FIND A DOULA!
Birth, Postpartum & End-of-Life Doula Directories
Find a doula and get the support your need with our doula caregiver directories. In addition to the three directories, we offer A Consumer’s Guide to Hiring a Doula which defines the role of the doula, describes “best practices” and services offered, fees, benefits and more. The Guide is intended to put you in charge of the hiring process, prompting you to identify key needs and concerns, and helping you know what questions to ask a prospective doula.
A CONSUMER’S GUIDE TO HIRING A DOULA:
GETTING THE HELP YOU NEED
“I wish I knew this before …” or “I don’t even know what questions to ask.”
If you have never had a baby before, never been a new mom or cared for a newborn, never witnessed a loved one die … then you simply don’t know what you don’t know. You likely don’t know what your full range of options might be, let alone the pros and cons and alternatives to various choices. We tend to rely on our doctors to guide us, but they often have only one piece of the puzzle and limited time to spend with each patient/family. Enter the doula who takes a holistic, relationship-based approach. She/he can help you identify the questions you should be asking so you can make the informed choices that are right for you. Next, your doula will help you create a pro-active plan to get your needs met.
We've listed below our comprehensive answers to what may be some of your key questions about hiring a doula:
A doula is a labor support professional who “mothers the mother” during childbirth, as well as during pregnancy and in the early weeks postpartum. Birth doulas offer services prenatally and during labor and birth, while postpartum doulas provide in-home services to families after the baby is born, typically lasting from two weeks to three months, or longer in special circumstances. Some doulas combine the birth and postpartum roles into a complete service package, thereby offering continuity of care throughout the childbearing year.
Emotional support is always a key component of doula care. In addition, doulas provide evidence-based information, community resources and referrals, and comfort measures such as massage, breath awareness and enhanced relaxation. By the time the mother goes into labor, her doula has become a trusted guide. Postpartum doulas simply love hanging out with moms and babies and easing the transition into parenthood.
Your doula is there to support you in your choices and to provide concrete physical and logistical support. Doulas do not take the place of dads, partners or other family members who want to help you.
Your doula's job is to facilitate everyone’s optimal participation at your birth, as well as to provide support to the entire family through the postpartum recovery and adjustment period. As non-medical care providers, doulas do not provide clinical care such as taking blood pressure, checking dilation in labor or diagnosing conditions postpartum, nor do they give medical advice. Birth doulas do not take the place of a midwife or doctor at your birth.
BIRTH DOULA SERVICES MAY INCLUDE:
- Tips for coping with discomforts of pregnancy
- Assistance in creating a birth plan
- Support at home in early labor
- Continuous support in labor
- Comfort measures in labor and massage
- Suggestions and support for positioning in labor
- Troubleshooting for difficult births
- Guidance for informed decision making
- Facilitate communication with the woman's health care providers
- Support for dads and partners
- Support for VBAC (Vaginal Birth After Cesarean)
- Cesarean and post-cesarean support
- Promote bonding and skin-to-skin contact with your newborn
- Encouragement and skilled support to breastfeed
- Postpartum home visit(s)
POSTPARTUM DOULA SERVICES MAY INCLUDE:
- Breastfeeding support
- Newborn care
- Comfort measures and support for the mother’s physical recovery
- Shopping, errands, meal preparation
- Laundry, light cleaning, household organization (not housecleaning)
- Sibling adjustment support (not babysitting or nanny services)
- Depression screening and referrals
- Education on infant topics
- Overnight care so parents can sleep
- Support for families with twins or multiples
Shifts worked by postpartum doulas vary. Some may do overnights, others may stick to the weekday hours when their children are in school, and so on. Expect a typical shift to be a minimum of three or four hours. There are no rules—it is up to you and your doula. Typically, support is more concentrated in the first two weeks and then gradually the family weans off doula support. However, in special circumstances such as multiples, preemies, babies with special needs or moms suffering from postpartum mood disorders, postpartum doulas may be involved over a longer period.
Some doulas specialize in the birth doula role, others in postpartum work, and still others offer both. If you anticipate needing comprehensive doula support, both before and after birth, there may be advantages to hiring one doula provider for everything. Such “continuity of care” means that one doula (or two or three, if you are working with a team of doulas) carries the thread of your story from beginning to end as a trusting relationship unfolds over time. This reduces the potential stress of having to build trust with a new person at an overwhelming or stressful time.
