Becoming a Doula
By Beth Scott Stenglein
Why do women become doulas?
Some of us feel it was a spiritual calling, others were motivated by their own birth experiences-both positive and negative. There are women who attended a birth of a friend or daughter, and saw how much their help was needed and valued. While our reasons for becoming doulas vary, all doulas I know share a philosophy that birth is a sacred event which has, "a long lasting impact on the physical and mental health of mother, baby and family." (Doulas of North America, 1998).How do I know if I would make a good doula?
Doulas come from all walks of life. While many of us have children of our own, some (myself included) do not. You do not have to have given birth yourself to be a good doula, though having gone through labor and birth certainly can provide a helpful perspective. An open heart, a willingness to serve women and their families, and quite a bit of flexibility and patience are characteristics that are important for doulas to possess. Some women become doulas because they felt disempowered by their own birth experience. Doulas in this situation may need to be especially conscious of their emotions and personal philosophies when working with clients, being careful to let each woman define her own birth experience.What are the most challenging and rewarding parts of being a doula?
In my opinion, one of the most challenging aspects of being a doula is the flexibility it requires. When I'm working with a mother, I have to be "on-call" for the two weeks prior and two weeks following her due date. A woman's labor usually begins sometime during this four-week block. I also have to be willing to drive and meet a laboring woman during the night or early morning, even if I have not slept well. Doula often have to miss holidays such as birthdays, holidays, et cetera if they choose to schedule a birth around these times. Labor can be unpredictable, and especially with first time mothers, long. Before becoming a doula, you need to realize that labor can last 16 hours or more, and that when a family hires you, you commit to being present from when labor begins (or they call you) until about 2 hours postpartum. If you have another job and/or family responsibilities, you need to make sure they support your doula work and allow you this kind of flexibility. Other challenges include sometimes having to work with difficult providers and hospital personnel, difficult clients, and many others depending on the situation.
These challenges many seem overwhelming, however most doulas deal with them and love what they do despite the difficulties. Birth is a life-changing event few people witness in our culture. Doctors and nurses do not have the same experience as doulas, because they rarely are with a woman and her family prenatally, continuously during labor and birth, and postpartum. As doulas, we witness a the transformation of a woman from pregnancy to birthing to motherhood. Some describe the experience with words such as "holy," "awesome," and "transforming ." Though the financial rewards many not be outstanding, being paid to do something you truly love is a gift.
What do I need to do to become a doula?
Currently doula practice is not regulated by the state. This means that anyone can call herself a doula and educational and practical experience vary widely. Most doulas choose to receive training and certification through one or more organizations, including Doulas of North America (DONA), the Association of Labor and Childbirth Educators (ALACE), or the International Childbirth Education Association (ICEA), just to name a few. There are advantages and disadvantages to being certified. The process usually includes reading/studying, attended doula training, and attending a certain number of births towards certification. It can cost upwards of $300 or more, plus membership to the certifying organization. Representing yourself as a certified doula of an organization means that you agree to abide by their code of ethics and standards of practice. Benefits of certification are numerous. Many parents who hire doulas for labor support ask about training and certification, and certified doulas often command higher fees (though experience is just as, if not more, important). Many certified doulas feel strongly they are professionals, much like nurses and social workers, and should be treated as such.How does doula work operate? How much money do you make?
The vast majority of doulas are self-employed, meaning we do not work for a hospital or other organization. There are some doulas, however, that work for such organizations and they pay varies depending on many factors. Unfortunately, doula work is not an extremely lucrative career for many of us. Because of the nature of doula work, there is a limit to how many clients a doula can carry at a time. The hours are unpredictable and require a great amount of flexibility that is often difficult. Some doulas form "practices" or doula in pairs to deal with these issues. Some insurance companies reimburse for doula services, but again, this varies widely depending on the state and region. Doulas usually base their fees on several factors, including education and training, experience and number of births attended, the state/region she is practicing in, etc. Of course, any doula can set her own fees as she desires, but most doulas charge an all-inclusive fee that includes a certain number of prenatal and postpartum visits, and continuous attendance at the mother's labor and birth, regardless of length of labor.I want to learn more! Where do I start?
