Lamar Greene is a passionate full-spectrum doula, spiritual life coach, and budding community herbalist with a meaningful background in reproductive health advocacy both in the U.S. and globally. They are the founder of Doula Alchemist Healing, a Black and Queer-owned healing practice centered around reproductive justice and spirituality.
Have you ever heard of a doula? In recent years, doulas have been all over the news, studied in medical research, and even referenced in TV shows. There has been a resurgence of interest in doula work in response to persistently high maternal mortality rates in the U.S. and globally. Still, despite this increased awareness, some people don’t fully understand what a doula is or the role it plays in supporting individuals during reproductive care experiences and other major life events. Don’t worry; this article will clearly explain what a doula is and four tangible ways doula support can improve your reproductive care experience.
What is a doula?
The doula profession dates back to prehistoric times. Both archaeological evidence and anthropological studies demonstrate that the idea of having a companion during birth is age-old. The word “doula” is derived from the ancient Greek word doulē, which means "female servant." Today, a doula is known as a non-clinical, trained support person who guides individuals and families during their reproductive care journeys, such as childbirth, pregnancy loss, or postpartum healing, as well as non-reproductive care experiences such as dying. People of all genders offer doula support, with an increasing number of dads taking on this role. This article will focus on doula support for reproductive care experiences. It is also important to note that some people prefer to use different titles due to the connotations of the word “doula” or for cultural reasons. Other common titles include birth worker, reproductive care worker, and birth keeper.
A brief history of birth work in the U.S.
Historically, doula work has been a part of many cultures globally. Some countries from Africa to South America had “birth attendants” or “wise women” who would provide guidance and support during childbirth. Birth work in the U.S. developed throughout the colonization and enslavement period. During that time, midwifery services and doula support were practiced by Indigenous healers and enslaved African people who brought their knowledge and cultural healing practices with them. According to the National Museum of African American History and Culture, Black midwives, often known as “Grand Midwives” or “Granny Midwives,” were spiritual leaders and healers among enslaved communities. They were relied on to provide midwifery and doula support for both enslaved families and the families of their slave masters. Even after Emancipation, Grand Midwives were trusted to support both Black and White birthing people in the rural South.
The development of obstetrics and gynecology as a medical specialty by White male physicians resulted in pervasive, racist anti-midwife campaigns and exclusionary public health policies in the 1900s. Despite multiple efforts of resistance, many Black midwives and doulas were pushed out of practice and replaced with public health nurses. We are still witnessing and feeling the implications of this today. The American College of Nurse-Midwives estimates that more than 90% of midwives and doulas in the U.S. are White, which is not representative of the country’s racial demographics. More than 13% of people in the U.S. identify as Black or African American.
Doulas vs. other reproductive health professionals
Doulas are not the only reproductive health professionals out there. You may have also worked with or heard of midwives, OBGYNS, and lactation consultants. What differentiates doulas from these other professionals is that doulas are not clinical providers and doula support is a non-clinical service. People can learn how to provide doula support from a training or certification program or by having generational knowledge passed down in their family or community. In contrast, midwives are clinical providers who assist with gynecological, prenatal, and postpartum care. Midwives also provide non-surgical clinical support during labor and birth, such as assessing labor progress, assisting with pain management, and more. People can become midwives through accredited midwifery or nurse-midwifery programs and pass the national exam. There are also lay midwives who are unlicensed and receive their training through traditional methods of apprenticeship. Midwives typically care for low-risk pregnancies and emphasize natural delivery options.
OBGYNs are also clinical providers who, unlike midwives, are trained to perform surgeries such as C-sections and hysterectomies. They provide preventive care, prenatal care, and reproductive healthcare. Within their scope of practice, OBGYNs can care for low-risk and high-risk pregnancies. For their training, OBGYNs attend four years of medical school and four years of residency. Lactation consultants are another type of clinical provider in the reproductive health space whose care differs from doula support. Lactation consultants support new parents in their efforts to breastfeed and chestfeed. Within their scope of practice, they can assist with feeding positions, latch issues, milk supply, weaning, and more. The IBCLC title is the most commonly recognized for lactation consultants, which requires lactation education, clinical experience, and passing the IBCLC exam. While the services provided are different than doula support, doulas can work with all of these reproductive health professionals to provide quality care.
