as a patient,” said Walton. “They are responsible for all clinical tasks, tests and advice. Their job should be based on taking care of you medically. A doulas job is to guide and support you and your team with everything else; mentally, emotionally and physically. A doula should never be checking your cervix, catching babies or performing clinical tasks such as listening to the baby’s heart rate, taking blood pressure or administering medications.”

A doula focuses on an expectant mother’s own needs, which enables momma to have a memorable and empowering experience while giving birth. 

A birth doula remains with the mother during birth offering support, as well as comforting services like massage/breathing techniques, and assistance with labor positions.

Image by Eden Rose Photography

Putting Fears to Ease

While not diagnosed as having “white coat syndrome”, being in a hospital setting made me nervous.  Past surgeries had left me fearful of the healing process, and while I was willing to do anything to make sure our baby was delivered healthy, I wanted to do it as naturally as possible and avoid a c-section at all costs.

Our doula had no control over whether a c-section was part of our birth plan. She did, however, have the ability to clearly explain the possible variables. 

Being able to request the medical staff leave the room so my husband and I could discuss our choices in private was important to us. She was able to offer techniques to assist with my 40+ hours of labor. She never left my side, which allowed my husband to rest as well.

A Doula’s Goal

The goal of a doula is to ensure the birthing momma, and their partner, feel safe and confident before, during, and after birth.

Having continuous support during labor is associated with improved outcomes for both momma and baby. Other benefits include a 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 a family/friend or as the medical staff. Your doula is a “neutral party” who is there to bridge the communication gap between the family and the doctors/nurses.

Part of Your Team

A doula is not a substitute for having a woman’s partner at birth. Doulas encourage participation from the partner and offer support and reassurance to the partner as well. Also, if your partner needs a break, your doula can step in so your support is continuous.

“They will not replace your partner, but they will support your partner,” began Walton.  “A good one will squeeze your hips or massage your lower back for 36+ hours. A reliable one will answer their phone, even at 2am. A doula who is paying attention will remember details you don’t and often keep a timeline of birth so you don’t have to. That being said, they will not remember what you looked like naked or if you pooped while pushing. An experienced doula should know how to work with even the most difficult provider. A doula will listen and support you in making any decision, easy or hard, that you feel is best for you and your family. A doula is for EVERY type of birth, every single one,” concluded Walton.

My doula offered to bring food and snacks for both me and my husband. She reminded us of the importance of nourishing ourselves because the work was still yet to come (aka LABOR). She offered to run errands if needed. And most importantly, she created a warm, homey environment out of my bare and cold hospital room. 

She was definitely part of our team, was a great team leader, and felt much more like family. 

Image by Elsa Boscarello Photography

Doulas are for Dads, too!

Birth isn’t just hard for the person experiencing it. It is hard for those who are observing it. 

“The average first birth is 24 hours, most births start in the middle of the night. That means that many people miss at least 2 nights of sleep. Even the best support can waiver when it has been two nights going and it’s now 4am and the room is dark and warm, but you just.have.to.stay.awake. It is not realistic to expect someone to be the birthing persons best cheerleader after hospital coffee, granola bars (if you’re lucky), no sleep and physically, mentally, emotionally helping someone through labor, especially since birth happens to be uncharted waters for the majority of you.” – Walton

“So many dads are concerned that hiring a doula will also hire them right into the sidelines. This just isn’t true. A good doula will know exactly how to help a dad that wants to be involved be the closest hand she reaches for. A doula should be able to find ways to bring you closer in your birth experience. We want you to both come out looking/feeling like a hero,” said Walton.

Antepartum (before birth) Support

While in most cases the term “doula,” implies a professional who is present during the birth, there are also doulas who specialize in antepartum (before birth) care. 

Typically most doulas offer prenatal meetings. This gives you and your doula (and your partner) a chance to get to know one another and go over any concerns, fears or thoughts you have. This gives your doula a base to find the best tools and resources to share and put into practice.

A doula also helps a woman prepare for birth, write a birth plan, review comfort techniques and develop a postpartum plan. Your doula can discuss any worries, fears or concerns you may have leading up to childbirth, and discover ways to release them. 

Always Available

Have I mentioned your doula is there for you?!? (I bet that Friends theme song is still playing in your head).  Your doula will be available for you should any questions or concerns arise. Most doulas are available 24/7 and encourage you to contact them.

Some doulas services include accompanying momma to prenatal visits. This facilitates a relationship prior to birth and builds a team of support. Many people choose to use this option in the event that the birth needs to take a more medicalized route with induction or cesarean.

And when it is “go time” your doula will meet you either at home or in the hospital and will stay with you throughout your labor.

