Module 1: Introduction to Birth Doula Work
IN THIS LESSON
Topics Covered:
Definition of a birth doula
The history and evolution of doula work
Distinguishing between a doula, midwife, and other birth professionals
Introduction
When families prepare for birth, it’s natural to have questions about who will be by their side and what roles each professional plays. While doctors and midwives provide essential medical care, doulas offer something different but equally important: continuous emotional, physical, and informational support. In this lesson, we’ll explore exactly what a birth doula is, trace the history and evolution of doula work, and clarify how doulas differ from midwives, nurses, and other professionals. By the end, you’ll understand how each role fits together to create a supportive birth team.
Definition of a Birth Doula
Learning Objectives
Understand what a birth doula is and the scope of their role during pregnancy, labor, and postpartum.
Recognize how birth doulas provide emotional, informational, and physical support to families.
Identify the differences between the role of a birth doula and medical providers.
Definition & Explanation
A birth doula is a trained professional who provides continuous emotional, informational, and physical support to a birthing person before, during, and shortly after childbirth. Unlike medical providers, doulas do not perform clinical tasks such as checking vital signs, delivering the baby, or prescribing medications. Instead, their primary role is to ensure that families feel supported, informed, and empowered throughout the birth experience.
For example, a doula may guide a laboring person through breathing exercises, remind them of comfort measures, and offer reassurance when challenges arise. This presence can help reduce anxiety and make the birthing person feel more confident in their ability to navigate labor. Many families describe their doula as a calming, reassuring figure who advocates for their preferences and helps them feel more in control.
The role of the doula is grounded in the theory of continuous support, which suggests that when individuals have a trusted, supportive presence by their side during childbirth, their outcomes often improve. This support is not limited to the birthing person—it extends to their partners and families. A doula may encourage a partner by showing them ways to massage the mother’s back or reminding them how to provide encouragement during contractions.
Real-life examples illustrate the doula’s role well. Imagine a first-time parent arriving at the hospital, nervous and unsure of what to expect. The doula might remind them of their birth plan, explain what hospital staff are saying in simpler terms, and suggest position changes to help progress labor. In another case, a doula may help a parent coping with an unplanned cesarean by staying by their side, offering comfort, and guiding them through emotional processing.
At its core, the work of a birth doula emphasizes non-clinical, holistic support. Their value lies not in replacing medical professionals, but in filling a unique space: combining knowledge, presence, advocacy, and empathy to ensure families feel both cared for and respected in their birth journey.
Scenarios & Tips
Scenario 1: A first-time mother is in early labor at home and begins to feel anxious about when to go to the hospital.
Doula Script: “You’re doing wonderfully. Early labor can feel uncertain, but let’s take it one step at a time. Remember the coping strategies we practiced—let’s try some gentle movement and slow breathing. I’ll help you track your contractions, and when they become longer, stronger, and closer together, we’ll know it’s time to head in.”
Tips: This response acknowledges the client’s anxiety, provides reassurance, and uses concrete steps (movement, tracking contractions) to give the client a sense of control. The doula validates feelings while offering a clear plan, which reduces fear and prevents unnecessary early hospital admission.
Scenario 2: A partner feels overwhelmed in the delivery room and isn’t sure how to help.
Doula Script: “You’re doing a great job just by being here. Let me show you something—place your hand here on her lower back and apply gentle pressure during the next contraction. I’ll guide you through it. This way, she feels your support physically and emotionally.”
Tips: In this scenario, the doula empowers the partner by giving them a concrete role, building confidence, and strengthening family bonds. Doulas should always aim to include partners in the process rather than replacing them.
Scenario 3: A mother becomes discouraged after several hours of labor and says, “I can’t do this anymore.”
Doula Script: “I hear you, and it’s normal to feel this way at this stage. You’ve been working so hard, and your body is making progress even if it feels slow. Let’s try changing positions and use the rebozo for some gentle movement—I’ll stay right here with you. You are not alone.”
Tips: This script acknowledges the mother’s emotional state (validation), reminds her of progress, and suggests a physical coping strategy. The doula’s presence reinforces that she is supported, which can renew confidence and resilience.
Evidence-Based Insights
Impact on Birth Outcomes: Research shows that continuous support during childbirth, including doula care, leads to lower rates of cesarean birth, shorter labors, and reduced need for interventions such as pain medication (Bohren et al., 2017). Families supported by doulas also report higher satisfaction with their birth experiences. This suggests that emotional and physical presence directly affects medical and psychological outcomes.
Maternal Mental Health: A study on doula support found that mothers who worked with doulas reported less anxiety and fewer symptoms of postpartum depression (Gruber et al., 2013). The emotional reassurance and practical coping strategies provided by doulas can buffer against the stress and trauma that sometimes accompany childbirth, improving long-term maternal well-being.
