What does a birth doula do?
The short answer is that doulas provide support—emotional and physical support prenatally, during labor, and through postpartum.
What does this look like? It’s a little different for everyone. But your doula should figure out what you need early on and go from there. Some clients want to stay in touch throughout the pregnancy, some hire me at 37 weeks. What follows below is a journey down the river of doula work. Lots a twists and turns and side pathways, but it all comes back together in the end. Trying to explain all a doula does is difficult. That’s what the trainings are full days long and take months to complete, but this is me trying to share parts of it.
The Annapolis Area has provided me with so many beautiful birth experiences, and I want to share those stories.
I had my first consult with Amanda in early October. She was then 28 weeks along and I was excited she got to have pregnant Halloween! She was planning on dressing as an avocado! I only had the chance for one pregnant Halloween—we all dressed as skeletons—my daughter (a year and some months at the time) wore a glow in the dark skeleton jammies that we the cutest and we were so sad when they finally didn’t fit anymore the next year. I think she wore them on Christmas even though I got us all matching jammies, but she just loved those skellies.
I go kinda crazy for Halloween, so I love to hear what every client who celebrates goes as, and then get picture updates from past clients on what their babies go as. State Puff Marshmallow baby was one of my favorites!
Image: Halloween. Stay Puff Marshmellow man baby.
Anyway, during the consultation with Amanda, she was telling me how much she wanted a natural birth and that she knew the stats on doulas. For those who don’t know—doulas reduce the rate of c-section, reduce the rate of interventions across the board, and women who labor with them rate their birth experiences as overall more satisfying.
But don’t take my word for it—take a look at this recent study published in the American Journal of Obstetrics and Gynecology:
Our cohort included 17,831 deliveries; 486 of those received doula care and 17,345 did not….Regardless of the analytical approach, for every 100 patients who received doula care, there were 15 to 34 more vaginal births after cesarean and 5 to 6 more patients who attended a postpartum office visit when compared with those who did not receive doula services. Infants born to these patients were 20% more like likely to be exclusively breastfed, and doula care was associated with 3 to 4 fewer preterm births for every 100 deliveries that received doula care.
Doula care was associated with more vaginal births after cesarean delivery, improved attendance of postpartum office visits, improved breastfeeding rates, and fewer preterm deliveries. The effect of doula care was consistent across race and insurance status (Lemon 2025).
Pretty amazing to see those results! A good doula is worth her weight in gold.
Anne Arundel Medical Center birth with Sarah Austin, labor doula.
Back to Amanda the Halloween pregnant mama—after she hired me, we got together with her husband to have our prenatal meeting. This is usually around two hours where we go over a seven page excel sheet covering all standard care options for a hospital birth. It is catered for AAMC since I am at that hospital most often and know their policies best.
Here’s the thing with hospital policies—they won’t always tell you this (although, most nurses will mention it), but you have the right to say no to anything they tell you. They won’t call the police or kick you out if you say you don’t want continuous fetal monitoring. You don’t have to do everything they say.
Now, the caveat is that your baby has to be doing well for you to be able to safely say NO to continuous monitoring. If they are showing signs of distress, it’s a good idea to continue watching their heart rate. But, barring any signs of distress in baby, you can say no. You can still say no to things. But most moms change up the game a little if things look iffy.
“I do not consent” is a powerful phrase.
That is not to say providers are out to mess up your birth. What I can say is that there are some doctors carry a sense of “I know better than you” with them. And, yes, they went to med school and residency and do have more knowledge about the process of birth. HOWEVER, it is YOUR body. If you want to push on hands and knees, but the attending is saying you can’t…just DO IT. As long as baby is ok, they aren’t going to man handle you back into position.
It is more convenient for a provider for you to birth on your back. But you don’t have to do that!
I go to a LOT of births…last night I was at one and after the birth, I walked into the hallway after sometime to hear the doctor complaining about me to some nurses for suggesting mom change position while pushing. It was awkward as hell because he saw me walk by knowing I heard what I heard. Oh well, buddy. I’m still going to do my job.
One of my main functions as a doula is to make sure you know your options throughout the process. I go over them in detail at the prenatal, which is usually at about 28-34 weeks—after that meeting, I develop a birth preferences sheet catered to your exact wishes. Sometimes these plans change in the moment. For a lot of people, one of the goals says “I am planning an unmedicated birth supported by my partner and doula.” Sometimes the birthing person decides they want to get an epidural or other pain relief medications. I call it a birth preferences sheet instead of a birth plan because birth is a trip—you can be very well read, you can have listened to every podcast—you can have given birth before, but each one is different, especially in the moment. Things can change quickly.
