When is a doula NOT the right choice?

I went to a “Meet the Doulas” event and have read plenty on why a doula is great. But there's little on why you'd opt out, so I’d love to understand why a doula could be LESS necessary / helpful / applicable, and NOT the right choice for me — want to make a decision with both sides in mind.

In considering positive data, I'm skeptical about studies on the benefits of doulas (lower Cesarean and unmedicated birth rates) b/c 1) studies often look at overall impact of having a SUPPORTIVE, FEMALE presence including hospital staff AND loved ones, which obviously muddies the data and makes attribution to just a doula impossible 2) self-selection; if you believe you need and want a doula, and have one, you’re likelier to report higher levels of satisfaction with the birth experience as a result of said doula. Also someone who has a holistic view on birth / invests in a doula is more likely to have other things contributing to a lower C-section rate, and probably leans toward wanting an unmedicated birth. True for me at least. ;) 3) positive anecdotes don't mention other support aside from the partner, so can’t get a full picture.

Context:

  • I have a loving & even-keeled husband
  • Strongly considering having my mother (who I'm close to, is a retired NICU RN, & would easily do the little things that people rave about in reviews e.g. repositioning, washcloths, etc.)
  • Considering having my mother-in-law who we're close to
  • Delivering at Alta Bates, whose nurses have a stellar reputation; one reviewer was more impressed by them than her doula
  • I'm an introvert and love the idea of creating inner resiliency; planning to learn HypnoBirthing (with husband)

In a vacuum / with no consideration of cost, having the RIGHT doula seems better than no doula. But there’s no guarantee I could find the right doula in time. At that point, seems that no doula would be preferable to an “okay” doula, given the presence of my partner and mother(s).

  • If you had partner + other loved ones AND a doula:
    • What value did she deliver that was unique and not redundant?
    • How was the dynamic of partner + family + doula?
  • If you had partner + other loved ones and NO doula:
    • How did it go / how supported did you feel?
    • What, if anything, slipped through the cracks?
  • What benefits - aka TRUE medical advocacy (which seems like a gray area given they are not medical professionals) - does a doula provide that neither husband nor my retired nurse mom could? Looking for beyond what I’ve come across in reviews (yes, partly because I feel $2k+ is a lot to pay for the below):
    • “The little things” - setting up delivery room (candles, lighting, decor), fetching coffee, etc.
    • Physical touch (one doula I met pitched “being loved on” both by her and my husband at the same time, and frankly that doesn’t appeal to me)
    • Verbal support (one example was repeating what my husband says - sounds weird and annoying, not necessarily helpful)

Thank you!

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With the caveat that I have not yet given birth, it seems to me like you’ve clearly laid out a case where it doesn’t make sense for you to have a doula. You have a supportive partner, and several female relatives who have some experience with childbirth who you feel would be supportive.

For me, the biggest reason to have a doula is to have an additional support person besides my husband. There is no way I would consider having my mother in the room, as much as I love her. We have very different approaches to stress, and medical situations, and her support would not be helpful for labor. There are no other female relatives or friends who I think would be helpful. I’m sure my husband will be a help, but he has a hard time seeing me in pain, and he needs someone who can reassure him that this is normal. I think the big push for doulas is because today, many gestational parents don’t feel comfortable having mothers/sisters/aunts/mother-in-laws in the labor and delivery room.

It doesn’t sound like there is a ton of support a doula could offer that your mom or mother in law couldn’t, with a little research into support measures (like counterpressure and such), and some conversations about what kind of support you want.

