What Is a Doula? What They Do, Types, Cost and How to Find One

What is a doula? A doula is a trained, nonmedical support person who gives you emotional support, physical comfort and information before, during and after birth, while your doctor or midwife handles all medical care.

Doulas have gone from a niche choice to a common question at prenatal visits, and the word gets used for several different jobs. Knowing what a doula is (and is not) helps you decide whether one fits your birth and how to work with one alongside your medical team.

This guide covers the doula meaning and origin, what birth and postpartum doulas actually do, how a doula differs from a midwife or nurse, what the research shows, training, cost and insurance, and the questions to ask before you hire.

What Is a Doula? The Short Answer

Cleveland Clinic describes a doula as a trained professional who supports you before, during and after you have a baby, and who complements your healthcare team rather than replacing any part of it. The U.S. Department of Health and Human Services’ policy office (ASPE) uses similar wording: doulas are nonclinical trained professionals who give emotional, physical and informational support during pregnancy, delivery and after childbirth.

Doula Meaning: Where the Word Comes From

If you searched “doula meaning,” here is the dictionary answer. Merriam-Webster defines a doula as a person trained to provide advice, information, emotional support and physical comfort to a mother before, during and just after childbirth. It is pronounced DOO-luh.

The word is Greek. Merriam-Webster traces it to Modern Greek for “female helper” or “maidservant,” which in turn comes from the ancient Greek word doule, meaning a female slave. Merriam-Webster dates the first known use of the word in its birth-support sense to 1969.

What a Doula Does Before, During and After Birth

Cleveland Clinic notes services are customizable, so ask what a specific doula includes.

DONA International describes birth doulas as giving continuous support during labor and delivery, including comfort measures, advocacy and emotional support for the birthing person and partner. Cleveland Clinic adds helping communicate your preferences to your care team.

ASPE adds that doulas can act as navigators and advocates, helping you understand your options and connect with services, so you can make informed choices with your provider.

Getting ready now? See our hospital bag checklist, our guide to what contractions feel like and the stages in early labor vs active labor, and the signs labor is 24 to 48 hours away.

What a Doula Does Not Do

This is the part that matters most for safety and for a good relationship with your hospital or birth center team. Cleveland Clinic is direct: doulas are not medical professionals, they cannot deliver your baby, and they cannot provide medical treatment or medical advice.

• No clinical tasks: a doula does not check your cervix, monitor your baby’s heart rate, take blood pressure, start IVs or give medication.
• No medical decisions: a doula helps you get the information you need, but you and your provider make the decisions.
• Not a replacement for your partner: Cleveland Clinic notes that some partners feel less involved with a doula present, so talk openly about roles. DONA International notes birth doulas support partners too.

If a doula offers to diagnose a problem or tells you to skip care your provider recommends, that is outside the role. Call your provider.

Doula vs Midwife vs Labor Nurse

Cleveland Clinic explains that a midwife has medical training that qualifies them to deliver babies in low-risk births and can prescribe medications, but cannot perform surgery such as a cesarean. You can have a midwife or an OB and a doula.

Types of Doulas

“Doula” usually means a birth doula, but the word now covers several kinds of support. Cleveland Clinic and ASPE describe these types:

• Birth (labor) doula: the most common type. Usually starts working with you in the second or third trimester, attends labor, and checks in after birth.
• Antepartum (pregnancy) doula: supports people whose pregnancies need special care, such as a high-risk pregnancy, bed rest or severe symptoms like heavy morning sickness.
• Postpartum doula: helps in the first weeks or months after birth: newborn care, feeding support, light household tasks and adjusting to new roles (Cleveland Clinic and DONA International).
• Full-spectrum doula: supports a wider range of reproductive experiences, which ASPE and Cleveland Clinic say can include miscarriage, stillbirth, abortion, fertility treatment or adoption.
• Bereavement (loss) doula: works mainly with families going through miscarriage or stillbirth, per ASPE.
• Community-based doula: ASPE describes doulas who practice in the communities they serve and often provide culturally matched support, frequently as trusted community members.

What the Research Says About Doula Support

The American College of Obstetricians and Gynecologists (ACOG), in Committee Opinion No. 766 on limiting intervention during labor (2019), states that evidence suggests continuous one-to-one emotional support from support personnel such as a doula, in addition to regular nursing care, is associated with improved outcomes for women in labor.

The main evidence is a Cochrane systematic review by Bohren and colleagues (2017) of continuous support during childbirth. It pooled 26 trials with 15,858 women in 17 countries. Compared with usual care, women who had continuous one-to-one support during labor were, according to the review:

• More likely to have a spontaneous vaginal birth
• Less likely to have a cesarean birth or an instrumental (forceps or vacuum) birth
• Less likely to use any pain medication, including regional analgesia such as an epidural
• Likely to have shorter labors (an average difference of about 0.69 hours, roughly 41 minutes)
• Less likely to report negative feelings about their birth experience
• Less likely to have a baby with a low 5-minute Apgar score

The review rated much of the evidence low quality, mostly because trials could not be blinded. It found no apparent effect on other interventions, on admission to special care nurseries, or on breastfeeding. The support in these trials came from different people (hospital staff, doulas, family or friends), and subgroup analyses suggested the drop in cesarean births was largest when the support person was in a doula role and in settings where epidurals were not routinely available. The review authors reported no evidence of harm from continuous labor support.

