Advice about Using a Doula

• What is a doula?
• Why we like doulas
• How to find a doula
• How much does it cost?
• Questions to ask a doula
• ObGyn disapproves of having a doula

What is a Doula?

A doula is a person who is present with the mom before, during, and after the labor. The doula's job is to take care of the mom. She helps you with your birth plan before the labor and helps you execute it during the labor. She suggests positions to try and has all kinds of tricks to help make labor easier. She can help you judge whether or not it is really time to go to the hospital. She is not a midwife; she is not medically trained. Her knowledge comes from having attended many births. She is a clear head during labor to help you when things get crazy; she can remind you about all the different things you learned in your birth class but cannot remember because you are in LABOR (and your husband is panicking)! She is like your best friend or your sister, but with a lot more knowledge about the birthing process. Invaluable. Laura 

A Doula is also known in many circles as a labor coach. Many times a Midwife is a Doula, and vice versa, but not always. In California, most Doulas have some training, but are not certified in the same strict manner as midwives. I had both a Doula and a Midwife for my hospital birth. A Doula is especially useful for an OB assisted birth in a hospital, since the doula will usually come to your house towards the beginning of labor, and stay with you until at least several hours afterward, a service doctors and most midwives are unable to provide. She will help you decide when to go to the hospital, run interference with the hospital staff, and do anything you request to help make you as comfortable as possible. Some doulas are also lactation consultants, which is a real bonus for getting breastfeeding off to a good start. She provides physical and emotional support to the mother. Even if your partner is with you, a doula is a help, since that allows the partner to get some sleep, take breaks, and focus on the mother.

One other way of looking at it is that the midwife/doctor's primary responsibility is the Baby. The Doula's primary responsibility is the Mother.

Hope that helps! Dawn

Why we like doulas

Doula's decrease the average first labor by 9 hours and the chance of C-sec by 19%. With statistics like that, invest in a good doula, it's worth it. Beth (Nov 2001)

I have to say that we found having a doula to be a wonderful thing and we certainly believe that it helped to make our daughter's birth a much easier, more enjoyable, rewarding and safe experience than we would have had if we had not had assistance from Linda Mixon-Jones. Good luck, Adam (Nov 2001)

To the person asking for doula recommendations... I'm not sure if I can be helpful in the reference department, since Janaki Costello was my doula, but I just want to encourage you to find a doula -- having that support made a huge difference to me in having a positive birth experience, and specifically a difference in my confidence before during and after. I also had superb nursing care at Alta Bates. I think they were making an effort (7/2000) to match women who wanted natural childbirth with nurses who were into it, so that may be something to pay attention to. I also was able to get a room with a bathtub, and laboring in the tub helped me a lot. Best of luck, Susan (Nov 2001)

If you're on the fence about hiring one, read Mothering the Mother by Marshall Klaus. There are listings of doulas at The Nurture Center in Lafayette and BirthWays in Berkeley. Meri (Nov 2001)

How to find a doula

Sept 2011

I am a 40 year old woman who is pregnant for the first time. CVS test showed fetus is thus far healthy at 14 weeks. I would probably give birth at Alta Bates. People have suggested I get a doula. How does one go about finding a doula? Do you interview different people? Does anyone have any suggestions? I am fairly agnostic on child birth. I would like to do things as naturally as possible, but I am not religiously opposed to drugs, if need be. The most important for me is safe delivery. anon

I highly recommend meeting a few doulas so you can find the one who is a good fit for what you are looking for. You can find some certified doulas at www.dona.org which is a very respected doula associaton. Renata

Having a doula is great. Especially true if you have not attended a few births of your friends or family, or if you mom and sisters cannot be with you during the birth, or have not themselves been at many births. Definitely worth the $1,000 that it costs.

I found doulas by asking friends and co-workers for their recommendations. Turns out half the people we know had doulas. And if a doula is full, she can recommend another doula in her backup group.

Also, Felicia Roche teaches the DONA classes, national certification of Doulas, in the east bay. Part of their training is attending many births before certification. And so many of them volunteer at births after their classwork is finished, therefore low or no cost.

If you plan a homebirth, many midwives will accompany you at the hospital in case of an emergency transfer and will act as your doula there. Ruby

If you haven't already asked your doctor at Alta Bates about a doula, then check there first. There are often doulas that specifically work with a hospital or that have signed up as volunteer doulas. If there is not already a resource for finding a doula through Alta Bates, I would try Birthways in Berkeley for referrals. loved having a doula

Doulas of North America have a website: http://www.dona.org/ On the left they have a search of certified doulas of all kinds (birth, postpartum, all doulas) based on your location. I was very happy with my postpartum doulas I found through that site. Best of luck, Victoria

First of all, congratulations on your pregnancy!! I think it is wonderful that you are considering hiring a doula. There are many wonderful doulas out there, especially in the east bay. I think the best way to find the right doula for you is to ask around for recommendations and look online (like you are doing) for doulas in your area. DONA International, www.dona.org, has a list of certified doulas all over the states, but there are many excellent doulas who are just starting out and working towards certification, like myself, who aren't listed.

