Home birthing explained: What's a 'doula' got to do with it?

The question of natural/home birth versus hospital birth has become a heated and sensitive matter, with stakeholders on both sides having strong opinions. But any reasonable discussion on this issue should start with a rudimentary lesson on the basic vocabulary.

For starters, the term ‘doula,’ a word of Greek origin, refers to a birth attendant or a labor coach. In a home birth, the doula provides non-medical support to the expectant mother and her family before (pre-natal), during and after delivery (post partum or post-natal), with an emphasis on building relationships with the family.

Among the more popular doula certification organizations are the ICTC, Doulas of North America (DONA), Childbirth Postpartum Professional Association (CAPPA) and International Childbirth Education Association (ICEA).

Midwives, like doulas, provide support to the expectant mother during labor and delivery, but are considered trained health professionals. Some midwives even work in a hospital setting. Like doulas, midwives can be certified or ‘lay.’ Without much federal regulation of midwives and doulas, states usually have their own legal parameters and standards on how each can operate.

Another important term is the ‘birthing center.’ Women seeking a natural birth but who may not be ready to do a home birth tend to make use of birthing centers. These alternative birth facilities, sometimes decorated and furnished to simulate a typical home environment, may operate as freestanding or hospital-affiliated entities.

Lastly, it’s important to understand what is called the “cascade of intervention.” The term is familiar in natural birthing circles and it’s often used by natural birth advocates. The cascade of intervention describes a situation where the use of one medical intervention leads to another.

For example, a woman in labor arriving at the hospital to deliver her child may be connected to an IV, which is a standard procedure. But, because she is connected to an IV, she may not be able to move around, thus she may not be able to relieve her labor pains. Therefore, she may be given an epidural to help alleviate the pain she is feeling. However, the epidural may lead her to run a high temperature, for which, she is given antibiotics. Finally, if the baby’s heart rate drops, the doctor may eventually conduct a cesarean section.

It’s this domino chain of events that midwives and doulas cite when making the case for a natural birth. They see medical intervention as interference with what should be a natural delivery.