The Role of a Doula in Reproductive Health

Childbirth can be a roller coaster of emotions but having the right support makes all the difference. As you plan who will be present for this life-changing event, consider those who can help create a safe, liberating experience that honors your delivery choices.

Here at Ruth Health, we’re big fans of doula care, both for childbirth and postpartum.

A doula is an advocate who provides emotional and physical support. During the 1960s they gained greater visibility thanks in part to the women’s liberation movement and increased desire for reduced medical interventions during birth.

Although they can’t provide medical treatment like your OB/GYN or midwife, doulas are well known to have a positive impact on birth outcomes including lower rates of maternal and infant health issues.

To learn more about the role of a doula and how doulas provide support, we met with Nickie Tilsner, BSN, RN, and Co-Executive Director of Cornerstone Birthwork Training. With 20 years of experience as a doula, Nickie frames her work as transformative social justice activism.

Here’s what you can expect from doula care.

Ruth Health: First, what can a doula do, and not do, in providing care?

Nickie Tilsner: A doula, or birthworker, is an integral member of your inter-professional reproductive healthcare team that:

• has your needs and goals top of mind
• supports you regardless of your choices or reproductive outcomes
• provides continuous culturally responsive emotional, physical, and educational care
• partners with your providers to ensure that your needs are being met on both individual and community levels

Doulas don’t diagnose or prescribe, but we can help you and your partner/s with making informed decisions about the care that you receive.

Ruth Health: Why is doula care important?

Nickie Tilsner: Doulas will help you sort through and understand your choices and help you craft a birth and/or postpartum plan. We support you with accessing the resources and community that you will need throughout your journey — whether that be during pregnancy, labor, birth, loss, abortion, or the postpartum period.

Doulas also fill major gaps in the reproductive healthcare system that most pregnant people and their partner/s and families are navigating. We are leading the charge in bringing forth more dignified, inclusive, equitable, and safe reproductive healthcare for all people.

These birthworkers commit to being there for you throughout the entire process. Doulas will speak up if your choices and needs aren’t being met by your providers or care team, and if you are not being treated in the way that you deserve to be treated.

Ruth Health: What else can doulas do?

Nickie Tilsner: Doulas also provide physical comfort measures like therapeutic touch, breathing, visualization, movement, and help with birthing positions.

We can offer lactation education, mental health support, and childbirth education.

Think of a doula as your cheerleader and a shoulder to cry on — we also assist with crisis response, abortion support, fertility support, pregnancy loss, and grief support.

Ruth Health: What certification or license is required to be a doula?

Nickie Tilsner: Doulas are unlicensed care workers, meaning that we do not have an overseeing or licensing body; we are autonomous. Some doulas are certified, and some are uncertified — both are equally relevant, and certification is not the most important thing to take into consideration when hiring a doula.

The services doulas provide will vary widely depending on the organization that they chose to train with and the particular training that they received.

Cornerstone birthworkers and doulas are trained through a culturally responsive and intersectional lens to provide full-spectrum support that is rooted in:

• community
• trauma-informed care
• patient rights
• client advocacy

Ruth Health: When is the right time to partner with a doula?

Nickie Tilsner: You can hire a doula at any point in your reproductive journey when you need support — fertility, IUI, pregnancy, postpartum, to accompany you to your abortion, and in times of grief and loss. There are even gender-affirming surgeries and transition doulas.

When looking for your doula consider the following:

• Where do they stand on advocacy?
• Are they flexible if your plans change?
• Will they stand with you no matter what you choose in your care?
• Will they be able to provide the culturally relevant support that you need?
• Do they work with backup in case of emergency, illness, or a long birth?

We recommend hiring your birthworker during the second trimester to create time to get to know one another and build trust, but you can hire your birthworker earlier or later than that; we are flexible and always present.

Cornerstone Birthwork Trainings’ mission is to advance birth and reproductive justice by equipping birthworkers with tools to provide advocacy, full-spectrum reproductive care, and support for all people. Cornerstone birthworkers (doulas) support all people, and all reproductive health choices, options, and outcomes. If you are looking to hire a doula, check out the Cornerstone Birthwork database.

Be sure not to miss Cornerstone’s first annual virtual conference, Access & Action: community-based strategies for connection, organizing, and change, from June 3–5, 2022, featuring special guest adrienne maree brown.

A note on inclusive language in this blog post: Nickie uses the term reproductive health rather than maternal health, and birthing person or folks instead of mother, because people of all genders and identities give birth, and not all people choose to or can carry their pregnancies to term. Further, she interchanges the terms birthworker and doula because not all birthworkers identify as doulas.