The mounting evidence is clear: having a doula can help decrease the risk of having a cesarean birth and significantly improve birth experiences. In fact, doulas have even been called a form of pain relief themselves, as people tend to want fewer pain medications and epidurals when supported by a doula. But what makes what doulas do so special and different from the care you receive from your other care providers?
Sabia Wade talks to Adriana about what a doula is, how to find one that will be a good fit for you, the difficulties in accessing a doula (and how that’s evolving), and why a doula’s uniquely non-clinical care can be so complementary to that of the rest of your team, no matter the type of birth you have.
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- The Evidence for Doulas, Evidence Based Birth
- Ten things to consider when choosing a birth doula, Radical Doula
- Doulas are for Every Kind of Birth by Sharon Muza
- Everything You Want to Know about Full Spectrum Doula Work, Birthing Advocacy Doula Trainings blog
- Why I Needed to Create a Full Spectrum and Inclusive Doula Training, BADT blog
- Black Doulas Are Banding Together to Beat High Infant Mortality Rates, Glamour
- Our Favorite Racial Justice-Centered Resources for Families and Birth Workers, Birthing Advocacy Doula Trainings blog
- Our Favorite Queer and Trans-Centered Resources for Families and Birth Workers, Birthing Advocacy Doula Trainings blog
- Sabia’s website (where you can find plenty of enriching opportunities, like their 6 Business Essentials for Birthworkers Workbook, executive coaching, entrepreneur mentorship, or where to book an antiracism training, plus some incredible press about Sabia’s work)
- The Birth Neoterist newsletter
- Plus find Sabia’s work babies, here:
Directories where you can find a doula:
- Birthing Advocacy Doula Trainings
- Queer Doula Network
- Sista Midwife directory
- National Black Doulas Association
- Doula Match
- Birthing from Within
- DONA International
- The International Childbirth Education Association
Related Birthful episodes:
- How Do You Know If Your Care Provider Is Treating You Fairly?
- How to Stand Up for Your Birth Rights
- [Postpartum] All About Postpartum Doulas
Why Your Team Isn’t Complete Without A Doula
Adriana Lozada: Welcome to Birthful, Mighty Parent or Parent-to-Be. I’m Adriana Lozada, and as we just continue chugging along with our Care Provider series, I really felt that the conversation wouldn’t be complete without bringing doulas— and specifically birth doulas— into the mix.
I mean, just the fact that every other provider that we’ve talked to in this series has highlighted the importance of having a doula? That in itself would be reason enough for including doulas in this series. But I also wanted to underscore that precisely because doulas bring a non-clinical, yet very valuable set of skills to the table, they are then able to meet needs that other providers don’t or can’t focus on.
So then, by making a doula part of your team, you are including this unique care that is complementary to the care that you get from your other providers, so that then you have truly holistic support for this part of your reproductive journey.
And as we’ll see, you’ll also be increasing the odds of having better outcomes and a more satisfying birth experience.
So then my guest today is Sabia Wade, who is the founder of Birthing Advocacy Doula Trainings, and also of For The Village, which is a nonprofit that provides doulas at no or low cost to low-income and marginalized communities in San Diego, California. Sabia is also the author of the book, Birthing Liberation, How Reproductive Justice Can Set Us Free.
Sabia and I ended up having a very flowing and organic conversation, and so because of that we didn’t really get into the statistics, into the numbers of how doulas improve outcomes.
Nevertheless, I did wanna make sure you know, you get those numbers so you know how impactful doulas can be and not just think that, Oh, we want you to have a doula because we’re huge champions of doulas and we’re doulas ourselves. So here are the numbers:
Having continuous support from a doula decreases whatever your baseline cesarean risk is by 39%, and it also increases your likelihood of having a spontaneous vaginal birth by 15%.
The research also shows that having a doula can even shorten the length of your labor by 41 minutes on average. Other benefits of having a doula are a 38% decrease in baby’s risk of a low five-minute APGAR score and a 31% increase in satisfaction with the birth experience.
Having a doula can also lower the need for pain medication, epidurals, vacuum- or forceps-assisted births. And, in fact, there is research to even say that birthing people may feel less pain when a doula is present, probably because having a doula can make you feel calmer, release tension, and increase your oxytocin flow, and your beta-endorphins, which are basically your own natural painkillers. Best of all, there is no evidence for negative consequences to continuous labor support, such as the support that a doula provides.
If you want more information on the research, evidencebasedbiirth.com has a fantastic conceptual model for why continuous labor support is so effective, and I will drop the links for that in the show notes.
Okay, so these numbers are based on decades, decades of research and is why we’re finally seeing more recognition of the benefits of having a doula from the medical community and policy makers alike, and is why I say that your care team is not complete without a doula.
At the same time, Sabia, and I understand that having access to a doula is not always easy, and so we do talk more about that in the conversation. Now, one thing you may notice that we don’t really talk about in this episode is the advocacy role, the advocacy piece of doulas. and that’s because that’s a conversation that needs its own whole separate episode, which will be part of the future series— but yeah, advocacy is definitely a huge part of what doulas do. And I mean, just consider that Sabia’s doula training organization is called Birthing Advocacy Doula Trainings.
So then in this episode, we focus more on the steps toward making a doula part of your birth team and why, and you wanna definitely stick to the end for a great list of questions from Sabia that you can ask your doula to see if they are a good fit for you.
You are listening to Birthful here to inform your intuition.
Adriana: Welcome, Sabia. It is so delightful to have you here. We finally made it! We are connected and we’re talking.
Sabia Wade: Technology is working for us today!
Adriana: And we are so appreciative of it, absolutely. And I’m so happy to be able to pick your brain and talk to you about doulas! Before we jump into that, though, can you tell the listeners a little bit about yourself? Who are you? How do you identify?