I recently had a surrogate mom who had two births previously. Her second baby came fast and furious and was a beautiful, unmedicated birth. When it came time for this third birth, the parents to be flew in to be by her side, along with her husband, and myself as her doula. The plan was to go unmedicated again, but this little lady in her belly had other plans. She was not in the best position (being OP) and it was causing a great amount of pain and back labor. The birthing mom (also called the gestational carrier) said to me “I won’t be badass anymore if I get an epidural” and she kept apologizing for wanting one. I told her,
“you are literally carrying someone else’s baby. You couldn’t be anymore BADASS.”
She had the epidural and was able to still get into her preferred pushing position—hands and knees. And baby came within a few hours of the epidural. It was truly so beautiful to witness and be a part of another surrogate birth and see that birthing person chose the loving gift on an epidural over trying to stick to her original plan. Her body told her what to do and getting the epidural was what she needed. She was so glad she had the experience she did.
All that to say, a good doula does not have any agenda of her own. My only motivation is that you feel safe and heard during the birth—I will advocate for you and with you, but I’m not going to make you stick to a birth plan that you want to change.
Natural birth can be beautiful and empowering and changes how your immediate postpartum time goes—with my first baby, I had an epidural ten hours into back labor and gave birth 13 hours later. I pushed for four and a half hours and she came out looking right at me, sunnyside up. That is why the pushing took as long as it did and the epidural was the absolute right choice. However, due to how long I pushed—I was grabbing behind my legs and doing about a thousand crunches pushing that baby out, and the next day, I felt like I had been in a car wreck. Everything was so sore.
When you get an epidural and anyone helps hold your legs open (whether on your side or on your back), you are numb so you aren’t able to tell us where you stretch limit is. Without an epidural, you can feel when you’ve hit that limit. Because of this, you’re often extremely sore the next day because we’re stretched you further than you could have stretched on your own.
I thought that was just how you felt after giving birth. But when my second came in the car and the ambulance showed up seven minutes later, they told me they were going to lift me onto a stretcher and roll me into the ambulance. My daughter was still on my chest, umbilical cord still attached, placenta still waiting to be birthed. I got up out of the car and walked into the ambulance holding her, cord still hanging out. I felt amazing. And the next day, I didn’t feel sore the same way at all as that first birth.
So there are many varied and valid reasons for wanting to go unmedicated and I 100% believe in your ability to do it! But there are also times where an epidural is the right choice, even when you originally didn’t want one. A doula can help you figure out when the time is right.
My job is to prepare you with coping techniques and knowledge before the birth so that you are as prepared as possible.
One thing I tell clients during the prenatal is that ‘This will be the hardest thing you’ve ever done.’ It is physically taxing and mentally draining. Labor is usually long and hard, intense and internal.
The Labor Prep Course included in the birth doula package also helps to give your partner the tools needed to comfort you during labor and knowledge of what to expect. As a doula, I consider it part of my job to also doula the partners. This can look like me reminding them to eat and drink because they get so focused on the birthing person that six hours goes by and then I figure out they haven’t had a sip of water that whole time. That is how we get partners passing out during pushing. We don’t want that.
I had one dad hear a nurse say “the baby’s heart rate is dropping” and he passed out and hit his head. They wanted to admit him but he refused. Baby was fine—baby’s heartrate dropping just mean that little guy was getting squeezed and ready to be born. But that dad hadn’t had enough to eat or drink and it contributed to his falling over.
That’s one thing I really go over with partners—you need to know your own limits.
You need to know when to sit down for a break, when to eat and drink. A good doula will be keyed into this and check in with you.
She wins Halloween!
This brings me back to my Halloween avocado client. She was very anxious about the medical setting and from the first time we met, I felt like HypnoBirthing would be a great fit for her. They signed up for my individual HypnoBirthing series that I taught at their house. HypnoBirthing is really great for anyone with anxiety about birth or the medical setting (if they are having a hospital birth). Not everyone can afford a home birth midwife or they could get risked out (if they’re too high risk), but that’s always my first suggestion when someone is stressed about a hospital. I love home births and everything about them is just more relaxed and chill. The difference between a home birth midwife and a hospital midwife is just astronomical in my eyes.
