Do I need a Doula?

What does a doula do—and do you really need one?
In this episode of A Mother Is Born, birth mentor and labor doula Kayla Mackenzie explains the real role of a doula in pregnancy, labor, and postpartum. Learn how doulas provide physical comfort measures, emotional reassurance, informed decision-making support, and advocacy in both hospital and home birth settings.

We’ll compare doulas vs. midwives, share research-backed benefits like lower C-section rates and shorter labors, and address common myths—such as “I don’t need a doula if I have an epidural” or “My partner can just be my doula.” You’ll also hear tips on how to choose the right doula for your values and birth plan.

If you’re pregnant, planning your first birth, or preparing for a VBAC, this episode will help you understand how a doula can transform your birth experience.

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Transcript

What does a doula do? 

Kayla Mackenzie: [00:00:00] Welcome to A Mother Is Born, a podcast to support you on your journey into parenthood. From that first moment when you wonder if you might be ready to try all the way through the logistical and identity shift into motherhood. I'm Kayla McKenzie, a birth mentor and labor doula based in Utah County. I offer in-person support locally and virtual mentorship wherever you are in the world.

This podcast is here to meet you wherever you are in the process, from preconception, postpartum, and everything in between. Through honest conversations, grounded education, and support that centers you. My hope is that you walk away feeling informed and empowered and never alone. Subscribe now and join me each week for real talk Tender truth, and the reminder that a mother is born right alongside every baby.

Hello. Thanks for joining me for another episode of A [00:01:00] Mother Is Born. Today we're going to be talking about doulas. So if you've ever wondered, what does a doula actually do? Could I really use one for my birth? Then this is the episode for you.

We're going to be diving into what a doula is, answering some common questions and clearing up common misconceptions about doula work so that you can make an informed decision about whether hiring a doula is right for your birth experience. So let's go ahead and get into it. First of all, what is a doula?

A doula is a professional who supports women during labor and child birth, so she's very well informed about birth. She knows how to recognize progress during labor. She knows all of the intervention options that you might be offered, as well as alternatives to them and when they're likely actually needed, and she comes with you to your place of birth to offer you physical, emotional. Informational and communication [00:02:00] support during your labor.

So here's a little bit of what that could look like.

Physical support. Sometimes this looks like giving massage, counter pressure, holding your hand, helping you change positions because changing positions when you have a baby in your pelvis is actually. Really hard, or sometimes you just forget to change positions altogether. She might be coaching your breathing. So those are some of the ways that a doula helps physically during your birth

emotionally, before you even went into labor, she helped to you to clarify what is actually important to you about your birth experience so that your values are not overlooked or. Swept away in the current of other people's opinions so that you can look back on your birth, feeling happy and satisfied in the moment. She helps you emotionally deal with the challenges of labor. She helps you stay present and focused one contraction at a time. Not [00:03:00] trying to, oh my goodness, how much longer is this gonna be? I'm gonna be here forever. And this is impossible. But she helps you stay focused. On doing just one contraction at a time. She reassures you that things are going well because she knows birth well and she can tell that everything that you're going through is normal. She might speak affirmations to you or help you with visualizations. Whatever coping methods you want to use, she's there to help. Facilitate that, and then she's also watching for signs of suffering. No doula wants their clients to suffer in labor. Suffering is what leads to birth trauma, so it's okay to experience pain and discomfort and challenge, but if you start to seem like you're not coping, that you're panicking that you're. Screaming and sobbing and just having a really hard time. Then your doula is there to step in to offer [00:04:00] more ideas and alternatives and to help ground you, to get you back to a place where you are coping and not suffering.

Another thing I mentioned is informational support. So doulas, like I said, know birth really well. They are a guide to help you navigate it. Before you go into labor in your prenatal meetings, they'll be there to answer any questions that you have about the process, about what to expect from your body about different places that you could give birth providers you could use. All of your options. Interventions to expect to be offered to you. And then during labor, they're giving you informational support in real time. So let's say the doctor comes in and they're like. Hey, so you've been at a six for a few hours and you haven't dilated anymore. We think it's time to start you on some Pitocin.