Image by Eden Rose Photography

Everything Happens for a Reason

I had envisioned that my water would break on a warm summer morning and I would labor at home with the support of my husband and doula.  Imagining the breeze blowing through my house as I bounced on my birthing ball. I had planned to dilate to at least 4cm before heading for the hospital.

And imagine my surprise when NONE OF THIS HAPPENED. Expect the unexpected right?

Instead of my summer dream, my doctor decided to induce me because of fluctuating blood pressure. I had just moments to grasp the idea that baby would be here sooner than expected. I was upset and devastated things were not to my plan.

My husband offered great support. But do you know who was able to calm us both down, clearly explain what was about to take place, and help us prepare for this change in a birth plan? My most awesome, amazing, doula!

She not only was quick to respond to our call, but she also continued to check-in via text, until she was by our side in the delivery room. And she was there every moment after until baby arrived.

C-Section and Doulas

The safe arrival of your bundle of joy is the ultimate goal, and sometimes a cesarean is your best/safest delivery method (whether scheduled or not). 

While it may seem counterintuitive, a doula’s support at this time can be essential! Having a doula present is beneficial no matter what type of birth you are having. 

Doulas can assist you and your partner, to help remind you of your birth plan/preferences and help bring comfort into the hospital or operating room. 

Remember, your doula is there for you. Once your little one is born, your partner will join baby while you stay in post-op.  Having your doula by your side can be comforting, so you are not alone. 

Setting Limits

The hours after your baby is born can be magical and overwhelming. Life as you knew it is different.

Your doula is an essential partner to have when adjusting to motherhood.  She can help change baby so you can rest. If you have questions about nursing or postpartum healing, she’s there. She can track down the nurse when you need more of those attractive “momma diapers”. 

And …when your loving family…is just so excited to see you and baby…arrives in a caravan …and has so much love to share (as well as flowers, balloons, and goodies)…your doula is there to set limits.

The last thing you want to do is monitor your family, and tell them to leave at the appropriate time. Your doula is a perfect mediator, who can provide a gentle hand (out the door) so you can enjoy that precious bonding time as a new family.

Postpartum Support

Usually, within the first week after birth, your doula will make a house-call.  She will check-in with you and see how you are feeling (emotionally and physically).  She will also go over any questions you may have and supply you with any additional resources you may need.

Doulas can offer to support you in establishing breastfeeding and newborn care.

“A Postpartum Doula is hired for in-home support most commonly within the first 3 months of your postpartum period,” said Walton. “Their job is to help take care of things (all of the things) so that you can focus on recovery and bonding with your new baby and the adjustment for your new family.”

Postpartum support services doulas provide include:

  • meal preparation
  • light housework
  • running errands
  • help with older children and/or pets
  • resources and referrals
  • companionship
  • company to appointments
  • care for baby so the parent can shower
  • eat or nap
  • baby-wearing assistance
  • soothing baby and education on soothing techniques
  • education on infant and parent care
  • and more!

Additionally, a doula is sometimes hired to work with families beyond the postpartum stages, providing continued informational, physical and emotional support, for as long as needed (but most commonly within the first three months). 

Placenta Encapsulation

Yes.  This is a thing. It’s as weird as it sounds. And something I would recommend. 

Placenta encapsulation is the process of cooking, drying and encapsulating the placenta to be taken as a homeopathic by new mothers. Many women experience postpartum depression but are limited in the treatments or medications they can take when nursing. Placenta encapsulation offers a woman the option of using a natural substance created by her own body. 

While the process of Placenta Encapsulation has not been widely researched, there are a couple of studies out of institutes such as UNLV on the popular postpartum practice with positive results. The UNLV study found that 96% of the women said they had a “positive” or “very positive” experience consuming their placenta, and 98% said they would do it again.

Does Placenta Encapsulation work?

Placenta encapsulation works because instead of experiencing the sharp hormonal change, the mother is able to ingest the hormone rich placenta (namely rich in CRH hormone which causes baby blues) which counteracts the possibility of depression.

Your baby’s placenta, contained in capsule form, is believed to:

  • contain your own natural hormones
  • be perfectly made for you
  • balance your system 
  • replenish depleted iron
  • give you more energy
  • lessen bleeding postnatally
  • been shown to increase milk production
  • help you have a happier postpartum period
  • hasten return of uterus to pre-pregnancy state
  • be helpful during menopause

Benefits

The placenta is composed of beneficial hormones, chemicals, iron, and proteins. 

