Dear Honest Midwife, 

I'm trying to decide whether or not to hire a doula for my next birth. Do you think they really help? I have heard some people rave about doulas but have read some horror stories too! Any tips for how to pick the right doula? Or should I just skip it? 

Thanks!
Xandra 

Dear Xandra,

On the other hand, a bad doula can be a disaster. Women have experienced doulas making judgmental comments about their choices, picking apart the actions of the medical team, and making inappropriate jokes and comments during sacred moments. But how can you tell a good doula from a bad one before you hire her? 

Here are a three things to look for in a doula:

1. She supports YOU rather than pushes an agenda. The most common agenda a doula will push is for natural birth. There is nothing wrong with a natural, drug-free birth; however, there is something wrong with a doula pushing you into having one if it isn’t what you want. A doula should respect that you may change your mind about your birth plan once you are in labor or if things take an unexpected turn, and she should happily support you regardless of your preferences.

2. A doula never gives medical advice. Doulas are not required to have any medical training at all. They should freely disclose that they do not have the knowledge to guide your medical decision making. You hire a medical professional (doctor or Certified Nurse Midwife) to consult with about medical concerns, and you hire a doula to rub your back, say encouraging words, and otherwise physically and emotionally support you during the birth process. 

3. You should feel very comfortable with your doula. This needs to be a person to whom you can say, “Stop touching me!” one second and “Hold my hand!” the next. She needs to be someone to whom you can say, “I need a few minutes alone,” and also someone to whom you can shout, “Puke bucket!” without shame. If your doula makes you on edge or uncomfortable at all, she is not a match for you, no matter how highly recommended she is. If she is someone you feel you can totally be yourself around, you have likely found the right person. 

All that said, a doula is not a necessity. Most women do not hire one. If you aren't excited about hiring a doula, you can safely skip it. 

When you interview a doula, you may want to ask her some “test” questions. I have made a little quiz that may be helpful in determining some questions to ask, as well as some possible answer variations you may hear. 

You ask, “Will you support me in staying home as long as possible before going in to the hospital?” Your doula replies:
A. “Yes, definitely, that is an excellent plan.”
B. “I’ll be happy to! I can even bring a doppler to monitor your baby, and check your cervix so we know when to go in!”
C. “Absolutely! And if we’re too late, I’ll just catch the baby for you!”
D. “I’m comfortable with supporting you at home as long as you follow your care provider’s recommendations as far as when to arrive at the hospital.” 

You ask, “What if I change my mind during labor and decide that I want an epidural?” Your doula:
A. Frowns, shrugs sadly, and says, “I mean, it’s up to you.”
B. Looks shocked and says, “I’ll remind you of all the reasons you definitely do not want to do that!”
C. Laughs and says, “Oh, don’t worry, I’ll talk you out of it!”
D. Looks into your eyes and says, “If that’s what you want, I’ll do what it takes to help you get it as soon as possible.” 

You ask, “How far will you go to help me avoid a c-section?” Your doula replies:
A. “A c-section is a worst-case scenario only and we will do everything in our power to avoid that.”
B. “As long as you listen to me, you won’t have to worry about c-sections! I have great statistics!”
C. “I’ll do anything to help you avoid a c-section, even if it means we sign you out against medical advice and head home to give birth with a midwife I know!” 
D. “C-sections are sometimes needed to make sure a baby is born safely. If that happens, I’ll do everything I can to support it being the best experience possible.”

You ask, “What are your thoughts on vitamin K, eye ointment, and hepatitis B vaccines in the hospital?” Your doula replies:
A. “Oh, those are totally unnecessary and you should refuse as many of them as possible.”
B. “It’s up to you whether or not to poison your baby with those things.”
C. “The hospital will force those things on you; have you considered giving birth at home?"
D. “You should discuss those with your pediatrician. It would be inappropriate for me to advise you on medical decisions for your baby.”

You ask, “What if I decide at the last minute to stay home and have my baby?” Your doula replies:
A. “Great! I’ll call a local midwife I know.”
B. “Perfect, I have a pair of gloves I’ve been carrying in my purse for just such an occasion!”
C. “Unassisted birth is really the safest choice; maybe you should just start planning one!”
D. “I cannot support an unsafe situation for you. I would be forced to call 911 and hope that you would accept transport from the paramedics.”

You ask, “What if the doctor says that I really need an intervention, like continuous fetal monitoring? What will you do?” Your doula replies, 
A. “It’s my job to help you avoid interventions. I’ll tell you how to refuse it when the time comes.”
B. “You can just relax and I’ll remind the doctor to follow your written birth plan exactly.”
C. “That’s probably going to happen. Have you considered avoiding that situation by planning a home birth?”
D. “Sometimes interventions are the safest option; they can help treat or avoid complications. If an intervention is needed, I will focus on helping you feel as comfortable as possible during the process.”

If you haven’t guessed it by now, D=Doula! If your potential doula answers like the D choices, she is a professional who understands the correct and safe role of the birth support person.