Generally doulas begin working with women in their third trimester so you are getting a great, early start! After collecting a list of doulas in your area I highly recommend interviewing several. It's best if you find a doula that you connect with. This is the woman that will be supporting you through an intense, life-changing event. You want to feel comfortable around her. When interviewing her she can provide you with her information and background, cost and answer any questions you have. The doula can work with you to plan and prepare for your ideal birth experience, be it natural or not. The cost of a doula will vary, especially if you have a newer doula. But the truly important thing is how you feel around her. If you don't feel comfortable with her, then it doesn't matter if she has 20 years experience or you're her first client. If you have any further questions, feel free to contact me! Take care, congratulations and enjoy your new adventure to motherhood! Nicole

I'd suggest going to a free ''Meet the Doula'' event. Birthways (www.birthways.org) has these on an ongoing basis - check their calendar. Looks like the next one is October 16th. On a personal note I have two dear friends who've worked with Anna and Candace at Family Doula Services and they were wonderful. Definitely interview a few to make sure you and your partner both mesh well with them and are comfortable. Doulas are absolutely amazing, and in my opinion an essential part of the birth team. Happy Birthing! doula fan

November 2001

I am looking for a doula. I am due Jan. 15 and will be delivering at Alta Bates with an OB. My husband and I have heard that delevery can go much more smoothly with the assistance of a doula. We would like to hire a Doula by recommendation. The lists that are out there seem overwhelming. Also, can anyone tell me how much I should expect to pay for Doula services? Elizabeth

I'm new to the area but here are a few suggestions
Birthways in Oakland, on Santa Clara near the Grand Lake theater (www.birthways.org) DONA - Doulas of North America (www.dona.com or maybe org) ALACE -Association of Labor Assistants and Childbirth Educators www.childbirth.org CAPPA - http://www.childbirthprofessional.com/ 
I am a birth and postpartum doula just learning the ropes here in California. I was doing this work in Western Massachusetts for the past 5 years. If you have any other questions, feel free to contact me. in peace Samantha

How much does it cost?

A doula usually costs around $300 to $500, which includes one or more pre-birth visits in your home, full support during your labor, and one or more visits afterwards. This cost is occasionally reimbursable through insurance, though rarely. It's well worth it, though, especially if you cannot afford to have a midwife, and must have an OB-attended birth. (Dawn, 1999)

We used Linda Mixon-Jones (see review below). As for cost, I think it cost a total of $650 or so. Adam (Nov 2001)

For 2 pre-consultations (not including the in-person interview) and support during labor (at home and hospital) and up to 2 post-partum lactation consultations, we paid just under $500. Susan (Nov 2001)

Most doulas charge from $500 to $1,000 for the birth and a few pre- and post-partum visits, depending upon their degree of experience. Meri (Nov 2001)

Linda Almond-Nichols ... did a wonderful job. I believed she charged $600, and was worth it! Amzel (Nov 2001)

Lisa Moon's fee 2 1/2 years ago was $800. Half up front half after the birth. What was supposed to be included was 2-3 pre-birth visits, the birth and 2 post-partum visits. Beth (Nov 2001)

Meghan Lewis charged us $775 back in April 2001. Teresa

Linda Jones-Mixon charges in the upper end of the $500-1000 range that others have mentioned for doula services. (Nov 2001)

When I delivered in February 2001, my doula, Jennifer Starling, was charging a sliding scale of $4-700, whatever you can pay. That included two pre-labor visits, one post-labor visit, and of course, being there for the birth. Whitney

Questions to ask a doula

July 2002

I know there are labor doula recommendations on the web site but most of them are 1-2 years old now. I was wondering if I could get any recommendations or cautions from people who have used this service more recently. Also are there any questions you didn't ask your doula that you wish you had in restrospect? Thank you for any help you might have.

I wish I had made it more clear that I wanted my doula to help me breathe through my contractions, and to help my husband coach me through my breathing as well. During the interview I was sure I had made my needs clear, but during my labor she seemed to get caught up in the moment and forgot about mt request. Finally I exclaimed, ''will somebody please help me breathe through these!'' and she did, but by then it was too little too late. To be fair, she was wonderful in many other ways.

I would suggest that you ask the doula you are interviewing to list her strong points before you tell her what you want. If her strengths match your needs then you may have found a good doula for you. If you have to ask her to do something that she doesn't list as a strength, she may not be the right one. anonymous

My wife and I heartily recommend the doula we used to assist us with the birth of our daughter 18 months ago. Her name is Linda Jones Mixon. She's caring, funny, easy going and just fantastic. She was an immense help all the way around. You can reach her at 510-540-7210. Linda also is the proprietor of ''Pickles and Ice Cream'' - the infant / baby store in No. Berkeley on Shattuck at Cedar. You can usually find here there.

Two other recommendations I'd like to pass along are Janicke Costello and Carol-Shattuck Rice. You can reach them at 415-525-1155. They team teach a great 8-week long birthing class in El Cerrito and they are birthing doulas as well. Their class is quite good and we have heard from other folks that they are great doulas. Good luck, Adam.

