Becoming a birth doula was one of the best and most rewarding decisions I’ve ever made. I cannot express with words the sheer joy I have experienced at each and every one of the 50+ births I’ve attended throughout my career as a doula. Although most of my “work” as a doula at the present time is spent volunteering to help teen moms and military families, you can have a very successful and lucrative doula business if you choose.

The training and certification to become a doula is fairly inexpensive (typically $400-$600) and requires both theory and practical training. To begin with, you will typically be given a book list to read. Next you will likely attend a series of childbirth education classes prior to your actual doula training. These consist of watching videos, discussing the female anatomy, what to expect during labor, and how to work with pregnant and birthing mothers. Your doula training usually lasts from 3 full days to 2 weeks or longer, depending on what organization you certify with, or who trains you. Your training will be in depth and about all things birth related. You will learn comfort measures to use with laboring mothers, and how to advocate for them when you interact with hospital staff. You will also learn how to market your services to the public and likely create your very first network with your classmates.

To give you an idea of the income potential, the average doula charges anywhere from $500-$1,000+ per birth, depending on her experience, services offered, and additional areas of expertise (a doula who is also a massage therapist is obviously able to charge more). As a doula, you can attend about 2-4 births per month on your own, or up to 8 births per month if you’re working with a group of doulas that provide “back up” in the event that 2 or more clients go into labor at the same time.

I completed my doula training and certification through DONA International in 2002, and ALACE (now To Labor) in 2005. While DONA is probably the most well-known, widely respected doula training organization, there are many options available. Furthermore, while any reputable doula should receive quality training, certification is not required to practice as a doula.  Anyone can work as a doula regardless of whether or not they have been certified to do so. However, many clients will only work with certified doulas, and if you are serious about pursuing a career as a doula, it’s definitely worth getting certified with a reputable organization.

If you’re interested in becoming a doula, I recommend registering for a birth doula training with one of the following reputable organizations:

DONA International
To Labor (Formerly ALACE)
CAPPA
ICEA
Birthing From Within- Love them!

When it comes to dads and doulas couples can have a myriad of concerns, but the truth is both play a very important role.  As a doula and mother who knows firsthand how important dads and doulas can be, I’d like to address some of the most common concerns – because dads and doulas make a great team!

Concern: If I have my partner, why do I need a doula?

Truth: The dad-to-be is in an unfamiliar environment, and trying to become familiar with the process and language of birth, understand medical procedures, and advocate for his partner is often extremely stressful. A doula can eliminate this stress by explaining what to expect, providing the information needed to help parents make appropriate decisions, and facilitate communication between the couple and medical team.

Additionally, it’s hard for a father to understand a woman’s instinctive behavior during birth and he may react anxiously to what a doula knows to be the normal process of birth. Seeing his partner in pain may cause the father to become distressed. A doula can skillfully help the mother to cope with labor pain in her own unique way, offer reassurance to both the mother and father, and encourage the father to participate at his own comfort level.

Concern: What if the doula takes over, displacing the father-to-be and interfering with the intimate birthing experience?

Truth: The doula can actually bring the couple closer, making sure the partner’s needs are met (food, drink, and reassurance) so the woman and partner can work more closely together. When the dad-to-be chooses to be the main source of support, the doula can help him be more successful by using her expertise to make suggestions for comfort measures, keep him informed about what’s going on, and offer words of encouragement and reassurance. During a long tiring labor, the doula can also offer the father a break or brief rest, without him feeling guilty about leaving his partner alone.

For the father who is shy, uncertain, or unversed in his role, the doula can suggest simple but truly useful tasks such as timing contractions, holding the woman, supporting her in a particular position, or showing him how to apply counter pressure to her back.

While the doula probably knows more about birth, hospitals, and maternity care, the partner certainly knows more about the woman’s personality, likes and dislikes, and needs. Moreover, he loves the woman more than anyone else there. The combined contributions of the father and doula, along with a competent, and caring medical team give the mother everything she needs to have the best birthing experience possible!

Concern: The doula has her own belief about how the birth should go, and imposes it on the woman and couple.

Truth: The doula’s number one goal is to help ensure the woman’s or couples birth plan is acknowledged and followed as best as possible. If the doula is thoroughly familiar with the couple’s wishes and their birth plan, she may actually think more about it than the couple, especially when labor is intense and things are happening rapidly. The doula can remind the staff or the couple of some items on the birth plan that are forgotten, but which later might be important. Sometimes when the birth plan is not followed, the couple later looks back with regret or disappointment- especially if it was a result of the choices they made.

