Ep 218: A Step By Step Process On How To Choose a Doula

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I’m sure you’ve heard me say how much I love doulas. Studies show that having a doula can shorten labor, decrease the need for pain medicine, and increase your chances for having a vaginal delivery. They provide physical and emotional support during labor and the postpartum period. But just like any other practitioner, not every doula is going to be the right fit for you.

In this episode I’m going to walk you through the process of finding the right support specialist to help you along your birth and postpartum journey. We’ll go over where to look and the questions you should ask potential candidates. Remember that it’s your birth and your money. Hire the person who is going to make you feel comfortable and be your ally.

In this Episode, You’ll Learn About:

  • What a doula is and how they help during labor and postpartum
  • Why you might consider hiring one
  • Where to find a doula
  • Why it’s important to interview multiple candidates
  • Which questions to ask when interviewing a doula
  • How available you can expect them to be
  • How a doula can help both you and your partner

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Transcript

In this episode, you're going to learn a step-by-step process for how to choose a doula. Welcome to the All About Pregnancy and birth podcast. I'm Dr. Nicole Calloway, Rankins, a board certified OBGYN, who's been in practice for nearly 15 years. I've had the privilege of helping over 1000 babies into this world, and I'm here to help you be calm, confident, and empowered to have a beautiful pregnancy and birth. Quick note, this podcast is for educational purposes only and is not a substitute for medical advice. Check out the full disclaimer at drnicolerankins.com/disclaimer. Now, let's get to it.

Hello there. Welcome to another episode of the podcast. This is episode number 218 where the are a new listener or returning listener. I am so grateful that you're spending some of your time with me today, so I'm super excited to bring this episode to you about how to choose a doula. Anyone who's listened to me for any amount of time or followed me on social media knows that I am a big fan of doulas. So again, yeah, I'm just really excited to share this and give you some information so that you can find a doula that works for you. To be honest with you, part of this episode or the idea for this episode came from a few recent birth stories and just chatting with people and my dms and things like that where they have had not so great experiences with doulas. And again, I love doulas and there's some great doulas out there, but doulas are also human beings and they can not provide the right services like anybody else.

So you really just want to have some guidelines and things to follow and recommendations just like you would for finding an OB doctor or a midwife. You need to do the same thing for doulas. So first off, in this episode, you're going to learn really quickly what are doulas I think most people know, but I'll go over it again just for those who may not. And then you will learn where to look for doulas, the questions to ask, it's about 12 questions to ask and then some things to consider when you're making your final decision about a doula. Now, inside the birth preparation course, if you are a member of the birth preparation course, then you have all of these questions and the things to consider that I will go over in a handy downloadable guide inside of the birth preparation course. It's one of those PDFs that you can fill out and type in so it's editable.

So if you are a member of the birth preparation course, you can grab that guide inside. You don't have to take any notes. If you're not a member of the birth preparation course, you can take notes and write down the questions or you can just become a member of the birth preparation course. If you're not aware of the birth preparation course is my online childbirth education class that will get you calm, confident and empowered to have the most beautiful birth with a focus on hospital birth especially, and it covers all of the things that you need. You can check out all of the details of the birth preparation course at drnicolerankins.com/enroll. Thousands of women have gone through the course. I'd love to have you go through it too. All right, let's get into the episode about how to choose a doula. So first up, what exactly are doulas?

Well, doulas provide physical and emotional support during labor and the postpartum period. And there are also different types of doulas these days, like I'm specifically in this episode talking about a birth or a labor doula, but there are some doulas who only focus specifically on the postpartum period. There are also doulas like abortion doulas who accompany people along the abortion journey. There are also death doulas who accompany people along the death journey. But I'm specifically talking about labor. Doulas and doulas are especially helpful when you want an unmedicated birth. They can help you with pain management techniques, but they can also be helpful even if you have an epidural or you are having a planned cesarean birth or you end up having a cesarean birth. And the reason that I love doula so much is because studies show that having a doula can shorten your labor, can decrease the NA need for pain medicine and can increase your chances for having a vaginal birth.

