Years ago new and expectant couples called on their parents and siblings to lend support and assistance during labor, delivery and postpartum. But today many extended families are separated by geographical distances or bound by work responsibilities, so some new parents are turning to doulas for the help they need.

“A doula is an experienced, non-medical assistant trained to support families before, during or after the birth of a child,” says Tracy Wilson Peters, executive director of CAPPA (Childbirth and Postpartum Professional Association). “An antepartum doula assists women on bed rest, overseeing household maintenance and administration and providing emotional support. A labor doula provides non-medical support during the latter part of pregnancy, labor, delivery and a few hours following. And a postpartum doula assists the family in the home after childbirth with information and support on breastfeeding, emotional and physical recovery, newborn care and domestic responsibilities.”

But are doulas a good fit for everyone? Susannah Vitsoric wasn’t so sure – at least not at first.

“Early on in my pregnancy my mom suggested we get a postpartum doula, but I wasn’t interested,” she says. “I didn’t want a stranger infringing on what I considered personal and private time; my husband and I thought we could handle things ourselves.”

Then the unexpected happened.

“I had an emergency c-section and was in the hospital four days,” she continues. “I learned quickly that recovering from surgery, being sleep deprived, breastfeeding and dealing with a newborn and domestic chores were going to be more than I could manage. So suddenly my mom’s suggestion sounded good.”

At that point, Vitsoric’s mother retrieved a list of certified doulas from the hospital’s lactation consultant and started making contacts.

When looking for a doula, check with childbirth educators, birthing facilities, local parenting organizations and other childbirth resources. Also ask friends and relatives for recommendations.

“Once you have a list of names, conduct telephone interviews to narrow your search,” says Hope Irvine-Sank, certified postpartum doula. “Then do face-to-face interviews to observe their mannerisms, style and personality to see who’s the best fit for you. Ask yourself, ‘Is this someone I could envision at my birth experience or assisting us at home?’ Talk with her about what she sees is her role and make sure it’s in keeping with what you’re looking for.”

When to start your doula search will depend on the type of services you need.

“Doulas work on a first-come, first-serve basis and can get booked up rather quickly, so if you’re looking for one to assist during labor, start searching by the fourth month,” says Peters. “For postpartum you can wait until a couple of months before you’re due.”

Cara Lewis did this.

“I was in my fourth month of pregnancy when I decided I wanted a doula to assist with labor and delivery,” Lewis says. “With my first child I had a c-section, but this time I planned to go natural and wanted the support and knowledge of a doula to guide me through it. I asked my doctor how she felt about my using a doula and she encouraged me to do it.”

Once a doula had been chosen, they communicated via telephone and email throughout the pregnancy. The doula also provided Lewis with information on Vbac (Vaginal Birth After Caesarian) births. Several weeks before her due date, they met to decide on a birth plan.

“We talked about my preferences – what I wanted in the birth experience and how I wanted to handle issues that could come up during labor,” says Lewis. “We also discussed her writing my child’s birth story by taking pictures and recording the chronological sequence of events.”

Once labor began, the doula suggested non-medical techniques to speed labor and make Lewis comfortable, and then stayed several hours after delivery.

“When I go into the labor room, I bring things like oils for massaging, a birth ball and a rice sock that can be heated. I also make suggestions about positioning, breathing and visualization – anything to make labor go quicker and smoother,” says Irvine-Sank. “But I’m there for dads, too. Sometimes they’re so emotionally wrapped up in the experience that they appreciate the knowledge, experience and objectivity I bring.”

Lewis’s birth went as planned and she delivered a daughter. After Vitsoric’s birth, the contracted work was just beginning.

“My doula came for a couple of weeks to take care of me, help with the baby and do some domestic chores,” she says. “But what I really appreciated was the newborn care instruction we received. Even though we did prenatal classes, it’s not the same as when the baby is home. Just having a professional there to guide us through was invaluable.”

Although initially Vitsoric had reservations about using a doula, now she’s sold on the idea.

“Even if I hadn’t had a c-section, we would have benefited from using her. It made my recovery and our initial adjustment with the baby go much quicker and smoother,” she says. “And we didn’t feel infringed upon. Looking back, I wouldn’t have had it any other way.”

Typical responsibilities of a trained, experienced doula

• An antepartum doula (APD) typically helps women who are on bed rest due to a high-risk pregnancy. She provides information on support groups and reading material, as well as emotional and physical support. She also assists with household maintenance and administration responsibilities.

• A labor/childbirth doula (LCD) is a support person who attends to the emotional and physical comfort needs of laboring women to smooth the labor process. She does not perform clinical tasks, but uses non-medical techniques and suggestions to help the labor process. She may also provide information support, explaining procedures and interventions, and work as an advocate for the mother’s wishes in communicating with the medical staff. She may do prenatal visits and offer phone support and pregnancy suggestions prior to the birth, and schedule at least one pre-birth meeting to discuss the mother’s preferences and prepare a birth plan. An LCD joins the woman either at home or the hospital/birth center and remains until a few hours after the birth. One postpartum meeting is scheduled to ensure the mother is well informed and supported.

• A postpartum doula (PPD) assists new mothers with the recovery of the birth experience and oversees her postpartum needs so she can focus on the baby. The PPD facilitates the mother’s rest periods, encourages proper nutrition and is available to demonstrate practical newborn care, from feeding and bathing to diapering and dressing techniques. She can also assist new fathers in learning skills and gaining confidence to care for the newborn. For families with older children, a PPD can create a fun and stimulating environment so parents can care for their newborn, rest or enjoy quality time together. A PPD also offers practical household assistance with regard to cooking, light cleaning, laundry and shopping. Postpartum doulas differ from nannies or baby nurses in that they do not take over the care of the baby. While they may offer assistance, their goal is to guide and encourage the mother to learn to care for her own infant and to shoulder domestic chores until she is physically able.

For more information on doulas, contact the following organizations:

• Birth Works
• Childbirth and Postpartum Professional Association
• Doulas of North America
• International Childbirth Education Association