What is Doula?
A doula is a trained companion who gives continuous emotional, physical and informational support to a person during a major health or life transition. The term is most often tied to pregnancy, labor and the postpartum period. It is also used for support around miscarriage, abortion, stillbirth, adoption and dying. A doula does not perform clinical tasks, deliver babies or give medical advice. The role is separate from that of a midwife, nurse or physician. In most places no law requires doulas to be certified, so the word describes a function more than a licensed profession.
Origins & lineage
Support for women in labor by other women is very old and widespread. The word “doula” is much newer in English. According to Wikipedia’s account, it entered English in a 1969 anthropological study by Dana Raphael, a protégée of Margaret Mead. Raphael said she took it from modern Greek doúla, meaning “slave” or “woman servant,” as told to her by an elderly Greek woman, Eleni Rassias. Other sources date Raphael’s popularization of the word to her 1973 book The Tender Gift: Breastfeeding, so the exact date of first use is not settled.
The modern role grew out of the U.S. natural birth movement of the 1960s. Physician-researchers Marshall Klaus and John Kennell later adopted the term for labor support. In 1992 Klaus, Kennell, Phyllis Klaus, Penny Simkin and Annie Kennedy co-founded Doulas of North America, now DONA International. It was the first organization to train and certify doulas. Dictionaries added the word in 2003 and 2004, and the 2008 Doula Project in New York City helped popularize the term “full-spectrum doula.”
How it’s practiced
A birth doula usually meets the client a few months before the due date. She or he then attends labor, offering comfort measures such as massage, position changes and breathing guidance. The doula also gives reassurance and helps the client understand options and talk with clinicians. A doula supports the client’s own decisions and does not make them. Postpartum doulas work in the home after birth, helping with infant care, feeding and household tasks. Antepartum doulas support people on bed rest or in high-risk pregnancies. End-of-life or death doulas support dying adults and those around them. Their work is practical and emotional, and in some cases spiritual, depending on the client’s wishes.
Doula today
People find doulas through independent practitioners, community programs, hospital-based programs and certifying bodies such as DONA International, CAPPA and ICEA. Training in North America typically takes a few days of coursework, sometimes online, plus attendance at births or other requirements that vary by organization. Insurance rarely covers doula care, so it has been more common among middle- and upper-income families. As of 2022, Oregon, Minnesota, Virginia and Wisconsin had Medicaid reimbursement programs. New York began a Medicaid pilot in 2019 and passed a state certification bill that year. Some New York doulas objected, citing dependence on the formal medical system and possible barriers for community doulas serving low-income clients.
The research base includes a Cochrane review, Bohren and colleagues (2017), of continuous support in labor. It covered 27 trials and found that people with continuous support were more likely to have a spontaneous vaginal birth. They were less likely to have a caesarean birth, to use pain medication, or to have a baby with a low five-minute Apgar score. The review found no harms. It rated the evidence as low quality overall. It described its comparisons by type of provider as exploratory, and it noted that cesarean reduction was greatest when the supporter worked in a doula role.
Common misconceptions
- A doula is not a midwife. Midwives provide clinical care. Doulas do not.
- A doula is not a replacement for medical care. Doulas do not give medical advice or treatment.
- The role is not tied to unmedicated birth. The role is support, and doulas work with clients who choose epidurals or cesareans.
- The title does not guarantee a standard of training. Standards vary, and anyone can call themselves a doula.
- The word is contested. Its Greek root means “female slave,” and some practitioners and groups prefer terms such as birthworker or labor companion. Others keep the word and note its changed meaning.
- Doula research is not settled. The strongest findings concern continuous labor support in general, and the doula-specific results come from subgroup comparisons.
How to begin
To learn what the work involves, read the Cochrane review on continuous support in labor, which is free online. Then compare training programs from organizations such as DONA International, CAPPA and ICEA. Ask about required births, continuing education and any scope-of-practice rules. To hire a doula, interview several, ask about their training and their experience with your type of birth or transition, and check local Medicaid or community-program options. Spiritual and conscious-practice settings often draw on end-of-life doula training, where the curricula differ widely, so ask what a program teaches and who certifies it.