by Christine Morton, Ph.D, and Elayne Clift, M.A.
Many women describe their reaction to learning about the role of birth (or labor) doulas — to provide physical, emotional and informational support to women before and during childbirth — as the ideal job they didn’t know existed. Some seek out doula training out of an ideological commitment shaped by their own birthing experiences (either wonderful or terrible).
Since there is no licensing agency for doulas, there are no formal requirements for calling oneself a doula. However, many doulas choose to get certified by organizations that oversee training programs, such as DONA International and the Childbirth and Postpartum Professional Association (CAPPA).
Certification programs vary but typically require: a multi-day workshop; additional issue-specific trainings and assigned reading; attendance at a certain number of births and descriptions of support provided at each birth; recommendations from mothers, family members and health care providers; and a personal statement. The cost ranges from around $400 to $700.
Doula care is presented as a return to the community-based, woman-centered care that existed prior to the shift from home to hospital births. As such, the training demonstrates how woman-centered support can reclaim a place within medicalized childbirth in Western cultures. Doulas learn about the birth process, medical issues that can arise, ways to support laboring women physically and emotionally, and how to advocate with and for a patient in a hospital environment.
Trainees learn that their non-medical role is what distinguishes them from other maternity care providers: First, the doula’s focus is specifically on the laboring woman’s emotional and physical comfort needs, rather than on clinical issues. Second, the doula provides a continuous presence and personalized attention to one woman, in contrast to the competing demands of a nurse, midwife or physician.
Doulas also learn that pregnancy and childbirth are normal, non-pathological life events — a central tenet of the midwifery model of care. The emphasis is on supporting the natural physiological process of birth. They are, however, expected to be conversant with standard medical practices surrounding birth.
Trainees learn about pain medications used in labor and other information that they are expected to review with their clients before and during labor to help them make informed decisions. Knowledge of both anatomy and physiology of childbirth is encouraged in order to understand how to help labor progress in situations where the baby is not in an optimal position, and to become familiar with situations requiring medical intervention.
Ultimately, labor support includes ensuring that the birthing woman has all the information she needs to make the best decisions for herself — and full, unconditional support of those decisions. Doulas are trained not to advocate for their own beliefs on behalf of other women.
Through their training, doulas also learn that one of the most powerful ways to interact with their clients during childbirth is by highlighting the normalcy of labor or the agency of the birthing woman, as opposed to focusing on birth as a scary, negative experience. What the doula says is as significant as what the doula does in shaping the story of that birth for the woman, her partner, and their families.
As they continue doula work, many women move into allied childbirth fields, such as midwifery or nursing school, that offer more professional status, better income and more stable work.
The typical practicing doula, then, is a woman who has been drawn by advocacy and passion to provide care for other women. She has adopted a belief in the transformative and empowering effects of unmedicated, low-intervention childbirth, but also in the right and ability of women to make their own choices. Most importantly, she strives to provide education and information that will enable women to become active participants in the birth of their child.
Christine Morton and Elayne Clift are the authors of “Birth Ambassadors: Doulas and the Re-emergence of Woman-Supported Birth in America” (Praeclarus Press, 2014).