What does a doula do?

I’m sitting in the corner of a hospital room watching a woman on all fours breathing in the dark.

We’ve been here for hours. Every couple of minutes I lean forwards to hold a bottle of water so that the straw in it is close enough to her face for her to take a sip if she wants but not so close as to be irritating. Sometimes she takes a sip of water, sometimes she ignores it but remains swaying slightly, eyes closed, breathing quietly and moving rhythmically.

I don’t say anything. But sometimes I’ll mirror her slow breathing technique, rub her back, or I’ll whisper a word of encouragement, a suggestion to change position or to get up and walk around, or just a reminder: “You are DOING it.”

I’m a birth doula.

If you have ever wondered what a birth doula does, this is a large part of it - just being quiet and still while a woman gets on with birthing a baby.  You could call me a “professional birth companion” but that doesn’t really explain what the job looks like.

What research there is on doulas finds that continuous support from a known, well-informed lay person improves birth outcomes overall - and crucially improves the satisfaction of the woman with her birth experience, which is the first step towards a good start in parenthood.

The best place to find a doula is to look on www.doula.org.uk for a trained doula accredited by Doula UK, the UK’s self-governing network of doulas. Or you could check out the National Childbirth Trust’s own doula network. It’s important to meet more than one doula before deciding on one, and to be absolutely confident that you - and your partner - can stand the idea of being cooped up in a room with her for 24 hours or more.  It’s also a good idea to start looking early as, as with childcare, the good ones get booked up fast.

To define the role, in doula meet-ups and literature I often come across the term “holding the space” which sounds a tad hippy-dippy but makes sense when you see it in action. Sometimes the doula’s holding not just the space but also a suitcase, a handbag and a birthing ball; sometimes she’s holding a baby while a mum has a shower. And sometimes she is just holding that water-bottle.

But doesn’t the partner do all that? Well yes, but many partners like having “someone on my team” as one brand new dad put it to me. I knew what he meant, but the idea that there might be opposing teams in a labour ward is a little bit sad. Too often a  them-versus-us situation can emerge in a hospital room, especially when a woman states her own well-informed preferences instead of meekly doing what she’s told. The atmosphere around her needs to be calming and nurturing, not confrontational. It’s a tricky balance.

One thing that many people don’t understand about doulas: how can someone ask £1000 to £2000 for what might be only a day’s work? The answer is simple: The doula can only be committed to one client at a time, and has to be AVAILABLE - and stone cold sober! - 24/7 all through the period the baby is due. She’s not on shifts like a midwife, and usually works alone or with just one or two other doulas as a team. She has to organise childcare so that she can literally disappear for several days at a time.

So there is very little other paid work that she can commit to for the three to four weeks she’s on call, and she has to be careful about accepting clients whose due dates are less than a month apart. If you look at your doula’s fee not as “a day’s work” but as a month’s wages, it suddenly doesn’t look quite so extravagant.

And to be honest, it always amazes me how many people cheerfully pay a fortune for their wedding, but hesitate to invest in a happy, supported experience on the day their lives will change far more dramatically: the day their child is born.

Sarah Johnson has been a practising doula for nearly two decades. She is also a sleep consultant and birth educator.

Find our more about her here