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As a single expectant mother, one of my greatest fears was giving birth alone. This was somewhat of an irrational fear, as I had planned on a hospital birth with my midwife, who assured me a team of nurses would be caring for me through every contraction. Still, my mind wrapped around the one thing I didn't have: a partner with whom I could share the labor experience. Intent on finding support, I decided to hire a doula, someone whose sole purpose throughout my daughter's birth would be my well-being as I made the transition into motherhood. Of course, nothing went as planned.
When I went into labor, my best friend, a woman who'd signed on to be my emotional support person, was out of town. My sister, traveling from the West Coast to Brooklyn, was delayed in transit. And the doula I'd hired couldn't make it to the hospital because her own daughter had come down with a fever. The backup doula sent in her place was nice but ended up fainting just as my daughter was crowning. Those 39 hours of labor were some of the most transformative of my life, but they also turned out to be a comedy of errors that manifested my fears.
As I write this, I'm reticent about appearing ungrateful for the privileged labor and birth I experienced, unexpected hiccups and all, especially given that Black women are 3-4 times more likely to die from pregnancy-related complications than white women. The harsh reality, especially with the high incidence of Black maternal mortality, is that our current birth model doesn't do enough to protect women—Black women in particular. But for centuries, women have relied on themselves and each other to offer invaluable support. When it comes to redistributing power for a more egalitarian system, women can do it themselves; we have to be informed about birth choices outside our the established model.
My experience acquainted me with the realization that sometimes it's not enough to ask for help, especially when the stakes are high. It's vital to do everything in your power to feather your nest in your vision, a tall ask but totally accessible with the right support. To help me work through my birth experience and to inform others about the breadth of support out there, I reached out to the Glow Maven, Latham Thomas, one of the most celebrated doulas in the business. Thomas, who has served as a lifestyle guru and doula for celebrities like Alicia Keys, Anne Hathaway, and Ashley Graham, offers insight on how a doula can transform the labor and birth experience leaving new mothers feeling seen, nurtured, and empowered.
Ahead, learn how doulas can restore trust in a flawed medical system—plus find advice on what to ask a doula to help you prepare for the unexpected.
Meet the Expert
- Latham Thomas is a celebrity wellness maven, birth doula, and the founder of Mama Glow a global maternal health and doula education company, instructing doula-trainees from around the world.
What Is a Doula?
A doula is a non-clinical professional trained to provide emotional, physical, and informational support to laboring mothers during childbirth and in the postpartum period. A certified doula has completed at least 30 hours of training and has attended at least two-to-five births.
Historically, women have been assisting other women during labor and childbirth since ancient times. Only recently has the western world recognized the role of doulas in the childbirth model, with the 1992 establishment of DONA, an international doula training and certification program. Studies like a 2012 report published in the National Library of Medicine endorse the practice of doulas in labor and childbirth and conclude that continuous support for women during birth is the exception rather than the rule. "We're filling the ancient and ancestral role of women helping women in birth," explains Thomas, who says having a doula is like hiring a producer for your birth. A doula assists with education, physical support, and advocacy, teaching you how to speak up for yourself. "If there is a partner present," says Thomas, "a doula offers guidance on how the partner can support the birthing person on the journey."
Because the need for safety and security is so critical for women giving birth, Thomas says, "we don't have a large understanding that birth is an emotional, spiritual event." Our current Cartesian model looks to separate mind-body or medical-spiritual experiences, which is where a doula can step in, providing a sense of integration that can mitigate birth-related trauma around this constructed fissure.
Today’s medical birth model has veered far from the ancient practices of midwifery. “Breech births are no longer taught,” says Thomas, “but rather result in an automatic c-section.” The problems underpinning our medical birth model run deep and parallel the many ills of systemic injustice perpetrated by our culture. This is no surprise, given that the root of western gynecology is deeply entwined in slavery.
