There is no doubt there is ample evidence to support the use of a doula before and during birth. Having a non-clinical support person with you during birth has been shown to decrease cesarean rates, induction rates, shorten labor time, increase the satisfaction of mothers with their birth, increase breastfeeding rates, and even reduce admittance to the NICU for babies! They can help make an extraordinary difference in outcomes for both mothers and babies.
However, it's so important to note that not all doulas are created equal. Just as in any profession, there are very skilled and wise doulas who are good and gifted at what they do and those that aren't. While overall statistics show that doulas improve outcomes, that doesn't mean it's always the case in specific circumstances. In fact, a doula can inadvertently sabotage a birth with poor advice, a negative or overbearing presence, her own fear, or even her mistakes. This is why it's incredibly important to meet and interview any doula before officially hiring her. You need to make sure that this doula is a good fit for YOU and be a helpful addition to your team, one who will reverence and honor the sacred work you are doing and who has the wisdom, skills, personality, and experience that are right for you.
Almost all doulas will offer an obligation-free interview so that you can meet with her and decide if she is a good fit. It's important to note that the doula also has the right to make sure YOU are a good fit for her, too! In fact, it is a good sign if the doula you are considering has her own boundaries, knows her own limitations, and recognizes that she is not meant to serve every woman and take anyone willing to pay her even if it is not a good fit.
When should you contact doulas and set up interviews? Short answer: as soon as possible after you know you are pregnant! Popular doulas will book up quickly for due times. However, you can and should absolutely still contact them later if you weren't able to earlier in your pregnancy for whatever reason. It's possible to hire a doula even right up to your labor however whether they are still free and have an opening for you will be less and less likely.
Below are some possible questions to take with you into that interview.
Questions to Consider Asking a Potential Doula:
How long have you been working as a doula?
How would you summarize your thoughts on the process of birth itself?
What has your training looked like?
How many clients are you on call for at a time?
What is your fee and how is that paid?
What services does that cover?
How many meetings do we have?
What are your religious beliefs? Do you attend or support abortions?
Are there any situations or places where you don't feel comfortable supporting a birth?
Are you bound in how you serve by any certification bodies?
Are you willing to offer any desired input or suggestions to my birth plan?
What happens if I have a miscarriage after I hire you?
What does support look like in the birth room?
When do you come during labor?
Is there a time limit to how long you will stay?
How long do you stay after the baby is born?
How do you determine the best ways to support me in birth?
How do you help my husband and support him during the birth?
Who is your favorite provider to work with and why?
Do you see yourself as an "advocate"? What does that look like to you?
What would be an ideal birth to YOU?
Do you feel comfortable praying with or over me? How do you support a mother spiritually?
Can you share with me about any of your most memorable births?
What happens if the baby comes before you arrive?
Do you have a backup doula? What happens if you are already with someone at a birth? Do you have plans to be out of town or any events you can't miss during our due time?
An important note on a doula's experience:
When it comes to the role of a doula, their experience should be factored into account BUT experience itself is not necessarily inherently helpful. It depends on what that experience is! If their experience is not the type of birth you are wanting to have, then it's not necessarily experience pertinent to you.
There are doulas who have worked over a decade who have never attended a home birth, never once seeing an unassisted birth or what a birth looks like outside a hospital. There are doulas who have ONLY worked in the home setting and would not know the ins and outs of the hospital setting and have no familiarity with navigating it. There are doulas who have attended hundreds of medicalized births but never once a completely undisturbed one. A doula with only medicalized birth experience could sabotage your desires for an undisturbed home birth. A doula with zero hospital experience might not have important skills for a planned or transferred hospital birth. None of these means that this doula shouldn't get the opportunity to serve at your birth if it's outside their norm or experience if she feels right for you. It just means that experience itself is unique and not a universal or standardized term when it comes to birth.
Similarly so with her personal experience. It's HUGE if a doula has gone through the birth process herself, has lots of experience in motherhood, labor, breastfeeding, etc. If she's experienced the type of birth you want, then she will often be more able to help you get there, too. There's a lot of wisdom, empathy, empowerment, and encouragement she can hopefully offer. However, there is also something beautiful about a maiden who has never gone through the process herself serving you freely without the context of her own experience or being tempted to extrapolate her experiences onto yours.
There's an idea out there that personal experience shouldn't matter when it comes to hiring a doula (or midwife or OB or otherwise) and even that it should be off limits for discussion. However, we very much disagree. Birth is not meant to be a professional transactional relationship. It was originally designed to be a rite of passage for a woman. It was originally almost always within the community and supported by women of that community who the mother knew well and personally. It was meant to occur and be supported in the context of relationship and almost always supported by women who had done it before themselves. It is certainly understandable and appropriate to want to have some sort of personal relationship with the people you are inviting into an incredibly vulnerable and intimate space! It's okay to want to know their story and them a bit! If a doula were to balk at answering ANY personal questions that could be a red flag.
