“Evidence-based care” has become a catchphrase implying high-quality care based on scientific facts. Sounds great, but what does it really mean? And what do I mean when I say that I provide evidence-based doula care, childbirth education, and breastfeeding support?  “High-quality” care requires much more than an evidence-based approach, but that is a topic for another time.
 
Quite simply, the information I provide and the techniques I teach are based on proven, scientific research.  This means that if I make statement, I can normally back it up by published, peer-reviewed literature (if desired). However, most often the references that I provide to my clients are in the form of short articles or handouts that are clear and easy to understand. These have been created by either me personally, based on my own up-to-date research, or have been authored by a well-respected organization that I know provides current and accurate information.
 
As a doula, I discuss and talk-through options on a personal basis with my clients.  I serve as a personal guide to help navigate through this time of change, uncertainty, and vulnerability.  I care deeply about empowering expectant parents to:

• A) Feel confident in making their own informed decisions, and
• B) Trust in their own abilities to manage the journey ahead, whatever that entails – pregnancy, labor, birth, postpartum, newborn care, and onward.

 
To provide you with examples of just a few of the topics that I discuss with my clients, here are the titles of a few of the handouts that I provide during prenatal visits: Stages of Labor, Pros and Cons of Methods for Induction, Comfort Measures for Labor, Pain Management for Labor (medical and non-medical), and 5 Keys to Successful Breastfeeding.
 
As with many things in life, the world of maternity health care is filled with uncertainty.  There is a lack of verified, concrete information available about many common pregnancy/birth topics, e.g. the use of certain herbs during pregnancy, or the risks/benefits of consuming the placenta after birth.  In these cases, I can offer what little information is available. I will always specify what appears to be scientifically verified and what is common/historical belief.  I always encourage my clients to discuss questions with their medical providers. Again, I do not provide medical advice. My goal is not to provide answers, but rather to offer options and information, enabling easier decision-making and communication.
 
On that note, providing evidence-based care does NOT in any way mean that I do not support choices that do not appear “evidence-based.”  This would be rather hypocritical. In fact, I think there is sufficient “evidence” to support that what might work for one person may clearly not work for another, even if all other factors appear equal.  Each laboring person has the right to decide what makes the most sense for them, whether it be an unmedicated birth, water birth, epidural birth, eating the placenta, not eating the placenta, using herbs, using acupuncture, planned c-section, elective induction, vaginal birth after cesarean, home birth, you name it. I trust my clients to make the decision that is right for them and their families.

​Perhaps you’ve read about the benefits of doula support and agree that working with a doula would help you feel more comfortable during labor and birth.  What’s the next step?
 
First off, congratulations on choosing to take an active role in your childbirth experience!  Whether or not you ultimately choose to hire a doula, the fact that you’ve consciously considered your approach to labor means that you are thinking about your physical and emotional health, as well as that of your baby. Research shows that individuals that take active roles in their health care tend to have better outcomes.
 
The first step to choosing a doula is finding the local doulas in your area. This may be through referrals, local listings, or a simple Google search.  The website DoulaMatch.net is a wonderful resource for finding doulas in your area.
 
Next, schedule interviews with a few doulas and really have an open conversation with them.  You may have a list of questions to ask, or you may choose to simply chat and get a feel based on the conversation.  Does the doula listen to you or are they too busy thinking about the next thing they want to say?  Do they only talk about themselves and their offerings or are they asking you thoughtful and considerate questions as well? 
 
After the interview, think about the conversation. Were your questions answered? Did conversation flow easily? Was the doula opinionated or respectful of your needs? Did she give you a copy of her contract to read through? How/when should the doula’s fees be paid. Be sure to read through the contract thoroughly, and request clarifications, if needed.  From there, most doulas will require a deposit in order to reserve time around your expected due date and initiate support.
 
Below are a few points to keep in mind to help you choose the right doula for you.

• Training / Certification: What kind of training has the doula received?  Through which organization? Is the doula certified/working towards certification? If she chose not to certify, ask her why.  There are currently no national standards regulating who can practice as a doula.  Be wary of the “doula” that chose not to certify because they felt “too restricted” by an organization’s standards   of practice.

• Philosophy: What is the doula’s perceived role as a birth support professional?  Do they have a childbirth philosophy?  How does it align to yours?

• Experience: In addition to training, what kind of experience does the doula bring to the role? What labor comfort techniques are they familiar with? How have they supported partner involvement? How might they facilitate a difficult labor? Many doulas chose the profession after experiencing childbirth themselves.  Others chose to become doulas after working in health care, public health, education, social work, or research settings.  How does this background affect their work – their ability to empathize, connect with, inform, calm, and empower their clients?  The doula may have experienced birth, but do they know birth?  What is most important to you - empathy/compassion? Or do you want someone who also understands the physiology, clinical care, and research surrounding birth support?  (For most people, it’s a combination of both.)

• Personality: This is why an in-person initial interview can be so beneficial. How does your personality (and your partner’s) mesh with the doula’s personality?  Do you feel comfortable with them, or does something not quite “click”? Do you feel they will respect your choices and boundaries?  Trust your instincts.

• Professionalism: Does the doula take her/his role seriously?  Do they respond to your calls and emails in a timely manner?  Do they use friendly but professional language?  Is there a clear, written-out contract? Is this their full-time job?  Do they work with an agency or are they self-employed? Do they hold other employment? Might it interfere with their availability for your labor?  Do they work with a back-up, and if so, whom?

• Services: What is included in the doula’s care package? How many prenatal/postpartum visits? When does on-call time begin? What is their availability to answer questions? Are you interested in just birth doula care, or other services as well? Many birth doulas are also childbirth educators, breastfeeding counselors, and/or postpartum doulas.  Some doulas also offer placenta encapsulation, belly casting, henna, birth/newborn photography, etc.  Often times doulas will offer discounts for “packaging” services.

 
Ultimately, the most important factor is that you feel comfortable working with your particular doula.  Think about the traits that are most important to you. Who you choose is a personal decision between you, your partner, and your doula.  Referrals are certainly wonderful, but remember that a doula that may have been a great for your best friend may not necessarily be the right fit for you.  Best wishes on your search.  Please leave comments below if you have any questions or have additional points that you would like to add.