Thomas brings up the pioneering developments in birth methods by a group of 19th-century gynecologists who researched experimental cesarean sections on enslaved Black women without anesthesia. “Gynecological medicine evolved because of slavery,” explains Thomas, “to treat pathology in black women to breed and feed.” This research is documented in the 2018 book by historian Deirdre Cooper Owens, Medical Bondage: Race, Gender, and the Origins of American Gynecology, and its despicable legacy is seen in the Black maternal mortality rate, which remains three-and-a-half times higher than that of their white counterparts, according to a 2019 report by the Centers for Disease Control (CDC).
Systemic racism shows up in birth for “descendants of folks who have endured this trauma,” says Thomas, but also for women who are showing up “queer, young, older, single, or disabled.” A doula can restore trust in a place where there was distrust. “Our training is about reproductive justice and looking at how to support the ancient ritual of birth."
Our training is about reproductive justice and looking at how to support the ancient ritual of birth.
Benefits of Having a Doula
Because birth is, as Thomas describes it, "a state of altered consciousness," it's vital to move through it with fluidity. "For labor to proceed, you need to move out of the thinking brain and into the primal brain, moving through fear and worry into a state of calm," says Thomas. "Stress hormones are the antagonist of birth hormones. Fear can close up the cervix."
Top on expectant mother's list of concerns is how to navigate the pain of labor and birth. A doula can help you exhaust the non-pharmaceutical options when it comes to pain management. "We can meet pain with pressure to help with the sensation," says Thomas, explaining several massage techniques that can help the birthing person stay comfortable. The key, she says, is to "expand your lexicon around pain," which doesn't exclude the use of an epidural when necessary or desired.
Another critical role played by the doula surrounds advocacy by people who are "well versed in knowing how to approach the system." Thomas says a doula is trained in "understanding your rights and what you have access to in terms of your insurance, what tests and screenings you're given," all things that can impact the birth outcome and things a birthing person might not want to focus on in the midst of labor.
A doula can advise you to ask for the attending physician. You can decline to have a student in the room in teaching hospitals where this is common practice.
A doula can be present for any birth, including a cesarean. "We can help process that birth experience," says Thomas, "and mourn the loss of what you’ve hoped for and move through the trauma of the experience." Or, perhaps you've opted for a c-section. A doula can help with recovery, including the prevention of infection and blood clots.
How to Hire a Doula
It's important to seek out a qualified, trained, and certified doula you trust. And it's common practice to interview potential doulas before you sign a contract detailing expectations. Be sure to tell your OB/GYN you're interested in working with a doula so he or she can advise when during pregnancy to begin the search. A doula will provide a home visit before the birth so you can review your birth plan.
Personal referrals are one way to find a doula. The DONA directory is another excellent resource. Be sure to ask about the extent of training your potential doula has undergone; Mama Glow provides various types of doula workshops speaking to a range of expertise.
In addition to providing you and your birth partner with support during labor and childbirth, your doula will check in with you 24 to 48 hours after birth, help you advocate for things like gaining possession of your placenta if you want to keep it for encapsulation, validate your birth experience, and offer support during the first hours of the fourth trimester. She will also provide a home visit sometime during your first week or so of new motherhood, which is such an invaluable resource during an intense time.
Questions to Ask Your Doula
When it comes to hiring your doula, the following can guide your expectations.
- Training and Experience: An accredited doula should have undergone at least 30 hours of training and will have attended two to five births at the very minimum. Feel free to bring up your concerns tactfully and respectfully. It might be odd to ask outright if your potential doula has ever fainted during a live birth. Instead, focus on asking about the extent of her training.
- Certification Status: There are birth and labor doulas as well as postpartum doulas. In addition to helping you design, advocate for, and execute your birth plan, some postpartum doulas may be certified lactation consultants who can assist with breastfeeding.
- Availability and Backup System: You can labor for days. It's important to set up expectations for how long your doula will be available to you. Be sure to ask your doula how best to reach her and about any communication parameters. Labor can happen at any time, and most doulas are available 24/7 to speak or text. She should also provide a backup doula (or two) who you should get to know in case an emergency prevents her from being present at your birth.
- Fees: The fee ranges depending on experience and, Thomas says, is on a sliding scale many times. "Some community-based doulas work starting pro-bono and slide up from there. A general starting range is $1500 to $ 3000." Thomas adds that postpartum doulas can charge hourly, starting at $35 to $50 per hour.