I would highly recommend my doula, Constance Williams. She attended my daughter's birth 16 months ago. She was incredible. I really believe that I would have had a c-section if it weren't for her. She did exactly what I wanted her to do. She is very strong and she massaged my legs non-stop for 5 hours. I gave birth with out an epidural which was also nice. She also knows all the nurses at Alta Bates which is very helpful because she made sure that we got terrific nurses. Good luck! Madeleine

Not sure if you want specific doula recommendations or genral info. I can just tell you that we used a doula for my daughter's birth last year. We had other family present at the birth but I just wanted someone who ''knew'' what they were doing there as well. Our doula had been our childbirth prep class instructor and we had started to really like her and felt comfortable with her. She was a Godsend. I had a very long labor and some glitches with the hospital. She kept me calm when there were several times I could have freaked out. I opted for an epidural and she was supportive. She made sure my husband and other family were taken care of (rested, got food, fielded calls, etc.) and made sure that I had everything I needed (jello, water, quiet, footrubs, etc.). She asked questions of the nurses and doctors that I wouldn't have thought to ask and did it in a respectful way so the staff didn't feel threatened.All in all, it was a wonderful experience and she definitely made! a difference. I am sure I could have done it without her but I wouldn't have wanted to. Especially with my first baby. My friend is now using her for her birth next month. Nicole

I've replied off-line to posters in the past, and now I'm wondering why -- no reason to keep such a good doula a secret!

We chose Rebecca Husband for our daughter's birth. She was wonderful, thoughtful and respectful of our wishes. Our baby was several weeks overdue and though it became clear that it wasn't going to be the natural birth we'd hoped for, she helped keep it close to our ideal. The fact that she has a very good working relationship with Alta Bates staff was a plus (she also volunteers there for women who arrive without partners and whose births could be helped with a doula) -- our delivery nurse was herself a former doula and personal friend of Rebecca's. Our daughter happens to share Rebecca's birth date, which has kept us close - she came to her christening and recently to dinner with her beau.

The activities we did with her as we got our brains around the reality of birth were interesting, and her information dovetailed nicely with that we received from the instructor, Jennifer, at the Alta Bates Childbirth prep class. My baby brother was born at home, so I was quite familiar with natural childbirth - but when I became frustrated and demanded drugs, she was patient and supportive. They also managed to coax me into the shower instead and the baby was born just 2 hours later (6 hrs total).

The only thing I might have asked her to do was rub my back more - my husband was exhausted and could have maybe just held my hand a bit, but who knows?

She had a sliding scale for three visits and a post-partum follow up, and brought fresh roses from her garden for the delivery room which was really really nice! Happy to provide more details if you'd like. Deirdre

We used Maria Steinman for the birth of our baby boy 7 weeks ago, and were very happy with her. Our son was three weeks early, so we missed two of the three prenatal visits we'd scheduled, (and so I'm not sure what she would've taught us during them) but she made up for that by coming to the house two additional times after the birth to give me an hour-plus massage (she's a certified acupressure practitioner). She's a delight. I would use her again and highly recommend her. If you want more details feel free to email or call me. Or call Maria. Her phone number is (510) 594-2575 Kate Hand pkhand AT attbi.com

I gave birth on February 28, 2002, with my amazing doula Kim Lyons and my husband present. Kim was warm, loving, kind, and unbelievably supportive during a MOST difficult 22-hour labor. She is a masseuse and does some accupressure, both of which were very helpful during the labor. She has a very positive energy about her generally speaking. Additionally, she does infant massage, and teaches you how to do this on your own baby in your post-birth meeting. My baby has been very grateful for this!! Please contact her at birthmate AT yahoo.com or contact me for her phone number. Jennifer

Debi Raya (925-939-2534) was the doula for my birth five months ago for my son Jonah. She was WONDERFFUL! Knowledgable, calm, supportive, well-trained, competent. She is also a massage therapist, which really helped with 30 hours of back labor! She came to our home, where she can do exams to see how dialated you are if you want (she was a certified midwife in Texas I beleive). She stayed in the hospital all night. She's more often at natural births but was very supportive of me when I chose to have petocin and then an edidural for the pain. She was wonderful. My husband and I felt very close to one another during the entire delivery and I beleive it was because of her presence and knowledge. We felt ''accompanied'', supported, and safe. She's a good advocate if you're thinking of a hospital birth. She definately worth having a conversation with to see if it's a good fit for you. Blessings, Sarah

My husband and I would like to recommend our wonderful birth doula, Kathrin Smith, who was with us for the labor and birth of our 2-month-old son. We found Kathrin through Birth and Bonding on Solano. I am a 40-year-old first-time mother, and, though I very much wanted as natural a birth as possible, I was quite apprehensive about being able to go through it without a lot of medical intervention. With Kathrin's knowledge, encouragement and support, we were able to have a better birth experience than we had imagined possible--it was certainly the most moving, amazing and wonderful experience of our lives. I truly believe that without Kathrin's guidance, I would have had a much different, and less participative, experience giving birth to our son. (Most of the labor was at home, and our son was born at Alta Bates.) Kathrin is experienced, smart, warm, loving, grounded, AND has a good sense of humor. I was very inspired and encouraged by her, particularly by the fact that she had her own two daughters naturally at home. She was also very good at including and relating to my husband. She was always available when we called, and was at our home as soon as I needed her once labor began. Kathrin is currently in Marin, but I believe she is moving to the East Bay soon. (She had no trouble getting to our home in the East Bay quickly from Marin.) Please feel free to e-mail me, or call Kathrin at 415/459-4737. Elizabeth

