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What is a doula? Here's what doulas do and how much they cost

With rumors that Meghan Markle will rely on a doula during labor, many are wondering what doulas do for moms.
/ Source: TODAY

British tabloids are buzzing with gossip about the next royal baby, and the latest rumor is that Meghan, Duchess of Sussex, will be assisted by a doula when she gives birth next month. While it's just idle chatter right now, the term has led some to wonder: What is a doula?

What is a doula?

“Doulas do not do anything medical. We are the emotional support and we give lots of information,” said Ravae S.M. Sinclair, certified doula and president of DONA International, a doula certifying organization. “Birth doulas are working with the families in the pregnancy and during the birth and immediately after the birth.”

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What does a doula do?

DONA International provides training for doulas, which involve a weekend-long workshop, readings and certification. The organization trains birth and postpartum doulas, who help women after the baby is born, which is also called the fourth trimester.

Birth doulas provide support to the couple having a baby without being as invested as a family member might be.

“There is a little bit of distance emotionally,” Sinclair explained. “Having a doula who is dedicated, who is helping keep you informed with the process and helping you understand your options and break down that medical speak, helps.”

Doulas aid couples with making a birth plan and advocating for moms during labor. If a mom doesn’t want an epidural, a doula can speak up about it, for example. Doulas are welcome in most U.S. hospitals, though some obstetricians refuse to work with them, said Shadman Habibi, director of the nurse-midwives program at UCLA Medical Center, Santa Monica.

“We do encourage our clients to reach out and hire doulas,” she told TODAY. “They are usually helpful in managing the discomfort. They are talking to the mothers, they are using massage … It is the role that aunties and sisters and moms used to play.”

Doula vs. Midwife: What are the differences?

There are three different types of midwives, and the training they have, where they can practice and what services they offer varies. A midwife will assist with labor and delivery (to what extent depends on his or her training), while a doula is more focused on a mom's emotional health.

Habibi, who has been a nurse-midwife for ten years, said knowing that a doula will be with a mom makes it easier for her as a midwife. During a busy day, for example, Habibi can’t spend much time with a woman in labor. With a doula in the room, a mom understands what’s happening during labor and doesn’t feel confused or like she needs help from nurses, midwives or doctors.

“A doula has experience in helping pregnant women. She doesn’t replace the husband’s role,” she said.

Studies have shown that doulas reduce the need for medical intervention, meaning fewer cesarean sections and less need for pain medication and oxygen, Sinclair and Habibi said. And, labor’s often shorter with a doula by mom's side.

“All the rates of interventions went down (when a doula was present),” Sinclair said, reflecting on the research. “Having a person in the room is so helpful that it means there are fewer intervention.”

Postpartum doulas

Postpartum doulas help families after the baby arrives. They provide support around tasks new parents struggle with, such as baby’s first bath, while helping families access the emotional support they might need.

“We may be processing what happened in that birth. It may be amazing or challenging or disappointing. Postpartum doulas are paying attention to how the family as a unit is recovering and managing the stress of adding a new person,” Sinclair said. “We are there for the transition into parenthood.”

How much does a doula cost?

Couples searching for doulas can find one on DONA International’s website. Cost varies from state to state and most people pay out of pocket for a doula.

“You can expect to pay, for what is in your area, a living wage,” Sinclair said. “If you are in San Francisco that hourly rate may be $80 and if you are in Mississippi it may be $20.”

Habibi said some hospitals provide doulas to their patients for free or at a lower cost and Sinclair noted that some community-based programs also provide the same. Insurance rarely covers doulas, though some people are able to use money from their health savings account to cover the cost.

“There is a lot of variation,” Sinclair explained.

Interested in hiring a doula? DONA International recommends scheduling an interview or initial consult first, so you can get to know the doula and see if they would be a good fit for you. Their site offers a few questions to consider for your chat.