Your doula knows that being at a six for a few hours is completely normal and they can provide you with that information [00:05:00] as well as help you ask the doctor, Hey, is there something that you're concerned about? In my case. That makes you feel like the baby needs to come out faster or is this just something that you always recommend to women who are at six centimeters or any other dilation for a few hours, right?

So she can recognize when, hey, maybe we need to ask some more questions here. This doesn't quite seem right that this is being presented as your only option,

and that kind of leads into communication support as well. Your doula acts as. A bit of a liaison between you and the medical staff to make sure that they do understand your birth preferences and that they're honoring them, and that if anything is happening outside of your birth preferences, that you've already expressed and stated to them that they are getting your consent before doing anything.

And that way she acts as an advocate for you, for your experience because she doesn't work for the system, [00:06:00] she just works for you.

One way that I provide communication support to my clients is during our prenatal visits. . I find it really useful to do some role plays with my clients. So for example, if I have a client who is nervous about presenting their birth plan in a prenatal appointment because they don't think their provider is going to agree with everything on it. Then we practice doing that together so that when the time comes for them to go to that appointment, they feel confident and ready to advocate for their desires. , Sometimes I even go with them to those appointments and help them do it in real time.

We also role play what it looks like to stand up for their preferences during labor. So for example, I'll have the mom kneel down, leaning over the yoga ball, pretending that she is in labor, getting ready to push, starting to feel those urges to push out her baby.

And her husband is supporting her, giving her counter pressure. And I walk in as the doctor and I say, okay, Sarah, I hear that you're [00:07:00] sounding pushy. Let's get you up on the bed on your back so you can push this baby out. Okay, husband, what are you gonna do? What are you gonna say? How are you gonna help her?

How are you gonna advocate for your preferences? So we work through all of those things and create a solid foundation of communication where my clients. Know what their rights are and they have words and tools that they can use to express their preferences.

Another role that a doula plays is acting as a witness for your experience. And this might sound simple, but it's actually huge. Do you know how much of a difference it makes to have someone who knows what your rights are and who is really familiar with birth and the medical system there watching everything that happens to you and everything that you're offered during labor, that's gonna change the way that your medical staff interacts with you.

If they know that there's someone that you've hired and you've brought in [00:08:00] to help advocate for your rights and that everything that they do to and for you is being watched by that person. It is also helpful to have a witness for processing your birth experience afterward. If you have any questions or concerns about anything that happened, you can talk through it with somebody who was there watching it all happen in real time.

And if there's anything that happens during your birth that you don't feel okay with that did violate your rights as a client or as a patient, then your doula also witnessed those things and they can help you bring forth a complaint. Or get legal restitution.

So one com really common question that I get asked is, what is the difference between a doula and a midwife? And these roles are actually really, really different in scope. There's almost no overlap actually with them. So let me explain. A midwife. Is there for your safety. Her scope is medical,

she's meeting with you for [00:09:00] prenatals and checking your vitals and measuring your fundal height, where the top of your uterus is, and maybe administering medications. , When you're in labor, she's monitoring your baby, checking on the heart rate, monitoring your bleeding, making sure that you and baby are safe and well.

A doula is there for your experience. So midwife is safety, doula is experience. Your doula's Primary responsibility is making sure that you can look back on your birth experience as a positive, empowering memory. Where you felt supported and heard and valued as a person, and like you got to lead your birth experience rather than it happening to you.

So hopefully that's clear again, midwife safety, doula experience. Another important difference is that at least if you're delivering in a hospital setting, your midwife [00:10:00] works for the hospital. They answer to the hospital. They are required to offer you things according to the hospital's policies and standards and procedures.

The doula just works for you, so she doesn't have these other pressing obligations and pressures that would cause her to act not in your behalf . she's not prioritizing, say, mitigating hospital's liability. She's prioritizing you. Just you.

So let's talk about the benefits of having a doula. So randomized trials and meta-analyses, including multiple trials. So 15 of these randomized trials with over 12,000 women consistently show. That having continuous support from a doula leads to shorter labor durations, reduced need for operative delivery, so that's C-sections, [00:11:00] episiotomies, forceps, and vacuum deliveries, lower uses of pain medication during labor, greater spontaneous vaginal births, and fewer negative birth experiences, so less trauma.

