Why are doulas attending only 3% of births?

This is the second installment of my series on doulas, in honor of International Doula Month.

When I first read the results of the second Listening to Mothers Survey, I was disappointed (although not surprised) to learn that only 3% of the respondents hired doulas to attend their birth. Three percent is a small number for sure, but considering that the modern doula has only been in existence for 15-20 years, 3% actually represents a growing number of doula-attended births, and in the years to come I expect that number will continue to rise.

As I will soon explain, I believe there are two reasons why so few births are currently attended by doulas, in addition to the fact that doulas are a relatively new phenomenon. They are 1) many women have never heard of doulas, and 2) a larger number still have heard of doulas but do not fully understand their role.

Efforts have been made by organizations, like Doulas of North America, and grassroots movements promoting chilbirth options, natural childbirth, and more supportive childbirth care in general, to publicly recognize doulas. As you can see here, news reports about the benefits and use of doulas have been on the rise for several years, and it is now highly likely that a pregnant woman will encounter the word doula while reading a pregnancy or parenting magazine, while sitting in on her childbirth preparation class, chatting with friends in her mommy group, or while perusing blogs and forums. Efforts to spread the word about doulas are being rewarded as more and more women are hiring doulas to attend their births. But the work is far from over, as hearing about doulas is not enough for women to believe that they should hire one, which explains the following result from the Listening to Mother’s Survey II:

A few questions were asked of the women who chose not to hire a doula. How many had heard of doulas? 81% How many claimed to have a clear understanding of what doulas do? 61% Knowing that well over half of the women who did not hire a doula claimed to understand their role, but chose not to hire one anyway, and that 100% of those who did hire a doula were HIGHLY satisfied with their service, it makes me wonder, do people really understand what a doula is?

A couple years ago, I had an account with CafeMom, the social networking site, and while there I posted a poll to learn a little more about this question of mine. This of course was not a scientific poll, but I think it fairly accurately described the understanding of American women. My question to them was, “Do you want a doula at your next birth? The results were as follows:

  • 15% said yes
  • 50% said they didn’t think it would be helpful
  • 13% said maybe, if they knew more about it
  • 20% said, what’s a doula?

While women may happen to hear about doulas, the general public is for the most highly unaware of them. A male relative of a client of mine told me after she gave birth that he had thought a doula was a wet nurse. Thankfully I was able to enlighten him, but misunderstandings about the role of a doula still abound.

So what is a doula? The following are a few posts I’ve already written on the subject. They describe what a doula is, what a doula isn’t, and the many reasons why every woman should have one.

Only a small number of women hire doulas today, but that number is steadily growing, and the more we tell women about them, the more that number will grow. And the more women hire doulas, I believe we will see a greater increase in the number of normal births and in the percentage of women who are satisfied by their birthing experience. If you are pregnant or planning a pregnancy, I highy recommend that you call your local doula and ask questions, even if you don’t think a doula would be useful for you. And if you have used a doula and know how wonderful it is to have one, tell everyone you know! Pass your doula’s business card on to your family and friends, or consider becoming one yourself.

What Kind of Mom Will You Be?

In some of my childbirth classes and prenatal visits with my doula clients, we do a little birth art. Expressing your thoughts and feelings through art is useful in several ways, one of which is to learn more about yourself and how you can become the kind of person you want to be.

It is easy, when pregnant, to consume oneself with thoughts about “D-Day” and save thoughts about parenting for later. Yet it is important for you to think about what will happen when you take your new baby home from the hospital or your midwife leaves your house.

One of the topics I give for birth art subject matter is: how do you see yourself as a mother, and what kind of mom do you want to be? Provided that you love your child(ren), I don’t believe there is a wrong answer. All mothers are different, unique, and special, but I would be willing to bet that you have an image in your mind of what makes a good mom.

Keep that image in your mind and then take the next step: what do you see in yourself that will make you a good mom? What characteristics, skills, experiences, and values do you have that will bring you closer to your image of a good mom? I suggest you take some time to think about this one. It is easy to place high esteem on others and only see the faults in ourselves, but we need to see the value in ourselves so that we will be healthy as individuals and be able to utilize those characteristics as we train, lead, and love our little ones.

