Top 10 reasons to hire a doula

If you're having a home birth, you may not think you need a doula. After all, when you're laboring at home, you won't be fretting over epidurals or arguing with nurses over your kooky HypnoBirthing birth plan. But in some ways, doulas are even more important during a homebirth. And because I didn't have a doula for my homebirth, I learned this lesson the hard way.

Here are 10 reasons to hire a doula for your homebirth.

1.  Doulas understand the birth process.
A certified doula receives formal training in childbirth and hands-on experience as a labor assistant.  They learn ways to support natural birth - everything from calming affirmations to different positions to enhance your comfort. Your well-meaning friends can boil you some tea during labor and offer reassuring words, but they likely won't understand the birth process the way your doula will. And having that professional experience - especially if this is your first experience with natural childbirth (see #7) - is invaluable.

2.  They'll be there whenever you need them.
Most of us aren't lucky enough to go into labor at 9 o'clock in the morning and have it all wrapped up by lunch.  On the contrary, labor can be awfully inconvenient, and when you're laboring at home, you don't have the luxury of a 24-7 nursing staff.  Friends and family who volunteer for labor support are great, but they may not be thrilled about having to drag themselves out of bed at 2 o'clock in the morning. Your doula, on the other hand, will show up whenever you need her, even if it's at the crack of dawn, in the middle of the night, on Christmas Eve or during her cousin's wedding. She's paid to be on call, and that's good to know.

3. They're in it for the long haul.
There was a moment during my 27-hour labor when I looked around the room and realized I was alone. My mother was sleeping. My husband had crashed. And there I was, breathing through each contraction, desperately craving a glass of water and wondering whether someone - anyone - could please, please, please turn down the heat. With a doula, someone will always be there with you. If your doula can't swing a 30-hour all-nighter, she'll at least help manage the shifts so your partner can get some rest while she's on watch and vice-versa.

4. They take the pressure off your birth partner.
This one goes along with #3, but I'll take it even further. Aside from being there to physically relieve your partner, the doula is an emotional relief. Just knowing someone else is there - and someone with far more experience - is reassuring to others in the room. Your doula can answer questions, offer advice, and make suggestions, empowering your partner to be the best support he can be.

5.  Your midwife will appreciate it.
Your midwife is the medical authority during labor. Her job is to focus on your health and the baby's health, which means she'll be checking your vital signs, giving you pelvic exams, and monitoring the baby's heartbeat. Although your midwife is likely to be nurturing and supportive, that's not her primary responsibility. She's not going to sit at your side for 15 hours as you limp along toward 10 centimeters - she's there to deliver your baby. So your midwife will probably appreciate that you have someone knowledgeable about the birth process to be at your side for comfort and support. It takes the pressure off of her to fulfill that role and enables her to concentrate on what she does best: delivering healthy babies to healthy moms.

6.  They've been there, done that.
By the time your doula attends your birth, she's probably seen a lot of other labors. Which means you don't have to worry about your labor being weird or unusual - your doula can reassure you that everything's normal or suggest you call your midwife if something warrants attention. 

7.  First-time mothers need more support.
First-time mothers are overwhelmingly more likely to transfer to a hospital during a home birth - up to 40% of first-time moms compared to 10% for those who've previously had children, according to some studies. At least one midwife I know requires first-time mothers to have a doula in attendance. Bottom line, doulas provide outstanding birth support. The 2006 Listening to Mothers II survey found that 88% of women ranked their doula support as "excellent" compared to their partner/husband at 72%. So if this is your first time around, a doula can be a wise bet for you and your first-time partner.

8.  Doulas won't take it personally.
You may not know how you're going to react during labor. You might make weird noises. You might scream or moan. You might snap at your well-meaning birth partner when he tries to massage your back or sponge sweat off your forehead. But while your husband might get offended, your doula won't take your emotional outbursts personally. And she can help put your crabbiness in perspective for your bent-out-of-shape hubby.

9.  Doulas are a great resource for other assistance you might need.
Many doulas are also lactation specialists, childbirth educators, or prenatal yoga teachers. But even if they don't have specific outside expertise, most doulas at least know where to find it. Since doulas are well tapped into the natural childbirth community, they can refer you to breastfeeding specialists, babywearing experts, like-minded pediatricians, natural parenting stores, and anything else you might need. They're a good source of advice and can also put you in touch with other homebirthing mommies.

10. You might have a better outcome.
This is probably the best reason to hire a doula. Numerous studies show that a doula's continuous presence, hands-on support, and encouragement can improve your labor and increase your success at breastfeeding. One study found that women who received doula support in a hospital were more likely to have a shorter labor and fewer interventions, and my favorite study (which was randomized and controlled - hello, gold standard of research!) showed that women with a doula were much less likely to end up with a caesarean section - 13.4% versus 25% - and less likely to get an epidural - 64.7% versus 76%.  Although these studies took place in a hospital, I have to imagine the results would hold for a homebirth.

Bottom line: I've never met a woman who regretted getting a doula. To find out more, go to DONA International, CAPPA, or ICEA.