Reducing Health Disparities: Research highlights that doula care is especially impactful for marginalized communities. Kozhimannil et al. (2016) found that low-income women of color who received doula care had improved birth outcomes compared to those without. Doulas help bridge communication gaps with medical staff, advocate for patient preferences, and reduce disparities in maternal and infant health outcomes.
Key Terms & Definitions
Birth Doula: A trained professional who provides continuous emotional, physical, and informational support during labor and delivery. Unlike midwives or doctors, they do not perform medical tasks.
Continuous Support: A model of care emphasizing the uninterrupted presence of a support person throughout labor. Research shows this approach improves maternal outcomes.
Rebozo: A traditional Mexican woven cloth used by doulas to provide comfort measures during labor, such as belly sifting, rocking, or easing tension in the hips.
Birth Plan: A written document created by expectant families to communicate preferences about labor, delivery, and postpartum care. Doulas often help families review or advocate for their plans.
Emotional Validation: A communication strategy where the doula acknowledges and affirms the feelings of the birthing person. This builds trust and reduces anxiety during childbirth.
A Day in the Life of a Doula at NewYork-Presbyterian Brooklyn Methodist Hospital
A group of women in NYC is fighting to make doulas accessible to everyone
2. The History and Evolution of Doula Work
Learning Objectives
Trace the origins and historical role of doulas and other traditional birth attendants across cultures.
Understand how the modern doula profession developed and became recognized in contemporary maternal care.
Identify key social, cultural, and medical factors that have influenced the role of doulas over time.
Definition & Explanation
The role of the doula has deep roots in history, though the title “doula” itself only became common in the late 20th century. In many cultures, childbirth has traditionally been supported by women from the community who provided comfort, guidance, and practical help. These attendants were often family members, neighbors, or wise women with experience in birth. Their focus was not clinical, but relational—ensuring that the birthing person felt safe and surrounded by support.
The word “doula” originates from the ancient Greek term for “a woman who serves.” In the context of birth, it came to describe someone who attends to a birthing person with compassion, presence, and practical aid. Before modern medicine and hospital births became the norm, this type of support was common and deeply valued.
As Western medicine advanced in the 19th and 20th centuries, childbirth moved from the home to the hospital. While this shift improved survival rates in some cases, it also reduced the presence of traditional support systems. Birth became more medicalized, with doctors and nurses taking center stage. Many families were left without the kind of continuous, personal care that had long been provided by birth attendants.
In the 1960s and 1970s, researchers like Dr. John Kennell and Dr. Marshall Klaus studied the benefits of continuous emotional support during childbirth. Their work highlighted how women supported by a consistent companion had shorter labors, fewer interventions, and more positive birth experiences. This research sparked renewed interest in non-medical birth support, leading to the development of doula training programs like the Doulas and Nurturing Traditions Network (DNT Network).
Today, the role of doulas continues to evolve. They have become more formally recognized as valuable members of the maternity care team, complementing doctors, nurses, and midwives. In many places, hospitals, insurance companies, and Medicaid programs are beginning to integrate doula services, recognizing their impact on outcomes and satisfaction. The history of doula work reflects both cultural traditions and modern research, showing how ancient practices can find new relevance in contemporary healthcare.
Scenarios & Tips
Scenario 1: A pregnant client asks why they should hire a doula when hospitals already provide nurses.
Doula Script: “That’s a great question. Nurses are highly skilled at providing medical care, but they often care for several patients at once and have to focus on monitoring and procedures. My role as a doula is different—I stay by your side the entire time, focusing only on your emotional comfort, physical support, and helping you understand your options.”
Tips: This response highlights the historical evolution of the doula’s role as separate from medical staff. By acknowledging the valuable role of nurses while clarifying the doula’s unique contribution, clients gain a clearer understanding of why both are important.
Scenario 2: A client from a cultural background with traditional birth attendants shares that her grandmother had a “birth helper” at home.
Doula Script: “That’s beautiful to hear. In many cultures, women have always been supported by someone experienced during birth. Today, doulas carry that tradition forward in a professionalized way. My role is to honor those traditions while helping you navigate the modern birth setting so you can feel supported in both worlds.”
Tips: This response respects cultural heritage and connects it to the modern doula profession. It reinforces continuity across time and cultures, helping clients feel that choosing a doula is part of a larger human tradition.
Scenario 3: A partner asks if doulas are just a “new trend.”
Doula Script: “Actually, doulas aren’t new at all. The idea of having someone provide continuous support during birth is thousands of years old. What’s new is the training and professional recognition doulas have today. We’ve taken those age-old practices and adapted them to fit modern medical settings, while still focusing on the same goal: making birth safer, calmer, and more positive.”
