Living in capitalism, we are taught to invest in things over experiences. 

You are partway through your pregnancy, and hearing friends suggest that you should hire a doula. It sounds lovely to have a support person, but you feel well supported by your partner and family and you attended childbirth classes. You're wondering whether you should save the $1000-$2000 to spend on other baby items because the expenses are racking up. 

It makes a lot of sense to be questioning whether doulas are worth the money. I am obviously biased towards doula care because, well, I am one and I have seen firsthand the impact that a doula can have on creating a positive experience in birth and postpartum. Here I will touch on the unique offerings of a doula in navigating birth in the current climate, as well as the importance of investing in your birth story as it becomes lore and ancestry. 

While some may think that continuous labour support may be the bulk of a doula's value, I would argue that the real value of doula care exists in informational and advocacy support. There may or may not be others attending your birth who are able to offer counter pressure and emotional support. However, the value of the prenatal work that a doula does to prepare for an effective and confident labour is truly unique to a doula's role. On top of that, having someone on your care team who intimately knows what is important to you and is comfortable advocating for that at your birth is also unique to the value of a doula. It is invaluable to have the support of someone who can confidently slow down the pace of decision making and politely challenge the authority of the doctor who just walked in who you've never met telling you to deliver with forceps. 

One of my doula teachers spoke during training on the particular value of doulas as support people who aren't also going through a transformation as the birth occurs. When the members of your family support you in birth, they too are going through a birth; the birth of a grandmother, of a father, sibling, and auntie is a transformation that also requires and deserves embodiment and attention. Your doula is not becoming anything new at your birth, they are simply there to hold space for your becoming. Having a calm person present who is not processing their own transformation is one of the unique magical elements of having a doula. 

The other thing that a doula offers in birth and postpartum is holding space for you, in particular. Something that I have found at births is that right when baby is born is when the birthing person often needs the most support. The care team and often family turn towards caring for the new human who has just arrived, and of course they want to, what a joy! But your doula is there to turn to you. I will not leave your side when your baby goes to the warmer. And when you are at home in the first forty days, I will be there to ask you what YOU need, not just what your baby needs. Of course your needs are entangled with your baby's needs but there are so many ways that a doula can bring you back to your own needs --- sometimes, you don't want to talk about your baby, you need a window opened, a shoulder to cry on, and a warm meal in your belly. 

We live in a culture obsessed with emergency preparedness and this often makes its way into the ways we plan for birth. I often speak with pregnant people who look for a clinical care provider based on how much experience they have dealing with the worst case scenarios; hemorrhage, shoulder dystocia, so-called "failure to progress", infant distress, and more. While it is important to be prepared for complications should they arise, pregnant people are often convinced to seek out specialist care at high risk hospitals for pregnancies that are low risk and normal. What if pregnant people searched for providers who want to give them the birth they want, rather than the birth they fear? 

Birth is a process led by hormones. Release of the "love" hormone oxytocin sends a signal to the uterus to contract, causing the cervix to dilate. Release of oxytocin occurs when the birthing person feels loved, supported and safe. Fear and anxiety can stall the progression of labour, because the flow of oxytocin is interrupted. Oxytocin release is best supported by a calming environment, a caring and attentive team, and continuous labour support. When this flow is interrupted, it is more likely that augmenting interventions such as rupture of membranes, synthetic oxytocin, vacuum and forceps will be suggested by a care provider. And, this isn't just my opinion - this is research supported!*

Yes, issues can arise even when the birthing person is prepared, healthy, and calm. But, your care team is prepared for these complications. A colleague of mine attended a home birth in the summer where a shoulder dystocia occurred that was solved by the midwives without the doula or birthing parent even knowing it was happening! I would therefore urge pregnant people to ask their care providers, how much experience do you have with the birth I WANT? How often do you induce? What kinds of stalls compel you to introduce synthetic oxytocin? What kinds of positions and movement do you encourage during labour? What is your experience with unmedicated birth? How do you care for the perineum, and do you have pelvic floor physiotherapists that you work with? Asking these questions can help you search for green flags in midwifery and OB care that encourage preparedness for the labour you want. 