The third step is to learn from your image. What areas do you need to grow in as a woman, and as a mother? Some things we can only learn and grow in over time, as we meet challenges and reach goals, but to be aware of these weaknesses and want to grow through them, before our children are born, and ideally before they are conceived, will help to keep your goals in mind. This is very similar to labor: remembering that you are having a baby will help you over the physical, mental, and emotional hurdles common to birth.

I am certainly not one to be speaking from years of experience. My oldest child is but three years old. But even now I can tell you that having that image of who I want to be in my mind has helped me to grow closer to my goal. And with that in my heart, I will rise to every new stage of parenthood.

The Monthly Doula – Farewell Letter

The time has come for me to discontinue publication of The Monthly Doula. I have been putting this off for a while now, but in closing out the first year of this newsletter I decided it was as good a time as any. Giving women information about pregnancy, childbirth, and parenting is something that I enjoy doing, and something I still do with my blog, but I have come to realize that I have way too many projects on my plate. With two young kids and one on the way, being a wife, stay-at-home mom, a doula, a midwife in the making, and with all the hobbies that I try to keep, writing this newsletter every month was, unfortunately for you my readers, not on the top of my priority list.

 I have tried to find someone who would be interested in continuing this newsletter, but have not gotten any nibbles, so the time has come to say farewell to The Monthly Doula. Yet, that does not mean that I am leaving you empty-handed. My blog is all about the topics I include in this newsletter, and you will find much more available there, if you haven’t already discovered that.

Thank you all for taking the time to read this newsletter and for your letters, I have appreciated it very much.

Happy summer to you all,


The Monthly Doula Vol 1 Issue 7 January 2009

The Monthly Doula

A newsletter by Birth a Miracle Services

Volume 1 Issue 7 January 2009

Benefits of Breastfeeding

Mission Statement: My goal is to educate and inform all parents and future parents of their rights and responsibilities of bearing children and of the truth and wonder of birth. My mission is to inspire them to enjoy their pregnancies and to look forward to bringing their children into the world.


Letter from the Editor

In the News

Quote of the Month

Benefits of Breastfeeding: A Look at What the Experts Are Saying

Website of the Month

Book of the Month

Online Video of the Month

What is Birth a Miracle Services?

Inspired Birth

Request for Contributions


Letter From the Editor

My second child is now almost 5 months old and we are currently enjoying breastfeeding. My first child weaned himself by 18 months, and I hope to make it at least that long this time around. Breastfeeding is certainly not easy to get used to, even when you’ve done it before, but I can’t imagine having it any other way, since it offers so many benefits to both of us. I especially love the cuddle time that it gives us, time that no others can offer her, and although I know that my milk is helping her to grow strong, I’m counting on the time we spend together as a jumpstart to a healthy mother/daughter relationship with her, as it did with me and my son.

Breastfeeding may not be for everyone, but many new mothers are unaware or underestimate the significant benefits that breastfeeding offers both them and their babies. Thankfully, breastmilk is now getting the positive reputation that it deserves, and I hope that our generation will continue the battle that our mothers fought to give babies the best start in life that they can. So if you are a new or expectant mom, I encourage you to take a closer look at what breastfeeding can offer you and your baby, and if you are a breastfeeding pro, I encourage you to share your knowledge with all the young women around you. I hope that the information I have included in this issue of The Monthly Doula will get you off to a good start.


Naomi Kilbreth, CD

Birth a Miracle Services

36 Greenwood Street

West Paris, ME 04289

(207) 754-8875

In the News:

Sleep Easy – Breastfeeding may provide long-term protection against the incidence or severity of a childhood SRBD, or sleep-related breathing disorder. See the full article here:

Saving Lives – Infants who are not breastfed have a 21% higher postneonatal infant mortality rate in the U.S. See the full report here:

Reducing Postpartum Depression – Mothers who breastfeed their babies have fewer episodes of post-delivery depression. See the full article here:

Quote of the Month:

“There are 4,000 species of mammals, and they all make a different milk. Human milk is made for human infants and it meets all their specific nutrient needs”.~ Ruth Lawrence, M.D., professor of pediatrics and obstetrics at the University of Rochester School of Medicine in Rochester, N.Y., and spokeswoman for the American Academy of Pediatrics.

