What Does a Doula Do And How Do They Support Families?30 November 2022 | Before Your Baby is Born | By Lisa H
In this article, we chat with Marta Palombo, a doula, yoga teacher and facilitator in circles for parents and babies. Originally from Italy, Marta has been living in Berlin for 7 years.
You can learn more about Marta’s work on her website.
Hi Marta, thanks for taking the time to tell us more about the work of doulas in pregnancy, birth and the postpartum period!
Would you tell us a little bit about your background? Why and when did you become a doula and what do you most enjoy about your work?
This makes me smile: I suspect I had been a doula for a while, even before I knew what a doula was! Back in 2017 I was teaching yoga, and started offering private prenatal yoga sessions. I received many questions about the body, the mind, and more. I remember doing lots of research and preparation – until I finally met a doula for the first time, and discovered a new world.
I was in love with the physical and identity transformations that I saw in the people I worked with, and so I decided to start the training to become a doula (with Ibu Robin Lim and Debra Pascali Bonaro, they are both wonders). This is still what is closest to my heart: the miracle of life, and how pregnancy, birth and postpartum are at the same time the most embodied and the most spiritual human experiences I have witnessed. Let me add that I have a background in political sciences, and that doula work for me is closely linked to advocacy and the feminine power of birth.
What exactly does a doula do and how does this differ from the work of a midwife?
The shortest answer I usually give is: a doula does not provide any medical service. A birth doula accompanies by providing physical, emotional and informational support before, during and after childbirth.
In practice, this means that a doula has no agenda: I can provide information, evidence and experience, and I respect the family’s decisions. I listen, hold hands and provide care. Most families I work with also have a midwife by their side, and they find the two figures complement each other.
Sessions with a doula, both in pregnancy and postpartum, tend to be longer (on average a couple of hours), to explore the body with movements, positions and touch, and to focus on the emotional landscape of desires, fears and expectations. Sometimes my support becomes very practical (from helping with pregnant body discomforts to cooking for new parents), sometimes it focuses more on the ritual aspect (blessingway and closing-the-bones ceremonies). When the person giving birth has a partner, I often involve them, too.
Finally, doulas generally work and travel to all parts of the city (or even beyond) versus a midwife, who has a fairly small radius.
How do doulas support families on their parenthood journey? What are the different scenarios and benefits of working with a doula?
Needs are specific to each family, and the way I work can change so much from case to case. Sometimes I only work with parents in pregnancy, sometimes only in the postpartum period, and sometimes I am present from pregnancy to birth and the following weeks.
In Berlin (and in Germany) families have access to a good base of support, and sometimes there is a need or desire for additional care. For example, when I work with a family in pregnancy, I often suggest they do their birth preparation course (Geburtsvorbereitungskurs), so that they have ground knowledge about the anatomy and physiology of birth.
That can be the place from which questions arise, and the theory becomes personal: what is it that we want? What is it that we fear? How can we process and communicate our preferences? How can we protect a sense of agency and empowerment? I think that working with a doula can nourish a sense of grounded stability, and allow the space to connect to the aspects that go beyond the technicalities of pregnancy/birth/postpartum.
Can doula services be paid for by German health insurance? How do doulas calculate the fees for their services?
German health insurance can reimburse postpartum doula services as “Haushaltshilfe” (household help). The exact amount depends on the specific conditions of the birth and family, and the Haushaltshilfe application needs to be signed by the hospital/gynecologist after birth.
For a “birth package”, different doulas in Berlin charge anywhere between a few hundred and a few thousand euros. Fees will depend on their experience and on the exact services they provide (for example, the number of prenatal and/or postnatal sessions included). Doulas who are starting their career sometimes provide their services at a lower cost. Some doulas also volunteer to support families in need.
When a doula commits to attend a birth, they will be “on call” (available 24/7 and ready to reach the family) from two weeks before the expected due date until birth, which can be up to two weeks after that date. That’s up to one month in which we don’t know when birth will start, or how long it will take, and most doulas also work with a back-up doula in case something unexpected prevents them from being at birth. That is why attending birth is usually the largest financial commitment. To give you an idea, for a private prenatal/postnatal session I charge €55 for the first hour, while for a birth package I charge €1.444.
How can a family find the right doula for them? What are some of the criteria to take into account? Is there a platform that lists all the Berlin doulas and their qualifications?
The first word that comes to my mind is trust. What is it that makes you trust a doula? How do you imagine their support? Is this in line with how they present their approach? Keep in mind that no qualification is legally required for this work. I am saying this as a certified doula: this role requires such a degree of intimacy, that the quality of “presence” of a doula (how you feel with them) may for some be more important than any formal qualifications. How do you find communication with this person? Is this the experience you are looking for?
Even at birth, the most essential requirement is that you feel safe with your doula. For some families experience may be what matters, or the language they speak. I know for some it is super important that part of my work is based on the body, while for others this may be irrelevant. Sometimes families need a first session together before committing to a full package.
I am not aware of any single platform listing all doulas and qualifications, but there is a Facebook group where many doulas are present, the list of Geburt in Berlin and associations such as Doula in Deutschland or Doula Verbund Deutschland.
Is there anything else families should know?
I feel like we are so used to receiving rules that are already set, and I would like to encourage families to recognize their freedom beyond that. Welcoming life is such a deep, meaningful and delicate moment, I see no need to standardize or banalize it. This is one of the values that I see in doula care.
Accessibility is another one, including the financial aspect. While doulas need to be fairly retributed for their work like everybody else (the rate of burnout is very high in this profession), what can help families have access to the care they need? Sometimes friends and families contribute to doula support (prenatal/postnatal sessions, or even birth) as a gift to the new parents.
On the social/community side, I also find it super important to be aware of what the German system offers: I have mentioned Geburtsvorbereitung and Haushaltshilfe. There are also Präventionskurse (I teach prenatal/postnatal yoga that is reimbursed through health insurance) and many courses and opportunities free of charge or at low cost in Familienzentren in Berlin, also in English (I facilitate weekly circles for parents, and work at the Familienzentrum Kiezoase, in Schöneberg).
Thank you, Marta!
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