Having a doula is all the rage these days- and for good reason. A knowledgeable woman by your side to help guide you through labor is game-changing. According to the American College of Obstetrics and Gynecologists, "Published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula. A Cochrane meta-analysis of 12 trials and more than 15,000 women demonstrated that the presence of continuous one-on-one support during labor and delivery was associated with improved patient satisfaction and a statistically significant reduction in the rate of cesarean delivery." (1)
If you're looking to reduce interventions and have the birth experience you're hoping for, a doula just might be your best bet.
However- all doulas are NOT created equal. There are women who just really love birth and can say a few encouraging words, and then there are women who are worth their weight in gold when it comes to birth outcomes. The difference in knowledge, experience, and comfortability is everything. How to know what you're getting? Here are 25 questions you need to ask your prospective doula before she's hired.
1. May I have a copy of your contract?
Looking over her contract of services can give you a great idea of what she offers.
2. How many births have you attended as a doula? How many total births (doula or no)?
3. Why did you become a doula?
4. What is your certification?
There are a number of organizations that certify doulas, and for most it’s quite a process. That said- there are programs that aren’t nearly as extensive as others, and there are phenomenal doulas who do not hold a certification. If someone has a ton of birth experience and skill, comes highly recommended, but doesn’t have the paperwork, you may not want to write them off on that criteria alone.
5. What do you see as your role on my birthing team?
Labor coaching well is a tricky business. Ultimately, a doula is not there to speak for you, but to help you articulate what you desire, AND to help ensure that your memories of your birth are as satisfying as possible. The doula should trust your instincts and be able to stand in your corner - even if you disagree with your doctor or nurse. The doula is a servant. Bottom line.
6. Have you birthed children?
Having a woman by your side who's been there can be really empowering. That said, it may be worth waiting until after you've got your own birth story to hear hers, as some doulas won't be comfortable sharing their birth stories because they don't want their experience to taint yours in any way.
7. Are you most comfortable in hospital or home births? How many have you seen of each?
8. What are your positions on (Placenta Encapsulation, Homosexuality, Epiduerals, Vaccinations) etc.?
If you plan to do anything that’s not standard care, ask her how she feels about those things to find out if you’re on the same page.
9. What is your cesarean rate? (Of all the births you’ve attended as doula, how many have ended in cesarean?)
Also ask specifics - were they PROMs, induced, G1P1? How long were the labors? What methods did you try? Were they emergency? Planned? Baby malpositioning? Will you be with me if I have to have a c-section?
10. Will you advocate to the doctor for my wishes?
A doula is not a spokesperson. She cannot advocate for you, but she can help you advocate for yourself with questions like "After hearing that, what are your thoughts? How do you feel with that plan? Do you need more information about that? Would you like time to discuss this alone? How can we help you to better understand what you were just told?” If a doula feels that she can step in and intervene, this is a red flag that shows inexperience. You've chosen your healthcare providers, and while she can empower you to speak for yourself, she can't speak for you.
11. Can you tell if a baby is asynclitic? How can you tell?
Asynclitism is when the baby's head isn't perfectly aligned on the cervix, but rather cocked to one side. Since the pressure of the baby's head on the cervix is what causes dilation, this is a big deal. While a doula cannot officially diagnose asynclitism, an experienced doula can sometimes spot it by the way you’re laboring, if you’re moving freely.
12. What will you do if my baby is asynclitic?
Look for answers that involve helping mother to move and provide more room for baby - physical manipulation of baby or trying to use oils alone is a red flag. Be aware, too, that she can try positioning, but she's not a magician. Baby ultimately gets to decide whether or not to adjust. Also- most malpositions beyond a less-than-perfectly tucked head are things like breech, transverse, and other majors- all out of her hands.
13. How much direction to keep labor moving? How will you help guide the flow of labor?
This is one of the primary roles of a doula. She should know how to help direct the flow of labor for the most efficient and enjoyable process possible. Not all of that has to be hands on, but if she's just going to sit on the couch scrolling Instagram and "let you labor"-- nope.
14. Do you have massage therapy experience? Do you have and use specific massage therapy techniques for laboring women? Would you mind telling or showing me a few of them?