Calls for reproductive justice and birth justice
Maternal mortality is defined as death during a pregnancy or within forty-two days after the end of a pregnancy, excluding accidental or incidental causes. Global maternal mortality rates are high, and the world is not on track to meet the United Nations’ target for the Sustainable Development Goals. While the global maternal mortality rate has decreased and stagnated since 2000, it has increased in some regions and countries, such as the U.S., during that time. According to The Commonwealth Fund, the maternal mortality rate in the U.S. in 2022 was more than double that of many other high-income countries. What is even more devastating are the racial disparities in maternal mortality that have long been present for Black and Indigenous birthing people. CDC data from 2022 shows that maternal mortality rates for Black birthing people are two to three times higher than rates for White birthing people.
Public health has identified systemic racism, sexism, and unequal treatment in healthcare facilities as contributing factors to racial disparities in maternal health outcomes. The Giving Voice to Mothers Study demonstrates that one in six of the women and birthing parents reported medical mistreatment such as being shouted at, scolded, threatened, ignored, etc. The rate of mistreatment was higher for women and birthing people of color, and experiences of mistreatment were significantly higher during hospital births than assisted home births. Due to this outlook, the growing Reproductive Justice Movement led by women of color has long been advocating for bodily autonomy, self-determined family creation, and safe and healthy communities. As a part of the larger movement for Reproductive Justice, Birth Justice calls for everyone, especially birthing people of color, to have knowledge about and access to culturally affirming care, lactation support, and traditional birth workers such as doulas and midwives.
Related: Why Are The Racial Disparities in Maternal and Infant Health Considered Persistent Crisis In The US
The different types of doulas
Beyond the data, some people choose to pursue doula support simply to have more meaningful birth and reproductive care experiences. Modern doula support encompasses more than guidance during birth. Drawing from traditional practices and skills, doulas support a wide range of reproductive care experiences and major life events. In an article on interviews with doulas, Planned Parenthood identified seven different types of doulas, including fertility doulas, abortion doulas, birth doulas, postpartum doulas, Indigenous doulas, transition doulas, and death doulas. For context, a transition doula supports gender-expansive people as they navigate gender-affirming care, and an Indigenous doula holds space for Indigenous people to receive reproductive care in ways that honor their culture and traditions. People who provide doula support for multiple types of reproductive care experiences (i.e., fertility, abortion, birth, and postpartum) are known as full-spectrum doulas. Some full-spectrum doulas even provide guidance for surrogacy and adoption.
4 ways doula support can improve your reproductive care experience
1. Educational benefits
Doula support can educationally improve your reproductive care experience. Doulas provide information about procedures, medical terminology, comfort measures, pain management strategies, and much more for whatever service they are guiding you through. Increasingly, doulas have also been educating clients about their patient rights as they navigate the healthcare system. This can include teaching acronyms and frameworks to coach clients on asking providers about interventions and ensuring informed decision-making is centered during the care experience. Doulas can also help in the creation of birth and reproductive care plans, including contingency planning, so that healthcare staff know and understand your intentions and goals for your care. Doulas are there to advocate not for their clients but with them. By educating you about your rights, informed decision-making, and care options, doula support equips you to be a self-advocate so that you have an experience that honors your preferences as much as possible.
Doula support also extends to educating you about aftercare and postpartum healing. This can include basic nutrition education as well as other physical tips, such as perineal care, to support your recovery. If applicable, doulas can provide evidence-based lactation information that is within their scope of practice. As members of the community, doulas can make connections and inform you about available resources such as support groups, childbirth education spaces, and care providers who offer related services. While doulas are not medical providers and cannot replace the care of medical providers, they provide invaluable health education and community support that can supplement the information you receive from your health provider.
2. Emotional benefits
Doula support can emotionally improve your reproductive care experience. Present and grounding, a doula can validate your experiences, offer encouragement when needed, and help reframe your perspective to boost your mood. Doulas can also use focused breathing, visualization, or meditation techniques to help you remain at ease and manage heavy feelings that may come up for you. Active listening is another skill that doulas use to support you during your care experience as well as to help you process and debrief your birth or reproductive care experience afterward. Not only do doulas support their clients emotionally, but they also support their clients' partners and families. Knowing that your loved ones are also being looked after can also provide a feeling of comfort.
