"Doula" is a Greek word that's usually translated as "female servant." Unlike midwives, doulas don't make any medical decisions during childbirth, nor do they undertake any clinical actions, such as catching the baby. Rather, most doulas describe their work as "mothering the mother." They provide emotional support for the birthing woman with techniques such as massage, wiping her forehead with a cool cloth, leading relaxation exercises and suggesting positions that will make the stages of birthing easier. And they remain with the woman throughout the birth, no matter how long it takes, whereas physicians are known for popping in and out of the room, and even midwives may have several clients they need to attend to.
Studies have shown that doulas can have the same beneficial effect on the birthing process as midwives do. Not only is the caesarean rate reduced by half, the need for an epidural is 60 percent less and labor time is 25 percent shorter for women who use doulas [source: Gilbert]. The use of a doula may also influence a mother after her child's birth; in one study, women who had a birthing assistant were rated more sensitive, nurturing and loving to their infants [source: Gilbert].
That's not to say doulas are without their detractors. Doctors and nurses may be wary of another person in the room, and one doctor wrote an editorial in a medical journal to say that a doula could affect a doctor's ability to provide excellent patient care [source: British Medical Journal]. These medical professionals may be concerned that there's no standardized training or certification process for doulas; essentially, anyone can deem him or herself one, though the Doulas of North America organization does offer a course. Some new fathers may feel that a doula is usurping their supportive role, though there are plenty of men who are grateful that someone can step up when they get a little woozy.
Doulas charge anywhere from a few hundred dollars to $1,000 for their services, which usually include some pre-birth consultations in addition to the birth. Post-partum doulas are also available on an hourly rate; these doulas help with the family's adjustment to a new baby by providing services such as cooking, cleaning, breast-feeding assistance and running errands. While these fees have meant that doulas are only affordable for wealthy women, some doulas will work on the barter system or a sliding-fee scale, and many cities are experimenting with volunteer programs that provide free or low-cost doulas to low-income women.
If you want to hire a doula or a midwife, you'll need to do your homework -- as we mentioned, the certification programs and training regimens vary, so you'll need to quiz prospective birth attendants on their backgrounds and philosophies. If you just want to learn more about childbirth and parenting, then see the links on the next page.