4 Signs You Need a Birth Assistant

When should you hire a doula?  Doula support has a lot of advantages, but are most often paid for out of pocket by the family.  So, you want to be sure that you’re getting your money’s worth when you hire one.  When is one really necessary — let’s talk about it.

But first, how do I know so much about doulas?

Hi! I’m Hilary — many people know me as The Pregnancy Nurse 👩‍⚕️. I have been a nurse since 1997 and I have 20 years of OB nursing experience, I am also the curly head behind this website Pulling Curls and The Online Prenatal Class for Couples. 🩺​ In all that time I’ve seen a LOT of doulas (both good and bad) and while I LOVE the good ones, I also want you guys to keep money you don’t have to spend, so let’s get into it!

When to hire a doula?

I think a doula is good to hire in 4 instances:

1.  You don’t get along well with your provider and can’t change

2.  You lack support from a partner or others

3.  Previous birth trauma hangs heavy on this birth

4.  The cost of the doula won’t be a big financial imposition for you

But, let’s talk about it….

But first — come join me in my pregnancy series that can be tailored just to where you are:

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What is a Doula?

Maybe you’ve just heard about doulas, but aren’t really sure what they are.

Honestly, a “doula” is just someone who helps in a difficult time.  There are also other types of doulas that help at other time, like death doulas.

In the birthing experience a doula is someone who has no medical training (that is important to remember) but is there to support you during labor and birth (and possibly postpartum too).  Their part is mostly emotional support (as well as some physical support such as helping with position changes, or massage, etc).

It is really important to find a doula that stays in their lane.  If they veer into medical support, offering you advice on what your provider is telling you (beyond how to get more information from your provider) that is out of their scope of practice, and it can make the medical staff and them butt heads a bit.

Believe me, there is plenty of emotional support that can be given before, during and after birth, they don’t need to veer into medical practice.

Some doulas are also trained in lactation support to help you postpartum as well.

Don’t miss my post on the disadvantages of doulas that you might find interesting as well.

How much experience do doulas have?

Honestly, that varies a lotAnyone can call themselves a doula.  Which is frustrating.  Some doulas are amazing, but often I find doulas that have been to a few births and think they know a lot about birth and then start charging.  So, be stringent as you look for one.

You can imagine that for providers in the hospital it’s hard to know what you’re getting when all of these people call themselves doulas.

How to pick a good doula?

Here are some questions to ask as you are looking to find the right doula.

  1. How many births have they assisted in?  You want someone with LOTS of experience
  2. Do they help all types of birth? (aka, home, hospital, cesarean, epidurals) — this will tell you if they only have a certain type of birth they prefer (and will push you towards).
  3. What is their pricing (if a doula is vague about this or doesn’t have a contract, that should be a red flag)
  4. What is included in their prices 
  5. Is there anyone who covers for them if they aren’t available (there are getting to be groups of doulas out there who work together, which is great because it is a very hard on-demand lifestyle).
  6. What references do they have (I’d ask for a bunch, and I’d call those people to see what they thought — a good doula should have RAVING fans as past clients)
  7. And finally, are they available for your due date 

Most doulas only schedule a certain number of clients/month so they don’t over-do it.  It is strenuous work and they need to take care of themselves to take care of you.  As you search for a doula don’t skip these questions, they are important (because a bad doula can impact your birth a lot).

Birth education classes can help as well, I recommend this one.

Reasons to Hire a Doula:

Let’s talk more about why those people I mentioned above might want to look into a doula.

You don’t get along well with your provider and can’t change

In some cases you’re not a good match with your provider but you are either far enough along in your pregnancy you can’t change, or due to other circumstances that provider is your best option.

In this case, a doula can help advocate for you with this provider.  They can also educate you in ways the provider may be unwilling to.

Doulas can aid in communication and education in these areas.  However, remember that provider may be called on to make life or death choices for yourself (and that is not something your doula is trained to get in the middle of).

Pro Tip:  If this is you and a doula isn’t in your finances, consider telling this to your labor nurse.  Just say that you and your provider have a lot of different viewpoints and you’re hoping that she can really help you advocate for yourself during birth.  It will give the nurse a clue she can go to bat for you!

You lack support from a partner or others

Some people come into birth alone.  They don’t have a husband, partner, mom, sister or friend that they trust enough to come into their birth space with them.  In this case, I think a doula can be extra helpful.  In fact, I would look around for programs that could help you financially manage this if it isn’t in your financial cards.

It’s just so nice to have a friendly face with you in the labor room.

That being said, as a nurse I was often called upon to be both a nurse and a support person to my patients and I really enjoyed those experiences as well.  Just communicate with your birth team that you’re alone and you’d love any extra care they can give you because of that.

I have some great tips for partners right here.

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Previous birth trauma hangs heavy on this birth

If you previously had a tough birth, it might be nice to have a doula there with you, particularly one that is trauma-informed.  It’s just another friendly face to have, as well as someone to advocate for you and educate you and comfort you during the process.

BUT if you did have previous birth trauma be sure to let your team know that your prior births have scarred you.  Especially when you’re specific about what happened we can often make sure that we carry you through those tough moments together.  You don’t have to have a doula in this instance either, it’s just a benefit to those that carry trauma with them.

The cost of the doula won’t be a big financial imposition for you

This is a big one, because no matter how the doula is priced, if it stresses your finances and you find yourself struggling after baby is born, the stress you experience then may not be worth the doula experience.

You need to be really sure of if this is something you can financially handle.

Be aware that the cost of a doula REALLY varies, but some areas do have programs to assist in the cost of a doula, so feel free to look into that or ask your insurance if they help out with it at all. How much is a doula?

This REALLY varies depending on where you are.  I do hear that some insurances are starting to cover doulas — so that’s something you can check on as well.