End-of-life doulas provide non-medical, holistic support and comfort to the dying person and their family, which may include education and guidance as well as emotional, spiritual or practical care, from as early as initial diagnosis through bereavement. Services are provided in the home, independent or assisted living facilities, nursing homes, hospitals and hospices—in other words, wherever the person calls home. Each doula defines their own service package and specialty areas creating variety between one doula practice and another.
End-of-life doula services may include:
- End-of-life care planning
- Mediation and advocacy so that the dying person's wishes are honored
- Non-medical, hands-on comfort measures for the dying
- Personal care for the dying person (helping keep them clean and dry)
- Life review and legacy work
- Respite for overwhelmed caregivers (day or night)
- Education regarding the dying process
- Vigil planning and support
- Logistical and household support (meals, rides, pet and child care, etc.)
- Guidance for after death care of the body
- Information about funerals
- Creating rituals
- Bereavement support
Best practices for doulas include the following:
- All doulas provide non-medical, non-clinical care and refrain from giving medical advice. (Exceptions may include doulas with dual training and credentials.)
- Emotional support is always a component of doula care.
- Doulas are knowledgeable about community resources and provide referrals to their clients for needs and services outside of the doula’s scope.
- Doula support is nonjudgmental and not agenda driven (e.g., support is not rooted in the belief that there is one right way to proceed).
- Support is geared toward the family as a unit.
- Professional ethics require transparency about services offered, exclusions, fees and terms of payment.
- While doulas are not explicitly HIPAA mandated, professional ethics require adherence to similar client confidentiality guidelines.
Unfortunately, all doulas may not voluntarily follow best practices, so the caveat “consumer beware” applies. (See “How to hire a doula” below.)
A growing number of hospitals are launching birth doula programs. The doulas may be volunteers, independent contractors or hospital employees. The hospital may be underwriting the cost of doula services or passing that cost on to the consumer. A more limited number of postpartum doula programs are hospital sponsored. And some hospices have begun to incorporate end-of-life doulas into their volunteer programs.
Community-based doulas may be working for doula agencies or employed by nonprofit agencies, but most are self-employed, meaning that they set their own rates. Hence there is a lot of variation in what doulas charge for their services. Expect doula rates to vary based on level of experience, certification status, services provided and, especially, geographic area. The rates listed below will give you a ballpark idea, but wider variations are to be expected.
Birth doulas charge from $700 to $1500 for a package of services. Keep in mind that this fee includes phone consultations, prenatal and postpartum visits, and continuous support during labor and birth.
Postpartum doulas charge from $25 to $35 per hour. Presumably, the more experienced and skilled doulas are the ones charging the higher fees, with less experienced doulas starting out at the lower end of the scale. Some postpartum doulas will charge premium prices for overnight work.
End-of-life doulas charge a range of fees, sometimes based on a service or package of services (e.g., home funeral guidance or advance care planning session), and sometimes based on an hourly fee (e.g., shift work, respite care, vigiling services). Package and hourly rates are likely to be similar to what birth and postpartum doulas charge.
To date there have been several studies about the benefits of continuous labor support on labor and birth outcomes. Laboring women who are supported by doulas have lower c-section rates, lower incidence of instrumental deliveries (forceps and vacuum extraction), and lower rates of epidural use than women who do not have doula support. Women who receive doula support also have shorter labors, more positive childbirth experiences overall, and are more likely to breastfeed. Furthermore, infants born to women receiving doula support have higher one-minute and five-minute Apgar scores (a routine assessment of the newborn's well-being immediately post-birth).
Postpartum doulas are thought to have a strong positive impact on early parenting success including increased initiation, duration and exclusivity of breastfeeding; decreased incidence and severity of postpartum mood disorders; creation of a stronger mother-baby bond; greater self-confidence regarding parenting abilities; and increased understanding of newborn care.
We do not yet have academic research that has been published about the benefits of end-of-life doulas; however, several studies are in progress. Anecdotal evidence speaks to the benefits for the dying individual and caregivers. Due to the similarities between all types of doulas, it stands to reason that continued study of end-of-life doulas will demonstrate benefits as well, especially in terms of easing caregiver stress and improving quality of life for the dying and their loved ones.