That continuous labor support makes a difference. And the difference is that a doula is going to be there for the duration of your labor, well, at least they should be. Whereas your nurse is going to change during the course of your labor. You may have a different physician during the course of your labor, your doula can be that constant presence that's there. And studies show that that continuous support again, helps improve outcomes. Now, most doulas do not have medical training. They may have additional medical training unrelated to being a doula like I know some physicians who are doulas or have gotten trained as a doula, or you may see lactation counselors who are also doulas or therapists who may also have doula training as well. But to be specifically for the role of a doula does not require medical training. And then you may also be thinking like you talked about or I just talked about how doulas provide physical emotional support.

Well, isn't that what my partner is supposed to do? And yes, your partner can absolutely provide support during your labor and birth, but a doula does not replace your partner. A doula will enhance your partner's ability to support you, so they will support you. They will also support your partner or they should to in helping you get the birth experience that you desire. Okay, so let's talk about those steps that you need to take when hiring a doula. And it's really just four basic steps, and I'll break down each one of those in more detail. The first one is going to be you need to create a list of potential candidates. I'll talk about why that's so important. Step two, you need to set up interviews at least three. I recommend. Step three is actually do the interviews, and I'm going to give you those questions that you should ask in the interviews.

And then step four is that post-interview process of things you need to ask yourself before you make a decision. And then I guess step five is make a decision whether or not you're going to hire a doula or who you are going to hire. So let's start out with step one. Step one is to create a list of potential candidates. And this is so important because I feel like doulas and rightfully so have gotten such a great reputation about the things and the services that they do that sometimes people are just the first doula that they see. They're like, Hey, can I work with you? Or, Hey, I should get this person without really being intentional about making sure that that doula is actually a great fit for them and we'll do the things that they want and that they expect. So you really need to start off with just creating a list of potential candidates.

And this does not have to be a list of 40 different people or whatever. I think like five or six is completely reasonable. So you want to be sure you don't just take whoever comes. You want to start with creating a list of potential candidates. And that list may include people who you're like, Ooh, I really, really, really want to work with this person, but I want you to definitely, I want to challenge you to be sure you look at more than one person, because even if you decide to go with that person, looking at other people will reinforce your decision. So you're going to create that list of potential candidates. And as far as places that you can find candidates, of course you may know people, but you can ask friends who've recently had babies for referrals. You can ask family members for referrals.

You can even ask your doctor or your midwife for recommendations They may have doulas that they work with in the community that they know have good working relationships together, and actually asking your doctor about whether what recommendations they have for a doula can actually set up a good conversation for you to understand whether or not they support doulas. So all doctors should absolutely support doulas because without question, the evidence shows that doulas improve outcomes, however, some doctors don't. So when you go and ask that question, Hey, do you have any recommendations for doulas? If you get language, I don't know why you need a doula. I don't know why you would do something like that, or eye rolling kind of thing. Or I guess if you have to have a doula sort of thing, that's a red flag, something that you need to pay attention to because really there's no reason why doctors should not be able to or should not support continuous labor support during labor because research shows that it makes a big difference.

ACOG has supported it, all of those great things. Now, another place you can also call up to the hospital labor and delivery and ask if they have recommendations for doula. They may or may not. Some hospitals actually have doulas internally who they employ at the hospital. That can be both good and bad. It can be good because you may have a doula there and you don't have to pay for it, but I don't want to say bad, but the potential con is that you may not know this person. You may not have an opportunity to meet them. You don't have a choice about who it is beforehand. Also, they are employed by the hospital, so they're potentially going to be indebted or lean towards the hospital in the sense that they're going to not mess with them out. They're not going to bite the hand that feeds them, so to speak.

So there are pluses and minuses to that. But you can ask the hospital if they have any specific doulas that they know come to the hospital on a regular basis or recommend just call up and whoever answers the phone on labor and delivery, you can ask them. And then there are a couple of good websites that you can go to search for doulas. There's doula match.net, and we'll put that in the show notes. And also donna.org, that's d o n a.org. Those are both places where you can put in where you are, put in what you're looking for, I think believe, I believe things like your budget. And then you can find doulas in your area who you can interview, because again, I want you to create a list of potential candidates. All right. Now, once you have that list, the next thing you're going to do is you are going to set up at least three interviews.