You are not paying for someone to rub your back. You need someone who understands how much pressure to use and where to apply it. There are specific massage therapy techniques that relieve pain, open the hips, and release tightness in the pelvis- she should know some. The word “counterpressure” should be used, as every doula needs to have that trick up her sleeve. Many bonus points if she has a prenatal massage, reflexology, acupuncture, or craniosacral therapy certification.
15. If I’m not progressing, what will you do to help?
The best answer is: I will do what you need me to do. If that is speaking words of encouragement, ok. If it is talking over induction methods, ok. If that is trying a new position, OK! Mom calls the shots. Period.
16. Which positions/activities are best for which stage of labor?
Correct answer: It depends almost entirely on what your body and your baby are doing. She should know how to observe what's working and what needs to be done next for your specific labor pattern, based on all the things.
17. Are you familiar with and proficient in using Rebozo techniques?
Rebozo is an important part of natural birthing and labor techniques. While we don’t expect her to be able to turn a breech baby with this (although this is done by extremely proficient Mexican midwives), she should be confident in using a rebozo for pain relief as well as helping baby adjust position- without hard pulling or abrupt yanking.
18. Are you familiar with and proficient in Spinning Babies techniques? Can you offer a story in which you used some of these techniques with success?
Spinning Babies techniques are often game-changing, and being comfortable and familiar with them is super important. If she has no idea what Spinning Babies is, be wary.
19. May I have the names of 2-3 clients who can give a referral?
20. How long will you be with me in labor? When will you show up?
Some doulas say “active labor,” which means when you're dilated to 5cm. The problem is, it's totally possible you'll need support prior to 5cm, and waiting until 5cm can diminish effectiveness of services if you've been in agony well before that. However, considering that labor can be really long and doulas are often paid a flat fee, this is tricky. If she's a flat-fee doula and therefore waits until "active labor," it would be worth asking if she's willing to be paid hourly (or an extra fee) to come beforehand if needed.
21. How hands on are you?
Doula services require hours of hands-on work, massage therapy, heavy lifting, and the like. If she’s not ready or not capable of literally holding you up for hours, holding in her pee, and possibly waiting a loooong time to get a drink of water-she may not be as hands on as you’ll need.
22. What will you do if the doctor suggests something I don’t want done?
Doula should offer time for you to voice your opinions or thoughts to your doctor while s/he is in the room. Asking, “Do you remember what you had said you wanted to do if _______?” Or, “What are your thoughts about _____?” Can help a mom to feel like she has a voice, instead of having to hide behind the doula and avoid expressing her feelings to her provider. A doula should always praise a mom for speaking up, even if she is timid (especially if she is timid). That’s what she needs to hear - Way to go, Warrior woman!
23. How will you help my birth team follow my birth plan?
Some suggestions: she can encourage you to review your birth plan not just with your doctor in your prenatal appointments, but have your partner review it with your birth team as soon as you arrive at the hospital, and with every new nurse who comes on shift. Whatever the case, she should have a few ideas that don't include her stepping in.
24. Can you tell me an encounter you had with a difficult nurse, doctor, midwife or other birth team member, and how you handled it?
Doctors and nurses aren’t always the biggest fans of doulas, so it’s likely she’s encountered some resistance before and should be able to speak to this. Also, if she's fully opposed to the medical model of birth but you've chosen to deliver in a hospital, there may be problems.
25. What do you expect my partners role to be?
Correct Answer: Whatever YOU want your partners role to be. Your doula should be comfortable guiding him to excel in his position as an advocate, as well as his position as a main support to you throughout the labor process.
Getting answers to the above question can help ensure that you're getting what you really need in a birth doula. Hiring the woman that meets your criteria and feels right (chemistry is important too!) gives you the best chance of success with whatever birth plan you've chosen. If you're not finding what you're looking for, don't be afraid to keep looking! But know this- having a woman in the room to encourage you and help you through it can be incredibly helpful no matter what. Even if you don't find what you want in a doula, having a woman with you who has given birth, whether your sister, mother, or a friend- is still a great idea. Ultimately, you know best what you'll need- trust your momma instincts, and know that you and your body will be amazing, regardless of who's in the room.