Most of the time, we don't need a specialist for our pregnancy and birth! Pregnancy and birth are normal, healthy and natural parts of having a body, not problems to be solved. I hope that this post encourages you to find care providers that are prepared to support you in the birth you WANT, not the birth you are afraid of. 

*https://www.dona.org/wp-content/uploads/2020/02/DONA-Birth-Position-Paper-2022.pdf

Oftentimes when I tell people I am a doula they ask how I trained, and if the training was similar to midwifery. They are surprised when I tell them that doula care is actually unregulated, meaning anyone can say they are a doula and work as one. This kind of sounds like a nightmare, especially when thinking about the uprising in anti-vax anti-science ideologies. And, you really don't want someone at your birth making baseless claims about the choices you should be making or arguing with a care provider that you really trust. But, what I like about the openness of certification is that doula care has us rethinking what it means to be an expert, and whether you really want an expert at your birth, or another human who really cares about what's happening. 

When I first became a doula, I was drawn to this work because our profession relates to certification differently than other perinatal care providers and many healthcare providers in general. Doula support is not a clinical practice, and while clinical knowledge is core to effective, evidence based support, doulas are also spiritual care practitioners, support people, harm reduction workers, mediators, and counsellors. We kind of fill this role of sponge in the birth space, melding together the visible and invisible players in the process of birth. And, on the practical side of things, not needing to be certified right away was helpful to me as someone who needed to be working another full time job to get doula experience at first. 

What I will say about certification is that it helps clients get money back from insurance, and that is undeniably important when it comes to accessibility for care. And, as I mentioned above, it does help to prevent the spread of misinformation and pseudoscience that exists so rampantly in the perinatal world. This is what made me decide to certify. But, the thing is, people are taught culturally to value experience and expertise over care and attention. And maybe while you want to look for expertise and experience from your clinical care provider, care and attention from your doula isn't something that comes from a certification necessarily. You might want a doula who exists close to your experience and is able to show up for you. Incarcerated birthers deserve access to doulas with lived experience of incarceration. Birthers who do sex work deserve doulas who are sex workers or have a respectful understanding of that work and its relationship to perinatal care. Queer and trans birthers deserve queer and trans doulas. Religious and spiritual birthers deserve doulas who can show up for the ceremony of birth. And the list goes on. Thus, certification might not be accessible to the doula who is best suited for a client. And even for families who are not marginalized by the healthcare system, the doula that might be best might not look the most impressive on paper but may just be a compatible and caring person to you. Attention and care are skills developed over lifetimes, not over a training period with DONA. 

So, when thinking about hiring a doula, while the question of "are you certified" and "how many births have you attended" may be on your mind, what I hope this post might also bring to mind is the questions of, "what is important to you" and "how will you care for me"? 

A very common query for families when looking for doula care is around OHIP coverage. Whether you choose to hire a doula for birth support or postpartum, care can come at a cost and money can cause barriers to accessing care. Doula care is currently not covered by OHIP, but that doesn't mean you have no coverage for care! It is becoming increasingly popular for insurance companies such as SunLife to offer some coverage for birth and postpartum doulas who are certified through a regulated body such as DONA, CAPPA, and Doula Canada. The best course of action is to reach out to your insurance provider to ask about doula coverage. 

Questions you can ask your doula when interviewing surrounding insurance coverage: 
- Are you certified in birth and postpartum or only birth/only postpartum? 
- Do you issue a receipt for services? 

If your provider currently does not offer coverage, there are a few options: 
- Request employer support: If you employer builds your care package, consider speaking to them about offering coverage for doula care!
- Request a doctor's recommendation for doula care: You may be able to secure insurance coverage if a doctor recommends doula care as a medical necessity for you. 

If cost is still a concern after taking these steps to investigate insurance coverage, speak with your doula about creating a payment plan or sliding scale offerings.