Your basic guide to what you should look for in a doula, based on my experience and those of the women I work with. This is by no means a comprehensive or exhaustive guide, please see Doula UK for any further information.
As a birth worker, I think choosing a doula for some women can be overwhelming. Often women are anxious about the process, which is understandable. What is the etiquette for engaging a doula? In an already confusing and emotional time in a woman's life she now has to forge a new relationship with somebody vital to her birth experience. As women I think we are conditioned to find it hard to hurt somebody's feelings or feel like we're wasting somebody's time. It's easy to see why some women go with the first person they meet to avoid the whole process.
However, there are lots of things to consider. All reputable doulas will admit that personality styles and experience levels differ between them and it's about finding the perfect fit. How do you find that person you are going to put your trust in when you birth your baby? In studies done on birth the only thing that was discovered to significantly affect outcome for mother and baby was the presence of somebody knowledgeable and with some basic training in birth. Having a doula can transform your birth experience and give you confidence in your body and choices.
Where to start?
My first priority when looking for a doula would be if they are accredited with any organisation. The interesting thing about doulas is anybody can get up one day and decide they want to be one - there is no requirement of any sort to have a qualification! The best place to go if you are looking for a reputable doula is Doula UK. They have a list of approved courses that you must attend to be a member, and every doula has to undergo a full mentored training process and assessment. They can also be held accountable and have a proper complaints procedure. As an antenatal teacher I would only feel comfortable recommending Doula UK doulas as I know that they are held to a certain standard. Another really good place to look if you are in South Wales is the Welsh Doula Network. It is a list of all Doula UK qualified doulas working together to support women in South Wales. Many I know personally and can fully recommend.
It might be worth having a search in your local home birth or positive birth groups. Don't immediately go with a Google search as they take paid adverts. Chances are if your doula is really passionate about her work, she is active on these groups to support and encourage women through social media and regular meet ups. Although a doula has to make a living, her passion for birth will undoubtedly spill over into her private life and I would expect to see doulas participating in the discussions. Most of these groups have a strict policy of no self-promoting which is wise. However, if you ask for a recommendation and keep spotting the same name over and over again by other people - that's worth investigating! Chances are if you have been in the group you will recognise their name already. You wouldn't hire a builder or a mechanic without some kind of recommendation and this is even more important.
And lastly - check with other doulas. Doulas often need a good support network due to the emotional strains of the job and will tend to associate with a few others. Any good doula will be happy to recommend any of her colleagues for you to have a chat with. They recognise what a deeply personal process this is. Most doulas are happy to have a no-obligation first chat and in that first meeting shouldn't make you feel pressured to engage their services. There is no one perfect doula for everybody and they should be able to admit where they might not meet your needs. If you are having a VBAC (vaginal birth after caesarean) you really need to think about finding somebody experienced in supporting women in this. Likewise, if you are having a planned caesarean perhaps you would wish to find a doula who has had c-sections herself or has experience attending women who have. A doula should never make you feel inadequate about your birth choices, she is there to serve you in whatever kind of birth that you desire. First impressions are everything and you need to be with somebody who makes you feel comfortable. Do you trust this woman? Could you spend 48 hours with only her?
How much should I pay?
In terms of cost, I would encourage women not to go entirely based on the money. Many doulas offer packages for clients and a lot of doulas will consider discounted rates if money is an issue. Doulas above all want to help women in birth and all the wonderful women I know have done a fair amount of work in the community for less than the going rate. Although this really doesn't seem a fair exchange for such a valuable skill, their passion for their work means they want to help where they can. If you meet somebody who you absolutely love who is outside your budget, can you cut costs elsewhere, such as downgrading on a travel system perhaps? Your doula will be a much better investment. Would it be worth negotiating with your doula on her packages or payment plans? Don't let your dreams go just based on cost. They are offering you a four week space in their life where they will be there for you unconditionally and that is worth the price.
However, if somebody is cheaper than you expect it doesn't mean they won't be a good doula. A lot of doulas are still being mentored within Doula UK and will offer a reduced rate at this time. If they have the knowledge and the passion then you might make a wonderful team!
You would most likely expect to pay between £300-£1500 for a doula's services, the higher price being for places such as London.
What should I be asking?
When you meet your doula, I would advise taking a list of questions so you don't get sidetracked and forget what you were there to find out. Here is a list of questions you might consider:
1. Who do you work for/who are you affiliated with?
2. How many births have you attended?
3. What is your availability around my due date?
4. If you are suddenly unavailable around my due date, who will be present instead? (Will this be a colleague, somebody of lesser experience, somebody perhaps you won't like? You should be encouraged to meet and get to know this person also.)
5. Are you experienced in my particular needs? (VBAC, freebirth, C-section, twins, home birth, etc.)
6. If not, can you recommend somebody who is?
7. Are you on call for me anytime, day or night?
8. What calming techniques do you use in labour? (verbal support, breathing, massage, aromatherapy?)
9. Can I see some feedback from your clients?
10. What were your births like?
11. Why did you decide to become a doula?
12. What will you do if I change my mind about my birth plan in labour? (regarding pain relief or interventions)
13. How will you work with my other birth partner (if you have one) to create a safe and supportive space for me to birth my baby?
14. What do you think is the most current/relevant issue regarding birth right now? (A doula should be continually improving her practise, learning and reading and keeping up to date)
15. What is your personal ethos?
16. Do you have any other commitments that would render you unable to attend me? (Any social or business engagements? Work commitments? Some doulas still keep their day jobs.)
17. Will you attend antenatal appointments with me or offer postpartum doula services? (Continuity of care is important and you might wish to see your doula all through your pregnancy journey.)
18. What will you do if I am pressured by the medical team into something that you know I do not want?
19. What happens if we change our mind close to the date? Is there a contract we must adhere to? What happens if YOU are the one to break the contract?
20. What is your mode of transport?
This is just a starting point but it is worth thinking to yourself what is important to you about your birth plans and where you specifically will need support. Are you looking for a mother figure to make you feel safe, or somebody of your own age who is more like a friend? The word doula is so broad for the types of women you will meet and each has something unique to offer.
Anything else?
It's really worth taking your time as early as you can in your pregnancy to have a look around and do a bit of 'doula shopping'. Your perfect doula should put you at ease, have the skill set to attend you at birth, be upfront about their capabilities and be able to recommend colleagues. Your doula should always be honest and give you confidence in your choices, letting you speak for yourself rather than speaking for you. Doulas believe that every woman has the right to her body and her birth and they have the privilege of being witness to that amazing moment when your child enters the world. Your doula is there to empower YOU. Choose wisely and it will be the best decision you ever make.
