Congratulations on your new path! Doula work is very challenging, rewarding, and life changing. For over 5 years I taught childbirth education and worked independently as a birth Doula. I wandered into the profession at 22 years old and quickly became a very busy birth attendant in the little town where I lived. I left birth work earlier this year to pursue a degree in Psychology, but from time to time I get questions about my experiences in birth work and for advice on how to become a Doula. Although every Doula is different, and you’ll certainly have to find your own way, I’m here to share what I know so hopefully all you new and aspiring Doulas out there can benefit from my experience.
What is a birth Doula?
A Doula is a supportive companion that is trained and skilled in how to support a woman and her partner during labor. Doulas provide informational, emotional, and physical support to a woman before, during, and after labor. Most Doulas are self employed by the pregnant woman or couple and usually do not work for institutions. Although most Doulas are trained to support physiological, non-medical birth, they should also be trained in supporting women who choose epidural anesthesia and/or cesarean birth. Birth Doulas accompany women at home, in birth centers, and in hospitals. A Doula should be there to advocate for the choices of the mother and her partner, no matter what they may be. Doulas are not able to bill insurance companies or obtain licensure. Though there are several organizations that certify Doulas, there is not one governing body and certification is not required to practice as a Doula. Generally, there are two kinds of Doulas – birth (or labor) Doulas and postpartum Doulas. A birth Doula supports the mother and family prenatally and during labor, and a postpartum Doula supports the mother and family during the postpartum period.
What a Doula isn’t
A Doula is not:
- A Midwife
- Trained to deliver a baby
- A clinician
- Trained to perform physical exams such as vital signs, fetal heart checks and vaginal exams
- There to make decisions for for the mother or her partner
- There to replace the mother’s partner
Getting Trained and Certified
Doulas are not regulated in the United States and technically anyone can call themselves a Doula, even if they have not obtained any training, certification and/or have not been to a birth. However, the reasonable thing to do is find a Doula training course even if you do not pursue certification. There are several organizations that provide workshops, usually one or two weekends long, that will train you in labor support.
Some organizations will train and/or certify you without a live training course, but I don’t personally recommend that option. Doulas don’t receive a whole lot of training for the amount of responsibility and skill that is required for to perform the job. If you can attend a live training course, you should. I believe you’ll get more out of it than if you’re just reading at home.
Once you’ve attended the training course, there’s usually a list of things you’ll need to do to obtain certification, if you choose to go that route. That list is pretty much the same for most organizations: join the organization, go to an approved workshop, read some books, and attend a few births for free and document them. Though I attended a DONA approved Doula training course, read the books, and attended many births (I was also teaching childbirth education every week), I chose not to become certified. That choice was personal, financial and political and in no way inhibited my ability to get clients and practice successfully. However, If you are working in a large area with lots of other Doulas, you may want to obtain certification to enhance your practice.
Things you will need
- A contract. Mine outlines my experience, training, how many prenatal appointments I offer (1-2), what my fee is, my availability (my on-call period is 2 weeks before and after the due date), comfort measures I offer, and what happens after the baby is born (I offer 2 appointments postpartum)
- A doula bag with the following: A change of clothes, energy bars, a birth ball, tooth brush and toothpaste, ibuprofen, gum, bottled water, quarters, my cell phone and charger, notepad and pen, massage oil or lotion, a blanket and pillow, chapstick, deodorant, and hair ties. Most of those items are for me, not my client. My experience is that both home and hospital usually have all the accessories mom might need, so I focus on what I need to be comfortable and supportive.
- A car. You just need one. Sorry.
One of the most challenging parts of Doula work is getting started. It’s really hard to convince a family to hire you when you haven’t attended a birth before. What’s more, it’s also difficult to get hired when you haven’t given birth yourself. While I think it’s totally silly that a family wouldn’t hire a Doula who hasn’t given birth, it’s a real concern for many parents. You can point out a few things that might make a difference to a potential client:
- Male obstetricians have never given birth but no one doubts their abilities to be an effective practitioner at births.
- By not being a mother yourself you can be more available to the mother and her family.