I had a doula at each of my two births. One was at Alta Bates and one was at Kaiser. My husband and I wanted to try to have a natural birth if possible but were open to whatever was needed at the time. My first birth at Alta Bates I managed with no meds, but it took me 3 days in labor, and I had a vacuum unexpectedly at the end. Although we liked lots of things at Alta Bates, I ended up having a nurse that we did not like and who was rude. Our doula was able to help support me at home during my early labor issues and then advocate for us and help us think through our options when we had to decide whether to do a vacuum or go straight to c section. Having her there helped my husband relax and gave him a support person. We felt that we were well prepared and educated but having someone else in the room to help us with thinking through options and coping through the pain was super helpful. My second birth was at Kaiser and we had a different doula because the one we used before is now a midwife. I ended up needing an epidural because I could not handle the pain, and then I had a vacuum. Because I waited so long to have the epidural, the doula was by my side (with my husband) supporting me physically and mentally through the pain. The Kaiser staff was great, but I couldn't squeeze their arms for literally 7 hours straight like I did with the doula. So all that being said, I think the main thing is to have a good support system with you just in case. You just won't know what kind of birth you will have. Could be easy, could be hard, could be something in between. If you have family that can serve that role that each of you really like and trust and won't annoy you, I think that can take the place of a doula, particularly if they know a lot about giving birth. However, if you have some second thoughts about having family in the room, and you can find a doula that you "click with" then I think it's worth it if you can afford it. Each of them will have similar ways to support you (physical, verbal, things in the room) but honestly you really aren't going to know what you want or need until you are going through it. My advice is have support in the room and go with the flow as much as you can. Congrats!

Congrats! I did not have a doula and didn’t consider it, I only wanted my partner, doctor and nurses at the delivery room. I even excluded kaiser because I knew sometimes they have students to watch the delivery. I had my baby at Alta Bates and loved it! I knew I didn’t want any medication and wanted a natural birth. To prepare for the birth my partner and I took one of the lectures offered by Alta bates about coping with pain during labor and it really helped! We used all the techniques provided plus the advices from my doctor of taking a warm bath when contractions came. I stayed at home as long as possible because I didn’t want to be too early at the hospital, when I arrived at Alta Bates I was already 8 cm dilated and it took just one hour from the moment I arrived until my baby was born (could have been shorter but we had to wait until for my doctor to arrive), no medication, very easy delivery but of course those contractions were super painful! Luckily they were short. 

One great advice from my primary physician was to exercise during my pregnancy, she said that the womb does a lot of work during delivery and my muscles should be ready for that, I enrolled in Bar method Berkeley and was going on average 4 days a week.

I didn't use a doula for any of my 3 births. I guess mainly because a) I felt like I could handle things myself (I did a lot of research so I knew what to expect, plus I'm pretty stubborn and didn't feel like I was going to get pushed around) and b) I'm not a terribly touchy-feely person (like you, I'm an introvert) and doulas didn't seem fit well with my personality. I didn't want candles and music and all that. But that's just me; I know lots of people rave about doulas, and of course every birth is different. I had 3 totally unmedicated births at Alta Bates with just the hospital staff (who were fabulous) and my husband present, and didn't feel like I was missing anything. Having your mom and her RN training there as additional support sounds like a great resource. I used Hynobirthing and highly recommend it - although I used the actual hypnosis to different degrees with different births, I felt like it really prepped me for the physical and mental processes the body goes through during birth, and I came out of all 3 births feeling really empowered. So, I guess the summary is that it's very possible to have a positive non-doula birth experience - don't feel pressured to have a doula (or do anything else about your birth a certain way) just because "everyone else is." What's right for you is right for you.

I didn’t use a birth doula for either of my two births at Alta Bates and have no regrets. I have a very calm, un-squeamish, helpful and supportive husband. He was the only person present other than hospital staff and that was fine. I had one nurse who was a truly bad fit for me, and my husband did a great job asking for a replacement nurse and it was all handled without drama by everyone involved. 

I saved my doula budget for postpartum doulas and that was worth every single penny. I had very little anxiety about labor and birth and generally feel pretty trusting of medical professionals, but I knew I would need support after birth since I don’t have much family support. 

In sum, I’m glad I didn’t spend money on a birth doula. Consider postpartum support instead, especially if you are particularly sensitive to sleep deprivation. 

I've had two unplanned c-sections and two doulas (one each time). Neither (highly recommended, experienced) doula turned out to be a good fit. The nurses I encountered while in labor were almost across the board amazing and provided much more meaningful support to me than the doulas. Between my partner, who was my main support person, and the nurses, the doulas felt unnecessary and even to my detriment. My take away is that doula fit is extremely important - and maybe some people (like me) aren't "doula people" for one reason or another. 

For what its worth, it sounds like you have a wonderful support team assembled between your mom and husband. I could personally see that sort of situation working wonderfully without a doula! 