Did you hear me set up at least three interviews? I know this may seem like a lot or maybe it doesn't, but I don't want you to just pick one person. I want you to have a little bit of a feel for different people and how they may work. And again, even if you fall in love with someone and you're like, oh, this is the one. Who is it? If you talk to other people, it can reinforce that or it may give you things that you didn't realize that you should have considered. All right, so you definitely want to set up at least three interviews. Now that COVID is not nearly the problem that it was before. I think just meeting over coffee at a coffee shop or Panera or Starbucks or whatever, or a bookstore, those are great places to sit down and have an interview.

I think about an hour, you can tell them an hour would be necessary. It could be less. I don't think it'll be much more than that. I think an hour is reasonable. I think ideally you want your partner to be there as well, because your partner should be part of this process and feel comfortable with the person too. So you want your partner to be there as well. But I want you to set up at least three interviews. Okay? Step three is ask the interview questions. I'm going to go through these questions. Again, if you're a member of the birth preparation course, you can print out this document. The PDF is already in there. If not, then just grab yourself some pen and paper and you can make some notes. So question number one is where did you receive your training and are you certified?

There are sometimes people who are like, oh, I'm a doula and I'm doing air quotes, but they haven't necessarily gone through any training or done anything, and they just decided that I'm going to be a doula. Being a doula is not a regulated profession. So unlike a certified nurse midwife, unlike a physician, unlike a therapist, unlike a lactation counselor, you, it's not certified. There's nobody regulating the profession of being a doula. So literally, anyone can hang up their shingles and say, Hey, I'm a doula. So you definitely want to ask what type of training they have and if they're certified. Now, certification isn't necessarily a make or break. I think it's just something you should know. It may help you end the decision making process about the fees that they charge and whether or not you feel like that's reasonable, that kind of thing. But they absolutely should have some sort of training in order to become a doula.

It shouldn't just be like, I decided I'm just going to be a doula. And some organizations that certified doulas are DONA International, D O N A, international Childbirth, international Birth Arts International. Those are common certifying organizations. In my area, I'm in Richmond, Virginia. We also have some local organizations that certify doulas like Birth in color or two Labor. And you also may have people in your area or organizations or groups in your areas that do doula training. So just ask where did they receive their training? You can go back and look it up and make sure you feel like it is in line or actually something that's serious and real and not someone who's just deciding, okay, I'm going to be a doula. All right. Next question is, how long have you been a doula and how many families have you supported? Now, this also is not a make or break question.

Maybe it's somebody who's new, and I can't say that I have a specific number for how many is a good number or a bad number because everybody has to start out somewhere. I think on average doulas, I think on the high end, supporting three or four families a month would be, I think on the high end. So it's not going to be in the thousands, right? Like what I do as an OBGYN, but you want to get a sense for do they have an ex experience with this? Maybe if you're looking for someone who has experience with your particular type of family, have they ever worked with black families for instance, or have they ever worked with families with a same sex couple? That kind of thing. So you want to make sure that you find somebody who's in line with what is comfortable for you, culturally congruent, maybe those kinds of things, or at least working with someone from your culture or your background.

So just ask, how long have you been a doula? How many families have you supported? Not a deal breaker, but just information that can be helpful when you make your decision. Okay, this next question is so super duper important. Really, really, really, really important. That question is what is your philosophy about pregnancy and birth? And you really want to be sure that you all match and you have idea the same ideas and thoughts about pregnancy and birth and that she won't push her own agenda on you. So examples of how I would expect someone to answer this question, or I believe in limited interventions or my philosophy is supporting the pregnant person and the choices that make work best for them. You don't want anybody who's like, well, you should never do anything during pregnancy. You shouldn't take any medicines. You shouldn't see a doctor or not.

