Giving birth with a doula

The word doula derives from the Greek and means, loosely translated, “a woman who serves”. In most cultures, women with experience of childbirth help other women give birth; this is an ancient phenomenon. But these days, what does it mean to hire a doula, and how much does it cost? We asked doula Stina Berg loads of questions, and she gave us a picture of how doulas work and what advantages they offer parents-to-be. Stina also offered her best tips for parents for having the most positive birth experience possible.

What is a doula?

A doula is someone chosen by the parents who provides mental, emotional, physical and practical support before, during and immediately after childbirth. Unlike a midwife and other medical staff, a doula is independent and has no medical responsibility; instead, this person focuses entirely on being there for the parents, in terms of their specific needs and wishes.

Who hires a doula?

First-time parents, current parents, single people – anyone who would like to have extra support in the room and who simply wants to give themselves the best possible conditions for a positive and empowering experience.

Stina, what would you say are the advantages of hiring a doula?

A doula is an extra person in the delivery room who can provide support, whatever that might look like, which is a huge luxury! Someone sensitive and thoughtful with whom to bounce ideas, and who provides assistance, massage, information, reminders and relief in general. Or who is simply there, close at hand, to help create a good vibe in the room. Their whole purpose is to help make this the most positive experience possible!

I would also point out that the midwife and nurse often can’t be in the room as much as most people would like. They have working hours to stick to, which means that the support they provide generally ends when the workday ends, and new staff arrive in the room. If you hire a doula, you have extra support in the room throughout the entire process, no matter how long it takes. A doula also offers security in the form of continuous support from someone you chose yourself and have met before.

In my experience, feeling secure is important for gaining access to that inner power while giving birth. And it can be tough to get that sense of security in the delivery room, which is usually a new environment with unfamiliar faces. You gain a lot from already having started to build a relationship with a doula , because so much of the security you need is in the room from the beginning. Some studies show that when the person giving birth receives continuous support from someone other than a medical staff member – such as a partner, friend, or doula – childbirth often spontaneously happens vaginally; it is faster; and the person giving birth needs less medicinal pain relief and has a better birth experience. I think that makes things pretty clear.

How do I hire a doula and when during pregnancy do you usually meet for the first time?

It’s best to contact the doula you’re interested in as early as possible, to improve the chances that they are available. The easiest way to find doulas is by googling “doula” and the name of your home city or town – most of us have a little website or can easily be found on social media. Schedule a commitment-free meeting, a cup of coffee is always nice, to see if you click – and if you don’t, then try meeting someone else. Good chemistry is probably the most important ingredient. If it feels good, then you will usually sign a contract, which generally includes one or two preparatory meetings during the pregnancy, on-call weeks around the expected due date, during which the doula will be ready, day or night, to head out and be there for the entire childbirth process and even a few hours more. After that, you will usually meet up to talk about what you experienced together and bring it all to a close.

If you have a partner, what is their role? Is there a risk that they won’t be as involved?

As their partner, you know the person giving birth the best and a doula cannot – nor should they – take over that role. That said, a doula can give advice on how, as a partner, you can best be supportive and soothing, as well as secure and confident in yourself, so that you can play an active role during the birth of the baby. And of course, having a doula present also means that you can actually get some food, go to the bathroom, or just rest for a moment, and then return with energy and positive support. This way, the person giving birth never has to be left alone – and that provides security. Practically speaking, it’s also nice to have someone to switch out with when massaging your partner through contractions has your hands cramping up.

It isn’t easy to provide optimal support by yourself as a partner, because you are also part of the process and likely have your own needs for support – you might feel uncertain and powerless as you stand by, not to mention the life-altering event happening before you: becoming a parent! In my experience, hiring a doula often results in the partner feeling more involved, both during pregnancy and during childbirth, which can have positive effects on connection with the baby and the new family.

What does it cost to hire a doula?

It varies a bit. Different doulas might offer different services, and they might also design them for each individual. The price usually varies a little depending on where you live and on the doula’s experience. You can expect to pay somewhere around SEK 5,000 – SEK 15,000.

What are the advantages of hiring a professional doula versus having a close friend present?

It might be wonderful to have a close friend or family member there, if that’s what you want. Especially if you don’t have a partner. In my experience, you can never have too much support – only too little. I would say that the advantage of having a certified doula is that they won’t be as emotionally tied to the experience, which means they can concentrate fully on the task at hand, in addition to the fact that they just know a lot about childbirth. They know everything about the different phases of labour and what the pain relief options are, and they can also help with non-medical pain relief, like massage, relaxation, breathing and acupressure. Many doulas are also trained in breastfeeding and offer breastfeeding support, or support with bottle-feeding.

What kind of feedback do you generally get from parents you have helped?

A lot of them say it was one of the best decisions of their lives to include a doula. Going through childbirth together is really special and the families with whom I’ve had the honour of sharing that experience all have a special place in my heart. And I think that is mutual, regardless of whether we’ve maintained contact or even if we never got back in touch again. Many people come back when it’s time for siblings, which feels really nice.

Finally, Stina, can you give us your best tips for future parents, so that they can have the most positive childbirth experience possible?

Knowledge is power! We tend to be afraid of the things we don’t know, so my suggestion is to read about the childbirth process, and what happens in the body and why. What happens when we get scared or tense (hello, adrenaline!) versus when we feel secure and relaxed (oh hello oxytocin!) and what a huge impact that actually has on the experience of labour.

I think you should be as prepared as you can possibly be. Think about what you need to feel calm and safe, about what kind of support you want and from whom. How can you give yourself the best conditions possible? And for partners: what can you contribute? Put together a birth plan, which will help you and the midwife when it’s time to establish a relationship in a short period of time. I also think it’s important to truly claim your birth experience, trust your body and know your rights.

During childbirth, my best tips are to allow your body to be heavy, to breathe “normally”, drop your shoulders, keep your jaw and forehead soft (smooth out those worry lines) and try to finish each contraction with a deep breath and a sigh to release tension. Try to take advantage of rest.

Think about whether there are any positive affirmations or visualizations that you like. If so, write them down on sticky notes while you’re pregnant and put them up where you will see them regularly. For example, maybe:

• The power of the pain can’t be stronger than me – the power comes from within me, so it is my power!
• Pain is not dangerous!
• I have the courage to let my body give birth!
• I can handle anything for one minute!

It’s good to remember here that a contraction isn’t usually 60 seconds of continuous sharp pain. Instead, think of it like this to make it more tangible: A 20-second entry, as the pain gradually increases; 20 seconds of maximum pain; and a 20-second exit, as the pain gradually fades.

Childbirth is not easy. And I know that sometimes it feels like the contractions aren’t doing any good, but believe me, they are. Every single one. So try seeing the work of contractions as a long rope of knots. With each contraction, a knot is untied, bringing you one step closer to the goal at the end of the rope: your baby!

You can read more about doulas here.

Please note that all information above is based on Swedish recommendations.