These healing substances include:

  • Estrogen, Progesterone, Testosterone: Contributes to mammary gland development in preparation for lactation; stabilizes postpartum mood; regulates post-birth uterine cramping; decreases depression; normalizes and stimulates libido.
  • Prolactin: Promotes lactation; increases milk supply; enhances the mothering instinct.
  • Oxytocin: Decreases pain and increases bonding in mother and infant; counteracts the production of stress hormones such as Cortisol; greatly reduces postpartum bleeding; enhances the breastfeeding let-down reflex.
  • Placental Opioid-Enhancing Factor (POEF): Stimulates the production of your body’s natural opioids, including endorphins; reduces pain; increases well-being.
  • Thyroid Stimulating Hormone: Regulates the thyroid gland; boosts energy and supports recovery from stressful events.
  • Corticotropin-Releasing Hormone (CRH): Low levels of CRH are implicated in postpartum depression. The regulation of CRH helps prevent depression.
  • Cortisone: Reduces inflammation and swelling; promotes healing.
  • Interferon: Triggers the protective defenses of the immune system to fight infection.
  • Prostaglandins: Regulates contractions in the uterus after birth; helps uterus return to its pre-pregnancy size. Anti-inflammatory effects.
  • Iron: Replenishes maternal iron stores to combat anemia, a common postpartum condition. Increases energy; decreases fatigue and depression.
  • Hemoglobin: Oxygen-carrying molecule which provides a boost in energy.
  • Urokinase Inhibiting Factor and Factor XIII: stops bleeding and enhances wound healing.
  • Immunoglobulin G (IgG): Antibody molecules that support the immune system.
  • Human Placental Lactogen (hPL): This hormone has lactogenic and growth-promoting properties; promotes mammary gland growth in preparation for lactation in the mother. It also regulates maternal glucose, protein, and fat levels.

Women notice that they feel calmer and have a balanced mood. Many experience more energy or muscle strength and commonly report an increase in milk supply and shortened postpartum bleeding and quicker healing.

Some new moms have reported experiencing an improved state of mind, reduced fatigue, a restored sense of balance and function, and an overall feeling of wellness. 

Average Doula Fees

When looking into including a doula as part of your birth plan, it is inevitable that cost will come up.  It is important to be prepared to avoid “sticker shock”. Remember, this is an investment in yourself, your family, the ease of bringing a baby into the world, and peace of mind.

Average doula costs in Northern Nevada range from $900 – $1400

Doulas believe everyone deserves the opportunity for support throughout their birthing process or placenta encapsulation if desired. Many doulas/practices will accommodate families and offer flexible and customizable payment plans. 

Image by Elsa Boscarello Photography

What Doulas Want You to Know

“Your birth experience can absolutely affect every other area in your life. Between 25%-34% of women report that their births were traumatic. That is potentially one out of three people! I wish everyone knew how many choices they truly have within their birth and baby journey. Birth is not easy, even when it IS easy, and the one choice you can make that is proven to drastically improve outcomes is to hire a doula. If you can not hire a doula, taking childbirth education classes can help inform and prepare you. Be mindful that classes taught within the hospital are often teaching on hospital guidelines and preferences and may not be evidence-based.” – Walton

All the Feelings

It is SO hard to see someone come out of their delivery feeling disappointed, frustrated, crushed, pressured, dis-empowered, shamed, scared, hurt, helpless, embarrassed, humiliated, distressed, assaulted and/or traumatized. 

“There is a lot that can be done to decrease your chance of feeling those feelings, and doulas are proven to improve outcomes, but there is sadly no way to guarantee a positive birth experience,” began Walton. “We can not 100% protect you. There will be times we could have done something better and other times that people will feel that we have failed them.”

“Basic doula training is all affirmations and massage techniques. It does not prepare us to see some of the way things unfold and the way some people are treated. We too experience a lot of trauma witnessing and holding space in birth. The job is easily romanticized but the average doula career only lasts two years as a result. And that is a pretty hefty reality.” -Walton

You Can Do It!

“I LOVE seeing families hold their babies on the outside,” said Walton. “There is something incredibly raw and real about that first meet. But that isn’t the most rewarding thing. The most rewarding thing is seeing a pregnant person come through birth feeling proud and well supported.

“I couldn’t have done it without you” is something we hear often from both mom and dad. The thing is, we knew you could do it, we knew it all along, you just needed to know it too. We are so happy to help shine that mirror.”

Disclosure: My husband and I enlisted the assistance and support of Sarah Walton and Bright Heart Birth Services for the birth of our daughter. Walton offers valuable resources to expecting parents and is not the only amazing option our community offers.

Sarah Bear Rively is a Reno resident for over 30 years and loves the uniqueness of Northern Nevada. Sarah and her husband are parents to a sassy, smart, considerate “three-anger". Sarah has spent the majority of her career helping Reno’s at-risk populations through non-profit and social service work.  She now proudly works for the Northern Nevada Chapter of the Alzheimer’s Association. Sarah considers herself a fun-loving person who enjoys laughing, getting creative, helping the community, and spending time with family.  You can follow her in real life on Instagram and TikTok.