I went to a meet the doula event as well and considered hiring one, but was undecided. There are also many medically related outcomes outside of our control, that a doula would not be able to change. If you have specific desires in this area, I would write them down and communicate them ahead of time. I saw the doula role as potentially helpful, but also potentially unnecessary. I decided to only have my partner present. He is not particularly squeamish and is very loving and encouraging, he made a great birthing coach. We also attended birthing classes together which I felt were helpful. To add to this, I gave birth at Alta Bates twice, and the nurses there were incredible. Both times they proved to be very attentive and provided what I think a doula might have. I am also not interested in the physical touch, being loved on by someone type of care. Everything I asked for I received and more. I hope this info is helpful. Feel free to reach out with any questions. 

We did not have a doula for either delivery (now 3yo and 9mo girls). We considered it for the first one and opted not to because we weren’t sold on needing one. First delivery was at Alta Bates and the nurses were fantastic. Second delivery at Kaiser during the nursing strike last year (worst timing ever!) but the traveler/strike nurses were also awesome.

I wanted deliveries without drugs and for the first one had a 24 hour stay at Alta Bates before delivering (not yet in labor, wanted to avoid induction). The nurses knew my preferences and set me up with the right next nurse on shift change who aligned well with what I wanted. That was amazing!

I did not feel like I missed out on anything not having a doula. Having a written birth vision helped them understand what I was about and find the right fit for me. Knowing I’d be at the hospital for a while before delivering, I had one nurse switch my room when a bigger one became available so I’d have more space. 

Similar experience at Kaiser, though shorter labor and strike nurses as an extra variable. In both cases the nurses really got me through it. I’ve heard they take a step back of you have a doula, but they are an incredible resource.

Both births ended up being really straightforward for me. Both of my babies ended up with complications we’ll post delivery (both were fine within days), but I don’t think handling that is part of what a doula helps with. I personally don’t think there’s a need to have a doula with such mother and child supportive hospitals here. But just my experience!

Hmmmm... I am also an introvert and would have hated having a doula. Birth seems like such a private, sacred event to me-- I just wanted my husband and sister there the two times that I gave birth. And I was at my sister's two births, along with her husband, and it was a special privilege. Perhaps a lot depends on the nature of the relationships among those involved and their level of comfort with those kinds of situations.  In the absence of a supportive partner and/or caring female relative/friend, I think a doula could be really helpful. I do agree the nurses at Alta Bates are awesome but they are not always able to give you their full, ongoing focus since they have other duties. You might also want to get your partner's perspective on the matter. 

Best wishes !

The reasons I appreciated having a doula are not the ones you mention. The benefit for me was that when something came up, I had someone who had been through it before there with me. Everything from when to go to the hospital to helping me navigate when my water broke but I didn't go into labor. The doc wanted to induce right away and she helped me delay that to see if I would go into labor on my own. My doula didn't light candles or love on me instead she was an advocate for me. Maybe talk to different doulas? The nurses are great at Alta Bates but they won't be there when you are laboring at home or after the baby is born and they can go off shift in the middle and then you need to get to know new nurses. But if it isn't for you, it isn't for you. That's ok too. I wouldn't convince yourself you need a doula if you aren't feeling it. 

Hi there. I did hire a doula for my first labor and delivery (where my husband and mom were also present) and did not feel it was worth the money. However, I did not do nearly as much research as you have and I only interviewed the one doula, so take this with a grain of salt... maybe it was just a miss-match of personalities. I was induced and had excruciating back labor, so pretty much everyone except my husband and the nurses annoyed me. I am also an introvert and I found it very awkward to have a complete stranger in the room with us while I was at one of the most vulnerable points in my life. She tried to help with positioning and massage, but after a while I just didn't want her to touch me. After 8-10 hours of back labor, I had only dilated 2 inches, so I requested an epidural. After that, she wasn't particularly helpful, though she did hold my legs during the 4 hours of pushing the next day. Basically, the one thing I got out of it that I didn't with my second delivery was a book with the birth story and pictures afterwards. Hope this helps? Good luck to you and congratulations!