I was at a home birth the other day where the mom was very clearly going to meet her baby imminently and she had never had a single cervical check. She asked the midwife what station her baby was at and the midwife told her to reach her fingers in to check. This mom felt her baby’s head half a fingertip up her birth canal. She got so excited and pushed that baby out shortly thereafter.
This would NEVER happen at a hospital birth. At least not with any of the midwives I usually work with. When you work at a hospital, you are beholden to the policies of that hospital. That is why I am an independent doula, not employed by the hospital.
I had a doctor insist a dad put on gloves at a birth to catch his baby (umm…why?) and he almost missed the birth while messing with the gloves. I told him to come right now so he wouldn’t miss it. Why did that dad need gloves? Baby was coming and he almost didn’t get to catch the baby and almost wasn’t watching to even SEE it!! But some dads would want gloves and that’s ok too. My whole thing is that people know you can say no.
Have you thought about your partner catching your baby? We talk about the options at the prenatal meeting.
The avocado mama labored at home for about nine hours. I got a midnight call that at that point, her water broke, she was no longer able to talk through the contractions, and that they were heading in. I met them at the hospital. She was 9 centimeters dilated when checked in triage, 90% effaced, baby was at 0 station.
These are all excellent signs that baby will be coming down soon. HOWEVER, this mom had felt so safe and connected to her baby at home that the shift to the hospital totally slowed progress. Contractions kept coming and I did all I could to help her breath and move through contractions. Her birth preferences sheet made it clear she didn’t want to be asked about pain or offered an epidural and this was respected.
She knew to ask for intermittent monitoring, so we labored in the shower for a really long time. On the birth ball, on all fours, partner standing in the shower with her slow dancing with the water beating down on her lower back. Hours of shared hip squeezes with me on one side of her and her husband on the other side. Having a doula takes the guess work out of which position to try. There are plenty, but when you’re the one in labor, you don’t want to have to think about it and make choices. You need help doing that, and partners don’t always know what is going to help labor to progress. I have the knowledge of most effective positions depending on where baby is in the pelvis, along with the knowledge of when to change them, how to move during a contraction, how to talk you through a contraction, how to comfort you with different kinds of massages and touches. All these things are taught in my class, but knowing how to do them in the moment is harder than you’d think.
For the avocado mom—we moved in all the ways and I set up her birth cave with gentle lighting, hanging up her birth affirmation cards, getting out her yoga mat, and putting on her relaxation playlist, but she was mentally really blocked. At a certain point, a doctor came in to say if she hadn’t made change yet, she may need a csection. This further derailed things and terrified her. She denied the cervical check as baby’s heartrate was great and there were no signs of distress. I read some more HypnoBirthing scripts to release fears and get her to relax her body as much as she could both during contractions and in between. She and I had a ‘come to Jesus’ talk and she understood and believed me when I told her “You are safe. Your baby is safe. You are not alone. We are right here with you.”
Imagine having that by your side! It makes birth so much better to have someone there who knows what you’re going through.
In these moments, I have moms look into my eyes not even so much for guidance but reassurance that everything is ok—that this is powerful, but so are you. I communicate these things both aloud and with body language. Doulas are always watching the birthing person and partners, picking up on any cues that may be important—to be a good doula, you need to be able to read a room and read people. It’s not a skill everyone has, but that one I do have on lockdown. Not to brag.
The avocado mama trusted her instincts and without a single cervical check after that initial one in triage (when she was 9 centimeters), twelve hours later, she pushed her baby out on all fours in unmedicated bliss and glory. She cried looking up at her husband, baby on her chest, saying, “I can’t believe it did it.” We all believed in her and always knew she could. I’m so proud of her and glad she was able to release and reset and bring baby Earthside the way she wanted.
Let me tell you, 12 hours of hip squeezes and being on my feet left no time to eat real food, so I just ate protein bars in the corner quick in the two minutes before the next contraction came—it was a long, hard, beautiful day for me. Every birth is so different. Every birth is so rewarding for me. I was an English 101 college instructor for a long time and that was not rewarding haha—I am grateful for every birth I get to be a part of.
