Source: The Conversation (Au and NZ)
A birth doula is a support person a woman can privately hire during pregnancy. They usually attend the birth and provide non-clinical comfort measures such as massage, assistance getting into different birth positions, and emotional reassurance.
While most doulas provide support during labour, some also – or only – provide support in the days and weeks afterwards.
Doulas also support the partner. They ensure the partner is informed and involved in the birth, while busy clinicians are often focused on the birthing woman.
When were the first doulas?
The word doula comes from ancient Greek, meaning female servant or slave. But modern doulas certainly aren’t servants or slaves; they run businesses and get paid for their work.
The word doula was revived in the 1970s in the United States by medical anthropologist Dana Raphael, to describe the women who supported breastfeeding mothers.
Two researchers, Marshall Klaus and John Kennell, conducted early studies on doula-attended births. As doctors in Guatemala, they saw that when a supportive female companion stayed with women, labour was shorter and less likely to result in a caesarean sections. Their 1993 book, Mothering the Mother, brought doulas to the public sphere.
The term doula officially entered the dictionary for the first time in 2003.
While non-clinical childbirth support has existed in Australia for many years, the demand for doulas started increasing in the early 2000s.
There is little data on how many Australians employ doulas for labour these days, but anecdotally, this seems to be increasing.
A 2018 survey in California found 9% of women used a doula. This was more common for Latina and Black women.
How much do doulas charge?
There are large variations in doula training. This can range from a three-day workshop and no ongoing mentorship, to a one-year mentored course.
The cost to hire a doula ranges from around A$500 for a trainee doula to more than $5,000 for highly experienced doulas.
As well as training and experience, the cost also depends on what services they provide, such as being on call for a birth.
Does having a doula improve outcomes?
A Cochrane systematic review of 26 trials and more than 15,000 people found those who received continuous doula-like support in labour were more likely to give birth vaginally and less likely to use pain medications. They were also more likely to be satisfied, have shorter labours and fewer babies with a low five-minute Apgar score (the score used to assess babies’ wellbeing at birth and shortly afterwards).
We don’t know exactly why this is, but it may be that doula support increases the important labour and birth hormone oxytocin. It may be due to the birthing woman’s increased mobility during labour. Or it could be because it improves confidence and self esteem. These all reduce pain and anxiety.
Similar outcomes are seen when women have continuous midwifery care, most likely due to the presence of a known, trusted person.
What’s the relationship between doulas, midwives and obstetricians?
We undertook a study in 2011 when doulas were first emerging in Australia and growing in popularity. This examined midwives and doulas’ perspectives of the role of the doula.
We found general agreement that the maternity system wasn’t meeting women’s needs.
Midwives were finding it hard to fulfil their role in supporting women due to high clinical workloads and a lack of continuity of midwifery care. Doulas were filling this gap.
But midwives felt doulas were taking their role and they were being reduced to performing clinical tasks. Midwives also described conflicts arising when they saw doulas overstepping their role and wielding decision-making power at birth.
But both midwives and doulas identified the potential for collaborating and the need to do this for the sake of women.
Conflict between midwives and obstetricians and doulas mostly occurs when doulas work outside their role and give medical advice which can conflict with the clinician’s advice.
Another Cochrane systematic review published in 2019 looked at the perceptions and experiences of women, their partners and health-care providers about labour companionship, including doulas, in 51 studies.
The authors found while the benefits are clear, some providers were resistant to or aren’t well trained on how to use “lay companions” such as doulas, and this could lead to conflict.
What shouldn’t doulas do?
Doulas don’t (or shouldn’t) provide clinical care such as vaginal examinations and monitoring the baby’s heart, or provide medical advice.
Doulas don’t make decisions for the client – medical or otherwise – nor should they pressure the birthing woman into choices that align with the doula’s preferences.
Doulas shouldn’t replace midwives or obstetricians in childbirth.
High-profile cases in Australia and overseas have shown the tragic outcomes that can occur when doulas (or birthkeepers) have attended “freebirths” with no midwife or obstetrician. Several babies and one mother have died from potentially preventable complications.
What if there’s an issue?
There is no national body that sets standards for doulas and holds them to account. Doulas aren’t a registered profession in Australia so they aren’t overseen by the Australian Health Practitioner Regulation Agency (Ahpra) in the way midwives and doctors are.
However, there are options to lodge complaints about doulas, such as state-based health complaints commissioners or the Health Ombudsman, depending on your state or territory.
Doulas are paid, so there’s also an option to go to Fair Trading or Consumer Affairs.
When a mother or baby dies, this would become a coronial issue, or even a police matter.
Bottom line
When working in alongside maternity professionals, doulas can provide women with valuable emotional support that can lead to positive outcomes for women and babies – especially when women can’t see the same midwife throughout pregnancy and during labour.
Read more:
Seeing the same midwife or doctor in pregnancy and labour reduces the risk of birth trauma
Hannah Dahlen receives funding from NHMRC and ARC.
Original source: https://analysis1.mil-osi.com/2026/08/10/whats-a-doula-what-do-and-dont-they-do-during-childbirth/