If you have a team of loved ones that aren’t afraid to get their hands dirty, and you’re receptive to having them do it, there is nothing a doula can provide that they can not. Especially, if you’re planning a hypno birth where essentially you’re coaching yourself. Please practice techniques regularly and frequently throughout your pregnancy. Doulas can offer they’re experience. Although you’re mom is a nicu nurse she probably isn’t very familiar with the labor process (only a guess); but as you’ve acknowledge doulas are not medical professionals and I believe Alta bates has you sign a form reiterating that. Alta bates is an excellent place to have a baby. Please trust your doctor & nurses. There is nothing more dangerous than families deferring medical decisions to consult with their doula. Excellent doulas know when to step back and should be a question you ask during your interview process. 

good luck and congratulations in advance.

Oh boy. You asked. I first want to say you should go with your gut. If you don't want a doula, don't have a doula. I had a doula for my first child because I wanted a natural birth and wanted to do hypnobirthing as well. I had my husband, my sister, and a doula at the hospital with me. Long story short it was a complete nightmare. It became comical at one point, with me screaming in agony during contractions and her misting me with aerosol water or something and trying to guide me through mindfullness or mediation or I don't know what. Hypnobirthing, I guess?

While I'm screaming in pain, she's waving her hands around me and then spraying the water at me, and talking about rivers and breathing and lord knows what else. I just remember wanting to punch her in the face. And wanting to punch my sister and my partner in the face for getting the giggles while I was in agony. They weren't laughing at me in pain, they were laughing at my reaction to her. At the time, I was pissed, but now, it's a funny part of my child's birth story. Maybe I'm just not a doula kind of person--I kind of knew it wasn't my style during our 'get to know you' sessions. I would have been just fine and actually much more comfortable without the doula there. 

And wait, it's a funny story only if you ignore the fact that I almost died from preeclampsia because neither my doula nor my midwives thought they needed to consult a doctor about my dangerously high blood pressure and failing kidneys and what ever else led to an emergency C section. It was my husband who finally said, Ok, she doesn't look right. You're all fired, get out of here, and get a doctor. They delivered my baby via c-section within a couple of hours of us asking for a doctor and it saved my life. It wasn't a "well, this is taking too long, we'll just cut the baby out" kind of situation. My organs were literally starting to shut down and it was life or death. I don't think my doula with her aerosol water knew anything about the medical side of birth. Maybe I picked a bad one? Probably, but just sharing my experience.   

Not a knock on doulas and midwives. I know they are wonderful for many if not most people who choose them. But my son's birth was traumatic for me, to say the least. The doula didn't cause it, but she sure didn't help. Hope my story helps you in any way. :) 

I delivered at Alta Bates last November. I met with half a dozen doulas in my second trimester because I had some fear of the unknown. I was not dead set on an unmedicated birth but I wanted to give it my best shot. I ultimately decided NOT to hire one, as I felt that it would be distracting to have this additional person in the room (who even after weeks of working together might still feel like a stranger). I still think that was the right call, and for me at least, less is more in a high stakes situation like that. It was just my partner and I and the incredible nurses at Alta Bates. I felt the experience was extremely intimate and memorable for my partner and I having it be just us. My parents were waiting at home for us and popped in to see us at the beginning of labor but left when contractions started picking up. And FWIW I was certain I was going to want constant massage during labor—got a custom oil made, forced my partner to practice for weeks :) — and when the day came, I didn’t want to be touched at all. Everyone is different, but there were lots of aspects of birth that were not at all as I expected. I do sometimes wonder if there are some aspects of my birth that would have gone smoother if I didn’t have that subconscious fear and anxiety. But at the end of the day, it was my first baby and i had no point of reference. I came away understanding that you have very little control over what kind of birth you are dealt, but the best thing you can do is surrender to that reality, make the best decisions you can given the circumstances, and let your medical team guide you. 