Also, between doula to doula the pricing varies.  Good doulas are a good chunk of money because they are worth it due to their experiences.  BUT, just because a doula is expensive doesn’t mean they’ll be worth it.

I had one of my favorite doulas on the podcast a while ago — her episode is so helpful:

The Best Doula: Postpartum Doula

Ok, I think labor doulas are great, but the reality is you’ll have a whole team of people in the hospital looking to take care of you.  What I really wish I’d gotten is a postpartum doula.  That’s someone who provides you support after baby.  Often they come at night to let you sleep.  They can also educate you more about your newborn, breastfeeding and just provide emotional support.

Oh man, what a dream that would have been.  I wish I’d saved my pennies to get one for a few nights, even as a labor nurse!  It’s just nice to know your baby is in safe hands so you can REST.

Grab my postpartum checklist to get you started:

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Reasons NOT to get a Doula

There’s plenty of reasons NOT to get a doula too — so, let’s talk about some of those.

You’ve been marketed to

Doulas often know those buttons to push.  They know how to whip-up your emotions into a frenzy about how horrible the hospital will be.  Don’t just get a doula because you’ve been marketed to.  It may peak your interest, but at that point you need to do some research on the cost, and why you think you really need one.  

Pro Tip: I’d also talk with your provider if you’re considering a doula.  It’s important that everyone in the birth room be on the same team including doctor and doula — so picking one they recommend or talking to them about it can be a big win.

Instead of a Prenatal Class

I believe everyone, people who have a doula or not, need birth education.  Studies show that childbirth education (or prenatal classes) improve birth outcomes.  Being educated before you got into the labor room (and I do mean partner too) is a huge win towards having a great birth.  

Doulas are in addition to prenatal education, not to replace it.

Come join The Online Prenatal Class for Couples — the all in one birth class couples love!

You have a super-strict birth plan

If you ONLY want to birth in one specific way (aka, no c-sections, inductions or pain mangement) hiring a doula can not gurantee that for you.  Only mother nature knows how your birth is going to go.  Just be aware that they can support during labor and can ease you into the birthing process, but they can NOT guarantee any specific outcome (and run from one who says they can).

I have some special tips in here about birth plans that you might find helpful.

Your friend had one

Some people need doulas, and benefit from them, and some don’t.  Just because your friend had one (or someone on social media) doesn’t mean you need one too.  “Run your own race” and discuss with your partner what you think you’d both like

Pro Tip:  Partners deserve a big voice in your choice to get a doula.  Not only is the financial obligation theirs as well, but also having someone in the birth space is something they should consent to (and feel comfortable with) as well.

When should I start looking into doulas?

I would say to start looking as soon as you think you might want one.  Doulas are sometimes a hot commodity (especially good ones) so start interviewing as early as you can, so you can both get on their calendar but also make plans together.  Some people even look into doulas when they are trying to conceive (but you will need a due date to book them).

If the doula you love is booked, ask them for references for other doulas.  Often there is a pretty-good network between the doulas in your area.  Sometimes they’ll have openings, so don’t feel like it’s too late to hire a doula if you haven’t looked around a bunch.

Should I have a contract with my doula?

If you are planning to pay that doula money, I would 100% have a contract with them that outlines:

  1. What they will do, and what they will be there for.
  2. What happens if they are not available (do they have someone who covers if they are on vacation, etc)
  3. How you pay
  4. Any rebates if they don’t come to the birth, or only come for a portion, etc.

How to Find a Doula?

While some doulas offer virtual birth support, I think most people agree having one there in person is probably preferred.  A few ways to find doulas:

  1.  Ask any labor nurse friends if they have ones they liked (or see if the local labor and delivery has a reference sheet)
  2. Talk with your provider to see if they have any recommendations
  3. Google it
  4. Check on social media for your area as well

You can also check the Dona International page as many doulas are certfieid through DONA (but many are also not certified by them, and they don’t have to be certified by them to call themselves a doula).

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Birth Doula FAQ’s

Why would someone choose a doula?

I think most people choose a doula to have a better birth experience.  However,  a doula definitely doesn’t mean you will have a good birth experience.

Do I need a doula if I have an epidural?

I see this a lot on social media, and I don’t think your choice to have an epidural or not is a reason to not have a doula.  Yes, if you really want to have a birth without pain medication you can get a doula.  But that doesn’t guarantee that you won’t need pain medication.

Doulas can be great at helping you manage pain during labor, but their experience and how well they help you cope really varies person to person.

What does a doula do before labor?

Some doulas will visit expectant parents prior to labor, to allow you to get to know your doula well before birth.  These prenatal visits can be a great way to ask them what you can be doing to make pregnancy easier, and what to expect from them at birth.

Often doulas will come to your home while you are in early labor.  Honestly, I think this is a time they really shine.  They can help you get comfortable, and maybe even get some sleep at home (when you don’t have any other nurses, midwives or doctors around).  They can also encourage you to stay at home a bit longer than you might otherwise which will allow you to have the comforts of home a bit longer.

However, it is really important to know what your doula plans to do (and hopefully have it in your contract).  Many only want to come when you go to the hospital, or are in “active” labor — so make sure it’s all clear.

Remember, giving birth is just one part in your parenting journey.  Doula’s can be super helpful in that journey, but using a doula isn’t the only way to have a great birth.  In fact, a doula might not be helpful and can be problematic during your birth (check out my post on the disadvantages of doulas) — so make sure you choose one wisely.  Remember that doula services and doula training varies WILDLY amongst them, so be mindful of that too.

And, make SURE to get prepared by someone with lots of experience in The Online Prenatal Class for Couples where we get you prepared for birth in just a few fun hours.

Or, if you’re not quite ready for the full class, check out my free prenatal class — It’s your first step towards being your own birth boss.

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