There are abundant resources available for aspiring doulas. I would encourage you to take your time, shop around, and learn all you can before committing to an expensive and lengthy certification process. If you live in Minnesota, a great place to start is the Childbirth Collective. Find your local chapter and attend an event. You can also email one of the current members - don't be shy! Many of us are happy to share our experiences, and meeting other doulas is important for networking should you continue on your path to becoming a doula. If you don't live in Minnesota, go to DONA's website at www.dona.org and click on "find a doula." There, you can find a listing of doulas in your area. You also can attend a birth as a support person for a friend or family member. While education and training are certainly important, helping someone through labor and birth is truly the best education. This is a great way to see if doula work truly is your "calling." Remember that everyone has to start somewhere, and no amount of reading and training can totally prepare you for the experience of helping a woman through childbirth. Some of the best doulas are those who learned through experience, before doula training ever existed!
WHATZADOULA!
What is a Doula?
Birth Doula
Women have complex needs during childbirth. In addition to the safety of modern obstetrical care, and the love and companionship provided by their partners, women need consistent, continuous reassurance, comfort, encouragement and respect. They need individualized care based on their circumstances and preferences. The role of the birth doula encompasses the non-clinical aspects of care during childbirth.
The doula’s role is to provide physical and emotional support and assistance in gathering information for women and their partners during labor and birth. The doula offers help and advice on comfort measures such as breathing, relaxation, movement and positioning. She also assists the woman and her partner to become informed about the course of their labor and their options. Perhaps the most crucial role of the doula is providing continuous emotional reassurance and comfort.
Postpartum Doula
Postpartum Doulas are trained in postpartum adjustment, new born characteristics, care feeding and development and promotion of parent-infant bonding. They are experienced in supporting families through their postpartum experience. Coming into the home during the fourth trimester (12 weeks following birth). The doula’s role is to provide education, non-judgmental support and companionship; and to assist with newborn care and family adjustment and household organization (including meal preparation, laundry and other light household tasks). Postpartum doulas offer evidence-based information on infant feeding, emotional and physical recovery from birth, infant soothing and coping skills new parents and can make appropriate referrals and suggestions when necessary.
The Doula’s goal is to facilitate the transition to parenthood by supplying reliable and factual information, reassurance and hands-on support with children and household organization. The non-medical support of a doula meets the practical and psycho-social needs of the family and allows doula’s to make referrals to quality care providers such as lactation consultants, pediatricians, counselors and support groups when appropriate.
Excerpted and adapted from DONA International Position Papers. www.dona.org
Birth Doula
Women have complex needs during childbirth. In addition to the safety of modern obstetrical care, and the love and companionship provided by their partners, women need consistent, continuous reassurance, comfort, encouragement and respect. They need individualized care based on their circumstances and preferences. The role of the birth doula encompasses the non-clinical aspects of care during childbirth.
The doula’s role is to provide physical and emotional support and assistance in gathering information for women and their partners during labor and birth. The doula offers help and advice on comfort measures such as breathing, relaxation, movement and positioning. She also assists the woman and her partner to become informed about the course of their labor and their options. Perhaps the most crucial role of the doula is providing continuous emotional reassurance and comfort.
Postpartum Doula
Postpartum Doulas are trained in postpartum adjustment, new born characteristics, care feeding and development and promotion of parent-infant bonding. They are experienced in supporting families through their postpartum experience. Coming into the home during the fourth trimester (12 weeks following birth). The doula’s role is to provide education, non-judgmental support and companionship; and to assist with newborn care and family adjustment and household organization (including meal preparation, laundry and other light household tasks). Postpartum doulas offer evidence-based information on infant feeding, emotional and physical recovery from birth, infant soothing and coping skills new parents and can make appropriate referrals and suggestions when necessary.
The Doula’s goal is to facilitate the transition to parenthood by supplying reliable and factual information, reassurance and hands-on support with children and household organization. The non-medical support of a doula meets the practical and psycho-social needs of the family and allows doula’s to make referrals to quality care providers such as lactation consultants, pediatricians, counselors and support groups when appropriate.