ObGyn disapproves of having a doula

March 2006

March 2006

I recently thought about hiring a doula as this will be my first childbirth and felt more reassured by the thought of it, but when I brought this topic up with my OBGYN she had this look of disgust. I asked her why she was against doulas, and she explained that besides them not being medically trained they also interfere with the medical staff and can be overbearing. My dilemma is that my insurance will cover a doula if referred by my OBGYN, but after having that discussion do I even dare ask her for the referral? Christine

Are you sure you are comfortable with your ob/gyn? I ask this, because it is very important. I didn't follow my instints with this one, and ended up with a c-section. It turns out that the practice I went to has probably a 50% c-section rate (the hospital has a 25% c-section rate). I had a doula that got me through some tough times with my induction and c-section. The practice I used usually frowns on doulas as well. I know it might be late for this, but I would urge you to switch if you are not comfortable with your ob/gyn. I thought about switching a month before delivery, and now I wish I had. On the otherside, doulas are not legally allowed to give medical advice. Muriel

the fact is, this is your birth and not your OB/GYN's. you have the authority and the right to ask--and then demand--to have your birth the way you want. it is absolutely true that doulas interfere with doctors and are overbearing. that is exactly what you are paying one for. you are asking someone to help coach you through the birth, help you follow a birth plan (even when it is not what the doctors think is convenient) and advocate for you when you might not have the capacity to do so yourself. that certainly is not easy for doctors, who push meds, interventions and procedures that are expedient for them, may help protect them from lawsuits and are based on a time clock not necessarily what is good for you and your baby. i'm sure i sound negative and there are lots of great, supportive ob/gyns out there, but i would be suspicious of someone who does not want you to be fully supported in your birth. i have seen too many people pushed (or scared) by doctors--in the absence of doulas or midwives--into procedures that have resulted in c-sections. studies have shown that women who have doulas tend to have less interventions, less c-sections and less medicated births--whether or not that is easy for your doctor to deal with, it is certainly the best choice for you and your baby. stick to your guns, and good luck! ann

It sounds to me like you are in the market for a new OB-GYN! The statistics (and we're talking many, many studies here) speak for themselves: Having a trained doula at your labor/birth leads to: 
50% reduction in the cesarean rate 
25% shorter labor 
60% reduction in epidural requests 
40% reduction in oxytocin use 
30% reduction in analgesia use 
40% reduction in forceps delivery

Why would any competent doctor discourage their patient from receiving these multiple benefits? I suggest you speak with other OBs and labor/delivery nurses regarding their positions on doulas. I imagine you'll get many positive responses, because while doulas are Not medically trained, continous emotional support in labor is proven to remarkably reduce the need for medical interventions. Couples who use doulas also report more satisfying, empowering birth experiences, not to mention less PAIN. Most local hospitals have volunteer doula services as well. You are in control of your birth experience. Decide what it is that you want and choose wisely. Good luck! Doula Fan

I wonder what your Ob's C-section rate is? I would be very concerned about delivering with an Ob who doesn't like doulas. I had a doula at two of my deliveries and they were so supportive for both me and my husband. They kept us informed throughout the process and helped us make decisions mostly on pain management. They were never overbearing. If I were you I would start looking for another Ob. You are so lucky to have coverage for a doula. Happy Doula User

Yes, ask for the referral. This is your birth. When you ask you could acknowledge your doctor's concerns and let her know that you will speak with the doula. If you haven't chosen one, this issue could be discussed in your interviews. Also, if possible, have the doula go with you to one of your appointments so the two meet at a calmer time. Had a midwife and a doula

I feel very strongly about this issue, as a former doula and a midwife. First off, your doctor won't be in the room more than a half hour under the best of circumstances, and usually docs are pretty professionally courteous to doulas no matter what their opinions about them, so there probably wouldn't be a clash of any kind. What I feel stongly about is this: the doc is not going to be willing to stand by your bedside for hours and hours and do all the things a doula would, is she? A good doula will not give medical advice, either. It sounds as if she has had some wierd experiences with doulas that are atypical. If she won't give a referral, I'd wonder what else she is going to control during your birth. (if she is there at all). Be careful. wary

You are right to feel reassured by hiring a doula! Doulas can help make birth a much more calm, comfortable and gentle process. Research has shown that women who had doulas reported:

Breastfeeding more successful 
More maternal infant interaction 
Less postpartum depression, anxiety and low self esteem 
Perceives her baby to be above the standard baby 
Overall more satisfaction with her birth experience

Also, many studies show that having a doula improves obstetric outcomes across the board: 
Reduced need for medication by 35% 
Reduced need for forceps by 50% 
Reduced need for cesarean Section 51% 
Reduced the length of labor by an average of 98 minutes

''If a doula were a drug, it would be unethical not to use it.'' - - John H. Kennell, MD

These statistics have been published in several studies and most OBs in the Bay Area are aware of them. Many OBs support doulas because of them, and because of their personal positive experiences of working with doulas. Further, all these reductions in medical procedures equal a very beneficial cost reduction for hospitals. Everybody wins!