Sabia: Yes, I am Sabia or Sabia Wade. I’m just like, “Oh, I’m just Sabia,” but also Sabia Wade. I am a full-spectrum doula. I’ve been doing this work since 2015, and since 2015 I have, like, expanded into three main birth-related businesses: so I’m the CEO and founder of Birthing Advocacy Doula Trainings, my nonprofit For the Village, and also my company (like, my own brand, if you will), The Black Doula, Inc.
So, I identify as a person who is sometimes kind of wild. I’m a Sagittarius— double Sag, Gemini Moon— so a little hell, a little chaotic. I am queer. I am black. I use she/they pronouns. I am a person who loves to learn. I am a person who, of course, loves to travel— need to do more of that. And I’m actually pretty introverted by nature— but I’m not a shy person, so you can’t ever really tell.
Adriana: Well, that is hilarious that you said you were double Sag, Gemini. I was trying to find the rising sign for a friend recently who’s also… she’s also a Sagittarius and my sister’s a Sagittarius and my daughter’s rising Sagittarius. So, I love you all— you drive me crazy, but I love you.
Adriana: Oh my gosh. So, and I’m Taurus, rising Cancer.
Sabia: Oh, that’s a lot.
Adriana: But they had a thing, a whole article about Taurus, rising Cancer, and it said, “You’re the ultimate homebody.”
Sabia: Yes, for sure.
Adriana: And I felt so seen!
Adriana: So when you said you’re, like, an introvert, but not… I feel that being a homebody just describes me. I love people. I can talk to people— I can get up on a stage and talk! I love traveling, but I always gotta come back and just cocoon for a while.
Sabia: Yeah. That’s the way that we get our energy back. I definitely don’t mind being with people and talking to people and connecting to people… but I don’t get energized from that. I get energized in the moment, right? But, like, in actuality, afterwards, I’m drained, right? But if I actually wanna build my, like, internal energy, it’s at home, it’s usually by myself. It’s low-key. Like, it’s opposite from what my, like, public-facing personality may be.
Adriana: No, I feel it so much. Same thing. Some people get so charged by being out with others, in community, and that’s not me. I, like you, get charged by being alone. So happy you get that!
So today we are going to walk the people through kind of, like, a primer of what a doula is and what we do, and just talk about a little bit of the misconceptions that are out there, the benefits of a doula, and, bottom line, why everyone should use a doula, full stop.
WHAT IS A DOULA
Adriana: So let me get off that soapbox and take it back to the basics. Sabia: What is a doula?
Sabia: What is a doula? I always give, like, a very, like, typical definition. Y’know, “a non-medical support person that provides support for birthing people through many stages.” And the kind of support that we provide, it’s physical, emotional, informational. And we are, again, really emphasizing this piece around that we can be utilized and assist through any type of reproductive health experience, ’cause you know, most people think it’s only for birth.
Adriana: And that is definitely—
Sabia: I’m, like, “No, it’s also just everything!” So pushing that in.
Adriana: And I think that’s something that’s been coming up more and more— the expansion of doulas from originally just birth, to birth postpartum and then to full-spectrum, that includes help during pregnancy with fertility, with loss, with abortion, through the whole spectrum of reproduction. And I totally appreciate and value and hold dear all the people who are full-spectrum doulas. I like birth, so I just hang out in birth.
Sabia: The first few years of the work that I did was definitely heavy on birth. Like, that was, like, my go-to. Like, I did postpartum a good amount, but my thing was birth, still is. I mean, actually, I’ve been getting really into death doulaing. But that’s just, like, exactly the range of the work that we do as doulas. And I think it’s the beauty of being a doula, is that you can go through periods of like, “Oh, I’m heavy on the birth. I’m heavy on the postpartum.” You could be mixing these things. “I’m heavy on abortion care. I’m heavy on death doula work.” There’s a spectrum of things that birthing people are experiencing. And I think, just like you said in the beginning, it’s like every person, no matter what experience they’re going through, should have a doula.
I often think about why doulas have become so popular now, right? Because doulas have been around for a long time, y’know, doulas back in history, generations. But I think about, like, why we’re so present now. And I think that really at least some of it is because of, like, before, our family structures were different. Money was different, right? So then, when someone was having a birth or having a postpartum or dealing with loss or whatever, it was kind of like you had your community— which usually was, y’know, your family members, your friends, usually/typically people who identify as women would be able to come into the space and help people out.
But then we look at, like, our current world, where we’re all like, “What is going on?” We all are working, how many hours a week? Retirement is not that easy, right? In the ways that it used to be. Like, time is harder to access, right? Like, time to care for yourself, time to care for others is harder to access in our current world.
And I think that’s where doulas have slid in, right? Where we’re like, “Okay,” y’know, “Your aunt/your uncle/your family/your friends can’t really be here for you in this way.” They’re doing what they can, right? But you need more. We don’t try to take over the role of family members or partners or friends or besties or whoever, but we try to add to that care, right? So, what are the gaps that are missing? Is it that you need more information about the process that you’re in? Because doctors don’t really have that much time either, right? So they’re coming in for a 15-20 minute, y’know, appointment with you… but are they really able to explain the every little step that’s gonna happen? Are they really able to answer the questions that you may have? Usually, no!
Then you have, y’know, emotional support, right? So, your partners, your family, your friends may be coming in with that emotional support— y’know, after work, and texting you and doing all that. But it’s nothing like having a doula sit with you for a couple hours and check in with you on a regular basis. Like, not only can you put that emotional… y’know, where you are emotionally in this conversation, but you can also understand that I’m not gonna put my emotions into this space, right? So it’s like, “I’m here holding space for you.” I’m not telling you what I did at my birth and how this worked and how I feel about that and why you should be… right? So all of that is left out.