Excerpted and adapted from DONA International Position Papers. www.dona.org
FAQ's
What does the word doula mean? The word “doula” comes from the ancient Greek, meaning “Woman’s servant.”
What effect does a doula have on birth outcomes? Tends to… result in shorter labors and fewer complications, reduce negative feelings about childbirth experience, and reduce need for labor inducing drugs, forceps or vacuum extraction. Reduces requests for pain medication, epidurals and the incidence of cesarean sections.
What effect does a doula have on mother? Women reported greater satisfaction with their birth experience, more positive assessments of their babies, fewer cesareans and medical interventions, and less postpartum depression.
What effect does a doula have on baby? Studies have shown that babies born with doulas present have shorter hospital stays with fewer admissions to special care nurseries, breastfeed more easily and have more affectionate mothers in postpartum period.
Does a doula replace medical staff? NO. A doula does not replace the nurses or other medical staff. Doulas do not perform clinical tasks such as blood pressure or temperature, monitoring fetal heart rate, doing vaginal exams or provide postpartum care. They are there to comfort and support the mother and to enhance communication between the mother, her support team and the medical professionals.
Will a doula make decisions on my behalf? No, a doula will not make decisions for clients or intervene with clinical care. She provides informational and emotional support, while respecting the families’ decisions.
Will a doula make my partner feel unnecessary? No, a doula is there to support both the mother and her partner and plays a crucial role in helping the partner become involved in the birth and newborn care to the extent he/she feels comfortable.
What is the difference between a birth and postpartum doula? A birth doula is a woman trained in childbirth who provides physical and emotional support during labor birth and the immediate postpartum period. A postpartum doula is a woman trained to care for the new family in the first weeks after birth providing household help, advice with newborn care, infant feeding and emotional support.
What are the benefits of having a postpartum doula? Some of the benefits include: increased success with breastfeeding, less chance of postpartum depression, less maternal exhaustion and frustration, greater understanding of newborn emotional, physical needs and behaviors.
Is it possible to have a non-medicated birth in a hospital? Absolutely, your body is designed to give birth. While there are many medical advances in the area of pain control there are also many options for non-medicated pain control. Most hospitals and physicians are quite respectful of your wishes as long as there are no complications that could endanger you or your baby. If you have any questions as to what your hospital or physician will allow; call them and ask.
What if I am considering pain medications? A doula is there to support the laboring woman with any decisions she makes and to help ensure a safe and satisfying birth as she defines it. She still needs continuous support even with pain medications. The doula can give dad/partner a break to go get something to eat or to take a nap if it's been a particularly long labor. She can take pictures, get ice-chips, do hand massage or just sit quietly while the woman rests.
Are most doulas licensed? At this time no license is available. There are a couple of nationally recognized organizations that offer certifications. Doulas of North America www.dona.org and Childbirth and Postpartum Professional Association www.cappa.net. Some doulas choose not to certify, I am currently working towards certification with DONA.
What does a doula cost? Cost varies from area to area and doula to doula. It is usually based on experience and the market. I am willing to barter, set up a sliding scale, and a payment plan. Do not allow money to keep you from looking into doula service.
When will I see a doula I have hired? You will see me at least twice for prenatal visits. As soon as labor begins I will meet you at your home and we will determine if it is time to transition to the hospital. I will stay with you through labor, delivery and up to two hours after the birth. You will see me again once in the hospital and for a minimum of 6 hours postpartum once you have gone home.
Are there any books that I should read? One of the most important parts of a successful birth and postpartum experience is being educated on what is happening to your body, your life and your baby. I suggest the following books:
Birthing From Within by Pam England
The Birth Partner by Penny Simkin
Ina May’s Guide to Child Birth by Ina May Gaskins
Mind Over Labor by Carl Jones, Marian Thomson, & emit Miller
Pregnancy, Childbirth and the Newborn by Simkin, Whalley and Keppler
The Baby Book by Drs. William and Martha Sears
The Breastfeeding Book by Drs. William and Martha Sears
Your Amazing Newborn by Klaus and Klaus
The Ultimate Breastfeeding Book of Answers by Dr. Jack Newman
What effect does a doula have on birth outcomes? Tends to… result in shorter labors and fewer complications, reduce negative feelings about childbirth experience, and reduce need for labor inducing drugs, forceps or vacuum extraction. Reduces requests for pain medication, epidurals and the incidence of cesarean sections.