Consider also for a moment if you would hire a football coach who had never played on the field or won a game. Or perhaps think about being trained for a marathon by someone who has never done the same. It's not necessarily a deal breaker to not have that personal experience, however, we can't discount the reality that experience breeds a wisdom and interior knowing that can't be replaced. Even if you are not looking to be "coached", that experience and deep understanding of what the mother is going through from another woman who has been there herself is priceless.
So with that said, here are a few questions to consider asking about her experience, the answers to which are up to YOU to decide if they fit well with what you are looking for:
How many births have you attended?
Where do most of the births you attend occur?
How often do the clients you work with have a low intervention or intervention-free birth?
What kind of complications have you seen?
Have you given birth yourself? Do you feel comfortable sharing about those births?
How long have you been a mother?
Do you have personal experience breastfeeding? How can you help support me in that?
An important note on certification:
Certification, like experience, does not inherently make for a better or worse doula for YOU. Much depends on what that certification process looked like, what the doula did with that certification, the beliefs and background of the certifying organization, and more. Currently, anyone can call themselves a doula and certification from a doula certifying organization is not required, except for a few states where it is required for doulas looking to work with Medicaid. This is actually a GOOD thing because this role of feminine service at birth is not one that should be regulated by or bound by any government. Doing so would not serve either of the parties. However, it does mean that the onus of vetting a doula is on the mother herself. Simply being "certified" may sound official and more professional but in reality, it doesn't necessarily mean all that much for the quality of support and the experience and worldview you are going to get from that doula.
There is an abundance of women who have trained or certified as doulas through organizations who go on to attend a few births who then quickly burn out, move on to different things, or find that the work can not realistically fit into their own vocation and motherhood. It's actually quite a common thing. There are women who have been working as doulas for decades (whether they use that term for themselves or not) and have attended hundreds of births but never once gone through a formal certification process. Many of them could teach those running these organizations! There are now numerous doula training programs formulated and run by people who had zero to little experience actually attending births in person themselves before coming up with these often very expensive trainings. Just like anyone can call themselves a doula, anyone can come up with a program and begin to "certify" doulas.
With that in mind, having a doula that is "certified" only means what you understand that certification to mean and is only worth what that specific certifying organization offers. It often means she has some training in labor support, has done required reading, reports, attended some required births, and perhaps attended some workshops. It's important to note, too, that some certification agencies require doulas to abide by certain protocols in order to keep that certification, protocols that may or may not serve YOU.
An important note about "bias":
Often doulas are touted as offering "unbiased" support. While that can sound noble, it's actually unrealistic and not necessarily ideal! We'd argue that every single person comes from a place of "bias". Being truly neutral or completely impartial to the mother's choices and outcomes is not only impossible but actually a negative. Your doula should be biased in the sense that she is deeply committed to helping you achieve the birth you desire. It is a beautiful thing to deeply feel with the mother and truly want and work for what she wants for her and her baby.
We'd argue that she should recognize that honoring God's design for birth should be the default approach to birth - that unnecessary interventions increase risk to you and your baby and that necessary ones are not inherently evil. A doula should not be expected to be a robot, completely void of deeply held beliefs, opinions, or preferences. That doesn't mean she should claim to know what YOU should do in every circumstance, confer judgement, or try to impose her own decisions on you at all. But she should show partiality toward her deeply held beliefs about God, her worldview, the dignity of the human person, and be working for YOU and not indifferent about choices made during birth that don't serve you or your baby. She should care deeply about the outcome and not remain "unbiased". What's most important to note during an interview is whether those preferences and beliefs and "biases" align with yours or whether there is a conflict there.
Questions to Ask YOURSELF After the Interview:
How did I feel in her presence? At peace? Uneasy? Open?
Can I see myself comfortable being completely vulnerable and naked with this woman?
Did our personalities connect?
How did my husband react to her?
Does her experience fit what I feel I need?
Do our beliefs align about important things like faith, gender, sexuality, human dignity, life, and the design of God for birth?
Did I get a sense of the gifts and fruits of the Holy Spirit working within her?
Does she want "fix" birth? Or does she have confidence in the process? Does it feel like she was trying to sell me something or support me?
Did she seem honest with me? Does it seem like she will share candidly about providers, protocols, what she's experienced in different settings?
Does she seem like she has her act together? Did she appear somewhat organized in our interactions, respond to messages in a timely manner, and come across as trustworthy?
When I picture her as part of my birth, do I feel excited? At peace? Supported? Joyful?
When I pray and sit with the idea of her supporting me, where do I feel the Holy Spirit leading me?
A wonderful, supportive, and skilled doula who fits your personality, faith, and desires can be a literal Godsend to your birth. Finding her is sometimes easy or it sometimes takes a lot of work but asking the right questions, taking it to prayer, and asking God to lead you to the right birth team all should be part of the process. Inviting Him into every part of every single part of planning is critical to a Spirit-filled, holy, transformative birth for you and your baby.
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