One time, a partner was really struggling with the intensity of labor. The mom was holding both my hands (luckily, I stuck my wedding ring in my pocket because this lady was STRONG) and he was standing next to us getting more anxious. In between contractions, I quickly dumped out my full water bottle discretely in the sink and asked him to go get me refill (and then quietly told him to take a break/a walk/a breather). The mom was fine with me there and I knew she knew he needed a minute. He came back into the room reset and feeling much less anxious.
This may be too woo-woo for some people, but the energy in the birth room is so important. If anybody is feeling anxious-not just the birthing person—it can throw things off. We want calm energy and confidence. I always aim to bring this into a room I’m entering for births and I help people to get back into their place of power and calm, when needed.
I had another client who hired me after experiencing seven miscarriages.
This eighth baby was their last round of IVF and their last chance. She was so scared to hope the whole pregnancy until she hit the 28 week viability line and then finally allowed herself to hope. A mom who went through so much to get pregnant, stay pregnant, and bring her baby forward is an absolute hero in my eyes. All moms are. But pregnancy after loss has its own unique set of feelings and deep valleys of emotional muck you have to work through—it can be overwhelming and so hard. As her doula, she and I spoke often before the birth with any concerns or questions she had. And when she had to be induced because that’s what was safest for her and baby, she knew exactly what to expect because we had in-depth conversations about it. The needs of every client are different and getting to know you and understand you helps me to be a better doula.
She called me into the hospital just as she decided it was time for an epidural and I moved her in all kinds of positions with the peanut ball to better help bring her baby down and out. She was able to nap and eat lots of popsicles, and snuggle her husband up under the same twinkle lights I bring to every birth to set that birth cave aesthetic. When she pushed her baby out and felt her only living child on her chest for the first time, there wasn’t a dry eye in that room as we felt the overwhelming release of so much grief mingled with so much joy—a tidal wave of celebration and remembrance of loss.
After each birth, I stay for at least an hour to ensure every person that wants that golden hour gets it. I can help with breastfeeding latch and positioning or hand expression—whatever the new parents need at that moment. I like to think of it as tucking in the mom with baby, bringing her any food or drink she needs, and slipping out while they snuggle each other up in love with their new little ones. I get to see people grow their families, watch doggies become big brothers, see mothers become grandmas, men turn into fathers. It’s honestly so moving to see it all unfold and while I’ve been at this a long time, it is still different every single time.
I thank each and every person who has invited me into this critical time in their lives to hold space, walk with them, and guide them through their labyrinth of birth.
Once baby is here and families feel settled, I check in over the next few days via text and make myself available for any questions or any support you may need. Some people need more breastfeeding help or want to know scar mobilization techniques for c-sections. We talk a lot during the prenatal about what to expect—baby blues vs PPD/PPA, mental load, what life might look like immediately postpartum. The Fourth Trimester is a great book to prepare for this. As a birth doula, I set up a postpartum meeting within two weeks of the birth to check in with moms and give time to process and discuss the birth. Especially in cases where things don’t go as planned, I make sure to give moms room to talk about what happened. It is normal for almost every woman to report she lost hours during the birth. This is also a normal side effect of sleep deprivation, being in the moment (I call this ‘being in labor land’), and a gift from mother nature to forget some of the parts of the ordeal. When you have a doula, they can fill in the gaps (if needed) to jog your memory.
I tell everyone, I’m still your doula even after the birth, and I make myself available or any resources and referrals going forward. Whether that’s a lactation consultant, pelvic floor physical therapist, or pediatric specialist, I have a referral list of providers that I know and trust because I either worked with them myself (with my babies) or a client has said they were amazing.
Doulas do so many things, it’s hard to get it all out without experiencing it yourself. I tell myself that goal is to make everything go more smoothly. I help you know what to expect, and help manage things as they happen the day of the big event. I have a doula friend who says doulas a like event planners—experts in the field, making everything unfold seamlessly. You could throw a wedding without one, but it’s much less stressful when you have someone you trust on your side.
A good doula is well worth the investment. Below is a graphic which encompasses my birth doula package. Reach out to set up a consult today!
Sources:
Lemon, Lara., Quinn, B., Young, M., Keith, H., Ruscetti, A., & Simhan, H. (2025, April). Quantifying the association between Doula Care and maternal and neonatal outcomes. American Journal of Obstetrics and Gynecology. https://pubmed.ncbi.nlm.nih.gov/39187115/
