A doula (; ; ) is a trained professional who provides expert guidance for the service of others and who supports another person (the doula's client) through a significant health-related experience, such as childbirth, miscarriage, induced abortion or stillbirth, as well as non-reproductive experiences such as dying. A doula may also provide support to the client's partner, family, and friends.
The doula's goal and role is to help the client feel safe and comfortable, complementing the role of the healthcare professionals who provide the client's medical care. Unlike a physician, midwife, or nurse, a doula cannot administer medication or other medical treatment or give medical advice. An individual may need to complete training to work as a doula, although training and certification processes vary throughout the world.
Some doulas work as volunteers; others are paid for their services by their client, medical institutions, or other private and public organizations. Doulas receive varying amounts of training, and their professionalism also varies.
The contributions of doulas during reproductive experiences and end-of-life care have been studied and have been shown to benefit their clients. For example, a birth doula providing support during childbirth may increase likelihood of vaginal birth (rather than Caesarean section), decrease the need for pain medication during labor, and improve the perception of the birthing experience.
The benefits of a doula providing other types of support have been less well studied, but might improve a client's experience with medical care or help an individual cope with health transitions.
History and etymology
The concept of having a companion providing support to the birthing woman dates back to prehistoric times, evidenced by archeological findings of stone carvings and statues and anthropological studies. However, the contemporary role of "doula" first emerged from the grassroots natural birth movement in the United States in the 1960s when women began desiring unmedicated, low-intervention births and began to have friends and others with formal or practical knowledge about childbirth provide them with support during pregnancy.
The term doula was first used in a 1969 anthropological study conducted by Dana Raphael, a protégée of Margaret Mead, with whom she co-founded the Human Lactation Center in Westport, Connecticut, in the 1970s. Raphael suggested it was a widespread practice that a female of the same species be part of childbirth, and in human societies this was traditionally a role occupied by a family member or friend whose presence contributed to successful long-term breastfeeding. Raphael derived the term from modern Greek (, doúla (), "slave"), as told to her by an elderly Greek woman, Eleni Rassias, and described it as coming from "Aristotle's time," an Ancient Greek word meaning "female slave."
Two physician-researchers, Marshall Klaus and John Kennell, who conducted clinical trials on the medical outcomes of doula-attended births, adopted the term to refer to a person providing labor support. In 1992, Doulas of North America (later DONA International) was co-founded by Klaus, Kennell, Phyllis Klaus, Penny Simkin, and Annie Kennedy, becoming the first organization to train and certify doulas. The organization with the backing of the research of Klaus and Kennell helped lend credibility and professionalize doulas. Due to the lobbying efforts of DONA International, the term doula was accepted into the American Heritage Dictionary and Oxford Dictionary in 2003, followed by Merriam Webster Dictionary in 2004. Alternative names to this role include "childbirth assistant" and "monitrice," but they did not catch on as "doula" had.
In 2008, activists in New York City began the Doula Project, to expand the role of the doula to other reproductive experiences beyond birth, grounded in reproductive justice framework. The participants began working as abortion doulas and coined the term "full-spectrum doula" who support all pregnancy experiences and outcomes such as pregnancy termination, miscarriage and fetal loss. Full spectrum doula groups may be found in major cities in the United States.