While doulas are not trained as therapists, they can be therapeutic for the clients and families that they serve. Research reviewed by March of Dimes shows that the benefits of doula support include less anxiety and depression for pregnant people, fewer negative childbirth experiences, and better communication with healthcare providers. Compared with pregnant people who don’t use doula care, those receiving doula support, while at high risk for labor complications, are more likely to feel happy about the care that they receive. Through compassion and non-judgmental space to express feelings and concerns, doulas create empathetic environments that have a positive impact.
3. Physical benefits
Through an array of tools and practices, doula support can physically improve your reproductive care experience. Doulas remind clients to stay hydrated and lightly nourished when needed, and they often include partners and family members in physically supporting the client. Massage is a technique that doulas commonly use to help alleviate pain and discomfort. This can consist of counterpressure on the hips, lower back, and other specific body points during pregnancy, labor, or postpartum, regardless of the outcome. Another technique that doulas use is position changes and movement. Moving when and as you are able during your birth or reproductive care experience can help you experience some sense of relief or comfort. Doulas can also use hot and cold compresses, deep breathing exercises, and aromatherapy to relieve pain and promote a sense of ease.
We have only scratched the surface of comfort measures that doulas use to physically support their clients, especially since they often have unique approaches and can incorporate cultural traditions. Still, the benefits are clear. According to research reviewed by March of Dimes, the physical benefits of doula support include fewer c-sections, less pain-relief medication during labor, and a shorter time in labor. Compared with pregnant people who don’t use doula care, those receiving doula support, while at high risk for labor complications, are two times less likely to experience a birth complication and four times less likely to have a low birth weight baby. Having a doula is also associated with being more likely to breastfeed or chestfeed. When creating this environment of comfort and ease, doulas provide physical benefits that can have a profound and long-lasting impact on the health of their clients.
4. Spiritual benefits
By creating space for deeper intention and reflection, doula support can spiritually improve your reproductive care experience. Doulas can incorporate elements of your spiritual beliefs and practices into the support they provide you. This can consist of curating sacred moments through the use of prayer, guided meditation, or chanting as relaxation techniques. Your doula may also guide you through breathwork or visualization exercises in preparation for your birth, abortion, etc., to help you feel a little more in control of the process. Time in nature can also be a practice that doulas coach their clients through to prepare for a care experience or process in the postpartum period.
Doulas also work with clients and their families to co-create rituals and mementos that help honor the experience or milestone that the doula is guiding them through. An example of this can be placenta work, which is something that many doulas have as a service they provide or a service that they refer clients to. In some cultures, the placenta is encapsulated and consumed, but in other cultures, the placenta is buried, planted, or burned. All of these variations of placenta rituals can provide a sense of connection, closure, or peace in some way. Assistance with creating and identifying mementos, such as sonographic images, footprints, individual and family photos, etc., can be important, especially in moments of loss and emotionally charged transitions. Through the support provided, doulas can help to create meaning for the individuals and families whom they guide through intense moments of change.
Let’s connect you to empowering reproductive care support
Are you ready to experience transformative guidance and support during your reproductive care experience? Whether you are juggling all the changes that come with being postpartum, seeking non-judgmental support alongside abortion care, or ready to set your intentions for an affirming birth experience, I am here to be a grounding and compassionate support person for you and your loved ones. Check out my service offerings, and book a free 30-minute consultation call to take the first steps toward a more empowering reproductive care journey.
Read more from Lamar Greene
Lamar Greene, Full-Spectrum Doula and Spiritual Coach
Lamar Greene is a passionate reproductive justice advocate who has answered their calling as a healer. Greene is a full-spectrum doula, spiritual life coach, and budding community herbalist motivated by their mother’s birthing narrative and their own life’s journey. They earned their Full Spectrum Doula Certification with Birthing Advocacy Doula Training and completed their Spiritual Life Coach Certification with Transformation Academy™. Their interest in spirituality was sparked in 2017 by a summer study abroad trip, where they lived and learned amongst Tibetan monastic communities in India. They are the founder of Doula Alchemist Healing, a Black and Queer-owned healing practice centered around reproductive justice and spirituality.
