Why Being a Doula is “the Best Job in the World”

For her, birth is a peak life experience

04.25.17
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For those who haven’t hired one themselves, the role of a doula might be a bit of a mystery. At least it was for me. Katinka Locascio is a labor doula, licensed massage therapist, herbalist, fertility awareness educator and the founder of Earth + Sky Healing Arts. I asked her to tell me everything about being a doula — the good, the bad, the hard, the surprising.


My choice to become a doula stems from a desire to be a part of a really wonderful and important life experience. I didn’t want birth to remain behind closed doors until it was my turn. I came to it circularly: About 15 years ago, six months before I was set to attend medical school, I decided to train in bodywork (an alternative medicine that has to do with breath and energy). I didn’t think about it too much; it sounded cool to get a massage every day for six months. But when I got there, I realized, Oh, this is really profound. I decided to forgo medical school because I wanted to study the body from this other vantage point.

Then one day, somebody called me up — a person I knew and really respected — and said, “Hey, do you want to come to our birth?” It was at this moment that I was like, ‘That’s it! I want to be at a birth!” It was amazing, magical and also scary. I really wasn’t prepared, but I was hooked. I started training as a doula.

Sometimes I’ll get the question, “What’s the difference between a doula and a midwife?” I totally understand why someone unfamiliar with the process would ask that question, but from my perspective, they couldn’t be more different. A midwife is a licensed medical practitioner that is responsible for the health of the mother and the child in a very legal and medical way, the same as an OB. A doula is non-medical — an emotional, physical and informational support person. I bring comfort and support to the couple. I’m in the room as someone who isn’t afraid of the process of birth, who’s been through it before. I only answer to the parents. And because I also offer fertility counseling, I’m often with them through the whole process: As they’re trying to get pregnant, while they’re pregnant, during the birth, after the birth. Every woman deserves support and undivided attention through that process.

I’ll never forget someone describing having a baby in a hospital, “like trying to take a poop in the middle of a shopping mall.” It’s hard to relax and get to that quiet, focused space in a very public setting. Studies have shown that extra support systems, such as doulas, reduce the chances of problems in the birthing process. There’s just something about mammals where, if they’re in a place of fear, it’s really hard to have a baby.

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There are some common hospital practices that are based on old, kind of patronizing ways of doing things. Like something as simple as women eating during labor. Most hospitals have a policy that says women can’t eat in labor, but when you dig into why, you’ll discover it doesn’t need to be so black and white. Most women don’t eat at the end of labor but they might want to eat at the beginning of labor, and that’s totally fine. It’s one of those policies that we’re seeing change as it’s been increasingly questioned. Being informed and understanding those trends is a really important part of my job. Everybody should feel informed and empowered to make decisions that are best for them; I’m there to help.

Another example is the hospital approach to pain relief. It’s unethical to deny a woman pain relief, but in a hospital, your options are morphine, anesthesia, Demerol, etc. They’re pretty intense. But, particularly in birth, there are so many other options. Like touch, massage, hot-and-cold compresses, hydrotherapy — side-effect-free, proven measures of pain relief that a doula or anyone can provide, but that aren’t covered by our insurance system. That’s where you see evidence of a more pharmaceutical-driven medical system.

After being a doula for a number of years, I felt clear on what I wanted when I had kids for myself, which was nice. I was lucky to have two satisfying and wonderful births. I was in labor for 25 hours with my daughter — it’s not like it was quick or easy — but it was a peak experience of life. I did not believe I could do it until my child came out and then I was like, “Oh my god I just did that. That’s crazy!” I was convinced that everyone on the planet could give birth except me. But then it happened and it was really cool.

That said, having kids has definitely changed me as a doula. On the one hand, it’s really nice to look someone in the eye and be like, “I’ve been there.” You can’t replace that. But it’s also hard to look someone in the eye and be like, “My boobs are about to explode, I really need to go pump, my husband’s going to kill me because I’ve been gone for 40 hours and, oh my gosh, that’s such a hard contraction you’re going through!” It’s also challenging to see women have less-satisfying experiences than I did. I’m still processing whether becoming a mother has helped me be a better doula or not.

In that vein, the hardest part of being a doula is watching people not get the level of care I want them to get. It’s tough to see women be talked down to or condescended to when they’re in that state. As a doula I’m witnessing all of it and seeing it a little more clearly, maybe, than she is. That part can be really difficult.

Another hard part of being a doula is being on-call. I take on about four clients a month, which translates to about four births a month. That means I can’t go away on the weekend, nor have more than half a glass of wine. I don’t make summer plans. I’ve missed Thanksgivings and Christmases, my daughter’s recital, my husband’s play, that kind of stuff. You can’t plan a birth! It can be very physically draining, because I’m missing nights of sleep repeatedly and have to go to work the next day or be with my kids or whatever, and I’m not always getting the catch-up time that I need.

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But whenever I’m tired, I just remember that feeling of being in the thick of it. That moment where the birth starts to feel like it’s taking a while. Everyone’s getting a little hopeless about the whole thing and you peer out of the hospital window and see people going to work and drinking their coffee and you think, I’m in such a different world than you. I’ve been up all night. It can be tough. Sometimes I wonder, Why on earth am I doing this? And then, lo and behold, a little person is born and I can’t help but marvel, This is the most amazing thing ever. This is the best job in the world.

I always joke with my clients that I will cry when their baby is born, because it’s such an incredible thing. Crying is a very human response to witnessing birth. It’s so beautiful when a little baby enters into the world. I still know many of the kids I watched get born. The first one I saw is 14 now.

