Do-it-yourself doula: Tips to choose the best labor support person

March 2, 2021

Robyn Horsager-Boehrer, M.D. Obstetrics and Gynecology

Having a support person during labor can lead to a more comfortable, pleasant birth experience.

Doulas are trained to support women through childbirth. Unlike certified nurse-midwives, doulas generally are not medically proficient – their primary role is to focus on you, advocating for your needs and preferences as you bring your baby into the world.

Right now, many hospitals – including UT Southwestern – are allowing just one support person in the delivery room. The pandemic will eventually subside, and opportunities to include more support people in the delivery room will likely resume.

But even when visitor restrictions are lifted, hiring a doula may not work in the budgets of many families. According to Doula Match, working with a doula in Texas can cost $500-$2,500 or more, depending on which services you request and where you live.

Every woman deserves dedicated support during labor. Research from the World Health Organization shows that continuous labor support can decrease the need for pain medication and labor duration, and can result in fewer operative births and increased satisfaction with the birth experience.

If a doula is not in your budget – or if you prefer to only include loved ones in your birth experience – you can include some of the best practices that doulas implement with laboring clients.

1. Gather resources to prepare for pregnancy

Doulas often recommend preferred books and videos to help clients set expectations around labor and delivery.

For example, one of the members on our survey team to become a Level 4 certified maternal health center – the highest level of pregnancy-related care – mentioned that her doula had suggested reading "The Birth Next Door." She said the compilation of stories from 28 deliveries around Tarrant County helped her feel prepared for her first delivery.

Here are a few more resources we recommend to our patients:

Video series: Preparing your body for childbirth. UT Southwestern's physical therapy team created a series of gentle exercise videos to help you strengthen and stretch key areas of your body during pregnancy.
Hospital bag checklist: Use this quick list of essentials to pack everything you need for the big day, including items you want your support person to help implement as part of your birth plan.
Prenatal classes: Registering for prenatal classes is free at most hospitals. You can bond with other expectant moms and get answers to all your questions. These classes often include videos, handouts, and breathing exercises to practice with your support person. Call 214-663-6640 or email us at womenscenter@mednet.swmed.edu to schedule in-person classes at UT Southwestern, or register for online courses.

5 exercises to train for childbirth

UT Southwestern physical therapist Ashley Rawlins demonstrates and explains five exercises and techniques you can use to prepare your body for labor and delivery.

2. Enlist a personal advocate

You will be doing the hard work during labor and delivery. And your care team will be focused primarily on the baby's health and your physical needs. A labor partner will have just one job: Being by your side through the emotional and physical journey of labor and delivery. In some cases, your spouse or partner might not be the person for this job. Witnessing childbirth can be emotional for your partner – they might be worried about you, worried about the baby, or struggling with the sights and sounds of the delivery room.

Your labor support person will:

Help you manage your pain
Remind your nursing team about your birth plan strategies – particularly during shift changes
Get you drinks and snacks as allowed
Serve as your voice when you are focused on giving birth

Most importantly, they will provide emotional support if something unexpected happens and your birth plan has to change. It can be disappointing or scary if you wanted a natural birth but end up needing a cesarean section (C-section). Having a comforting person focused just on supporting you in tough times can make a world of difference.

We recommend you also choose a back-up support person in case of illness, especially during the pandemic. The stand-in should be someone who has given birth or attended births before and can be ready to go at a moment's notice.

3. Seek experience and soft skills

Many women prefer to choose a support person who has experienced childbirth, either personally or as someone's labor partner. Make sure your support person is:

OK with seeing blood and other bodily fluids – childbirth is beautiful, but messy!
Ready to pivot if your birth plan needs to change or an emergency happens.
A good communicator – you want someone who is firm but kind and can help make your preferences known in a busy environment, and possibly during nursing shift changes.

Your support person should be a good communicator and capable of adapting quickly to changing birth situations.

Your support person can also be in charge of texting updates to your predetermined list of loved ones who you want to keep current. Or, depending on their knowledge, they can also help "translate" the Ob/Gyn's and nurses' directives to your loved ones. For example, one of our surveyors said she specifically chose a labor support person who spoke Spanish, since Spanish is her husband's native language. The support person helped explain what was going on in a more natural way for her husband.

Many patients prefer to enlist the support of someone who mirrors their cultural, ethnic, and religious beliefs. Having those connections can help you more comfortably communicate with each other and with your labor and delivery care team.

Related reading: Birth plan updates during the COVID-19 pandemic

4. Plan for support after delivery

Chances are, you won't feel "postpartum perfect" right after delivery. Postpartum doulas help support new moms in the hospital and at home after giving birth. However, if a professional helper is not in your budget, you can enlist loved ones and access hospital and community resources to fill in the gaps.

Postpartum support can help in several key areas:

Breastfeeding. Check whether your hospital offers lactation support services. For example, women who deliver at UT Southwestern’s William P. Clements Jr. University Hospital have access to lactation consultants at our Women's Center. These certified experts offer in-person guidance and online courses on positioning, latching, pumping, and continuing to breastfeed after you go home.
- You can find free tips, strategies and resources on Breastmilk Counts, a breastfeeding website from the Texas Health and Human Services Commission, as well as the Texas WIC Lactation Support Center and hotline in Dallas.
- If your baby is premature or has serious medical concerns, milk banks such as such as Mothers' Milk Bank of North Texas can connect you with safe, donated breast milk.
Emotional needs: The hours after delivery can be the start of emotional ups and downs that may last a few weeks or months. Friends and family members can be a great resource to offer advice for new parents.
Help at home: Even while social distancing, a friend or loved one can still offer help at home when you arrive with the new baby. Moms who had a cesarean section or a difficult birth might need additional help, such as lifting, cleaning, and moving around.

Pro tip: Start planning for the postpartum period early in your pregnancy. That way, you will be able to focus on recovering after childbirth and spending time with your new little one.

You deserve childbirth support

If you really want a doula and having more than one support person is approved at your hospital, consider asking for cash or a gift certificate to a doula service as part of your baby registry.

Some doulas may accept HSA or FSA cards, and some offer low- or no-cost services for people on fixed incomes. DONA International is a well-known and reputable organization where you can find doulas near you with a range of qualifications. Search now.

Right now, having a doula or additional support person besides your partner in the delivery room might not be possible because of COVID-19 restrictions. But you can still implement some of these doula best practices to have a pleasant birth experience.

Check with your hospital to see what is possible. Having a comforting, calming advocate by your side can make a world of difference.

To visit with an Ob/Gyn about your birth experience options, call 214-645-8300 or request an appointment online.