Benefits of Breastfeeding: A Look at What the Experts Are Saying

By Naomi Kilbreth

As a birth doula, one of my responsibilities is to encourage my clients to make healthy decisions following the birth of their child. As there is overwhelming evidence of breastfeeding being advantageous over formula feeding, it is my responsibility to inform them of the benefits that follow the choice to breastfeed. Here is what a few of the experts on breastfeeding are saying:

“Breastfeeding is one of the best starts a mother can give her baby.”1

“The benefits to the mother of immediate breastfeeding are innumerable.”2

“Even breastfeeding for a few days will give the added insurance for a healthy first year.”3

“Breastfeeding after a cesarean can be a joyful way for mother and baby to learn about each other.”4

Because the benefits of breastfeeding are truly innumerable for both mother and baby, I will only list a few of those benefits here. For the baby, his mother’s milk is specifically tailored to meet his needs. So much so, that the ingredients in the milk can change between feedings in order to meet his needs. Breastfeeding is associated with drastically reduced rates of illnesses, resulting in fewer hospital stays and less medical costs from infancy through adulthood. Breastfeeding has also been found to increase the child’s IQ level by an average of 11 points.5

For the mother, breastfeeding promotes faster recovery from birth, including a return to pre-pregnancy weight, burning an average of 500 calories a day. Breastfeeding also releases mothering hormones that give her increased calmness, self-esteem and confidence. Breastfeeding is also associated with a reduced risk of cancers of the reproductive organs and of osteoporosis in the mother.

Not only does the breastfeeding couple benefit physically and emotionally, but it also benefits their pocketbook. The American Academy of Pediatrics stated that in 1993, the cost of purchasing formula was $885 for the first year alone. Newer estimates average $1,200 for the first year.

Breastfeeding exclusively for the first six months of life is the healthy option for all families. Even women who have serious illnesses and women who have had breast reductions and implants have been successful in breastfeeding their children.

If you do decide to breastfeed, congratulations on your choice! You will be grateful that you did. If you do not breastfeed, remember that the choice of feeding method (although important) is only one way to influence your child’s life. There are many excellent articles available on how to start out right when formula feeding.

Make sure to ask your doctor or midwife for hand outs on positioning, starting a feeding, milk storage, working while breastfeeding, breast engorgement and sore nipple management. You may also wish to be referred to a lactation specialist in your area.


1 – “10 Great Reasons to Breastfeed” Minister of Supply and Services Canada, 1990

2 – “Touching” by Ashley Montague

3 – “Postpartum Healing Through Breastfeeding” by Katie Corcoran, LLLI consultant

4 – “Breastfeeding After a Cesarean Birth” La Leche League International, 2004

5 – National Institutes of Health, 2002

2009 © Associated Content

Website of the Month:

Book of the Month:

So That’s What They’re For! by Janet Tamaro

Online Video of the Month

What is Birth a Miracle Services?

Birth a Miracle Services is the name of the birth doula and childbirth education service that I started in 2002.

A birth doula is a person who offers informational, physical, emotional, spousal, and advocacy support to women through pregnancy, birth, and the early postpartum period. I also offer traditional childbirth preparation classes, birth art classes, and childbirth counseling.

All of this is available to women within an hour of my home in West Paris, Maine for a sliding scale fee. Single, teen, and low-income moms can receive my birth doula support for free.

For more information visit my blog:

Inspired Birth

I am proud to announce the birth of my first book, Inspired Birth: A Fresh Perspective for Christian Maternity Care Providers. It is an inspirational guide for all Christians who attend women in childbirth, with fresh ideas on how to meet the emotional and physical needs of childbearing women while addressing current challenges to American maternity care. This book is still in the editing process and is not currently available for purchase, but if you know any Christians who are doctors, nurses, midwives, or doulas, please let them know that this book is on the way!