Doulas are not medically trained because our focus is on the mother's comfort and emotional needs. Certified doulas have pledged to uphold a code of ethics specifically to avoid the kind of situation your OB describes. It might be worth considering wether a doctor who opposes doulas so strongly is the right doctor for you.

Since you will be the one hiring her, you can make sure that you don't hire someone who will be overbearing or interfere with the medical staff. Most of us don't! But by hiring a good doula, you will ensure that you have an advocate in the hospital whose only goal is to ensure your comfort and emotional well being!

Best to you and your baby on this amazing journey to motherhood.

If having a doula is important to you then I would suggest looking for a provider who welcomes doulas and ask them for doula referrals. That's great that your insurance covers doulas. Can you please tell us the name of your insurance? Prenatal yoga teacher, whose students change doctors/midwives even in the last trimester because of reasons like yours.

I recently thought about hiring a doula as this will be my first childbirth and felt more reassured by the thought of it, but when I brought this topic up with my OBGYN she had this look of disgust. I asked her why she was against doulas, and she explained that besides them not being medically trained they also interfere with the medical staff and can be overbearing. My dilemma is that my insurance will cover a doula if referred by my OBGYN, but after having that discussion do I even dare ask her for the referral? Christine prenatal yoga teacher

You need to decide on your own if you want a doula. If you do, then you need an OB who is onboard. Either keep the OB and be intimidated into having no doula support, or decide that you will have a doula, and get another OB who will work with your needs. You don't need that kind of tension with your doctor. You need all the support you can get while pregnant/laboring.

The whole reason doulas are ''overbearing'' is because many times laboring women - in their vulnerable state - are manipulated by overbearing medical personnel to do things they disagree with. It's overwhelming to try to stand up for yourself while popping out a kid. Switch OBGYNs

I'd say get a new ob. I got reccomendations from my ob on doulas -- his words were something like ''she is one of my favorite doulas to work with'' -- my ob is Dr isenberg at obgyn partners in oakland & my doula was chris gonzalez. (he gave me three names)I cannot stress how much she MADE my birth experience. seriously. you spend hours with your doula -- not so with your ob. he/she is with you for a couple of hours at most. good luck

Hi, Not sure how far along you are, but to cut to the chase it sounds like you need to find a new OBGYN. I found one at 30 weeks with no problem when we moved to a new area. Doulas are great! Anon

If you're considering a doula you probably have a good idea of the benefits already, so I'll just say that I found having a doula there to provide reassurance that labor was proceeding normally to be a great advantage during labor. Ask your OBGYN for the reference, because this is your birth, not hers. A doula will be there the whole time for you and your partner, while the OBGYN will flit in/out or just come in at the very end. If you really like your OBGYN, find a doula that doesn't seem ''overbearing''. If you're not crazy about your OBGYN, consider switching to someone who will support your choices. Heather

Go ahead and ask for the referral, and simply reassure your OB that you are 1) Not expecting the doula to perform any medical duties, so her lack of medical background will not be an issue. 2) You will carefully interview and choose a doula who is dedicated to being diplomatic with the medical staff

Every doula is NOT ''overbearing.'' A professional, experienced doula will make a point to be diplomatic and cooperative with medical staff, because they want to be welcomed at hospitals, not spurned. My doula, Betsey Appell was wonderful in this way. She works expertly with the medical staff, while still advocating for your needs, when necessary (in a very non-confrontational, non-overbearing way). I highly recommend her, and I was so glad I hired her. You may want to suggest to your OB that she speak with the people you are considering to hire as doula's, so that she can be reassured and feel comfortable referring one for you.

If you're interested in talking to Betsey, she can be reached at betsy[AT]berkeleydoula.com (her website is www.berkeleydoula.com) Finally, I strongly urge you to go for the doula. Statistically, they make such a huge difference in how women feel about their births. I was so glad we had Betsey at mine!

Best of luck Alesia

Ive had 4 babies & 4 doulas; the doulas were FAR more valuable than the OB. Your OB is wrong: most staff highly appreciate doulas. Ive heard two L nurses tell each other ''doulas make my job so much easier. Avoid OBs & staff who are threatened, they are having turf wars instead of caring for you. You want a doula who can be firm but not confrontational; interview past clients and ask how the doula did with the staff.

A doula is your assistant; your partner will be busy providing emotional support & youll need an advocate in the hospital. Your OB will only see you briefly & again at delivery. Neither she nor the nurses will be your constant companion. The doula will, though, & will work with the staff, making sure allergens are avoided & your birth plan followed (one doula noticed a nurse about to give her patient an iodine rub despite allergy notes posted). When the doula conveys a need to the nurse/doctor, they listen better; she's not a freaked out mom or partner.

My first babies were born in a hospital (last 2 at home). I had back labor for my first 2, and it took 2 people: Id lean on one person & the other would jam her elbows into my back. One helper couldn't have done it alone.

There are things the doula will know that the partner & mom won't know:

1. The OB told my doula I was taking 3 hrs to dilate each cm. She started acupressure and my dilation tripled to 1 cm/hr.

2. The nurses wanted to do the fetal monitoring but we were laboring in the shower. My doula had the nurses unhook the cart and set it up in the bath to do the readings at the shower.

The emotional benefit is significant. After 12 hours of back labor, to find I was only at 5 cm, I thought the baby would never come & Id die from the pain. The pain can exhaust a person, conquer them, and without the doula, it might have beat me.

