How the on-demand economy is shaping childbirth and more

Just as you can order a valet virtually anywhere, or hire someone to pack your suitcase for a business trip, the niche service economy has come to the more biological moments in life.

As doulatraining.net puts it, “You can be any type of doula you want, even more than one.”

Traditionally meant to support and transition families during and after birth, doulas now tend to other life events. An abortion doula may soothe and guide a woman through her procedure. A death doula stands by the dying or their bereaved family members, helping with funeral arrangements or simply holding hands through grief. A newborn adoption doula caters to either the birth mother, or the adopting family, or both, attending to needs before, during, and after birth (“options vary”).

But some believe the doula in the age of bespoke everything is a drift from the role’s original intent. If the term is appropriated and expanded for marketing purposes, it may dilute a profession that already fights for legitimacy.

The term “doula” was first used by medical anthropologist Dr. Dana Raphael in 1976 to describe a trained female professional who assists women with postnatal breastfeeding. Though derived from the Greek, meaning “woman who serves,” a doula needn’t be a woman. She contributes labor support but performs no clinical tasks. Instead she may provide basic comfort measures, facilitate communication with medical staff, and maximize a positive birth experience.

Doulas are not to be confused with midwives, who have existed for centuries and can perform medical services in the delivery process, but the two practices are intimately linked.

In 1971, a midwife named Ina May Gaskin opened the Farm Midwifery Center on a commune in rural Tennessee and legitimized “spiritual midwifery” — no medical experience required. Gaskin sought a departure from the detached, mechanical, and often medicated hospital births that characterized the early 20th Century, and in most cases still constitute Western birthing today. Her midwifery model encouraged natural home births supported by the family’s own community. Attending over 1,200 births and hosting many more at the Farm Midwifery Center, she helped prove that properly planned home births can be safe, less stressful, and emotionally empowering for families. She is commonly known as the “mother of authentic midwifery.”

Though she didn’t coin the term, Gaskin’s work inspired the tenets of doulahood: informal support around birth, based on the needs of the family. It inspired a demand for home births and documentaries like 2008’s The Business of Being Born, which praises the benefits of midwives and accuses hospitals of adopting a birth-for-profit model.

Today, birth and postnatal doulas may charge anywhere from $20 to $50 an hour, through DONA, an international doula organization founded in 1992. Though, prices depend on location and personal family needs, and some doulas even barter for their services.

But lately, doula dilution is a concern.

“There are other professions calling themselves doulas. Some have existed long before and then they just put the name ‘doula’ to it,” says Melissa Harley, DONA director of public relations and marketing. “But at this point we feel the name ‘doula’ is connected with birth and postpartum.”

When (privileged) parents can hire a night doula to sleep train, a daytime nanny, a diaper delivery service, and someone to deliver the dry cleaning, they are participating in the “concierge economy.” On-demand services sometimes employ certified professionals, but mostly they’re like Uber — virtually anyone can sign up to drive a car or deliver dinner, after a clean background check.

“There isn’t one description,” writes Alina Tugend in a New York Times article about death doulas. Some visit bedsides as volunteers; others charge a fee for helping the family choose a casket. One woman invoices $800 to $1,200 for three visits plus “staying with the patient in the final hours.”

Just as there isn’t one type of a doula anymore, neither is there a standard of certification. Based in New York, The Doula Project is a group of volunteers who undergo a 40-hour training course. DONA’s certification involves experiential training such as learning a hip squeeze on an actual body. But doula certification is not universally recognized like a medical degree, for example. Various national, local, and private agencies offer different versions. It is the responsibility of the birth family to research or ask about a doula’s background.

This grey area can cause hospital staff butt heads with doulas in a kind of turf war. The American College of Obstetrics and Gynecology takes no official position on doula practice. Most insurance companies don’t cover doula expenses.

But organizations like The Doula Project argue there are profound benefits to all types of doula support “across the spectrum of pregnancy.” All of its services are free and each of its doulas a volunteer. Abortion doulas may particularly help people below the poverty level, who are five times more susceptible to unintended pregnancies but three times less likely to have an abortion than affluent women.

A 2013 study of socially disadvantaged mothers at risk for adverse birth outcomes showed those who used doulas for pre-birth assistance were two times less likely to experience a birth complication involving themselves or their baby, and more likely to initiate breastfeeding. A collection of clinical trials since the 1990s also suggest births supported by doulas reduce the need for emergency cesareans, pain medication, and length of labor overall.

While some may argue the benefits of a death doula, does the terminology threaten traditional birth doulas already defending their nebulous roles? When everyone can be a doula, what is a doula anymore?

Perhaps if each new type of niche doula gains healthy credibility like birth doulas have, they can continue to help improve lives. But it will take more than a word.