So to give some numbers with these studies, if women had a doula, they had a 13 to 14% chance of having a C-section versus without doula support. A 25% chance So. That's a double. Without a doula support, they were twice as likely to have a C-section.

That difference in cesarean outcome is actually amplified if a woman has an induced labor. So if a woman has an induction and she does not have a doula, she has a, she had in the study. A 58% chance of having a C-section. If she had a doula with her, she had a 12 point a half percent chance of having a C-section.

For [00:12:00] epidural use. 65% of women with doula support opted for an epidural.

76% of women without opted for an epidural.

So again, this is just because the doula is there to provide support and to act as a witness and advocate on this woman's behalf. That's what's changing these numbers.

So that all sounds great, right? But how much does a doula cost? That is another frequently asked question, and the answer is, it's hugely variable.

So you can find doulas who are more of hobby doulas., They're in it because they love witnessing births, but they don't really do it as a career and they don't do it to make ends meet for their family. , If you can get a doula like this, it might be as inexpensive as like $800 for doula support. Now it's important to remember as we go through the rest of these numbers, what a doula is offering you and how much time and energy and effort and [00:13:00] expense she's putting into your care.

'cause not only is a doula attending your birth, which might be four hours long and it might be 36 hours long and she's there for it, right? Not only is she there during labor, but she's providing. Prenatal visits in preparation, sometimes postpartum care and on-call support. So oftentimes, let's say you are pregnant until you're 42 weeks, and then you have your baby, your doula was likely on call for four or five weeks.

Just always being available, ready at the drop of a hat to leave whatever she's doing, not traveling, making sure that she can get to your birth. So that's a lot of where the cost comes from is the on-call period. Okay,

so again, you can get like a hobby doula for maybe $800. . If you want a really fancy package with all the bells and whistles, lots of prenatal support or lots of postpartum support, or a really specialized doula, you might pay as much as 5,000. Now I'm in Utah County and most. [00:14:00] Professional doulas around here for a package that includes, say, two prenatal visits, one postpartum visit, and birth support is gonna run anywhere from 1200 on the low end to 2200.

On the higher end is about what you're looking at for that kind of support

Now it's definitely an expense.

I personally think it's kind of cheap for what a doula does for their whole on-call period for the difference that they make in your outcome. As far as like both medically, whether or not you have a C-section, how the baby's doing when the baby's born, and also. Mentally and emotionally, right? Like whether or not you need therapy because you had a traumatic birth experience is hugely influenced by whether or not you had a doula on your side.

Like half is likely to need a C-section. That's huge and will likely save you money if you have any out-of-pocket costs on your insurance because you won't be as likely to have to pay for a C-section if you have a [00:15:00] doula,

but I recognize I'm a doula talking. Of course. I think it's worth it.

Next, I wanna talk about some misunderstandings about doulas. So here are some of the most common myths and misconceptions that I hear that I wanna take some time to talk about.

First, I'm getting an epidural, so I don't need a doula. Or maybe a doula wouldn't even want to support me. They wouldn't have any job. Epidural births deserve support too, and they need support too. I think sometimes in our culture, we have this idea that the epidural takes away all of the intensity out of the birth experience.

, And sometimes it does a really good job at that, but sometimes, honestly, getting an epidural makes a birth experience more intense than it would be otherwise. I've had clients who get an epidural and they were always planning on the epidural, and then it doesn't work.

They still have so much breakthrough [00:16:00] sensation and pain and discomfort, but. The immobilizing effect of the epidural works. So they're stuck in bed and they can't move and get into positions that make them more comfortable. And they're still getting all of this pain. And I don't tell you that to just like scare you and share a horror story, but I think it's important to be aware that you should have other coping techniques in your back pocket if you decide to get the epidural in case you still need extra help managing the discomfort.

And so when I've had clients do that. I am there with them working with their breath and still giving them counter pressure and massage and affirmations, and helping them stay calm and present and reduce the amount that they're suffering when their choice of pain relief didn't work for them.

Getting an epidural or an induction or any other kind of intervention also increases the likelihood that you'll need or be offered [00:17:00] other interventions.

And in that situation, a doula can really help you navigate what your options are, whether or not you actually need these additional things. Because often once you're immobile in the bed because you have an epidural, unfortunately a lot of medical providers take that as permission to just do whatever they want to your body.