Our doula helped with our birth plan, planned her ''labor outfit'' to be my favorite color and avoided colors I disliked. She helped prepare DH to see me in pain & planned how many times theyd talk me out of drugs.

http://www.dona.org is Doulas of N. America. Your OB is here to serve YOU and if she wont refer a doula, youre better off with another OB. shannon

Oooh, that would be a red flag for me about the Ob/Gyn. Can you switch doctors? If she's negative about doulas, how does she feel about natural labor and delivery? How overbearing is she going to be about having your labor and delivery her way?

Good doulas are not ''interfering'' or ''overbearing.'' They understand that some things may be medically necessary, but they also try to help balance the wishes of the woman to have as natural a birth as possible, with the truly overmedicalized way that birth is treated in hospitals.

I am also pregnant right now, and I have talked with my doula about how she deals with the hospital staff and doctors/midwives. She understands that they have protocols that they have to follow, and she is really knowledgeable about the reasons for interventions, and the alternatives to them, and ways to work with the hospital staff without being overbearing. She talks about asking them to try other things first, before ''necessary interventions''.

I would really recommend having a doula. I did without one for my last delivery and would never do that again. I would have had a really different experience with a doula. no interventions for me please!

Get a new OB. She should support any decision you are making in regards to YOUR birth experience. If you really like the OB or don't want to change for any reason.... take a more aggressive/proactive position so that you are not influenced, or even bullied by her/him. This is your birth experience and you should be in control. Period. A doula is a wonderful support system for you, your spouse and your baby-- don't let anyone take that away from you. anon

personally, i would consider finding a different obgyn, i don't know how far along you are, or if this is feasible w/ your insurance...

i'm about to give birth any day now (my first), and have a friend who is a proffessional doula, who will be acting as mine. first off, doulas have medical training, just not as extensive as doctors. my doula took many of the same classes as the nurses in the hospital, and was a certified midwife for a while. it's a doula's job to know what her pregnant lady wants and doesn't want during her birth, and to advocate for her (during a time when it's very difficult to advocate for oneself) if the dr.s are pushing for things that aren't absolutely necessary. which i can understand might make some uptight western doctors annoyed if they just wantto tell the patient what to do and get on w/ the medical procedure of birth...

(i'm not really into dr.s, i'm having a home birth) anyway, the point is to make you comfortable, and i have found having a doula to be very comforting during this whole pregnancy, she's been very helpful to me in making decisions along the way, and supporting my decisions. she'll be the first person i call when i go into labor, and the first to come over, and help us know when to call the midwife.

incidentally, it works the same way if you're going to the hospital, she can come over and help with the pre-labor, so you don't go to the hospital too early (which often happens and can lead to more interventions and c-sections, when they feel you've been there too long)

i think if you feel it's important to have a doula, if you feel it will reassure you, you should have one elzza

Having a doula present is your choice, not your OBs! This is about you and not your OB's ego. A doula's role is to be you best advocate, but your role is to be your child's advocate. A good doula will help you evaluate your medical options as they arise, a good doula will not impose herself into the medical process. A good OB will let you know in no uncertain terms if and when a difficult decision need to be made, and their ultimate professional authority should be respected by you and the doula. If your delivery is typical, you will see your OB only a few times before the final pushing and emergence phase. The nurses will typically be in and out of the room as they will be attending to other women in labor as well. A doula is there for you alone. A doula's role is to be at _your_ side throughout the entire labor to encourage you and your. If you decide to have a doula you should ask where they have worked, are they familiar with and to the NURSING staff of where you intend to deliver. Check ''DONA'' and the doula comments on BPN. I believe WADDLE & SWADDLE on Shattuck Ave. has classes on choosing a doula. My doula was Linda Jones-Mixon, the owner of W She was absoluteley, a piller of quite, assured and assuring strength. The birth of my daughter was a very positive and empowering experience. On a related note, try to write a birth plan. A birth plan is a guideline for wishes, not a writ- in-stone action plan. The real power of a birth plan is that it allows you to state clearly who will and will not be allowed in the labor room with you, besides hospital staff, obviously. It's good to submit a birth plan early enough to get in included in yoru preadmission chart (about two weeks before due date) and to also have several printed copies to give to hospital staff on arrival and through transitions from labor to deliver. Make it NOT more than one page, and general in sara d

I'm sorry, but that is absolutely ridiculous for your dr. to be so short-sighted and self-centered. I had my doula at both of my children's births and she was a lifesaver! I don't think I could have done it naturally w/out her. And my husband was thrilled to have some of the pressure off of him. And I have to say, at the end of both births, I think the staff (nurses and midwife at Kaiser WC) were happy she was there! If your insurance will cover it, I would definitely talk to your dr. and assure her that your doula will be completely professional and not interfere, and offer to bring her along to your next appt. And remind her YOU could use the extra support. My experiences w/my sister's deliveries w/out a doula at Kaiser WC and Alta Bates are that you don't get even close to the kind of personal support from the nurses that you get from a doula. Plus, the chances of your grumpy dr. actually delivering your baby are slim unless she's always on call. Love, love, LOVE doulas!

