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June 25, 2018

Doulas and birth plans: Empowering each birthing woman

Hiring that additional support is a trend that's growing year by year

Women's Health Pregnancy
AmyWrightGlenn_DoulaBirthPlan Josh Willink/

So, you're pregnant and wondering how the upcoming birth will unfold. Feeling anxious during pregnancy is common, and worries can certainly spike while navigating the available options regarding labor and delivery.

Today, we have at our fingertips a plethora of information regarding life's most primal and natural event. 

Women share their stories and pictures. Pregnancy blogs cover everything from birth trauma to unassisted birth. There is a smorgasbord of opinions and options from which to choose.

Should one try to have a baby at home? How about at a birth center? 

If one chooses a hospital setting, as 99 percent of American women do, there are a wide range of options regarding pain management.

If that includes medication, which kind? What about the possibility of birth via Caesarean section? Who will be in the room with the mother? Will she be given clear information to make informed decisions? 

Sometimes procedures at hospitals have become so routine that we forget they are optional. (The debate surrounding vaginal exams is a good example.)

Given that the United States has “the worst rate of maternal deaths in the developed world,” it is not hyperbole to consider that some of these answers, when combined with medical-team actions, can be a matter of life or death.

Around 6 percent of birthing people hire a doula for support through labor and delivery – and this small trend is growing year by year.

There are many types of doulas available for emotional and physical support today. Birth, postpartum and full-spectrum doulas are the most well known. There is a growing movement of bereavement, divorce and death doulas, as well.


I am a birth doula and when I introduce myself as such, I’m often confused for a midwife. While the legal status of midwives varies from state to state, midwifery is a licensed and regulated medical profession. 

Midwives dedicate themselves to years of training that focuses upon the medical side of pregnancy, child-birthing and postpartum care. 

In contrast, the doula profession is not regulated or licensed. Doulas may or may not be certified. However, if trained well, doulas focus on offering proven comfort measures. They are skilled at providing emotional and spiritual/religious support, if requested.

A birth doula commits to being focused at a mother’s side during labor, delivery and the initial postpartum period. This may all occur over the span of 30-plus hours. 

A doula “mothers the mother,” providing consistent and compassionate care to birthing people and their partners. Yes, midwives and doulas differ even if their support methods can, at times, overlap. 

Nonetheless, both professions emphasize the normalcy of the birthing process and celebrate the power of each individual woman as she crosses the threshold into motherhood.

When birth doulas meet with expectant couples, they will go over a template birth plan or birth-preferences checklist. They also discuss all of the options available as the couple imagines their ideal birth, and as they consider how they would navigate choices should the birth be far from ideal.

Doulas provide information, but they mostly listen.

Doulas are trained to care, empathize and discover what really matters most to each individual family, setting aside her or his own agenda and focusing on what will make a birth as memorable, meaningful and positive as possible. 

Every birthing person manages the emotions, intensity and pain of labor differently.

Yes, it’s nearly impossible to fully “plan a birth” because so much can happen from the beginning of labor until a baby safely suckles upon her or his mother’s breast or drinks from a bottle for the first time. There are many unexpected twists and turns on that journey. 

Every birthing person manages the emotions, intensity and pain of labor differently. Each body is different. Each story is different. It is far from one-size fits all. Sitting down with a doula to discuss birth preferences can be beyond helpful as it takes a standard template and individualizes it with mindfulness and care. 

Even for the majority of expectant mothers who do not hire a doula, taking the time to go through one’s birth preferences with a loved one can make a big difference in how the birth unfolds – and how women feel about their experience afterwards.

Even if the birth unfolds dramatically different than one’s preferences, it's wise to have taken the journey of considering choices which will not guarantee the birth one desires, but do allow a person to mindfully move in the direction of their hopes and aspirations. 

For example, if a birthing mother knows she does not want pain medication, extra attention can be placed on massage, comfort measures and, among other things, positive affirmation. Knowing what one does, and doesn't, want allows for more informed choices.

As a doula, I offer informed reflection on the rights of birthing people and encourage individuals to speak to their medical providers about any concerns. 

When I sit down with a client and her partner/husband, I have a draft birth plan that I review. It's a basic flow of preferences. I listen carefully as I go through each point. What matters to this particular person? How can I best support this family in the momentous and powerful moment to come?

Birth, like deathis a threshold point. Hopefully, we have wise and kind guardians with us as we traverse the great mysteries of the beyond.

To learn more about hiring a doula, contact one of these organizations.

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