The doula never makes decisions for the couple, but instead asks questions that will ensure the right information is provided so the couple can make an informed decision of their own.  She may also suggest alternatives (like waiting a while) for the couple to consider their options.

In summary, the doula helps make the birth experience as rewarding and satisfying as possible. As one father said “I heaved a big sigh of relief when the doula walked in. I hadn’t realized how much pressure I’d been feeling. She not only calmed my wife, she calmed me down too.”

The father’s presence and loving support in birth is comforting and reassuring. The love he shares with the mother and his child and his need to nurture and protect his family are priceless gifts that only he can provide. With her partner and a doula at birth, a mother can have the best of both worlds – her partner’s loving care and attention and the doula’s expertise and guidance in birth.

Many women and couples are now choosing to hire a professional birth doula to support them during their birthing journey. If you’re considering hiring a doula, here are some tips on where to find one, and what you should ask her before you seal the deal.

If you are looking for a birth doula, I recommend using the Doula Locater at www.DONA.org. Other options include asking your midwife or childbirth educator for a referral, or doing a Google search for birth doulas or doula groups in your area. Many doulas and doula groups have their own individual websites. Here in San Diego, we have www.beautifulbeginnings.org as well as several others.

I also recommend interviewing several birth doulas before deciding on one that’s best for you. Here are some points you may want to consider, and questions you may want to ask when you interview a doula…

• What kind of training does she have? Is she certified? How experienced is she? Has she given birth herself? Has she worked with your OB or midwife, at your birthplace? Can she provide references? What is her fee? Does she accept monthly payments or require one lump sum?
• What services does she provide? Does she have training in any other areas such as aromatherapy or massage? Will she come to your home in early labor? Can she offer suggestions for comfort and facilitating labor?
• What is her availability around your due date? How will you get in touch with her? Does she offer 24 hour phone support? Does she have a backup doula in case she is not available? Can you meet her? How many clients does she accept each month? How often will you meet prenatally and postpartum?
• What are her philosophies on childbirth? Do they “feel right” to you?
• How do you get along with her? How about your partner? Beware- personality conflicts can bring negative energies to a birth. You should feel confident and positive with her.
• Discuss your partner’s role at birth. She should be enthusiastic about support for both of you- offering her skills while supporting and enhancing your partner’s role.
• What does she expect from you in terms of preparation for birth and assuming responsibility? Although doulas act as advocates, remember that you and your partner are the parents of this baby, it is your birth, and you are the ones who must ultimately assume responsibility for decisions that are made. The doula can provide information and point out alternatives, but she cannot make decisions for you!

If you would like to have a doula, but are worried you can’t afford one there are several options available! Many doulas love their work so much they are willing to offer it on a volunteer basis, I know, because I am one of those doulas. I am not sure of the best way to find a trained/certified volunteer doula, but you could try searching your local Craig’s List, posting a wanted ad on Craig’s List, doing a Google search for volunteer doulas in your area, or simply try asking around. There are some hospitals that offer volunteer doulas to all patients, such as UCSD Medical Center in San Diego- if your hospital offers these services by all means take advantage! If you are a military family, there is an organization called Operation Special Delivery with doulas that volunteer their services to active duty military families. Another way to find a low or no cost doula is by contacting the organizations that train/certify doulas such as www.DONA.org (others listed below) and ask for a list of doulas who have recently completed their training, but are still working towards certification (you may have to get the name of your local doula trainer and contact her for the list of doulas she recently trained). Most doulas have to attend a certain number of births before they can get certified, and these doulas are often eager to volunteer at births in exchange for the experience they will gain.

National Birth Doula Organizations:
www.CAPPA.net
www.DONA.org
www.ChildbirthInternational.com
www.BirthingFromWithin.com
www.ICEA.org
www.ACBE.com
www.ALACE.org

I’ve had a birth doula present at 3 of my four births, and at the birth where a doula was not present I had a 50+ hour labor, an epidural, a vacuum delivery, an episiotomy, and many regrets.  Sure, in the end a healthy mom and baby is what counts, but having a doula at your birth can make the experience a whole lot better!