At that point, they're like, oh, okay, she's got the epidural, she's in bed. She wants whatever else we have to offer her. We can stick our hands inside of her as much as we want, and. That's just how it goes. , She's fair game now, and that's not the way it should be. So your doula can also still be your advocate and still help you be able to retain autonomy and informed consent and control of your body in a situation where you have given consent to certain medical procedures already.

Another common myth. I'm giving birth in a hospital so a doula won't be allowed or won't help. Again, this, this kinda goes along with the epidural thing, [00:18:00] and obviously you're not gonna be getting an epidural if you're outside of the hospital, but this in the hospital, I believe, is where a doula is needed most.

Even though doulas are often associated with home birth or natural or birth center births, when you're at home, you are the center of your experience and the lead by default. That's not the way it is, in a hospital setting. The hospital setting is a system that is meant to maximize efficiency and minimize liability, and their top priority is not catering to whatever you want.

It's not making sure that your values are honored, and again, a doula can act as an advocate to help prevent you from just getting whisked away downstream. On the hospital system conveyor belt, that doesn't value the things that you value. Another common thing that I hear from people is, I don't need a doula because my [00:19:00] partner is going to be my doula.

And honestly, I could talk about this one for so long that I probably will have to do another episode just solely on this idea of the partner. Your partner, so usually the baby's dad, for example, being your doula. So first I wanna say that yes. A partner can be such a great support during labor and they can be involved and it can be this beautiful experience, and that's what most people want and are looking for when they're saying, I want my partner to be my doula.

They're saying, I want this to be a beautiful connecting, intimate experience just between me and my partner. And I think that that's a beautiful desire. Unfortunately, what often happens is the partner ends up watching helplessly as the laboring woman suffers and they don't know how to help. And let's say she's planning an unmedicated labor and he's practiced the counter pressure ahead of time, and it's working for the first little bit, but then [00:20:00] things get more intense and the type of counter pressure that he was doing just isn't working anymore, and he doesn't have the background and the experience to know the best way to pivot to help take care of her. And so then she gets the epidural and then he sits on the couch and kicks his leg up and chills for the rest of the experience. 'cause he doesn't know how to still be involved after she gets the epidural.

Quick break. If you've been listening and thinking, I wish I could just talk to someone about my specific situation, I have good news for you. You totally can. I offer virtual consults for people in all stages of the journey, trying to conceive, preparing for birth, or processing a past experience. If you want some grounded guidance in a place to talk it through, head to Kayla mckenzie.co/support to book your session.

I'll link it in the show notes for easy access. Now back to the episode.

A doula is really there to help support your partner's experience as much as to support your own [00:21:00] experience.

So when I have a partner. Who wants to be really involved, which is most of the time, most of the clients I work with have a partner who wants to be really involved in the experience. We always talk ahead of time about what do you want that involvement to look like? Do you wanna do most of the physical support?

Do you wanna focus on emotional support? Do you wanna focus on advocating with the medical staff? What do you wanna do? And we really flesh that out because it's a lot to expect just one person to do, especially when that person is not trained as a birth professional. Another example, let's say. The husband is offering amazing emotional and physical support to the woman, and she needs it through every contraction to help her stay focused, to help her stay grounded and calm.

And then the doctor comes in and says, Hey, we're ready to break your water now. And the birth partner knows that that's not what his wife wanted, but she. Needs him through every contraction to be giving pressure to be focused on her. And so he struggles to [00:22:00] create that space, to ask questions and to make sure her preferences are honored because really it's just a lot for one person to do. I always recommend, even if you don't wanna doula, bring a second person. Bring somebody else who loves you and cares about you.

If possible, bring somebody who's a little bit more neutral than your partner , because your partner's gonna have a harder time seeing you in discomfort and have a harder time managing if the doctor seems to think that there are any risks with the baby. Related to your birth preferences.

Whereas a doula is a neutral party, and she can help navigate these situations in a way that's less emotional.