What effect does a doula have on mother? Women reported greater satisfaction with their birth experience, more positive assessments of their babies, fewer cesareans and medical interventions, and less postpartum depression.
What effect does a doula have on baby? Studies have shown that babies born with doulas present have shorter hospital stays with fewer admissions to special care nurseries, breastfeed more easily and have more affectionate mothers in postpartum period.
Does a doula replace medical staff? NO. A doula does not replace the nurses or other medical staff. Doulas do not perform clinical tasks such as blood pressure or temperature, monitoring fetal heart rate, doing vaginal exams or provide postpartum care. They are there to comfort and support the mother and to enhance communication between the mother, her support team and the medical professionals.
Will a doula make decisions on my behalf? No, a doula will not make decisions for clients or intervene with clinical care. She provides informational and emotional support, while respecting the families’ decisions.
Will a doula make my partner feel unnecessary? No, a doula is there to support both the mother and her partner and plays a crucial role in helping the partner become involved in the birth and newborn care to the extent he/she feels comfortable.
What is the difference between a birth and postpartum doula? A birth doula is a woman trained in childbirth who provides physical and emotional support during labor birth and the immediate postpartum period. A postpartum doula is a woman trained to care for the new family in the first weeks after birth providing household help, advice with newborn care, infant feeding and emotional support.
What are the benefits of having a postpartum doula? Some of the benefits include: increased success with breastfeeding, less chance of postpartum depression, less maternal exhaustion and frustration, greater understanding of newborn emotional, physical needs and behaviors.
Is it possible to have a non-medicated birth in a hospital? Absolutely, your body is designed to give birth. While there are many medical advances in the area of pain control there are also many options for non-medicated pain control. Most hospitals and physicians are quite respectful of your wishes as long as there are no complications that could endanger you or your baby. If you have any questions as to what your hospital or physician will allow; call them and ask.
What if I am considering pain medications? A doula is there to support the laboring woman with any decisions she makes and to help ensure a safe and satisfying birth as she defines it. She still needs continuous support even with pain medications. The doula can give dad/partner a break to go get something to eat or to take a nap if it's been a particularly long labor. She can take pictures, get ice-chips, do hand massage or just sit quietly while the woman rests.
Are most doulas licensed? At this time no license is available. There are a couple of nationally recognized organizations that offer certifications. Doulas of North America www.dona.org and Childbirth and Postpartum Professional Association www.cappa.net. Some doulas choose not to certify, I am currently working towards certification with DONA.
What does a doula cost? Cost varies from area to area and doula to doula. It is usually based on experience and the market. I am willing to barter, set up a sliding scale, and a payment plan. Do not allow money to keep you from looking into doula service.
When will I see a doula I have hired? You will see me at least twice for prenatal visits. As soon as labor begins I will meet you at your home and we will determine if it is time to transition to the hospital. I will stay with you through labor, delivery and up to two hours after the birth. You will see me again once in the hospital and for a minimum of 6 hours postpartum once you have gone home.
Are there any books that I should read? One of the most important parts of a successful birth and postpartum experience is being educated on what is happening to your body, your life and your baby. I suggest the following books:
Birthing From Within by Pam England
The Birth Partner by Penny Simkin
Ina May’s Guide to Child Birth by Ina May Gaskins
Mind Over Labor by Carl Jones, Marian Thomson, & emit Miller
Pregnancy, Childbirth and the Newborn by Simkin, Whalley and Keppler
The Baby Book by Drs. William and Martha Sears
The Breastfeeding Book by Drs. William and Martha Sears
Your Amazing Newborn by Klaus and Klaus
The Ultimate Breastfeeding Book of Answers by Dr. Jack Newman
Thursday, April 10, 2008
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