Since 1980, research has been done to determine the benefits of doula assisted births. These studies showed that there were significant decreases in birth interventions including:

• 50 % decrease in cesarean births
• 60 % decrease in epidurals
• 40 % decrease in the use of Pitocin
• 30% decrease in the use of narcotics
• 30% decrease in the use of forceps
• Overall, a 25% decrease in the length of labor

In addition, research also shows parents who receive good support during labor:

• Feel more secure and cared for
• Are more successful in adapting to new family dynamics
• Have greater success with breastfeeding
• Have greater self-confidence
• Have less postpartum depression
• Have lower incidence of abuse

A doula “mothers the mother”, and offers continuous support that most doctors, midwives, and labor nurses simply don’t have time to give. During most hospital births, the doctor checks in once or twice before being called in to deliver the baby, and labor nurses are busy juggling multiple patients at once. Aside from the woman’s partner and any family members attending the birth, a doula is the one constant source of support present throughout the birthing journey. She comforts, listens, informs, and helps protect the birthing experience as an advocate, helping communicate the birthing mother’s wishes to the medical staff.

In addition to supporting the birthing mother, a doula can also help the partner and other family members feel more at ease, resulting in a less stressful environment for all. Often times the father or partner wants to help the laboring mother, but doesn’t know how- a doula can show him what to do. When a nurse says the mother is 2 centimeters dilated, 50% effaced, and a -2 station, a doula can explain what that means. When a birth doesn’t go according to plan, the doula can help the mother and partner look at all possible options and make an informed decision they both feel good about.

If the birthing mother wishes to avoid pain medications, a doula can greatly increase her chances of success. Partners and family members often have a hard time seeing their loved one in pain, while a doula can reassure the mother what she’s feeling is normal, offer coping techniques, and empower the birthing mama to make it through drug free.

A doula can also be helpful to women who plan to use pain medication and/or epidural anesthesia. Giving birth is much more than a medical procedure. It is an emotional as well as a physical journey, and having a doula can help smooth the transition from pregnancy into parenthood. Epidurals do not hold your hand, rub your shoulders, or explain what is happening. Epidurals cannot suggest position changes to help your labor progress. Epidurals will never advocate for you, or help you get what you need from the hospital staff. Simply put, an epidural does not replace a doula.

When a doula is present before, during and after childbirth, women report greater satisfaction with their birth experience, make more positive assessments of their babies, have fewer cesareans and requests for medical intervention, and less postpartum depression. No matter what kind of birth you desire, a doula truly can help you have a better birth!

When I tell someone I’m a birth doula, the number one question that follows is…what’s that? Thankfully, I’m delighted to answer this question!  I believe the more people who are informed about doulas, the better birth outcomes will be. Numerous studies have found that a doulas presence tends to result in shorter labors with fewer complications, more positive feelings about one’s birthing experience, and a significant reduction in the number of interventions used during labor and childbirth. So what is a birth doula anyways? I’m glad you asked!

The word “doula” comes from the ancient Greek meaning “a woman who serves” and is now used to refer to a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during, and just after birth.

Although doulas are just starting to gain popularity in the United States, the concept certainly isn’t a new one. In almost every culture throughout history, women have been supporting and caring for women during childbirth. Artistic representations of birth throughout the world usually include at least two other women surrounding and supporting the birthing mother. One of these women is the midwife, who is responsible for the safe passage of the mother and baby; the other woman or women are behind or beside the mother, holding and comforting her. The modern day birth doula is a manifestation of the woman beside the mother.

When it comes to the birthing team, each person involved in the care of the laboring woman contributes to her emotional wellbeing. However, doctors, nurses and midwives are primarily responsible for the health and wellbeing of the mother and baby. Medical care providers must assess the condition of the mother and baby, diagnose and treat complications as they arise, and focus on a safe delivery of the baby. These priorities rightly take precedence over the nonmedical emotional needs of laboring women. A doula helps ensure that these nonmedical needs are met while enhancing communication and understanding between the woman or couple and the staff.

Doulas also offer help and advice on a variety of comfort measures such as breathing, relaxation, movement, position, massage, and more.  They keep the woman and her partner informed about the course of their labor and the various options available, allowing them to make well informed decisions about the birth of their baby.  Another crucial role of the doula is providing continuous emotional reassurance and comfort for the duration of the labor, and moments immediately following the birth. Some doulas are also trained in lactation, and are able to help initiate breastfeeding as soon as the baby is born.

Doulas do not interfere with or replace the woman’s partner or support person, but instead work with him or her to create a strong and supportive team. Doulas also do not replace nurses or other medical staff, nor do they perform medical tasks such as taking blood pressure or temperature, monitoring fetal heart rate, doing vaginal exams, or providing postpartum clinical care. Most importantly, doulas do not make decisions for their clients, and never project their own values and goals onto the laboring woman.

In short, women have been supporting women during childbirth since the beginning of time, and today we call those women doulas. Research now supports what women have known for centuries- a doula’s continuous, knowledgeable, and reassuring presence can make a dramatic difference on how confident and comfortable a woman feels before, during, and after the birth of her baby.