I'm not going to say you shouldn't see a doctor, but you shouldn't take any medicines. You should never be induced. Those tests that they do are unnecessary. Like that to me is red flags. So you want somebody who is in line with how you feel about pregnancy and birth, because this really is about supporting you in helping you and your pregnancy and helping you have the best experience that you want, not their own agenda, not what they think is best. And if you have a doula who is not medically trained but is talking about, she can do some medically trained things or she can do some medical things, also a red flags a red flag rather good. Doulas will not be trying to do medical stuff. They know their limits and they will refer you appropriately. So if you hear them talking about how they can some practicing medicine sort of things, that is also a red flag as well.

And again, you may decide that yeah, you want an unmedicated birth, but you're open to an epidural. You don't want anyone to say like, oh, I absolutely don't think anybody should get epidural or get any medicines or anything like that. You just want somebody who's in line with supporting the things that you want for your birth. Okay, next question is how many visits do you provide prenatally, and how many visits do you provide after the birth? One of the things that is helpful about having a doula during your pregnancy, and you can actually hire them as early as you want about having a doula, is that you should be able to get to know them a bit. You shouldn't just be meeting them at the time of your birth. You should have a bit of a relationship beforehand. So I would anticipate or guess they're probably going to be at least a couple of visits prenatally where you sit down, you talk about things, what you want.

They should probably help you with making a birth plan or birth wishes. Some doulas actually also do childbirth education, so they may offer that as part of their services and kind of wrap that into their fee. So you definitely want to do ask or how many visits they provide prenatally and what those visits entail. And then you want to ask or have clarity on what they're going to do for you after the birth. You definitely need at least one or two visits. Often doulas will come see you in the hospital right after the birth, and then they will also see you at home to help you get situated and settled in your new role. So you want to have clarity on exactly what you're getting, what you're paying for as part of the experience. I have unfortunately seen a few people who have been kind of surprised or taken aback at what ended up being the lack of visits and care related to having a doula.

So ask how many visits they provide prenatally, how many visits they provide after birth, and what exactly do those visits entail? Okay, next question is, what is your accessibility? Are you available by text? Are you available by phone call? Are you available by email? How often am I able to reach out to you? Now, it's unrealistic to expect that someone's going to be available 24/7, right? At least through your whole pregnancy, surrounding the birth time. Yes, they do need to be available 24/7, but during your pregnancy, it may be like, oh, from nine to five, you can text me. If it's after five, I'll respond the next day, or emails or those kinds of things, because sometimes it can be helpful right after you have an appointment and if something was confusing or maybe you just want to run something by someone else, then being able to text your doula quick question, maybe helpful. So you want to ask what is their accessibility and how frequently they are okay with you contacting them?

Okay, next up is how will you support my partner? As I said in the beginning, a good doula does not replace your partner. A good doula supports you and supports your partner in helping you have your best birth experience. So some examples of how your doula may support your partner are that I'll teach your partner some pain management techniques like back massage or how to get things like a warm washcloth or rubbing your back or those kinds of things so they can teach your partner some of the moves and things that they do. They can maybe remind your partner, Hey, have you gotten something to eat? Or you can run out and get something to eat or do some of those things to make sure your partner is also taking care of them themselves during the process of your birth experience. You don't want them to ask the question and be like, oh, I don't know.

I guess I do this the other. You want them to have a clear understanding and thought out response to acknowledging that supporting your partner is also a part of their role as well. All right, next is how will you interact with my medical team? And I want you to specifically ask, do you feel comfortable playing an advocacy role? This is super duper important, all right? There are some doulas who are out there and I am ready to advocate. I will intervene. I will speak up on your behalf. But that is not what doula by definition means. Doulas are trained to provide physical and emotional support. It doesn't necessarily mean that they're ready to intervene on behalf of you and your medical team. Now, I think ideally they should. And if they don't feel like they're comfortable with that, then your partner absolutely has to be able to do that because you need to have someone with you during your birth who can advocate for you on your behalf, for sure, for sure, for sure.

But you really want some clarity ahead of time because you don't want to get in the birth experience and things are happening and you're in the thick of things and you're thinking your doula's going to speak up about something and they don't. And examples of advocacy, don't expect that your going to be scrapping with the hospital staff. But some things that they may do that can just provide a little bit of space and time for you to think about things is, for example, when something is being presented to you as an option, they can nicely calmly say, they can look at you and say, do you want a minute to think about it? Do you maybe want a minute for you and your partner to discuss this and kind of open up that door to give you some space to think about things? So you can discuss things in private, or if it's like you have some hesitancy about getting a cervical exam or getting your water broken, and your doula can say, is there any way she could reassess?