And so I feel like, y’know, because of the systems that are currently around us— whether it’s capitalism, patriarchy, whatever systems— we have been able to come in as a necessary resource, right, for the gaps that need to be filled. And filling those gaps, it shows in research that is better for everyone.
Adriana: What you’re saying about the family structures and how things have changed… I think there’s also the part of when we were more in community together (and multigenerational community) and were able to connect with each other’s life milestones in a more intimate way, as a matter of fact. So when somebody was having a child or bodyfeeding, it was something that you knew about when you were little— like it was in the air, so you knew about it. And now we’ve got that disconnect. So I think that’s also, y’know, one of the many amazing tools that doulas bring is that knowledge of birth in many different settings, because I find in that since we’re hired by the person giving birth, and we go with them wherever that is, we see birth with different providers in different hospitals and birth settings, at home, birth centers. So when somebody says, “Oh, no. This is how we do it,” and they make this Protocol (capital P!): “Everybody needs to get—
Adriana: —monitored,” da, da, da. It’s like, “Well, down the hall with these other providers, they’re not doing it like that,” and “Over at home, they’re not doing it like that.” So that’s a very unique perspective that nobody in the perinatal system brings.
Sabia: Yeah, and I think, like, usually providers— as far as, like, physicians, midwives, depending on what type— they usually master the skill set for the setting that they’re in, right? And some of ’em actually don’t even see other settings, right? It’s not part of their learning process. So, y’know, a midwife who’s in a hospital has probably… hasn’t been at a home birth, doesn’t know what that looks like, or been at a birth center, doesn’t know what that looks like. So there’s, like, this very one-sided way of learning, and just knowing like your environment and not necessarily the full spectrum of environments that birth can happen in or any other experience.
And then the other thing that I always bring up to parents who are either, y’know, expecting, or people who could be expecting at any time— ’cause they’re adults, right?— but I’m like, “The wild thing about birth is that it’s so normal.” Like, people exist because someone created them, and there was a baby, right? But so many people don’t actually have any connection to birth or even have witnessed a birth or witnessed bodyfeeding or witnessed anything until they’re in it, right? And then by the time you’re in it, not only are you trying to learn this new skill, but you’re also dealing with your hormonal imbalance. You’re dealing with the shifts of life that are happening. You’re dealing with the mental changes, the physical changes, all these things. So it’s hard to— even if you have, like, the logic, right, of, like, understanding how these things work— it’s so hard to put that thing, to put it together, ’cause you’re going through these other elements.
There’s relationship changes, and your parents are coming over and your aunt… and then people are in the middle of COVID having babies, like, feeling very isolated, right? You’re dealing with, sometimes, with a great birth experience, sometimes more of a traumatic birth experience. And then you have a doula, right?
And a doula comes in and says, “Okay, I know that you are holding all these things,” right? And “I’m here to talk you through it. I’m here to provide resources,” if that comes out of my skill set, right? I’m here to connect the dots in whatever ways that we connect. I’m also here to tell you that what you’re feeling is absolutely normal. So even though you may be feeling, like, out of sorts, right, and may be feeling like, “Am I okay?” or “What’s going on?” to have someone that could say, “This is normal,” or “Here’s a resource for this,” or “Maybe this isn’t normal,” right? And “This is what we can do about it.” And also “Let me hold the baby,” or “Let me hold you,” right? Like, that is just… it’s invaluable. Like, it’s just… it’s amazing. And that’s the work that we do.
Adriana: Well, and so amazing of having somebody listen to you with their ears and heart and mind, and like all of them, listen to you and be also able to center you.
Sabia: Mhm. Mhm.
Adriana: Because the doula is primarily— like, yes for the whole family— but understanding that at the core of the family is the birthing person. And if they’re not doing okay, then everything falls apart.
So having somebody completely champion the birthing person… I find the whole process, medically, is really looking at you in terms of a container that’s holding a baby and making sure that container is working properly so that that baby can exist. And then once the baby is born, it’s all about the baby, right? And you can see the pattern of perinatal appointments that as you get closer to your expected date of delivery, become every week, and then after the baby’s born, they’ll see you in six weeks. If that doesn’t tell you who matters, nothing will! So I think we can’t undervalue the importance of the doula as a care provider for the birthing person in a different way, in a holistic way, that they can’t really find anywhere else.
Sabia: For sure. And I think, like, that really, like… At least the thought that comes to my head is about the informational support that we give. And when we think about birth, obviously we think about the actual labor process, right? Because it’s this whole buildup and then it’s like “Labor!” What is that gonna look like? And the answer is, “We don’t know what labor’s gonna look like.” I mean, we have a picture of, like, what it could look like, what it maybe most likely would look like, depending on the factors of your pregnancy experience and your body and this, that, and the other. But we actually don’t know, right?
So as a doula, a big part of our care is providing you with this information in prenatals before we go into the actual labor. So in that sense, we’re looking at, like, “What do you want your birth to look like?” I mean, people call it a birth plan, you can call it a birth wishlist, you call it whatever you want, right? That’s up to you. But really talking about… like, I always say, “What is Plan A? What would be an ideal situation for you?” And also there, there’s no judgment if your ideal situation is a c-section. There’s no judgment if your ideal situation is with an epidural from the start. There’s no judgment in whatever that is. But with a doula, I, right, feel the responsibility to allow you to dream, right? Dream about what that is. Is it the music in the background? Is it, y’know, certain family support? Is there some type of spiritual practice that’s happening? Right? Like, what is your ideal dream?