Request for Contributions

Next month’s topic is protecting the perineum during childbirth. If you have anything you would like to contribute, such as a tip on how to avoid tears, please email your thoughts with the subject line “Monthly Doula” to . Thank you!


To subscribe to this newsletter, send a blank email to with “subscribe” in the subject line.

To unsubscribe to this newsletter, send a blank email to with “unsubscribe” in the subject line.

To view previous issues of The Monthly Doula, click this link:

Normal Birth Characteristic #2 Women have freedom of movement during labor

Today’s primary resource for learning about childbirth is to watch Birth Day or A Baby Story on TLC. Once in a while you will see a “natural” childbirth on one of these shows, but for the most part they are made out to be emergencies with women writhing in pain, lying on their backs, and their doctors have to come in and rescue their babies. Now, the next time you see an episode where the mother is sitting in a chair, walking around, or kneeling in the tub, see if you can tell the difference in the way these labors seem to go. Although the mothers are obviously working hard, in some amount of pain, and anxious for the labor to be over with, most of the time the active mother’s babies are happier, there are less emergencies, and the delivery itself usually requires less active management on the part of the doctor. And this is no coincidence.

 “Women who walk, sit, kneel or otherwise avoid lying in bed during early labor can shorten the first stage of labor by about an hour,” according to a new Cochrane evidence review. Women who labored out of bed during the early stages were also 17 percent less likely to seek pain relief through epidural analgesia, the review found. Women who have a baby in the posterior position (what frequently causes “back labor”) have nearly a 90% chance of turning their babies in labor if they remain upright and moving during much of their labor. Shortened labor, less pain, and better positioning of babies are just a few of the benefits of remaining active during labor. Here are some others: increased comfort to the mother, as well as distraction and an enhanced sense of control. It can also help to relieve the sense of being overwhelmed. Other benefits include reduced likelihood of tearing (if in an upright position while pushing), less fetal distress, and a reduced incidence of low maternal blood pressure (this can happen if mom is lying on her back or even semi-sitting).

Why does being active keep things normal? Pelvic bones are not inflexible. They are actually made of a few bones held together by flexible cartilage. When the mother remains upright and active, her bones are constantly moving and adjusting. This means that her baby, who needs to move it’s head quite a bit to rotate down and through the pelvis, is getting help from his/her mother to be able to mold and flex his head and neck to be born. Being active not only makes this process easier, but faster. With direct pressure from the baby’s head on the mother’s cervix, she will also dilate and soften her cervix easier than if she were only lying down or sitting in bed. 

As for the pain, it is not usually completely removed by being upright, but a woman’s pain threshold can be increased this way, and pain from certain positions (like being on her back) can be removed. Lying on one’s back in labor really is the most painful position for a couple different reasons. One, when her uterus contracts it tilts forward, so if she is lying on her back her uterus has to tilt up and forward and the harder it has to work to remain efficient, the more pain it causes the woman. Second, lying or sitting ontop of a surface prevents the mother’s pelvic bones from moving, and constricts the space within the pelvis, both actions make it more difficult for the baby to mold and descend through the pelvis (often this situation mimics a case of “baby too big for pelvis” when really the mother just needs to get out of bed). This of course is not only difficult for the baby, but more painful for the mother.

Although most women will need some encouragement from a knowledgeable person (such as a doula) during labor on choosing helpful positions, they also tend to adopt positions or movements that will help them without being told how to do them. For instance, hands and knees is a very common position that laboring women will try without suggestion, simply because it feels right. And the positions that “feel right” are probably the best ones for them to use. In this case, pain directs women to choose positions that not only feel better but are also beneficial for the progress of labor and the health of her baby. If good progress is not being made, changing positions, or trying different movements, every 20 or 30 minutes may help to get things moving again. I very strongly recommend that if you can’t buy any other books about childbirth, that you pick up these three books: Ina May’s Guide to Childbirth by Ina May Gaskin, The Labor Progress Handbook by Penny Simpkin, and The Birth Partnerby Penny Simpkin. Ina May’s Guide will give you some great ideas on creating an environment that encourages freedom of movement and great progress in labor, and the other two have wonderful drawings of positions that you can try during normal labor and during any complications that might arise. Here is a website with a few good examples of positions you can try in labor.