Or we could look at things in a couple of hours and kind of see where things are. So ask, does your doula feel comfortable doing those kinds of things? And ideally, you don't want a doula who is going to be an adversary or who goes into it like gangbusters. We got to fight the hospital staff. That's not what works best. When you have a labor and delivery nurse and a doula who worked well together to support the patient, that is the best, the absolute best. So you want a doula who feels comfortable helping with or working with a nurse, working with the physician, having a conversation and not like an adversarial kind of thing. That's what makes the best environment or situation particularly in a hospital birth. Okay? Next is, at what point are you on call twenty four seven for my birth. Birth is unpredictable. The only predictable thing about birth is that it is unpredictable.

So your doula needs to be very clear for you when will they be available? Typically, that's going to be once you're full term. So 37 weeks, maybe 38 weeks up until when you give birth. That means you can call them any time or text or any time when things happen because things happen whenever they happen. So you want to know very clearly at what point your doula is on call twenty four seven for your birth. All right. Next question is, at what point in my labor will you join me? Now, I love doulas, and this one is probably going to, if there's some doulas listening, this may cause a little bit of friction. I hope not. But doulas are human beings too. They have lives, and it can be challenging to be with someone during a whole labor, and that lasts for hours and hours and hours and hours and hours.

I, I think doulas are starting to recognize that work life balance. The reason why, for example, we in our specialty have things like hospitalist where I only work in the hospital and I work certain shifts, and I know that outside of that I'm not working, or midwives who share call and responsibilities. I think they're starting to understand that being with someone during that whole time is a lot. It's demanding physically. It's demanding mentally. So sometimes I think it used to be like, oh, my doula, your doula would kind of come to your house and when you first started having contractions and things like that to sort of assess and help give you an idea as a time to go to the hospital. And I see that sort of hands on treatment less and less, to be honest with you. They'll definitely talk to you over the phone.

They'll definitely help you think through about whether or not it's time to go. But I rarely are doulas that I see, and y'all can DM me on Instagram at Dr. Nicole Rankins if you know something different. Are they going to people's houses and doing that type of thing? It used to be in the beginning. It's just a difficult model to sustain, to be there for so long, again, is demanding physically and mentally. And same thing. If you're in the early part of labor, then sometimes they may say, Hey, I'll join you when things are a bit more active, or I'll join you once you get to be five centimeters and you're in the active part of labor. Or definitely if you're having a labor induction, your doula is not going to be there for your whole labor induction. I can guarantee you that. And they don't need to be right.

They don't necessarily need to be, especially if you're in a good environment. They don't need to be there until things get more active. So they may come and help you get situated or settled in or talk to you over the phone or by video chat or things like that. And then they'll join you when things are more active. So don't expect from the second you hit the hospital door until you give birth that your doula may be there because they may not. So you just want to ask really clearly, at what point in the labor process will you join me? Okay, next up is what happens if you are not available when I give birth? As I said, doulas are humans. Things happen. Maybe you give birth a little bit earlier than anticipated or things like that. So most often they will have a backup doula, and it's kind of up to their own policies and procedures or how they do things as to whether or not you will meet that backup doula ahead of time.

But there should be something clearly in place for what happens if they aren't available when you give birth. Okay. And then last two questions. What are your fees? Be real clear upfront. How much is this going to cost? All right, so you definitely want to know what your fees are, what their fees are. And fees can range from $400 to a thousand dollars or more, all right? It really depends on your area, depends on their level of experience, depends on how much they provide. But definitely get clear what are your fees? So you can make a decision based on that. And sometimes people have payment plans or sliding scale, depending on your income level. Some doulas will even barter for services and things like that. So just be clear and ask upfront what are the fees? And then if any part of the fees are refundable, if for some reason they aren't able to give you the services that were promised, okay?