A doula cannot guarantee any particular outcome, and your birth can still change course for medical reasons.

Doula Training and Certification

Doula is not a licensed medical profession. Cleveland Clinic notes that no laws require doulas to be accredited, but most doulas complete training and earn a certification. ASPE states that doula training and certification are not standardized across the U.S., and that some states have created their own certification or registry requirements, especially for doulas who bill Medicaid.

Several private organizations train and certify doulas. DONA International is one; it says it has trained doulas for over 30 years and that its certification must be earned and maintained through continued education and evaluation.

Cleveland Clinic lists common elements of training: studying birth and newborn care, a multiday workshop, attending several births and continuing education. Ask about both training and experience.

How Much Does a Doula Cost, and Does Insurance Cover It?

Private doula fees vary by region, experience and package, and there is no official national price; Cleveland Clinic notes the expense can add up. Ask each doula for a written fee that lists the prenatal visits, on-call period, labor attendance, postpartum visits and backup coverage it includes.

Insurance is changing. ASPE reported in December 2022 that private and public insurance generally did not cover doula services, but that as of October 2022 eight state Medicaid programs and Washington, D.C., covered doulas and four more states were implementing coverage. ASPE also listed the Medicaid reimbursement amounts those programs set at the time, from up to $350 in total in Nevada and Oregon to up to $1,500 across all visits in Rhode Island, which ASPE says became the first state to require both Medicaid and private insurers to reimburse community-based doula services.

• If you have Medicaid: ask your state Medicaid office or your managed care plan whether doula services are covered now, how many visits, and how to find an enrolled doula.
• If you have private insurance: call the number on your card and ask whether doula care is covered or reimbursable, and what paperwork you need.
• Ask locally: ask your hospital or birth center whether it runs or partners with a doula program, and ask doulas whether they accept Medicaid.

How to Find and Interview a Doula

Cleveland Clinic suggests starting early, because demand can be high and a doula can only take so many clients with nearby due dates. Ask your provider, hospital, friends and parent groups for names, then interview two or three.

Questions worth asking (several come from Cleveland Clinic’s list):

• Where did you train, and what certification do you hold?
• How many births have you supported, and at which hospitals or birth centers?
• What does your fee include: how many prenatal and postpartum visits, and when does your on-call period start?
• When will you join me in labor, and how do I reach you?
• What happens if you are sick or at another birth? Can I meet your backup?
• How do you support partners?
• How do you work with doctors, midwives and nurses?
• How would you support me if I choose an epidural, need an induction or have a cesarean?
• Can you give me references from recent clients?

Then trust your gut. Cleveland Clinic notes a good doula should be knowledgeable but also someone you like and trust. Also check your hospital’s support-person policy, since Cleveland Clinic lists facility visitor limits as a possible drawback.

Postpartum Doula vs Night Nurse

Both can help you get through the newborn weeks, but they are different jobs. A postpartum doula, as Cleveland Clinic and DONA International describe it, supports the whole family in the first weeks or months: newborn care, feeding support, light household help and emotional support while you recover.

“Night nurse” is an informal title families use for someone who takes overnight newborn shifts so parents can sleep. Some are licensed nurses and many are not, so ask directly whether the person holds a current nursing license and verify it with your state board of nursing if medical skills matter to you. Neither a postpartum doula nor a night helper replaces your baby’s pediatrician.

Whoever helps overnight, the safe sleep basics do not change: your baby sleeps alone, on their back, on a firm, flat surface with no pillows, blankets or bumpers. See our guides to the fourth trimester, splitting night shifts with a newborn, sleep deprivation and postpartum depression and postpartum essentials.

Related Betteroo Guides

• Hospital Bag Checklist
• Early Labor vs Active Labor
• What Contractions Feel Like
• Signs Labor Is 24 to 48 Hours Away
• The Fourth Trimester
• Postpartum Essentials

Talking to Your Provider About a Doula

Tell your OB or midwife early that you plan to have a doula. Ask about your hospital or birth center’s policy on support people, whether a doula counts toward visitor limits, and whether there are rules for the operating room if you need a cesarean.

A doula is a support person, not a medical safety net. The CDC’s Hear Her campaign lists urgent maternal warning signs that need medical care right away, during pregnancy and in the year after birth. Call 911 or go to the emergency room for:

• Trouble breathing, chest pain or a racing heartbeat
• Fainting or passing out
• Thoughts of harming yourself or your baby
• Heavy bleeding after birth (soaking one or more pads an hour) or passing large clots

Get medical care right away (call your provider or labor and delivery, or go to the emergency room if you cannot reach them) for:

• A headache that will not go away or gets worse, or vision changes such as blurriness or flashing lights
• A fever of 100.4 F (38 C) or higher
• Sudden or severe swelling of your hands or face
• Your baby moving less than usual during pregnancy
• Vaginal bleeding or leaking fluid during pregnancy, or foul-smelling discharge
• Swelling, redness, warmth or pain in one leg or arm
• Severe belly pain that does not go away

If you are not sure, call. Tell whoever answers that you are pregnant or gave birth within the last year. This article is general education, not medical advice.

Frequently Asked Questions