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Becoming a parent can be an immense source of joy and at the same time, it can overwhelm a person. The number of resources available to expectant parents about what to expect when a baby is on the way are numerous. While there is much to learn from books, classes, products, and freely dispensed advice from family and friends, parents may find themselves wishing they could hire the services of a neutral third party to help guide them through the birth and postpartum phases of bringing a child into the world. Expectant mothers seeking additional birth support may choose the maternal-focused support services of a doula to meet this need.
Doulas are childbirth experts who work in tandem with birthing teams to guide expectant mothers through labor and delivery and postpartum phases of newborn care.
Doulas have been supporting mothers through childbirth as long as recorded history. One of the most widely recognized certifying agencies, DONA International, states that there are currently more than 13,000 certified doulas in more than 50 countries worldwide and that number is growing (DONA 2020).
A study, first published in 2014 and reaffirmed in 2019 by the American College of Obstetricians and Gynecologists (AGOG) and the Society for Maternal-Fetal Medicine (SMFM), supports the expansion of doulas and summarizes its findings as follows: “Published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula […] Given that there are no associated measurable harms, [doulas are] probably underutilized.” (ACOG 2019). This published research has had profound impacts on the maternal health medical community in legitimizing and expanding birth support opportunities for current and future doulas.
There are two types of doulas: birth and postpartum.
A labor and delivery doula is a person who is highly knowledgeable of techniques related to labor pain management, birthing, and emotional support to families during the birth experience.
A postpartum doula provides breastfeeding and other infant feeding techniques, basic newborn care, and emotional and physical support to mothers recovering from childbirth and their families. Some doulas are registered nurses with specialized doula training and others are certified through organizations such as DONA International that provide basic obstetric training through courses and supervised work experience.
As a baby’s due date draws closer, usually in the third trimester of pregnancy, a birth doula meets with the mother and other members of a birthing team in order to learn more about the family’s birth plan. Details such as where the family plans to give birth, whether the mother desires to have a medicated or unmedicated birth, and how the doula can best support the mother and birth team are discussed. A doula commits to being present for the labor and delivery and, if applicable, provides postpartum care after the baby is born. It is possible for doulas to hold certification in both labor and delivery and postpartum care.
Doulas and midwives both support mothers and babies during labor and delivery and postpartum care and many people wonder: what’s the difference between these two professions?
A doula can be classified as a childbirth and postpartum coach and a midwife has more advanced medical healthcare training. A doula primarily supports the needs of the mother during labor. The Midwives Alliance of North America (MANA) provides detailed information about the educational pathways to become a midwife as well as state licensure requirements (MANA 2019). Registered nurses (RNs) desiring to specialize in labor and delivery have the option of completing doula certification as well as midwifery education programs accredited by the Accreditation Commission for Midwifery Education (ACME).
While there are no state licensing requirements to practice as a doula, there are professional doula certification programs that provide high-quality courses and supervised practical experiences to prepare doulas for the exhilarating work of obstetric support care.
Read on to learn more about how to become a doula.
Step-by-Step Guide to Becoming a Doula
Step One: Graduate from high school (four years).
While this is not an official requirement to apply for a doula certification program, the first step in pursuing many rewarding careers is to graduate from high school or earn a GED. This step is recommended to give applicants future flexibility should they decide to pivot their doula training into a related-career in healthcare such as a registered labor and delivery nurse.
Step Two: Enroll in a DONA International-approved birth doula workshop (16 hours or more)
DONA International (formerly Doula Organization of North America) is the leading professional and training organization for doulas. DONA International-approved training workshops include at least 16 hours of instruction time and auditing a childbirth class for expectant parents. Courses in breastfeeding, doula business webinars, and other related birth and newborn care are offered in-person and online.
Aspiring birth or postpartum doulas can choose one or both types of doula certification, and in-person training courses for both certifications are valid for four years from the date of completion. Courses cost anywhere from $400 to $700 and additional textbooks are typically required.
Registered nurses (RNs) who have a bachelor’s degree in nursing and are interested in becoming labor and delivery nurses may opt to enroll in doula certification to specialize in a specific area of nursing and earn continuing education credits for their RN certification.
Step Three: Become a member of DONA International
By becoming a member of DONA International, doulas desiring to earn certification will receive professional affiliation and be able to purchase certification packets at a discounted rate. Membership to DONA International costs $100.
Step Four: Purchase a DONA International birth doula packet for certification (up to two years)
After an applicant has taken a DONA International-approved course and become a member of the organization, the aspiring doula is then permitted to purchase a doula certification packet. Purchasing the DONA International doula certification packet officially begins the doula certification process.
To become a certified doula, DONA International requires applicants to provide supporting documentation to verify working as primary doula at three separate births with a minimum of 15 hours on each birth experience. Certified doulas have two years from the time of packet purchase to submit their application to DONA International for birth or postpartum doula certification. The certification processing fee is $110.
