After working with a doula for the delivery of her first two children, Elise Slade knew she wanted that personalized support the third time around. Except for this birth, the doula didn’t come to the hospital.
Instead, she texted and called her doula with questions and updates while she labored. "I didn't want a lot of extra bodies in the room, but I still wanted some extra encouragement," she recalls Slade.
Like many other virtual pregnancy services, virtual doulas first took off during the COVID-19 pandemic, and they've remained popular today. Here's what to know about the growing trend and how to decide if you should take advantage of this type of tech support.
- Virtual doulas provide emotional and educational support to moms during pregnancy, birth and postpartum through phone calls, video chats and texts.
- They typically cost less than in-person services, but moms miss out on physical support (like labor massage).
- If you're going to hire a virtual doula, talk to your OB/GYN or midwife first, plus your partner, if you have one.
What is a virtual doula?
Doulas are trained non-medical professionals who provide emotional, physical and educational support to moms during pregnancy, birth and postpartum. This support traditionally happens in person, but with a virtual doula, you'd get guidance through phone calls, video calls and texting.
Many doulas now offer remote prenatal and postpartum appointments, similar to how you'd meet virtually with a doctor or a therapist. "We'll provide pregnancy support and education and talk about creating a birth plan, for instance," says Kristin Revere, C.E.D., owner and founder of Gold Coast Doulas in Grand Rapids, Michigan.
That virtual support can extend to labor and delivery too, with the particulars depending on your preference. The doula might Zoom or Facetime with you and your partner while you labor to demonstrate different labor positions; suggest questions to ask your provider; or offer support, advice or just positive affirmations over the phone or via text, explains Micaela Segura, a full-spectrum doula and owner of Matriz Jaguar in Philadelphia, Pennsylvania.
What's the difference between a virtual doula and an AI doula?
Virtual doulas are real, trained people who offer remote support as part of their care package. They could be people in your community or someone you're matched with on a digital platform. That's different from artificial intelligence (AI) doula apps, which essentially offer ChatGPT-style pregnancy support rather than advice from a live person.
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Virtual doulas are humans, so they may not respond to you right away throughout your pregnancy (though they'll likely be on call throughout the duration of your labor and delivery). When you do meet or speak with them, the support you'll get is tailored to you and your needs. Over time, you'll likely form a deep, trusting relationship with your doula, Revere says.
AI doulas, on the other hand, can offer real-time responses to your questions or concerns, including ones that pop into your head at 3:00 a.m. But it's a chatbot and the answers aren't necessarily vetted by experts or customized to you. Since there isn't a real person behind the screen, you're unlikely to feel that deep, trusting sense that your doula is there for you, notes Revere.
Pros of virtual doulas
While the research on virtual doulas is limited, experts say that remote support from a doula likely has a bunch of benefits. "Anyone can benefit from a degree of virtual support," Segura says. These include:
- Improved birth outcomes. Using a virtual doula is linked with more positive birth experiences and lower C-section rates compared to people who didn’t use any doula services, a recent study found.[1]
- Lower cost. How much doula care costs can vary based on where you live and your doula's experience level. But in most cases, virtual care will cost less than the in-person kind, according to DONA International.[2] That's important, since doula care ( in-person or virtual) isn't typically covered by insurance.
- Increased access to care. Many rural areas and underserved communities simply don't have doulas who can meet with moms in person. If you live in one of these maternity care deserts, the only way to access doula support may be virtually, says Gianna Taylor, C.L.D., owner of A Doula's Calling in Voorhees, New Jersey.
- More opportunities to find a doula you like. Maybe you're looking for a doula who shares your cultural background, or you want to work with a doula for a subsequent pregnancy after you or the doula have moved. With a remote option, you can work with the doula who gets you rather than whoever might be available nearby.
- A more intimate experience. Maybe you want the knowledge and support a doula can provide without actually having an additional person in the delivery room. If that's the case, having a doula you or your partner can reach by phone or video could be a good choice.
Cons of virtual doulas
The virtual doula experience simply isn't the same as an in-person one. "Some of the physical ways that we support our clients aren't going to necessarily translate smoothly into virtual support," Taylor says. Some of the potential downsides include:
- Lack of hands-on care. During labor and delivery, one of a doula's primary functions is to provide physical support. "We can [virtually] instruct partners or other family members who are there on how to do a hip squeeze or labor massage or give position suggestions, but there's nothing that fully replaces the experience of the doula," Revere says.
- Less relief for a birth partner. Labor can last for hours or even days. In-person doulas can stay with you during those moments when partners or other support people need a break. "We're also there for your partner so that they can rest, eat or shower and not have to worry about the birthing person not having someone there to support them," Taylor points out.
- Lack of closeness. You may find that real-life interactions help you bond and connect better. "With virtual [services], it's going to take more to build that relationship and trust, and the doula-client relationship is very much based on trust," says Rachel Urrutia, M.D., an OB/GYN with UNC Health and an associate professor of general obstetrics at the UNC School of Medicine in Chapel Hill, North Carolina.
- Unavailability in certain states for Medicaid patients. Some states, including Oklahoma and Maryland, require that doula support happens in person in order to qualify for Medicaid reimbursement. (Learn more about the telehealth laws in your state.) Regardless of your insurance situation, if you're planning on using a virtual doula, check with your hospital or practice to make sure it's allowed. It's also a good idea to ask your OB/GYN or midwife if they're comfortable with it, too. Most are, reassures Dr. Urrutia. "It hasn't been uncommon for people to have their mothers on FaceTime while they're birthing," she says. "Having a doula on FaceTime wouldn't feel that different for me."
How to decide if a virtual doula is right for you
The remote option isn't right for everyone. "As with most things, factors that are pros for some people might be cons for other people, and vice versa," says Dr. Urrutia. "It's about thinking through what works best for you."
With that in mind, the virtual route might work for you if:
- You want to hire a doula, but you're worried about the cost.
- You can't find any doulas near you.
- Emotional support and education are more important to you than physical support.
- You and your partner feel comfortable talking on the phone or video or texting during labor. (It's especially important for partners to be on board here, since they'll likely be the one communicating with the doula as labor progresses, Revere points out.)
Tips for using a virtual doula
Think remote doula support might be a good fit for your pregnancy and birth? Here are some things you can do to get the most out of your experience.
- Make sure you feel a connection. "This is a really intimate time in your life," Revere says. "Interview multiple doulas to see who's the best fit, not just in terms of experience but to make sure your personalities mesh."
- If you're partnered, make sure your partner is on board. It's important that your partner feels comfortable acting as a go-between and handling the communication, Segura says.
- Commit to practicing physical positions and comfort measures before labor starts. Your doula can give you and your support person instructions for what to try ahead of time so you're prepared when the big day comes. If you'd prefer to get physical help as you practice, consider taking a local childbirth class, Revere recommends.
- Talk it over with your OB/GYN or midwife. Most OB/GYNs are unfazed by birthing moms making calls or texts during labor, Dr. Urrutia says. Still, it's worth giving your provider a heads up just to make sure everyone is on the same page.
- Put it in your birth plan. It's just another way to give your care team advance notice. If you'd like, you could even request a nurse who's willing to help you with the comfort measures and positions that your virtual doula is recommending, Segura suggests.
Virtual doulas may not offer the same physical support as in-person ones. But if you're willing to shift your expectations and do some of the physical preparation on your own, they can help you prepare for a positive, empowered birth experience.
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