So ask if there are any things that are refundable as well. And then the final question is, if I decide to hire you, what are the next steps? So again, very clearly what to expect and what is to come going forward. All right, so those are those 12 interview questions now, and you're going to ask again, all of those to three people. Three people, at least three interviews. You can do more if you want, but three interviews. And then the last step is these are questions that I want you to ask yourself after the interview questions to ask yourself after the interview to help you make a decision about who will work best for you. So question number one is, did I feel comfortable with this person? You have to feel comfortable with this person. They're going to see you in a very vulnerable, vulnerable state.

They're going to see you when you may not necessarily be at your best and your brightest and your shiniest, where you'll be in pain. So you just want to know, like, or ask yourself, did you feel comfortable with this person? Next question is, did she communicate well? Communication is really important. Do you feel like you had a clear understanding of the services that she offered, that talking to her, you understood everything, that you didn't leave feeling confused or having any questions about anything? So ask yourself, does she communicate well? Next question is, would I feel comfortable having her in my home? I think a lot of that or a lot, and I think a lot of that is related to if you decide to have them for more extended postpartum care. But are you going to feel comfortable having this person around you and in your home in particular, especially if you're considering having them for postpartum care or a postpartum doula? And then the final question to ask yourself is, what does my intuition say? What does my intuition say about working with this person? I want you to trust yourself. Trust those nudges. Trust those little bits of information that are filtering in from your spirit, from your soul about what you feel will work best for you. Your intuition really, really, really plays a big role, not just in this choice, but of course in choices that you make throughout your life.

Okay, so just to recap the four step process for choosing a doula. Number one, create a list of potential candidates. You can ask family and friends, ask your care provider the hospital. You can go to doula match.net or donna.org. Step number two is to set up at least three interviews, three interviews, three interviews. I want you to talk to more than one person for sure. Three, ideally before you make a decision. Step number three is do the interviews. And the 12 questions you're going to ask are, where did you receive your training? And are you certified? How long have you been a doula? And how many families have you supported? What type of families have you supported? What is your philosophy about pregnancy and birth so that you all match? How many visits do you provide prenatally? And after the birth? What do your services cover?

What is your accessibility? Are you available by text, phone calls, emails? How often am I able to reach out to you? How will you support my partner? How will you interact with my medical team? Do you feel comfortable playing an advocacy role? At what point are you on call twenty four seven for my birth? At one point in the labor process, will you join me? What happens if you are not available when I give birth? What exactly are your fees? And then if I decide to hire you, what are the next steps? And then finally, the questions to ask yourself afterwards are, did I feel comfortable with this person? Does she communicate well? Would I feel comfortable having this person in my home? And then, what does my intuition say? And remember, if you are part of the birth preparation course, there is that PDF download that you can fill out, print out for each of the interviews, take it to the interviews with you.

So you have the questions right there. If you're not a member of the birth preparation course, then come on in. What are you waiting for? Come join us. It's dr nicole rankins.com/enroll. I would love to serve you inside of the course. Childbirth education is a must for everyone. Even if you don't do the birth preparation course, you better be doing some child childbirth education because it is so critical. But I'd love to have you inside of the birth preparation course. It's a great, great program. So check it out, drnicole rankins.com/enroll. So there you have it. Do me a solid share. This podcast with a friend sharing is caring. I'm on a mission to reach and serve as many pregnant folks as possible, and I'm so grateful for anything that you can do to help me reach and serve as many folks too. Be sure to subscribe to the podcast, an Apple podcast or wherever you're listening to me right now.

Leave me an honest review and Apple podcast. It helps other women to find the show, helps the show to grow. Also, shoot me a message on Instagram. I'm at Dr. Nicole Rankins. If you have some thoughts about the podcast, something that you want me to talk about, I am always open in the dms to receive messages. I also like to get pictures, love to see pictures, not just of baby, but pictures of you and baby. So definitely send me pictures on Instagram. I'm at Dr. Nicole Rankins, and just follow me there for more great pregnancy and birth information as well. So that's it for this episode to come on back next week. And remember that you deserve a beautiful pregnancy and birth.