Step Five: Gain three supervised birth experiences (45 hours or more)
In order to fulfill requirements for the aforementioned certification packet, a doula-in-training must be the primary doula for three birth experiences of at least 15 hours. These three support experience births are documented by the families and evaluated by medical professionals, midwives, or other birthing professionals on the mother’s labor and delivery team. Initial meetings with mothers and their birthing support team before labor and delivery count towards the 15 hours of time required for each birth experience.
Step Six: Fulfill additional coursework and home study requirements (two months or more)
In addition to three documented supervised birth experiences as the primary doula, applicants must also complete additional classwork and a home study including the following:
- Agree to and sign the DONA International Birth Doula Code of Ethics
- Agree to and sign the DONA International Standards of Practice
- Take an in-person or online course in the basics of breastfeeding
- Observe a childbirth education series class for expectant parents for 12 or more hours offered by a hospital or other childbirth support source
- Read required texts from the birth doula required reading list
- Attend one DONA International-approved doula business webinar (offered online)
- Create a list of 45 professional resources in the local area
- Write an essay on the value and purpose of labor support
- Provide written references from perinatal health professionals and clients
Doulas who fulfill the aforementioned three birth experiences should obtain the necessary documentation by having their clients sign a confidentiality release form, taking detailed notes, completing a birth doula support record, and requesting evaluations from birthing professionals in attendance.
Once all certification materials have been received by DONA International, applicants can expect to learn about their doula certification status within one month.
Step Seven: Gain professional experience as a certified doula (timeline varies)
Research from DONA International shows that DONA-certified doulas earn higher fees and attract more clients (DONA 2019). DONA-certified doulas may seek the following credentials:
- CD (DONA) – Certified birth doula
- PCD (DONA) – Postpartum certified doula
- AdvCD (DONA) – Advanced birth doula distinction
- AdvPCD (DONA) – Advanced postpartum doula distinction
- BDT (DONA) – Birth doula trainer
- PDT (DONA) – Postpartum doula trainer
- CD/PCD (DONA) – Certified birth and postpartum doula
Step Eight: Apply for recertification (every three years)
DONA International certified doulas must apply for recertification every three years. Depending on the doula certification, the following number of minimal contact hours are required to reapply:
- Certified birth doulas must complete a minimum of 15 contact hours of continuing education in birth or a parenting-related field
- Postpartum doulas must complete a minimum of 18 contact hours in areas related to perinantal or postpartum period including birth, breastfeeding, postpartum mood disorders, or early parenting
An $80 recertification processing fee is also required and must be postmarked before the expiration of a doula’s certification.
Step Nine: Become a birth or postpartum doula trainer (optional)
Applications to the doula trainer candidacy program are accepted only from qualified DONA International certified birth or postpartum doulas by need and invitation-only.
Helpful Resources for Doulas
Being a doula requires more than patience and presence. In order to give exceptional support, doulas need to receive support for their profession. It takes a significant amount of physical and mental effort to work well in the unpredictable environment of birth; labor and delivery and doulas need a unique support network to aid them in their work of coaching mothers through childbirth. The following organizations provide professional development, political advocacy, and peer-reviewed scholarly articles to support doulas and other labor and delivery professionals so that expectant mothers and their newborns can thrive:
- American College of Obstetricians and Gynecologists (AGOG): published an article in 2014 with the Society for Maternal-Fetal Medicine (SMFM) with data that supports the value of childbirth labor support provided from doulas.
- American Journal of Obstetrics and Gynecology (AJOG): a 150-year old peer-reviewed publication dedicated to improving medicine and science for women.
- Childbirth and Postpartum Professional Association (CAPPA): an international certification organization for doulas, childbirth educators, and lactation educators.
- DONA International: the leading certification and professional organization for doulas worldwide.
- International Childbirth Education Association (ICEA): a professional organization that supports educators and healthcare professionals dedicated to maternity and newborn care.
- Lamaze International: a parenting advocacy organization that empowers parents through pregnancy, birth, and parenthood.
- NAPS Doulas: a professional organization that specializes in the certification of postpartum doulas.
- Pacific Association of Labor Support (PALS): a doula certification and professional association providing four different pathways for doula certification.
- Society for Maternal-Fetal Medicine (SMFM): a non-profit organization committed to supporting the clinical practice of maternal-fetal medicine through education, research, and advocacy for high-risk pregnant women.
Rachel Drummond is a freelance writer, educator, and yogini from Oregon. She’s taught English to international university students in the United States and Japan for more than a decade and has a master’s degree in education from the University of Oregon. A dedicated Ashtanga yoga practitioner, Rachel is interested in exploring the nuanced philosophical aspects of contemplative physical practices and how they apply in daily life. She writes about this topic among others on her blog (Instagram: @racheldrummondyoga).