And then I tell people, “Okay, we gonna go over all the things that could happen though,” from, y’know, a general standpoint and look at the Plan B, okay? So Plan B is if things go left, okay— ’cause things go left sometimes. Sometimes you think you’re gonna have a vaginal birth with no interventions and you’re like, “Gimme that epidural,” right?
So then we make a plan for it, Plan B, right? It may have some of the things that you would prefer and may not have some of the things that you would prefer, but how do we move through it? What do these interventions mean? What do these types of monitors mean? What is happening, right? What should we be looking out for? How do we talk to providers? How do we communicate in efficient ways?
And then I always say Plan C, right? And so Plan C is really a c-section for the person who is planning for a vaginal birth… but also we can plan that, right? So, if you had a c-section, y’know, what do… What would you like us to do? How would you like to be comforted if it, y’know, switched to this? Also, what does c-section aftercare look like? That’s gonna differ from vaginal care, right? What is the expectation that you can build— y’know, tell your partner, like “If this was to happen… This is what I would like if this was to happen. This is how much care I’m gonna need from you. This is gonna shift.” Right?
So I think it’s, like, really this informational support, and to what you were speaking to as far as, y’know, obviously we go through the birth and we try to be present for the whole birth. Sometimes we have to switch out, depending on how long the birth is— ’cause it could be a two hour birth, it could be a four-day birth, you never know.
But also in that postpartum, especially in that immediate six weeks— my non-profit, y’know, we work with low-income and marginalized communities. A lot of our families are… they speak different languages. They have different barriers. They have, y’know, different things going on. But there’s been a few times where, in that six-week time where they weren’t being seen, that they were having medical conditions that they weren’t aware of, right? Some of ’em were having high blood pressure after the baby was born, right? So postpartum eclampsia was happening. Too much bleeding, too much this, too much that— and the only caregiver, right, that was with them in that six weeks was their doula. Like, you know they weren’t going to a medical doctor appointment. You know, depending on the situation, a midwife— if it’s a home birth midwife, they do see you within that six weeks, usually a few times, depending on the midwife— but they weren’t getting that like continuous care that doulas can get. We’re checking in, “Hey, how you doing? How’s your bleeding? How’s your mental health? What’s going on with the baby? Is the baby eating?” Helping to get into anything that may be present. And so it’s like you can’t… like, that informational support that we give priceless.
Adriana: Priceless. And you have the permission to text or call this person— ’cause you’ve got their cell phone number— 24/7.
Sabia: Mhm. Mhm.
Adriana: So, I mean, that alone is… I don’t know why we do this work that we do, that we’re on-call, ’cause life on-call is, it’s a special level of intense.
Adriana: But we’re there for you, right?
I think, too, like I always, like, say… Especially when you’re a doula who’s— I mean, everyone deserves all types of care resources, but I think other populations have higher needs. But either way, like, for example, like the way that we train our doulas in BADT is, like, we help them to build a food resource, right? So if someone’s dealing with food insecurity, we help them to figure out a resource. Of mental health providers. We help them to build the resource for bodyfeeding support groups. And we also have these conversations that are particular like, y’know, if you are— for example, I’ve had clients who are black folks, who are maybe low-income and are like, “I don’t necessarily feel great in a support group of, y’know, white women who are high-income,” right?
So even just, like, us being able to hold those nuances and those differences around like “Where do you feel comfortable?” right? What is gonna feel like a conversation, a place that you can really be open and have a very open conversation.
So I think, like, we’re also just like— y’know, I always say doulas have so many resources, and even if we don’t have an answer, we can call somebody or know somebody or connect, right? Like, for example, if you’re looking for someone who’s gonna do body balancing, right? Now, you can look up body balancing on Google and hope that you come up with some providers, or y’know, massage therapists or people that can do that. But also you can go to your doula and your doula’s like, “Actually I have this one person I really like. I really suggest them.” So it’s also like we save time, ’cause we have these, like, community connections. Whether again… Whether it’s, y’know, something that is like food insecurity or whether it is like just trying to get someone that can help you with your hips ’cause your hips are in pain.
And I think that’s also like this: It saves time. It builds connection. It helps people feel connected to their community. I mean, I think that’s something that is also very valuable in the work that we do.
DIFFICULTIES IN ACCESSING A DOULA
Adriana: So let’s take a step back and go into… Okay, so we have “What a doula does,” and then it’s “How does a person access that doula?”
Sabia: Yes, yes. Right. And so one of the things I wanna name in this conversation about access— is that accessing a doula is not always easy. And I mean that in so many ways, whether it is the financial piece that comes with hiring a doula (some insurance companies are getting more hip with, like, y’know, putting some money towards that, but a lot of people don’t have that, right?). So there’s a financial accessibility that can definitely come into the picture.
And then I also wanna say that sometimes there’s just no doulas in your area. I think sometimes, like I’ve been spoiled, right? Living in Massachusetts, living in San Diego, living in Atlanta, there’s like a flurry of doulas, right? There’s just, like, doulas everywhere. But in some like rural communities or smaller communities or different locations, doulas aren’t always available for in person. And so the great thing is some people do offer virtual services that can be very helpful to the process.
But just naming that, like, accessibility for doulas is something that’s currently being worked on very heavily— because we do believe that everyone should have a doula, right? But also that doulas should be paid for their work.
Adriana: Oh, well, a hundred percent! And paid a living wage— not only just paid, paid a living wage.
Sabia: Yes, yes. Right? So that’s an ongoing thing. That’s a whole ‘nother conversation.
FIRST STEPS IN FINDING A DOULA
Sabia: However, I always tell folks, “When you’re thinking about having a doula for whatever, y’know, part of the reproductive experience you’re in, really start with thinking about ‘What is important to me in my connection with my doula?'” right?