- You do not have your own birth experience to color your perception. Personally, I think this is a huge leg up, especially if you’re a Doula who had a difficult birth yourself. I had an especially traumatic birth experience and when I first started attending other women’s births, I had a lot of old feelings to deal with.
Initially, you will probably need to provide your services for free to get those first few births. How you connect to pregnant mothers will vary depending on where you live and how much free time you have. I was a childbirth educator first, so that’s how I connected with families and got hired as a Doula. If you aren’t already and educator and/or do not have any ties to your local birth community, you will need to hustle.
- Get to know the local hospital, birth center, Midwives, childbirth educators, and Doulas. Let them know who you are and give them your contact information.
- Create business cards and give them out like it’s going out of style.
- Find any local childbirth organizations and join them.
- Try to volunteer your services at the local birth center or hospital.
- See if you can’t get started going to your friend’s births in the beginning. Once you get those first few births out of the way, it’s way easier to market yourself.
- Create a website! Put up pictures, testimonials! This will really help.
- Do a google search for “Doula Finder” and register with every Doula search engine you can. One perk of certification is that you will be listed on the organization’s website, so that’s something to consider.
Something you need to understand before becoming a Doula is that Doula work is something you do because you love it, not because it’s a way to make a living. Sure, it’s true that some Doulas are able to support themselves attending births, but they are not the majority. Most Doulas work other jobs because Doula work is not paid for by medical insurance and families have to pay out of pocket. Most families cannot afford (or do not want to pay) a high priced Doula, no matter how valuable her services may be. When I was an active Doula I charged a sliding scale fee. Initially I charged around $150 and increased my fee as I gained more experience. The most I ever made at a birth was around $800, but I was there for about 3 days. When you do the math, that’s about $11.00 per hour, not including the money I lost being absent from my day job. I highly recommend making a contract and getting a deposit. I’ve had more than one family hire me and never call me for the birth. This can be really frustrating, especially when you’ve been waiting several weeks for a call and spent the time and effort to have prenatal appointments. Basically, people value what they pay for. Although it’s not really fun to discuss payment with your client, your services are of huge value and you should be paid.
Being a Doula with a Day Job
When I was an active Doula I also worked a variety of other jobs. I was a childbirth educator, preschool teacher, waitress, barista. Basically any odd job that would allow me to go to births. And yes, I did loose a few day jobs when I was a Doula. Just imagine going to your boss right now and saying, “Yeah, so I’m going to have to take some time off. I don’t know when it will be or how long I’ll be gone. I might even have to leave in the middle of my shift. Is that cool?” I’m sure you can imagine how your boss might not like that too much. Here are my suggestions for being a Doula with a day job-
- While it may be tempting to run to your client’s side the first moment she thinks she is going into labor, it makes for a long, potentially exhausting experience that could get you fired from your day job. After a few years of practice, I would counsel my clients to call me when they thought mom was in labor. I would stay on the phone with mom for about 5-10 minutes and pay attention to her breathing. If she was able to talk though her contractions, I would tell her I’d call back in an hour and check in. If she couldn’t speak though a contraction, I’d assume she was close to or in active labor and I’d leave to be with her immediately. Although it’s not always possible, the sooner your client can alert you to labor beginning, the better prepared you’ll be to leave work. Encourage your clients to communicate with you as much as possible around her due date.
- Don’t take clients who live too far away. Offer to find her a Doula closer to her home and leave it at that.
- Be really upfront with your boss about your Doula work.
- If you can, avoid medical inductions. They can take a really long time. This wasn’t always possible, but after a while, I stuck to home births when I could. This wasn’t because I have moral or philosophical issues with hospital birth, but simply because I couldn’t be gone from my family and job for days at a time. My experience was that home birth went quicker, so that’s what I gravitated towards.
More than anything I believe Doula work to be practicing love. A Doula is a professional, it’s true, but what a Doula does is nurture and care for a woman and her family, which is something that most of us know how to do. When I was a new Doula my Birth Bag overflowed with all sorts of fancy massage tools and accessories I thought I needed. After a while, however, I realized all I really needed was my hands and an open heart. Good luck on your journey, new Doulas. It’s an amazing one.