This is such a great question. It's so interesting that this is now the question, as opposed to "why have a doula". I'd love to respond from the category of "had a partner (only) and NO doula" - I never felt like I needed or wanted or would benefit from a doula. A little background - I'm a pediatric nurse practitioner with lots of nursery RN experience and have worked adjacent the L&D nurses, so I never understood why anyone would pay so much money for someone to do what is essentially the job of the L&D nurse. They are there to support you. And get you ice, and dim the lights, and provide counter pressure for back labor, and tell you what's happening. If you have a supportive partner (or two!), then all the better! Perhaps other people come to the birth experience with less familiarity with (or outright distrust?) of the hospital environment and nurses, but of course I feel comfortable talking to nurses and doctors and feel like I absolutely can advocate for myself. It sounds like, with a nurse mom, and an even-keeled husband, you might be in the same situation. I only wanted my husband with me for my 2 births and he was amazing. It's OK to lean on your L&D nurse. I wonder if people who say "she wasn't in the room all the time" only say that because they had a doula, so the nurse felt like maybe they could step back on some of the tasks the doula was being paid to do? From my 2 experiences, I can share that with no doula, the L&D nurses were present for me when I needed them, and they also knew when to let me be - who wants to be touched and talked to and hovered over their entire labor? Not me. My 1st birth was at CPMC in SF, 2nd at Kaiser Oakland. I have L&D nurse friends at Alta Bates and can confirm - you're in great hands. Good luck with your decision and with your birth! 

I did not have a doula. I had a delivery at Alta Bates that was just fine. In fact, and maybe I am just clueless, I had never heard of doulas before taking a child-birth class. When the other moms-to-be in the class were discussing doulas, I thought to myself, why? Like you, I predicted my husband would be great (and he was; I did not need another support person at all). I have no trouble speaking up for myself. I trusted my doctor and the Alta Bates team. Nothing slipped through the cracks. Another person in the room probably would have been more of an annoyance than a help. I told my mom to wait until I was out of the delivery room.

If you had partner + other loved ones and NO doula:

  • How did it go / how supported did you feel?
  • What, if anything, slipped through the cracks?


I delivered at Alta Bates with my "even-keeled" husband and loving mom. The nurses there definitely provided additional support that my loved ones could not. In addition to suggestions on various birthing positions, it also felt nice to have verbal encouragement and good humor from someone not emotionally invested in me (I had a long and difficult labor followed by a c-section... which was hard to smile through for my family). TL; DR: If it weren't for the amazing nurses at the hospital, I'd recommend a doula. The only other thing I would consider is the energy level of your family members: both my mom and my husband could manage on little sleep through my labor, but if that may not be the case for you, it would help to have another pair of hands for the "little things".

Good luck!

I share your thought that no doula might be better than the wrong doula, especially given your description of your partner and mother.

We worked with the same doula for two births. Both were hospital births; one was a completely unmedicated vaginal birth and the other wound up being an unplanned c-section. Here's what our doula provided that no one else could... she had 25 years of experience and had attended dozens (if not hundreds?) of births at Alta Bates, the hospital where I delivered. So this meant she had excellent, mutually respectful relationships with the L&D nurses and the doctors. But her focus was different/complementary to the medical professionals' focus. So while the nurses/doctor are focused on the baby as the primary patient, our doula was focused on me and my experience. She didn't do any of the woo-woo stuff; I had zero interest in massage, aromatherapy candles, or even verbal support. But what she did do was carefully observe me. So when we got to hour 12 of labor and the baby's heart rate began to drop during contractions, the nurse was about to pick up the phone to call in the doctor, but our doula asked her to wait a moment before calling the doctor. She had noticed that I had spent most of labor on my feet, and she noticed that the baby's heart rate had dropped when I had a contraction after lying down. So she asked the nurse to wait one more contraction and she asked me to stand up. And indeed, when I stood up, it must have relieved some pressure on the umbilical cord in some way, because the baby's heart rate stayed normal during the next contraction. Possible c-section averted because she was just very observant, very experienced, and was able to communicate respectfully with our L&D nurse, whom she had known and trusted for years. This is the absolutely irreplaceable value that a doula can provide.

Generally speaking, I found it incredibly calming and reassuring to have someone in the room who had attended hundreds of births. Have L&D nurses and your doctor attended hundreds of births too? Of course. But they may or may not be there with you for the whole time. Your doula will be there with you the whole time, through nursing shift changes and through having a doctor you've never met before deliver your baby because they happen to be on call, etc. My mom, partner and friend who attended the birth are all fabulous, supportive, wonderful human beings. But there is no substitute for having someone experienced in the room whose focus in on mom's health and experience.

In my second birth (the c-section), it was incredibly valuable to have her there because when it finally got to the point where a c-section became necessary, it was much, much easier for me to trust and accept that that was the right decision because of her. I knew how much she prized natural childbirth and knew how many births she had attended and knew that she would not just go along with it if there was any safe way to avoid it. So I didn't struggle after the birth (the way other mothers I know sometimes did) with wondering if I had been pushed into a medically unnecessary c-section. What a relief.