Tips: This helps clients understand that doulas are not a fad, but part of an enduring tradition supported by evidence. Framing the profession as both historical and modern strengthens trust and legitimacy.
Evidence-Based Insights
Cultural Traditions of Birth Support: Anthropological studies show that nearly every culture historically included supportive figures at birth, from “granny midwives” in the U.S. South to traditional birth attendants in Africa and Asia (Jordan, 1993; updated ethnographic reviews 2015). These findings emphasize that the doula role is not new but deeply embedded in human societies.
Reintroduction Through Research: A landmark randomized controlled trial by Kennell et al. (1991) found that women supported by a continuous companion (similar to a doula) had shorter labors, fewer cesarean births, and less need for pain relief. This research was pivotal in reviving interest in birth companions and shaped the modern doula movement.
Modern Professionalization of Doulas: Recent studies highlight how doula programs in hospitals and communities are formalizing this support role. For instance, research by Kozhimannil et al. (2016) shows that Medicaid coverage of doula care reduces healthcare costs by preventing unnecessary interventions while improving maternal satisfaction. This reflects how ancient traditions are now recognized in policy and practice.
Key Terms & Definitions
Traditional Birth Attendant (TBA): A non-medically trained community member who assists in childbirth, often drawing on cultural practices and wisdom passed down through generations.
Medicalization of Birth: The process by which childbirth became increasingly managed by medical professionals in hospitals, often shifting focus away from natural and relational aspects of the experience.
Kennell & Klaus Studies: Foundational research in the 1970s–1990s demonstrating the benefits of continuous birth support, laying the groundwork for modern doula practice.
Professional Doula Movement: The 20th- and 21st-century shift in which doulas became formally trained, certified, and integrated into maternity care systems.
What is a doula?
3. Distinguishing Between a Doula, Midwife, and Other Birth Professionals
Learning Objectives
Differentiate the unique roles of doulas, midwives, obstetricians, and nurses in the childbirth process.
Understand the non-clinical versus clinical responsibilities of birth professionals.
Recognize how collaboration between doulas and medical providers improves outcomes for families.
Definition & Explanation
The birth team often includes multiple professionals, each with distinct roles. Doulas provide emotional, informational, and physical support but do not perform medical tasks. Their focus is on comfort, advocacy, and helping families feel empowered during the birth process.
By contrast, midwives are licensed medical professionals trained to provide clinical care during pregnancy, birth, and postpartum. They can monitor fetal heart tones, administer medications, and in many cases, deliver babies. Midwives often work in hospitals, birth centers, or homes, depending on their training and local regulations.
Obstetricians (OB/GYNs) are physicians specializing in pregnancy, childbirth, and reproductive health. They handle high-risk pregnancies, perform cesareans, and manage medical complications. Unlike doulas and midwives, obstetricians have extensive surgical training, making them essential when advanced medical care is needed.
Labor and delivery nurses are also key players in hospital births. They monitor vital signs, administer medications, and support physicians and midwives. While nurses may offer emotional reassurance, their responsibilities often include multiple patients, meaning they cannot provide continuous one-on-one support in the same way a doula can.
Understanding these distinctions helps families make informed choices about their care team. A doula complements—not replaces—medical professionals. By recognizing the strengths of each role, families can create a supportive, collaborative environment that combines clinical expertise with compassionate, continuous support.
Scenarios & Tips
Scenario 1: A client is confused about whether hiring a doula means they don’t need a midwife.
Doula Script: “That’s a common question! My role as a doula is to provide emotional support, comfort measures, and guidance, but I don’t do medical tasks like checking your baby’s heartbeat or delivering your baby. A midwife, on the other hand, is a licensed healthcare provider who does those things. Together, we make a strong team: your midwife focuses on clinical care, and I focus on your overall experience.”
Tips: This response clarifies without minimizing either role. It emphasizes teamwork, helping the client understand that both professionals contribute in complementary ways.
Scenario 2: A hospital nurse expresses concern that a doula might “get in the way.”
Doula Script: “I really respect the medical expertise you bring to this birth. My role is to focus on the family’s comfort, communication, and emotional needs so you can concentrate on the medical aspects. If there’s anything I can do to support your work, please let me know.”
Tips: This approach builds collaboration, showing respect for the nurse’s clinical authority while reaffirming the doula’s supportive focus. Establishing mutual respect reduces tension and improves teamwork.
Scenario 3: A partner asks, “Why do we need a doula if we already have a doctor?”
Doula Script: “Your doctor will play an important role in ensuring medical safety and delivering the baby. My role is different—I’ll be here the entire time, helping you both feel supported, explaining what’s happening in everyday language, and suggesting comfort techniques. Think of me as the steady presence who stays with you no matter what.”