So, for example, some people may say, again, “I want someone who’s, like, culturally-congruent,” right? And so that may be we share a similar race, we share a similar ethnicity, maybe we share a similar understanding of gender and sexuality, maybe we share, y’know, a similar place, of coming from a certain place, right? Whatever it is, like, what feels in alignment, that is important to you— and then from there, starting your search on for a doula.
And so the great thing about the internet is that usually, if there is something that you want to be congruent, there are a lot of, like, databases or— I can’t remember the word right now— where you can find doulas that are in alignment with that.
So like, there’s a Queer Doula Network, right? So if you’re looking for someone who’s queer. There’s Sista Midwife, National Black Doula Association, if you’re looking for someone who’s Black or a person of color. BADT has a directory— that’s what I was looking for— if you’re looking for someone who is, like, into full-spectrum work and y’know, understanding the world and its nuances, right?
BUDGETING FOR A DOULA
Sabia: So start with that. Also be mindful of what your budget is. And think about— and I will also bring this in— it’s like, if you’re thinking about, like, “Okay, my budget is $1000,” and y’know, “I’m finding doulas that are $1,400,” is there some other, like, thing that you can barter? Right? Are you an accountant? Can you do their taxes at the end of the year? Are you this… Is it something that you can bring into their life that will also help them, right? It may not be monetary, but it may be very helpful for someone who has a small business.
Adriana: And I love the idea also of putting it in your baby registry.
Sabia: Oh, yes. Putting it on your registry!
Adriana: Right? Or have, y’know, your family come around to the idea of the importance of a doula— and both the birth and postpartum doula, right?
Sabia: For sure.
Adriana: Or a full-spectrum doula that does those things. It is that… It’s way more important than the wipe warmer!
Sabia: I mean, seriously!
Adriana: I would say, even than the stroller, like yeah!
Sabia: Yeah, have an understanding of, like, these are the things that we need, right? And then also the other thing, it could be $100 donations, $50 donations, $25 donations— all those things add up, especially if you’re working with a doula who has, like, a payment plan or things, like, that where you can, like, make payments over time.
And then I think it’s also important to, like, name that when you do meet maybe a couple doulas that you’re interested in— there’s an alignment with the things that you want— that it is now interview time. And so interview time is a really good time to…
WHAT IS YOUR DOULA’S EXPERIENCE?
Sabia: Oh, and the one thing I would say, before I move on to that, is some people are gonna want certain experience and I think that’s okay, too.
It may not be, like, years of experience. It may be “I’m having twins. Who has twin experience?” Y’know, “I’m having a kid with this. Do you have this kind of experience?” Not necessarily, like, numerical years, if that makes sense. And it’s okay to want that.
Adriana: Absolutely. Mhm.
MORE ON DOULA ACCESSIBILITY
Adriana: And before you move on, I also wanna say that, in terms of that accessibility and financial ability for doulas, that we are in a period of transition, and I don’t know how many years it’s gonna take to get there. But as more people want to have doulas and demand doulas, and as more policymakers become aware of the importance of doulas in terms of outcomes (how we reduce cesarean rates, we reduce the needs for interventions, we reduce negative outcomes, Apgar scores, y’know, for babies), as they understand the value of a doula— not just ’cause it’s nice— but it also really helps their bottom lines. We are in the transition of— at some point, I’m sure, insurance and Medicaid at large is gonna be covering doulas. Right now it’s an out-of-pocket expense. In some places you can use your FSA or HSA accounts. That’s why we were both saying, y’know, figure out how to pay for this, but get creative to pay for it. Because right now there is that barrier of “Insurance does not cover it.” I think we’re gonna get there.
Sabia: And it’s also a struggle because there are some states that cover, like, Medicaid covers doula care, but they do not pay enough, right? So even though doulas—
Adiana: Not a living wage!
Sabia: —doulas would love to be on these lists, it’s just not accessible to many doulas, ’cause they will be taking a pay cut that they can’t afford to take, right? So, y’know, that’s a whole… we could get into that for hours, but…
Adriana: Well, and to put it, like, really succinct for people, it’s because you don’t know how many hours you’re gonna be and they’re paying a standard rate. Which is a standard rate, what we— like, we don’t do sliding, y’know, depending on how many hours we cover, you get for birth, you get, y’know, have to pay more— but they’re not taking into consideration the average of a 14 to 20 hour birth. If I split the amount that you wanna give me between those hours, plus the prenatals I put in and the postpartum, you pay me less than, you know, minimum wage wage—
Sabia: And even signing in—
Adriana: —or less!
Sabia: —with the phone support, right? The text message support. Y’know, a lot of doulas have children of their own. They have to, y’know, send their kids to overnight care, y’know, in hope paying for these services, right? Like also when you’re at a birth, you’re missing things. Sometimes you’re missing paid opportunities. Sometimes you’re missing whatever it is because you’re being present at this birth. But the current reimbursement rates are definitely not high. So that’s why you see a lot of doulas, even if they do have that option, still maintaining their private practice with, y’know, whatever price they need. Y’know, we have a long way— but we’re working on it.
QUESTIONS TO ASK YOUR DOULA
Sabia: But I would definitely say, for the interview—
Adriana: So, interview time! Yeah.
Sabia: So, with the interview process, I think it’s really important to write out questions that you may have, right? So, like, starting off with, like, a very focused conversation, things that you might wanna know.