DO NOT let your OBGYN talk you out of hiring a doula if that is what you want to do. It is your right to have the kind of birth experience that you want to have. It is also your right to find an OBGYN who will support you and who has your best interest at heart. Do not hesitate to change doctors if you don't feel that this person is the right fit for you and your family. I also recommend that you do some research for yourself on why doula's are beneficial. You could then share it with your OBGYN (if you decide to stay with her) and explain why it is you think it will benefit both you and your baby to have a doula. If she still gives you the same line about why she doesn't like doulas, ask her to back it up with real, scientific evidence and studies. If she's going to tell you not to do something, she better have good, solid evidence as to why it's not a good idea, not just circumstancial or anecdotal evidence. Here are some resources that should help:

1. Henci Goer's book, The Thinking Woman's Guide to a Better Birth. She also has a web site, www.hencigoer.com that has a lot of excellent resources, including several articles specifically detailing why doulas may be beneficial and how to go about deciding whether or not you should hire one (as well as how to hire one).

2. The Lamaze International website, www.lamaze.org, also has great resources.

3. BirthWays, www.birthways.org. They have a free doula info night every month and are located in Oakland. The phone # is 510-869-2797.

4. Ina May's Guide to Childbirth is also an excellent book. And there are many others. Locally, you could visit Waddle and Swaddle on Shattuck Ave. in Berkeley, which has a good resource library. Just doing a Google search on doulas or ''benefits of doulas'' (or something like that) will probably turn up a lot as well. I wish you the best. -Fight for your birth rights!

If you would like to have a doula you should definitely have one! And if your obgyn won't provide a referral, I honestly think you should consider finding a new doctor. I gave birth to my first baby in December and struggled with whether to hire a doula (I wanted one but was afraid it was an expensive indulgence that might not be necessary depending on how the labor went). I wound up choosing to have a doula and it was absolutely the right decision and well worth the money. The right doula will be invaluable during labor. In my case I was at the hospital (Alta Bates) in labor for over 30 hours and we went through 4 full nursing shifts by the time our baby was born. Our doula provided continous support throughout the shift changes. Plus the nurses are required to document every little thing that happens during labor (mom's blood pressure, baby's heartbeat etc) and are not available to stay by your side to help you breath, stay calm etc. And even though doulas are not medically trained they are very knowledgeable about childbirth. At one point during my labor there was concern that my cervix was swelling and also b/c the baby was turned sideways. It was my doula who suggested a strategy to take the pressure off my cervix and to turn the baby -- I credit my doula with the fact that I didn't need a cesarean. My husband was also very relieved and grateful to her, even though going in to the labor he was skeptical that we really needed her. As for my obgyn: she was not on call during my labor so I saw two other doctors from her practice for a total of about 15 minutes until I was ready to push. Most likely your doctor will only see you very briefly every few hours to check how far you are dilated and won't spend any time with you until pushing -- and so will not be much help to you. Finally a good doula is respectful and will not cause problems with the doctor even if she disagrees with the doctor's advice or approach. Definitely ask your doctor for the referral -- I think it is very wrong of her to discourage you from having all the help and support you can get during labor (especially since your insurance will pay for it!). I highly recommend our doula Paula Santi if you are looking for someone. eve

Sounds like your OB has had some bad experiences with doulas (or maybe just one) I wonder if she would lighten up if you could arrange for your doula to come to one of your prenatal appointments to meet her before the rubber meets the road. You may also want to ask your OB how what percentage of her patients does she actually deliver the babies for. for mine it was something like 30%. after all if you give birth at night or on a weekend or holiday the only way you'll get your OB is if he or she happens to be on call. In any case your doula will be there for you all through the labor - that's the hard part. in an uncomplcated birth, the OB just pops in to catch the baby and stitch you back u if you need it. if she still in obstinant about not wanting a doula I'd consider changing doctors. doula fan

Oh, definitely get a doula!! And certainly try to get your OB's buy-in. My OB (Dr. Honegger) was cautious when I first told her I was going to use a doula (Treesa Mclean), but I reassured her that I was going to hire someone who would be supportive of all types of birth, not just natural. And then the OB was pleased, and said, ''With a normal labor and enough support, there's no reason why you can't have a natural birth.'' And I did!

You might tell your OB that although doulas might have a bad reputation as overbearing anti-interventionists, you would never hire one like that (most aren't, anyway). Tell the OB that you don't want the doula to provide medical advice (they don't, anyway) , explain your uncertainty about labor, and point out that you'd feel reassured by having the same caregiver at your side for the entire labor. That's something the OB can't offer you, so hopefully she won't feel threatened.