During inherently stressful times of transition, and in the face of complex choices and a fragmented medical system, families benefit from focused guidance and support.
Our doula caregiver directories are designed to help you find the support you need. Below you'll find listings of Birth, Postpartum and End-of-Life Doulas who have trained with Lifespan Doulas.
Some doulas choose to become certified and some families prefer to hire certified doulas. Regardless, certification is not required for any type of doula by any state or federal agency. Exceptions may include Oregon and Minnesota which have passed legislation licensing birth doulas. Legislation efforts are underway in other states as well at this time.
Whether it is necessary that the doula be certified is up to each family to decide. In many cases, good word of mouth about someone’s services can trump certification status. Certification simply means that the doula has completed a formal process offered through a training organization. At last count, there were 83 different birth/postpartum doula certification agencies worldwide and perhaps a dozen end-of-life credentialing organizations. DONA International is known for setting industry standards and is the oldest, largest and most prestigious professional birth/postpartum doula organization in the world. The certification offered by Lifespan Doulas for end-of-life doulas is based on the DONA model.
While certification processes differ, certification is designed to guarantee that the doula has achieved a minimum level of training and experience and is held accountable to professional standards. Some certifications may be less meaningful than others, for example a lifelong “certification” granted after simply completing an online class. There is no one over-arching doula credentialing organization. Doulas are, for the most part, self-regulating.
It is important to find the right match!
- Gather information online (and/or referrals/recommendations from family and friends).
- Conduct a short screening interview by phone with the most promising candidates.
- Set up an in-person interview with the most favorable candidate(s). Make sure that the key decision makers come to the interview (e.g., pregnant woman and her partner, dying individual and primary caregivers). Do some preparation for this interview to identify your needs.
- Hire the doula who is the best match for your personality, beliefs and needs. Hiring typically involves signing a contract, paying a portion of the overall fee as a non-refundable retainer, and setting a schedule for the doula’s services.
A growing number of experienced doulas are starting agencies. Doula agencies do the vetting for the consumer.
You can expect that your agency doula will:
- have completed a professional training program
- be certified (or at least working towards certification)
- have passed a background check
- carry professional liability insurance
- have a solid backup plan in place
- whatever else the individual agency guarantees
Typically, agency owners will conduct the client interview and then search for a good match for the family from among their pool of doulas. Should a conflict arise between the doula and the family, the agency owner is responsible for resolving the problem and ensuring that you get your needs met. It should be noted that private-practice doulas may very well check all the above items as well. Certainly, all doulas should articulate a backup policy and have a plan in place for occasions when they are unable to complete agreed upon services for a family.
Try to think of a few questions before the interview that are designed to get at the answers most important to you. Just what are you looking for? What gaps need filling? Consider that the doula will be present at a time when you may feel especially vulnerable. Ask yourself with whom you (and your partner or other key decision makers) feel most comfortable. What helps you when you are feeling stressed? Information, humor, kindness, a flexible attitude, a good listener?
- Check regarding availability and fees charged.
- What services are offered? What services are excluded? Avoid making assumptions here. For example, some birth doulas provide in-person support in their client’s home during early labor and others do not. Some postpartum doulas are willing to help with childcare, throw in a load of laundry, clean the bathtub, or run errands, while others may not. Likewise, all end-of-life doulas do not provide the same set of services. Some provide overnight respite care for exhausted caregivers or personal care services for the dying person (helping to keep them clean and dry), while others do not. Ask for what you want.
- Inquire about experience, formal training and certification status.
- Ask about the doula’s philosophy of care.
- What are the doula’s strengths? What does she/he enjoy most about doula work?
- Inquire about the doula’s policy regarding use of a backup doula.
- Ask for and check references.
- Check credentials (a claim of certification can be easily verified).
- Does the doula have an agenda (my way or the highway)? If so, is her/his agenda congruent with yours?
The personality and beliefs of your doula may well be more important than any other factor. Keep in mind that an enthusiastic but inexperienced doula with whom you feel a warm rapport may be preferable to a more experienced doula with whom you feel uncomfortable, for any reason. In the end, make sure you hire someone who can provide non-judgmental support for you and your family. Trust your instincts. This is all about getting your needs met.