I always tell people, like, just get an idea of, like, their philosophy on birth, right? Because although doulas— some people think that doulas are only for “natural childbirth,” quote-unquote, or vaginal deliveries— I’m like, “We’re here for everything.” But doulas are also individuals, right? So the way that we practice is not, like, in a way that we all have to have the same individual thoughts about birth. So some people may have a thought process that you’re not with… They may, y’know, have a practice around birth that you’re not with. Maybe they are people who think that, like, interventions are super unnecessary and maybe you’re the kind of person who’s like, “Hey, if I need an intervention, I’m gonna use it,” like, y’know?
So really getting an idea of like, “What are your thoughts about vaginal births and c-sections and epidurals?” and, y’know, “Do you educate on all of these topics?” Right? “So even though I may be leaning for a no-intervention birth, are you still able to educate me on these other resources?” Y’know, things such as “What should I expect from you? So let’s say I call you in the middle of the night— are you gonna answer? Is there a window of time that I should expect an answer by?” “When we do prenatals, how long will the prenatals be?” “Will you feel comfortable coming to my house?” So really just writing these questions to get, like, y’know, knowledge— that logical knowledge.
But also the other really important part about interviewing is just like feeling in your body: What is the vibe? Right? “Do I feel like I am kind of constricted around this person?” Right? Beyond nervousness. Or “Do I feel, like, not so comfortable?” “Do I feel really comfortable? Do I feel open? Do I feel like I feel supported?” Those things are just as important as understanding someone’s birth philosophy, because this person is going to see you naked, vulnerable, in need of assistance, in need of help, emotional, right? And you want someone that could hold that for you.
Adriana: And hold it in a way that you want them to do that, right? And be like, “No, please don’t touch me,” and then they’re like, “Yeah, no problem,” right? And I wanna say that I like to get partners— if there is a partner involved— in the interview process as well, at some point. Or just make sure that the birthing person gets their feedback and their buy-in to this, because I know that when we get down to it, I’m there to support them as much as the birthing person. And because we kind of adapt what we do so much to the individual person or family that we’re serving.
Y’know, like, I had one client that hired me once. She knew that her husband’s default when he got stressed is he needs to sleep. So they knew that he was gonna be sleeping through this birth, he was gonna be there, but he probably gonna be sleeping. And that’s what— and y’know, and like, I don’t care. That’s… I’m there to support you 100% on your choices, so if that’s what works for you… So that’s why they were getting a doula. It was—
Sabia: I’ve been there before.
Adriana: —so you adapt to it. Like, y’know, I think at one point we had to shake him, ’cause he was snoring and she’s like, “Please tell him to stop snoring.” But other than that, he was asleep. But yeah, and now I told a story and lost my train of thought of what we were talking…
Sabia: No, what you’re leading to— at least what I think you’re leading to— is, like, that being part of the interview process, which is 1) if your partner can be available, make them available, like, for the actual interview process. So also see how they feel, what their vibes are, what questions they may have.
And I think just, like, a very general question to kind of bring into the space is “What part do you see my partner playing?” Right? “How do you create an experience for the partner as well?” So, for example, a lot of partners— and we have, like, a whole thing about caring for partners in our training because of this— but a lot of partners end up kind of being shoved in the corner ’cause they’re like “No one’s talking to me. I don’t know what to do. I’m lost.” Like, it’s like “I’m here! I’m trying to be here, but I feel like I’m in the way.” Whatever the case is, right? And so, like, as a doula, if that is… If partner involvement is something that you and your partner have agreed on as being important, right, as a doula, I would want to explain to my clients like, “Hey, every prenatal, if you can be here, I wanna teach you these things, too. Here’s my number. You can connect to me and ask questions just as well as your, y’know, the birthing person. I’m gonna teach you comfort measures. I’m gonna teach you how to communicate in the room. I’m gonna make sure that, like, I’m not taking over your part in this.” That is never the mission for me. My mission is to make sure that this is more of I’m, like, coaching the room, making it a little bit more seamless. And also when you go take a nap or you need to take a break, I can be present, right? So I think, like, during the interview process, if partner involvement is very important to you and your partner (or partners), that you ask your doula like, “Hey, how can we make this happen?”
Adriana: Yeah. And I think what you say is true, in that during this whole pregnancy process, partners tend to be even less, like, forgotten even, right? Right? So it… Some of my biggest advocates are the partners, because they feel valued. And you bring ’em back in and to let them know, like “You bring to this space”— if this is what you wanna be involved in and the birthing person wants you involved in this— “You bring to the space something that nobody else can bring,” which is that—
Sabia: I feel like another added addition of having a doula is that we aim to continue intimacy between partners, right? So, like, intimacy, y’know, of course there’s sex— can’t do anything about that, that’s on you. But what I can do is, at prenatals, make sure that you’re learning together. Make sure they’re asking questions together. And I think another— y’know, just keeping this in mind to your listeners— is, like, one of the biggest (at least in my perspective), like, one of the biggest things that birthing people have a fear of (or that actually happens) is that partners after the baby is born, they don’t have that connection, right?
They’re like, they don’t have that connection. Like, I’m here doing this whole baby thing and they’re kind of floating, like that kind of thing. But I’m like, “If we…” my goals as a doula, if I can get that partner connected in the prenatals and the birth when a baby comes out, they feel like they were just as equally, y’know, active in that situation, and it helps with them connecting in the postpartum stage, right? So that if I’m your postpartum doula, I’m also teaching y’all how to interact as partners. Not just telling a birthing person, “This is your responsibility to make sure this baby is okay?” right? And I feel like—
Sabia: —the work of a doula is seeing like this full picture, right? And not just a laser focus on the client or not just a laser focus on the baby or the partner, but we’re like, “Hey, here’s a full picture that we’re trying to create here,” and I can be the avenue and the assistant to help that happen.