Tips: This frames the doula’s role as filling a gap in continuous support, which doctors cannot provide due to clinical responsibilities. It reassures partners that having both is not redundant but rather adds balance to the birth experience.
Evidence-Based Insights
Role Differentiation and Teamwork: A 2017 Cochrane Review (Bohren et al.) showed that continuous support during labor—often provided by doulas—led to better outcomes compared to standard care alone. This reinforces that doulas complement, not duplicate, medical providers, making team-based care stronger.
Family Understanding of Roles: Research by Steel et al. (2015) found that families who understood the distinctions between doulas, midwives, and physicians reported higher satisfaction with their care. Clarity about roles reduces confusion and helps parents feel confident in building their birth team.
Interprofessional Collaboration: A study by McLeish & Redshaw (2019) highlighted that when doulas and medical staff collaborate respectfully, outcomes improve, especially in reducing stress and improving communication between families and healthcare providers. Hospitals that integrate doulas into their teams often report higher patient satisfaction.
Key Terms & Definitions
Doula: A non-clinical professional trained to provide emotional, physical, and informational support during childbirth. Focuses on comfort and advocacy.
Midwife: A licensed medical provider specializing in pregnancy, childbirth, and postpartum care. Can deliver babies, monitor health, and manage complications within their scope of practice.
Obstetrician (OB/GYN): A physician specializing in pregnancy, birth, and reproductive health. Provides medical and surgical care, including cesarean sections.
Labor and Delivery Nurse: A registered nurse trained in maternal and newborn care, responsible for monitoring vitals, administering medications, and assisting physicians or midwives.
Interprofessional Collaboration: The practice of different professionals working together to provide comprehensive care. In childbirth, this means doulas, nurses, midwives, and doctors coordinating efforts to support families.
👉 Knowledge Check
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A birth doula is a trained professional who provides continuous physical, emotional, and informational support to a birthing person before, during, and shortly after childbirth.
Doulas do not provide medical care but work alongside healthcare providers to enhance the birth experience.
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ohren, M. A., Hofmeyr, G. J., Sakala, C., Fukuzawa, R. K., & Cuthbert, A. (2017). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, 7, CD003766. https://doi.org/10.1002/14651858.CD003766.pub6
This Cochrane Review found that continuous labor support, often provided by doulas, leads to shorter labors, fewer cesareans, less need for pain medication, and greater maternal satisfaction.Steel, A., Frawley, J., Sibbritt, D., & Adams, J. (2015). Trained or professional doulas in the support and care of pregnant and birthing women: A critical integrative review. Health & Social Care in the Community, 23(3), 225–241. https://doi.org/10.1111/hsc.12112
This review examined professionalization of doulas, highlighting their unique role distinct from midwives and physicians, and how role clarity influences care experiences.McLeish, J., & Redshaw, M. (2018). A qualitative study of volunteer doulas working alongside midwives at births in England: Mothers’ and doulas’ experiences. BMC Pregnancy and Childbirth, 18, 35. https://doi.org/10.1186/s12884-018-1667-0
This study found that respectful collaboration between doulas and midwives improved women’s experiences, reduced stress, and enhanced communication in maternity care.Jordan, B. (1993). Birth in four cultures: A crosscultural investigation of childbirth in Yucatan, Holland, Sweden, and the United States (4th ed.). Prospect Heights, IL: Waveland Press.
Jordan’s anthropological work documents that birth support figures are a cross-cultural constant, embedding the doula role in human societies historically.Kennell, J. H., Klaus, M. H., McGrath, S. K., Robertson, S., & Hinkley, C. (1991). Continuous emotional support during labor in a US hospital: A randomized controlled trial. JAMA, 265(17), 2197–2201. https://doi.org/10.1001/jama.1991.03460170051032
This landmark RCT showed that continuous emotional support shortened labor, lowered cesarean rates, and reduced need for pain relief, sparking modern doula interest.Kozhimannil, K. B., Hardeman, R. R., Attanasio, L. B., Blauer-Peterson, C., & O’Brien, M. (2016). Doula care, birth outcomes, and costs among Medicaid beneficiaries. American Journal of Public Health, 106(4), 698–704. https://doi.org/10.2105/AJPH.2015.302982
This study found that Medicaid beneficiaries with doula support had lower odds of cesarean delivery, lower costs, and improved maternal satisfaction, especially among women of color.Gruber, K. J., Cupito, S. H., & Dobson, C. F. (2013). Impact of doulas on healthy birth outcomes. Journal of Perinatal Education, 22(1), 49–58. https://doi.org/10.1891/1058-1243.22.1.49
This study reported that doula care was associated with reduced anxiety, fewer symptoms of postpartum depression, and healthier maternal mental health.