“Let’s say you’re going on a journey to a foreign country where you don’t know the language, everything is unfamiliar,” says San Francisco-based doula Britt Fohrman. “It’s helpful to have a knowledgeable and compassionate guide. Someone who knows the terrain and won’t get emotional, as you or your partner inevitably will.”

This is how Fohrman, a doula with 15 years of experience who has attended over 350 births, describes the services she provides to clients during pregnancy, birth, and postpartum.

Metaphors aside, in the US, there’s little to no continuity of care for pregnant women — no single individual to support a woman throughout her pregnancy and postpartum experience. “Doctors or midwives who administer prenatal care may not attend the birth, or may not consult with patients postpartum,” says Fohrman. “I’m there for the entire ride.”

So, what exactly is a doula?

Doulas are trained, non-medical professionals who provide emotional support to a mother before, during, and after birth. “My job is to be the most relaxed person in the room during the birth,” says Fohrman “But I help clients learn tools so their confidence is bigger than any fears they have about birth.” While these tools vary from one doula to the next, Fohrman’s teachings focus on breath, visualization, and body awareness.

Doulas are trained, non-medical professionals who provide emotional support to a mother before, during, and after birth.

“Nearly every culture, from the beginning of time, incorporates breath into the birth experience,” says Fohrman. “We use deep or short breaths depending on what’s happening in the body, like a contraction (what doulas refer to as a ‘surge’), but also what needs to happen in the body to birth the baby, like pushing.”

Fohrman also uses visualization to help clients. “Let’s say my client is feeling an intense surge,” she says. “I ask her to imagine what the baby is doing in that moment — is it pressing its head against the cervix or wiggling to come out?” Visualization keeps you connected to what is happening in that moment. This reminds the mother that though her body is in pain, it’s also facilitating the birth of a human.

Lastly, she offers prenatal yoga. “My classes translate yoga poses into the birth experience,” she explains. “We spend time on hands and knees or squatting, doing movements to help the baby get into the optimal position when it’s time for it to come.”

What it’s like to work with a doula

“I’m on call as soon as my client is 37-weeks pregnant,” says Fohrman. (Most pregnancies last around 40 weeks.) “Meaning I’m ready to wake up for clients at 3AM, or whenever labor begins, to go to the hospital or call the midwife for a home birth.”

If you have a home birth, it’s easier to use a doula during birth because it’s your own home. But hospitals are different. “A hospital’s admittance of doulas varies from hospital to hospital,” says Fohrman. “Some midwives and doctors are grateful to hear the information I have on my client. Others are not as receptive to my presence or may not admit doulas at all.”

One of the most critical parts of Fohrman’s role is advocating for the mother. “If a mother doesn’t want to use a medication or undergo a procedure, I support her in that decision and express this wish on her behalf,” says Fohrman. “During birth, the mother and her partner are under a lot of stress and may not be able to do this well.”

One of the most critical parts of Fohrman’s role is advocating for the mother.

Fohrman explains that when pain arises, it’s easier to stray from the birth plan that she and her client initially established. “I encourage clients to stick to what they wanted their birth experience to be,” she says. “Sometimes this goes against what a doctor or midwife recommends.”

At the end of the day, the mother and baby’s safety is most important. Fohrman says, “I speak up as much as I can when both safety and a mother’s birth vision can be achieved, without compromising one or the other.”

Speaking of midwives, what’s the difference?

While a midwife or an obstetrician (OB-GYN) is the medical care provider for the mother and baby, doulas are non-medical professionals. “My job is not clinical, it’s more about providing preparation and emotional support,” says Fohrman.

Doula’s also offer partner support, which many midwives and doctors do not. “Many men have no biological memory to go on, in terms of the birth experience,” she says. “I spend time preparing them for what to expect and how to support the woman during birth.”

Since doulas are non-medical professionals, there’s no standardized requirement to become one, however, most doula trainings have a set of credits to fulfill. Typically, this means a number of classroom hours and attending live births. “In training, I learned about the physiology of birth, comfort measures and techniques, and standards of care in the medical community,” she explains, who combined doula training with prenatal yoga training. “But it’s the in-person, practical experience in the field that really trains you.”

The bottom line

Doulas, like Fohrman, are helping to fill gaps in modern pregnancy care. Whether you’re interested in learning tools to assist labor, having an advocate during birth, or accurately recounting your child’s birth story, doulas ensure their clients feel well-prepared and, most importantly, emotionally supported. While these offerings are unique, ultimately, the ability to work with the same person before, during, and after birth makes doulas a truly unique option.

English Taylor is a health and wellness writer living in San Francisco. Her work has been featured in Nylon, Refinery29, and The Atlantic. English enjoys spending time with her friends, family, and 150-pound dog named Bubbles. Her favorite foods are peanut butter and pickles (sometimes together).