But even if your OB still frowns, you know what? Chances are she won't deliver your baby anyway, and even if she does, you'll only see her at the very end. Loved My Doula

Hi, I had a baby last year and having a doula really helped my husband and I during my labor. Doula's are there to convey your wishes during childbirth. I am assuming you had made a birthplan. Doulas meet with you several times before the actual childbirth to discuss what you want and don't want to happen. Doulas are great because during the actual birth you and your husband are not quite yourselves and can't remember anything and doctors tend to say things and sometimes will ask you to make a decision and believe me, you will not really comprehend what they are saying, so doulas will give you scenarios on what might come up that doctors would want your decision on. So, what I am trying to say is, if you want a Doula have one or have a consultation to get an idea on what they do because I believe in how helpful they are. Yes, most doctors don't like them but if they are helping you get through the labor mentally and not have to worry about anything they are great. They allow husbands to help you focus on the pushing and being just focussed on you. That's my two cents. Hope this helps. Emily

Sept 2003

I recently mentioned to my OB that my husband and I are considering hiring a doula to assist us during my VBAC labor a few months from now. My doctor had a less-than-positive reaction, and while that won't sway me from having a doula if that's my choice, I'm curious: Why would a doctor not encourage me to hire a doula? Why might he believe a doula isn't helpful? Are there legitimate reasons he may have negative feelings about doulas? Is there commonly a tension between doctors and doulas, and if so, what is the source of the tension? Did anyone else have this issue, and how did you handle it? My reason for wanting a doula is just in case the labor nurse on duty is too busy to focus on me, or unkind, or simply not to my taste, I'll have chosen a labor attendant I know I'll feel supported by. (Please don't ask me to change doctors; I have a high-risk pregnancy and my doctor is an excellent and caring physician, albeit one with strong opinions.) Thanks for any thoughts you can share with me. anon

I have heard that some OBs feel that doulas are too anti- medical, and that they think that doulas try to take over, or try to make it their scene. I think you should bring your list of doulas in to the doctor and ask that he tell you if there are any that he has worked with that he absolutely does not like, any that he loves, and any that he's neutral on. Let him know you respect his opinion (it sounds like you do), but that you know that he's only going to be there at the end of the process (when the baby is crowning), and that you need someone to help you throughout (or whatever you feel). You will not let the doula take over, you just need more support than your family can provide, and you know that labor nurses aren't always to be counted on.

That should at least open up a dialog, during which you can hopefully come to some sort of agreement. Jen

My OB, whom I adore and who shall remain unnamed, thinks doulas areunnecessary and a terrible waste of money. When my OB told me this, I laughed and told my OB I'd be having a doula at my labor and delivery notwithstanding my OB's opinion. My decision was fine with my OB. There are ''legitimate'' reasons for both sides of (almost) every issue, depending on how one thinks about the issue. I sensed a little bit of tension between my doula and certain members of the medical staff during my labor and delivery at Alta Bates, but my feeling was that the tension was not my problem -- it was for the doula and the medical staff to work out. We really appreciated our doula. Could be have had a lovely labor and delivery without her? Sure. Were we glad we hired her anyway? Yes. But we also had two fabulous L & D nurses, a great delivery OB (not mine, who was not on call) and a great anesthesiologist. anon

The doctor may have had a bad experience with a doula in the past and had negative opinions about it and has no one to come along and change their mindset. As a doula, I try to work WITH the doctors instead of getting in their way, but its hard to know what his or her past experience was. No matter what, though, keep your doula if you feel comfortable w/ her and don't let your doc tell you otherwise. Doulas do a great service to families expecting a baby and sometimes docs and nurses don't realize how important they can be. congratulations and I hope your birth is one you will always celebrate. Shaana Keller Celebrations Doula Services

When I mentioned to my OB that I wanted to have a doula at our birth (not VBAC, just our first) he said great, if I wanted he would give me some names of doula's he has worked with. He was very positive. He is in a practice with a couple of midwives (and ob's) and maybe is simply more open. Good luck.

Your doctor might possibly be against a doula if he/she is not supportive of natural- non-medicated childbirth. That is a doula's main focus- how to help the laboring mother get through childbirth with as few medical interventions as are possible (and realistic). They provide emotional as well as physical and even spiritual assistance during labor. I don't know what your doctor's ideal labor is but it seems like many doctors would prefer a pain medicated birth with labor speeding medications and procedures to hurry the whole process up. That seems to be what many doctors learn is standard in their medical training these days. Doulas, on the other hand, focus on letting nature take it's course and helping the mother through the process which may mean a longer, less ''pretty'' labor than one with interventions. If your doctor leans towards medicated labors, then that may be why he/she is at odds with the whole idea of a doula. I was very dedicated to the idea of a natural birth for both of my labors and was able to have two drug-free labors- one with twins. I would not, however, have been able to do it without the support of a doula. I would highly recommend getting a doula- just make sure she feels like a good ''fit'' for you and your partner. I think my husband really appreciated the doulas as well becuase it took a lot of the pressure off of him to help me when things got rough. He was able to concentrate on comforting me just by holding my hand and being with me rather than having to remember all the the labor aids that we had studied. Best of luck with your birth and new baby. fellow mom

I know from experience that the doctor somehow feels that there will not be enough communication between her/him and the patient. And yes, a bit threatened.

I assured our doctor that there would be communication between she and I, but as first time Moms, I felt it was important for my partner and I to have someone completely focused on me throughout the labor and delivery. Our labor nurse was also great, but I knew she would not be able to be present for all aspects of the labor. I spent the first hour or so of my labor in the bathroom with a hot shower on my back with my partner and our doula, Judy.

In the end, I think my doc, and the labor nurse, were glad I had the doula (and a good friend) there to help me through the tough pushing of getting my daughter in position for the ''real'' pushing.

Hang in there. I think you're on the right track with the doula!! :=} Kathy