So again. Your birth partner is amazing. They're vital, and a doula is not meant to take their place. Really. A doula can help them have a better experience and feel more involved. She can be watching when he's kind of retreating to the corner because he doesn't know what to do and she can say, [00:23:00] Hey, can you come and help her slow down her breaths with each contraction and give him a job. Or, Hey, how about you try this counter pressure? Let me show you where to put your hands. Empowering him to be the partner that he wants to be. And again, I could do a whole podcast on this topic and maybe I will sometime. So we'll put a pin in that for later.

But just know that your partner and your doula. Play different but cooperative roles.

Another myth, some people think that their nurse will be in there with them the whole time basically playing , the role that a doula plays, and this is simply not the nurse's role.

Nurses are awesome most of the time, and they also one work for the hospital. So, they have all of those pressures that come with working for the hospital system on them. To push you toward whatever the hospital wants you to do or your doctor wants you to do. They also have a lot of responsibilities.

They might have multiple patients at the same time. They have to chart all of your medical notes and monitor your [00:24:00] baby, and they're just not available to consistently give you physical and emotional support throughout your whole labor.

So if you are leaning toward hiring a doula, let me give you some ideas of how you can find the one that's right for you. A lot of people interview a bunch of doulas and they look up lists of questions online, and those lists of questions are always the same. I can always tell when somebody is poll all their questions from one of those lists, which is fine, and I'm happy to answer them, but they always include questions like, how many births have you attended?

This question, in my opinion, isn't the most important question that you can ask. One, because newer doulas are often the best. Being a new a newer doula does not mean that she's less qualified to support you during your labor. Second, a lot of doulas don't even keep track of that number because it just, again, isn't that important?

Yes, experience is helpful. Yes, it matters, but it's just [00:25:00] not. How many births your doula has attended, whether it's 10 or 50, is not likely to make or break your experience with them.

So here. Are some questions and information that I would try to get from a doula. When you're considering hiring them first, what is their philosophy about birth? What do they believe about it? How do they feel about medical interventions? Are there any birth choices that they would not support? For example, some doulas won't go to the hospital because they don't believe that birth should take place in the hospital, or they're just not comfortable there.

Some doulas do not wanna support you if you get an epidural and other doulas are all for it.

Also ask how comfortable they are in advocating for your needs within the medical system is if that's something that you want them to do, because some doulas do advocacy and some doulas don't do advocacy. So some doulas are gonna tell you that's your responsibility. I am here for your physical and emotional support.

And [00:26:00] that's it. Also, what sets them apart from other doulas, what are their specialties or their focuses or their loves?

So for me, I specialize in against the flow births. I love supporting women in hospital births who don't wanna birth on their back and who. Are not open to having cervical checks or whatever the case is. I'm like, yes, let's defend your right to choose for yourself within the hospital system. I love working with that kind of a client.

I love working with first time unmedicated parents who it's their first birth and they're preparing to do it without the epidural, which is very , against the grain for our culture, and I just love that. I also specialize in working with. Parents who had a previous traumatic birth experience and who want something different this time.

Love helping them figure out how they can make it different this time and being with them when they're looking back and saying, oh my goodness, that was amazing. That was so much better. [00:27:00] It was everything that we hoped for. Those are, are my specialties.

Find out what your doula. Specializes in and find one who values what you value.

Besides that, I would say don't be afraid to just lean into the vibes. So your doula is going to be with you in a really, really intimate and vulnerable situation. Do you feel like you can imagine this person in that situation with you?

And like you would feel comfortable and safe with them.

I love clients who feel like best friends. Honestly, it's my favorite thing to have clients who are just so aligned in . Our philosophy about birth and our philosophy about life, and they become people that I love keeping up with throughout my life.

So find a doula who's like that for you.

There are a lot of great options out there. Hopefully there are in your area. If not, I do [00:28:00] offer virtual. I do offer virtual coaching to at least help you with the prenatal side of things.

Getting ready for your birth,

anyway, that's what I have for you today. Hopefully you found this helpful. If you have any more doula related questions, feel free to reach out on Instagram through email. Links are in the show notes. I would love to hear from you. I would love to make that connection and answer your questions. Thank you for being here and I will talk to you next time.

Thanks so much for listening to a Mother Is Born. Don't forget to check out the show notes for lots of great resources and for ways to connect. I would absolutely love to hear from you. If you are listening to this episode and you thought of a friend who might benefit from this message, please send it their way.

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