Our doula was Linda Jones, based here in the east bay. I have so much love and gratitude for her to this day - 10+ years later. And I haven't even mentioned how wonderful she was during the post-partum visits, when she helped me get nursing going. She is the best of the best.

Congratulations on your upcoming birth. I had midwives for both of my deliveries and no doulas. I also had very good support from my husband. With my first, there was concern about the extremely long period of pushing and my midwife was able to work with the hospital staff to avoid a C-Section. I'm also an introvert. I didn't want lots of people around me as I felt that might inhibit the birth process. I would absolutely not have wanted to be "loved on" by anyone! I didn't have medicated births, also supported by my midwives and husband. There was a lot of pressure from each nurse at change of shift to use pain meds and I was able to advocate for myself just fine. Had I not been able to, my husband would have stepped in. You have great support and trust the nurses at Alta Bates...I think you've answered your question already. All the best to you for a positive delivery and healthy baby.

Congrats on your pregnancy! I hope it has been fun for you! I just have to comment that you are WAY overthinking this. I'm exhausted just reading your question! The 'right answer' is for you to have whoever makes you feel supported there for your baby's birth, period.

For example, I had a doula, because my mom had passed away and my girlfriends were not yet mothers. I wanted to have a woman with me that would help (mine was also a massage therapist which was a big help the second birth) and make me feel she was advocating for me and our birthing plan if I didn't feel like doing that for myself.

But if I had had my mom or another woman with me that I loved and trusted that would have been fine and I probably wouldn't have hired a doula. I also have a great husband who was there and helpful.

You will have SO many bigger decisions once your baby is born, I hope you might learn to go with your 'gut' on this one and future decisions, realize that you WILL make the wrong choice sometimes, and most likely it won't be the end of the world. It's fine to consider things deeply, but a lot of parenting can come naturally if you let go and let it. Wishing you a wonderful and healthy birth!

I think if you your mom (or another woman) was with you and she is informed about how to encourage labor progression and you're on the fence about a doula, you would be better not to have one. My husband embodies "loving & even-keeled" but that isn't the same as having someone who is informed and educated on improving birthing outcomes via repositioning, "female centric encouragement" -- hard to quantify but in my experience, it was different hearing my doula (who is also a mother) say "you're doing a great job" and hearing my husband say the same thing -- and other things. My doula encouraged various positions that I believe helped progress labor, she offered focused and specific instructions for breathing and "centering" myself -- another thing my husband could have attempted but I believe it was different coming from another woman. I think it's also a gift to allow your partner to feel whatever emotion he might in the moment (anxiety, nervousness, panic, happiness, etc.) instead of relying solely on them for grounding -- if you don't have to... but again, if your mom or MIL can offer that to you, and you believe in their wisdom, go with them. (As an aside, check your insurance if they cover a doula... Mine did -- I was very surprised -- and we had to meet our deductible first, but in the end, they shelled out the $2k for us) Best of luck to you!

Our midwives STRONGLY encouraged a doula, but we just knew it wasn't right for us. We recieved all the positive data you did about why we should, but I felt the same as you. I trust my husband to support me above anyone else, he is competent, memorized spinning babies techniques, how to labor at home and for as long as possible before going to Alta Bates, and knows when to push me and when to listen to me. He even knew when it was time to trust his instincts and insist to our midwife both times that we were going to the hospital when they were on the mindset I'd waiting a little longer (they fear the slowing of progress when you get to the hospital, which I never did both times). Also, my Midwives, who used to be nurses at Alta Bates, and the nurses still on staff ARE amazing.

I am sure having a doula can benefit some people, but I say trust your gut. If you know the support you have are capable and trust them, you are probably right.

Feel free to ask me for more info if needed. I gave birth to my first last September and my second a week and a half ago. Both at AB, with my midwife, no doula unless you could consider my husband as seudo-doula ;)

If your mother is a retired NICU nurse and you want her to be there, that seems ideal. Do you feel she would be a good advocate for you and the baby? Does she have the energy? If you and her think it would work out, that seems like a great choice. The time I needed a doula was in early infancy to help with getting nursing established.