So happens if you choose not to get out of bed, or if you are restricted to bed by your risk level, complications, or pain medications? It is more difficult to get the benefits of movement when you are restricted to bed, so it is helpful if you can stay out of bed as much as possible. Frequent trips to go pee in the bathroom are a help if you are given no other excuse to get up. Sometimes it is better for you or the baby if you do stay in bed, although realistically this doesn’t happen very often. If your doctor or midwife asks that you stay in bed, first ask why they are saying this. Then, ask how strict this rule is, since there might be leeway. For example, if you are supposed to get frequent heart rate monitoring, you may still be able to get off the monitor and out of bed for 20 minutes every hour. If you must stay in bed, like if you have a high-dose epidural, ask the nurse to help you switch positions every half hour or so to encourage good progress. You can sit up, lie on each side, try the exaggerated side position, hands and knees, and others. The Penny Simpkin books I mentioned above all have very good drawings describing these positions and how they can help you to dilate more quickly, or to help move the baby if he/she is not positioned well.

What you can do to ensure freedom of movement in labor:

1. Exercise during pregnancy to build your stamina for labor. Brisk walking and the breast stroke while swimming are two of the best and safest exercises you can use.

2. During early labor, REST as much as you can, drink water to quench your thirst, and eat carbohydrate and calcium rich foods.

3. During active labor, take a sip of water after EVERY contractions, and try to eat nourishing food to keep up your body’s energy. Sometimes labor slows down just because a woman isn’t hydrated, she’s too tired, or she hasn’t eaten all day. If you are well nourished with food and drink and labor still slows down, consider taking a rest before going for a walk. Don’t be afraid to give your body a break during labor. If you and your baby are tolerating labor well, there is no reason to rush the birth.

4. Talk to your doctor or midwife about staying upright and active during labor. Ask them in what situations you would have to stay in bed, and ideas of how you can stay active even if complications arise (eg. rocking in rocking chair, sitting on a birth ball, or sway-dancing with a partner next to the bed so you can stay on the fetal monitor).

5. Read books and visit websites (preferably with a person who will attend your birth) to get ideas of positions you can try. If you can, bring one of these books (like the ones I mentioned above) to your birth place so that if you forget them you can look up some fresh ideas.

6. Hire a doula. She can remind and help you to keep up your energy, to encourage you and reassure you that what you are experiencing is normal and that you are doing a good job, and physically support you in different positions so that you don’t get tired too quickly.

7. Don’t worry about trying to find the “right” position. Just do what comes naturally, do what feels good, and chances are you will be doing just what you should be doing. Stay out of bed unless you are tired and need a rest. Even when you are in bed you could still adopt a hands and knees position, or get on your knees and rest on the back of the bed (when the head of it is raised). There are so many options, so pick your favorites, use one of them for a while, then try another one.

Here is a University of Toronto study that shows what happens when the hospital bed is no longer the “focal point of labor”.

Rx For a Normal Birth

The Cochrane Collaboration has done a lot of research about childbirth practices and has broken down “optimal maternity care” into six characteristics, all of which make a normal birth more likely. These six characteristics are:

1. Labor begins spontaneously

2. Women have freedom of movement during labor

3. Interventions are medically justified rather than routine

4. Women have continuous emotional and physical support

5. Pushing occurs in any position but flat-on-back

6. Mother and baby are not separated

I am going to do a six part series on these characteristics, because they are so important to a woman’s medical care, even if her birth will not have been considered “normal”. If you have special knowledge about any of these areas, please send me a message and I’ll try to incorporate what you have to share into my posts.