The field has grown in the last 10 years. There are so many smart people in this industry, I learn from them all the time. It’s a really alive and energetic group of people that are called to do this work. I wish that anybody who feels like they want support from this world could have it. In the words of the inimitable Dr. John H. Kennell, if the job of a doula could be made into a pill, it would be unethical not to prescribe it to everyone who wanted it. Birth is a lot of work and can be scary, but women are amazing and I’m in constant awe of the work they do to populate the planet. It’s no doubt underappreciated.

Illustrations by Juliana Vido; follow her on Instagram @julianavido.

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  • 20 oz filet

    The illustrations for this story are rad. Great work Juliana Vido!

  • I’ve completed most of my labor doula training through CAPPA, but life has gotten busy and I’m wondering if I’ll ever complete my certification. I really want to experience the magic of childbirth, and enable a woman to have her best possible labor, but it’s an intense place to voluntarily put yourself in.
    I certainly think more women need to be informed of their options for childbirth, so they can fearlessly have the labors they want.

  • SL

    Beautiful story 🙂

  • SC

    Possibly silly questions ~ are doulas allowed in hospital births, or only at-home births? I’m sure this varies, but what are the general costs associated with hiring a doula? Can you get an epidural and have a doula? Seems like the best of both worlds to me 🙂

    • The doula you hire is there to give you the type of birth you want. If you want a hospital birth with an epidural, she will help you make that happen. (Though generally doulas are trained to help manage pain with the use of fewer drugs). A doula can charge anywhere from $400-$1000 for her services. The upper limit of that spectrum would be for big cities like NYC. Some insurance companies have started to cover a doula’s services, which is great, because there are fewer complications when another support person is present!

      • BrooklynCyclist

        In a city like NYC, $1000 would definitely not be anywhere close to the upper range of the fees for a doula (or even in many other cities like Seattle, San Fran, LA, Chicago). In NYC the fee range is more like $500-$4000 for doula services. Many of my clients have epidurals in hospitals and my training is definitely not specific to the type of birth you have but rather to helping my clients have a positive birth experience.

  • LS

    I had my first child in September and was extremely fortunate to find some amazing caregivers who helped me on the way. There is so much focus on baby shower gifts & shopping during pregnancy (when you really need very little) but almost no mainstream emphasis on the physical and emotional preparation for pregnancy. I did Pilates 1-2 times a week from weeks 18-41 and did Hypnobirth as well the standard hospital course (which is essentially a hospital induction). I also chose to give birth in a hospital birth centre under the care of a midwife, not an obstetrician. My baby didn’t kick much in utero so I was offered a medical induction. After lots of research & discussion I refused this and spent time in foetal monitoring 3x per week, did acupuncture & induction massage instead. I was fortunate enough to have a 6-hour drug-free labor, which I think was part luck & part the result of a thousand small decisions along the way. Good luck to all the ladies preparing for birth – don’t be afraid to seek out advocates, second opinions & above all make sure you advocate for yourself.

  • Elizabeth

    I am confused as to where the births take place with a doula? What if something goes wrong during the birth? Having a doula sounds wonderful but so does being surrounded by a hospital of trained medical professionals who can immediately wheel mother or baby into emergency surgery if necessary.

    • Stephanie

      Most doulas attend births in hospitals, homes or birth centers, where there are Midwives, Obstetricians and nurses to oversee the delivery and provide medical support. Doulas can support and empower you emotionally and help you plan for whatever kind of birth you envision – medicated, unmedicated, cesarean, water birth, home birth. It is a common misconception that doula services are only appropriate or helpful for those seeking “natural” home births.

    • India Rouge

      At the hospital. My doula insurance only covers me in a hospital or birth center with a clinician present.

  • Bailey Stark

    I’m currently a nursing student and cannot wait for my OB clinical, pregnancy is seriously the coolest thing ever, and the emotional support a doula provides is awesome. I love it.

  • Delphine Gintz

    Crazy how I was just wondering about what a doula is and then this popped up on my feed 🙂 I like seeing that other people are just as excited about birth as I am, and I admire mothers so much for going through all that! Thank you MR for such an original article on a fashion site!!!
    A soon to be OB 😉

  • Claudia Gimson

    I was just telling a friend about my experience with a doula, now almost 36 years ago, and what a tremendous gift Susan was. She was an incredible woman – a bit of a late comer to motherhood In those days herself, a college professor, but just absolutely loved being a mother and wanted others to share her experience so this became her career. What a wonderful attitude she had. This was my third child via the Lamaze-natural childbirth approach and way down the road when she came into the picture, so not really involved in the birthing plan. I was fortunate to have very supportive doctors (the doctor that delivered me, delivered my first two then retired and the next doctor was great, but out of town Thanksgiving and his back up didn’t make it either..I was very fortunate to have quick, (too quick) easy deliveries; 7, 4, and 2 1/2 hours from 1st contraction to Baby!! Before you say not fair! my pregancies were marred by unremitting nausea throughout so with four year old and two year old toddlers, and broken leg, exhausted! Susan unexpectedly came to me via a friend and gave her love and support and just took over did any and everything required in our busy household so I could focus my energy on healing and bonding with my baby. She said the term came from the Greek house slave, It sounds as though perhaps the focus is a bit different now, more as a patient advocate in the beginning. But for two weeks my husband came home to candlelit dinners, clean house, clean kids, yard chores done, rested and happy wife and then, well reality eventually comes back, but what a wonderful and unforgettable start!. For those considering providing this service, blessings! For those receiving this service, blessings on you and your baby and I hope you will still feel the same warmth and gratitude when you look upon your grandchild decades later.