Adriana: And I think— y’know, absolutely, 100% all you said— and I have, even within the birthing room, y’know, creating space for that partner, giving them permission to insert themselves, ’cause you see them step away when the nurse wants to take a blood pressure. It’s like, “No! No, you don’t. Her job’s to go around. They can go around. You are exactly where you need to be in there.” Or y’know, just a simple question after the baby’s born and the birthing person has had ample time, say, if that’s what they wanted to, to do a lot of skin-to-skin. Just say, “Hey, do you wanna do some skin-to-skin with the baby too?” And then just that permission of like, “Oh my gosh, this is something I can do?” And it changes, that permission of “You can! You are part of this. You come in here.” So I think we’re just, as we serve the whole family, whatever that family configuration is—
Sabia: Absolutely. And I think, y’know, coming into this when we’re talking about, y’know, a client (or birthing person) choosing a doula, it’s really thinking for the client (for the birthing person), “Hey, what is the story that… What is a fairy tale that I want to happen?” right? Like, “What is the story that I want to happen? How do I envision these pieces of this process?”— right from the pregnancy, to the birth, to the postpartum stage or whatever else is in between— and really like allowing them to dream. Understanding, right, that this is dreaming, so it ain’t gonna be perfect, right?
But how do you see a partner involved? What is that emotional support that you need? What is the information that you need? How are you comforted physically? Do you want somebody to rub your back? Do you want somebody to give you some hip squeezes? So really to think about, like, “What does that story include in this next phase of your life?” right? And then who do you want to support that?
And, like, that’s where doulas come in, right? And I think it’s, like, so great about doulas because we’re kind of like— we’re not a “one-size-fits-all.” We are, like, different, ’cause we could bring our personality into the space, we could bring our culture into the space, we could bring these different… y’know, whatever, we could bring that into the space, right? And we can really be probably one of the most kind of, like, personalized caregivers in your circle, right? Where, like, a doctor, you’re like, “Okay, these are the doctors that are on my medical plan. This one is decent. Let me go and do this thing,” right? Where like—
Adriana: They may or may not be there!
Sabia: They may not be there, I don’t know if they’re gonna be there at the birth. Like, I don’t really know what’s going on. But a doula, you can really— in your own way— really personalize what that person could be for, y’know, not all the way, right, but a good amount. And you can also… They can be the person that helps you build what that story is for you.
Adriana: And I think we have to, once again, underline the importance of how birth is a physiological process, but so much of it is psychosocial and emotional, and how doulas— by the mere fact that we don’t do anything medical— it means that all our tools are the not-medical, and we gotta get really creative with all that, and that’s what we bring to the table.
And because the medical system that we have that is so imperfect and so broken, is such that it does not— like, y’know, the perinatal saying right now is “Healthy mom, healthy baby,” which is a really low, awful bar. ‘Cause if you can’t even do that— and we aren’t even doing that, right, we aren’t even there— but if that’s the focus, all these quote-unquote “touchy-feely” things are seen as nice extras, and they actually are the cornerstone of a proper birthing process because you need to feel safe and secure for oxytocin to flow. Oxytocin is causing contractions and it brings your baby forward!
So it’s not that we’re just nice to have— it’s this type of care is vital for a flowing birth, and which is why I’ve included doulas in the Care Provider series. But also every single provider that I’ve talked to so far (except maybe the Maternal Fetal Medicine specialist), but everybody else— and even them— has said, “Get a doula!” and has valued doulas.
Sabia: And I think, y’know, a way to put it is like, a medical provider is very important and necessary for this space— so is a doula, right? We’re not saying that a doula is “better” than a midwife or “better” than a doctor. It’s about: How do we create a full team (a full team) of caregivers and care providers that can help meet all of your needs? Right? So whether it’s medical, emotional, y’know, like, all the— and that’s, like, the beauty of, y’know, “care providers,” is that when we work together, we can really give you holistic care, right? And like, in order to have a baby— you can have a baby, ’cause the baby’s gonna come out when they come out— but in order to have a birth that is supported, where you feel safe (where you feel physically safe, where you feel mentally safe), where you feel like if something was to happen (y’know, an emergency, physical emergency), that there would be somebody there.
But also that, during that physical— that first physical emergency, whether it’s, like, y’know, a trip to down the hall, to a c-section— whatever that looks like, that you’ll also get your emotional needs met too, right? Like, how many times have you been, y’know, at an unexpected c-section and the room is going wild because they’re caring about the physical aspects, right? Which is their job, right? But as a doula, I’m sitting—
Adriana: Yeah, and we’re all grateful that they’re doing that. Yep!
Sabia: —right by my client and vision with them, right, and their partner, and saying, “Hey, what are you feeling right now? Let me explain what’s going on right now. Let me explain to you what to expect. Is there something that I should know? Is there someone that you want me to call? Do you need to hold my hand right now? Do you need me to rub your back right now? Partner, what do you need?” Right? And so when we’re talking about those things, it’s not that that experience wouldn’t be traumatic, right? Like, it is, to a certain degree. But I’ve noticed, as doula, that when there is support that it’s happening holistically, right, it’s just easier to process. It’s easier to be in the present. It’s easier to be in it. To be fearful, of course, right? But to be held in that does make a difference.
So, like, as doulas, we always say, “I don’t know what’s gonna happen.” I don’t know. Like births, babies do what they want— but what I can tell you is that I’m gonna be there the whole time. That’s what I can tell you.
Adriana: Yeah. And just providing that assurance of— and reflecting back, “I know this is not what you wanted to happen. This sucks.” Like, not saying, “Well wait, it’ll be fine.” No, no, no. “This sucks! This is not what you wanted. I’m here with you, to feel all the feels.” Supporting whatever needs to be supported and holding space for it, instead of dismissing it, which is a huge part of why it allows the processing to start, and not just get stuck in trauma.
