03/12/2026
What do doulas do?
Doulas nurture and support the birthing person throughout labor and birth. Their essential role is to provide continuous labor
support to the mother, no matter what decisions the mother makes or how she gives birth. Labor support is defined as the therapeutic presence of another person, in which human-to-human interaction with caring behaviors is practiced (Jordan,2013).
Importantly, the doulaâs role and agenda are tied solely to the birthing personâs agenda. This is also known as primacy of interest. In other words, a doulaâs primary responsibility is to the birthing personânot to a hospital administrator, nurse, midwife, or doctor.
A doula can provide labor support via the four pillars of labor support. In the textbook Best Practices in Midwifery, the author describes three pillars of labor support as emotional support, physical support, and advocacy. In the book Optimal Care in Childbirth, informational support is also listed as a pillar of support.
Physical support is important because it helps the birthing person maintain a sense of control, comfort, and confidence. Aspects of physical support provided by a doula may include:
-Soothing with touch through the use of massage, counter pressure, or a rebozo
-Helping to create a calm environment, like dimming lights and arranging curtains
-Assisting with water therapy (shower, tub)
-Applying warmth or cold
-Assisting the birthing person in walking to and from the bathroom
-Giving ice chips, food, and drinks
-Emotional support helps the birthing person feel cared for and feel a sense of pride and empowerment after birth.
*One of the doulaâs primary goals is to care for the motherâs emotional health and enhance her ability to have positive birth memories (Gilland, 2010b).
Doulas may provide the following types of emotional support to the birthing person and their partner:
-Continuous presence
-Reassurance
-Encouragement
-Praise
-Helping the birthing person see themselves or their situation more positively
-Keeping company
-Showing a caring attitude
-Mirroringâcalmly describing what the birthing person is experiencing and echoing back the same feelings and intensity
-Accepting what the birthing person wants
-Helping the birthing person and partner work through fears and self-doubt
-Debriefing after the birthâlistening to the mother with empathy
Informational support helps keep the birthing person and their partner informed about whatâs going on with the course of labor, as well as provides them with access to evidence-based information about birth options.
Aspects of informational support include:
-Guiding the birthing person and their partner through labor
-Suggesting techniques in labor, such as breathing, relaxation techniques, movement, and positioning (positioning is important both with and without epidurals)
-Helping them find evidence-based information about different options in pregnancy and childbirth
-Helping explain medical procedures before or as they occur
-Helping the partner understand whatâs going on with their loved oneâs labor (for example, interpreting the different sounds the birthing person makes)
*Advocacy is a pillar of support that is considered controversial by some for two reasons: first, the word advocacy has several meanings and definitions, and second, doulas differ on their beliefs about whether or not advocacy is part of their role.
In an important paper about the concept of advocacy in the nurseâs role, Kalaitzidis and Jewell (2015) compiled all of the existing definitions of patient advocacy. They found that in the past, the most common definitions of advocacy were âpleading the cause of someoneâ or âspeaking on behalf of someone.â Advocacy can also be defined as âsupporting an individual or group to gain what they need from the systemâ or supporting a person in their right to self-determination.
Advocacy has long been considered an essential component of the nurseâs role. However, while some doulas believe that advocacy is a part of their role, others have been specifically trained that advocacy is not part of their role at all. For many years, DONA International, the first doula training and certification organization, has stated in their standards of practice that advocacy is part of the doulaâs role, as long as the doula does not speak on behalf of the client (DONA Code of Ethics, 2015).
Advocacy can take many formsâmost of which do not include speaking on behalf of the client. Some examples of advocacy that doulas have described include:
-Encouraging the birthing person or their partner to ask questions and verbalize their preferences
-Asking the birthing person what they want
-Supporting the birthing personâs decision
-Amplifying the motherâs voice if she is being dismissed, ignored, or not heard, âExcuse me, sheâs trying to tell you something. I wasnât sure if you heard her or not.â
-Creating space and time for the birthing family so that they can ask questions, gather evidence-based information, and make decisions without feeling pressured
-Facilitating communication between the parents and care providers
-Teaching the birthing person and partner positive communication techniques
*If a birthing person is not aware that a provider is about to perform an intervention, the doula could point out what it appears the nurse or physician is about to do, and ask the birthing person if they have any questions about what is about to happen. For example, if it looks like the provider is about to perform an episiotomy without the personâs consent: âDr. Smith has scissors in his hand. Do you have any questions about what he is wanting to do with the scissors?â
Evidence Based Birth