Sabia: For sure. For sure. And even if your birth is great— we’re still there! Y’know, I’ve been to some great births where, like, y’know— whether they’re homebirths or hospital births or whatever— but even to have someone to be there to reflect what happened, ’cause you were just in the space. But this, to remind them like, “No, this…. So this happened next, and then you did this and then you moved this way and I helped you with positioning and with that, and you rocked it.” Like, y’know, “…And it was great!” right? So even that type of recall is helpful.
So in any situation— any outcome, any reproductive health experience, whatever it is— get you a doula.
Adriana: Yes. So they can see you.
Adriana: You can be seen and supported. Ah!
And I think in our roundabout way, we weaved through and touched upon all the questions that I had, all the things that I wanted to mention.
Sabia: Oh, yay! Great.
Adriana: Yay! I… One thing that I wanted to bring perspective into: where we are in doula usage, if you will. So, we don’t have great numbers, because that’s so hard to pinpoint. But there was the [Listening to Mothers survey] of 2006, and in that survey, 3% used the doula (2006), and then there was the 2012 survey (which is the last data that we have), and 6% used a doula then. So, in six years, it doubled! It’s been more than six years, and we know that the growth is being exponentially…
But interestingly enough, in that 2012 survey, 27%— so almost a third of them— said they would have liked to have a doula. So I do… I’m so happy to start seeing that we are at a tipping point. And I do believe there’s gonna be doulas for everybody in the not so far future, right? Not like when somebody comes here to talk to me and says, “Not in my lifetime.”
I think in our lifetime, we’re gonna see doulas for all. But that growth tells you something because it’s paid out-of-pocket! If people didn’t see the value in it, it wouldn’t be growing when they have to pay so far out-of-pocket for it.
Sabia: Yeah. And I think it’s— y’know, people are seeing the value and they’re seeing the results, right? And the one thing about birth specifically is that you pretty… you see the results pretty quickly. Like, it’s not necessarily, like, y’know, an elongated process! But someone can say right after they have their baby, whether they felt like they had a good time or not, or whether they felt like things… Maybe they would have went for this intervention, but because of the doula that was present, they didn’t. Or maybe they were at risk for a c-section and it didn’t happen, and they felt like… Whatever it is, right?
I feel like doulas are something that— it’s kind of like, we can see, of course, the long, the long term, like, kind of reflections of our work. But there’s also an immediate kind of feedback, that I think is spoken through word of mouth, right? Through clients and their families and friends. Like, “Hey, I had a doula! Maybe I thought it was a wild concept in the beginning, but now, like, I think you should get a doula.” People go from having a doula to being a doula. So I think it just, like, speaks for itself, and it reflects in the numbers, as well as it’s reflecting in our community just through word of mouth.
Adriana: Absolutely! Sabia, before we close, is there anything that you wanted to say that we didn’t get to?
Sabia: Nope! My message stands: Everyone deserves a doula. Accessibility can be hard, but, y’know— look for resources in your community, whether it’s virtual doula services or whether maybe there’s, like, a nonprofit or organization that has… y’know, can help create a better link to accessibility, y’know. Do your research! Don’t be afraid to ask for what you want, right? And ask your family for support, your friends for support, and definitely make it happen.
Adriana: Make it happen! Thank you so, so much for this fun, fabulous… Ah, I love talking to doulas! Great conversation.
Sabia: Thank you! Thank you for inviting me.
That was Black queer CEO, investor, educator, author, full-spectrum doula, and expander of Black luxury, Sabia Wade.
Clearly Sabia and I could have talked about doulas for days, but somehow we forgot to mention that a doula’s responsibility lies solely with the birthing person and their family— meaning that doulas support you and your wishes independently of those of your care providers or the hospital or birth center where you give birth.
Now there are some hospitals and birth centers that have been exploring different models and may have doulas on staff, but even then, these models work best when the doula continues to safeguard the birthing person’s interests and not that of the hospital or the birthing center. So if this happens to be your case, make sure you clarify where your doula’s responsibilities lie and how that works if your wishes are at odds with the hospital or birth center protocol.
You can connect with Sabia on Instagram @sabiawade, and you can connect with us @birthfulpodcast. In fact, if you’re not driving, it would be just so lovely. If you would take a screenshot of this episode right now, and then post it to Instagram. Sharing your biggest takeaway from the episode and our conversation. Make sure to tag @birthfulpodcast so we can see it and amplify it.
You can find the in-depth show notes and transcript of this episode at birthful.com, along with all the show links, and there you can also learn more about my birth and postpartum preparation classes, and download your free postpartum preparation plan.
Birthful is created and produced by me, Adriana Lozada, with production assistance from Aysia Platte.
Thank you so very much for listening to and for sharing birth. Be sure to follow us on good pods, Spotify, Apple Podcasts, Amazon Music, and everywhere you listen, and then come back for more ways to inform your intuition
Lozada, Adriana, host. “Why Your Team Isn’t Complete Without A Doula.” Birthful, Birthful. November 2, 2022. Birthful.com.
About Sabia Wade
Sabia Wade (she/they), is a Black, queer CEO, investor, author, educator, full-spectrum doula, and expander of Black luxury. Sabia is the founder of Birthing Advocacy Doula Trainings, an accessible and inclusive training program for community care workers, and For the Village, a nonprofit providing doulas at no or low-cost to low-income and marginalized communities in San Diego, California.
As a coach, board member, investor, educator, and programming development consultant for organizations throughout the birth and reproductive health industry, every part of Sabia’s work centers on liberation of all people through reproductive justice. Her book Birthing Liberation: How Reproductive Justice Can Set Us Free is out and available for purchase.
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