Doula

The famous African proverb “it takes a village” rings true for many community-supported endeavors—and childbirth is no exception. For those who feel compelled to provide emotional and physical support to women during childbirth, becoming a birth doula is an ideal career choice. The care provided by birth doulas to laboring mothers and their families has lasting positive impacts on the physical and emotional health of mothers and babies, as well as improved societal and financial outcomes.

The doula profession has been around for centuries and emerging research reveals that when expectant mothers have the continuous support of a doula present during labor and delivery, their birth experiences are more positive.

The Cochrane Review, published in 2017, evaluated 26 medical studies and concluded that women who had a doula present during their birth experiences were more likely to have shorter labor times, spontaneous vaginal births, decreased cesarean deliveries, and less likely to use pain medication. Furthermore, public awareness of the benefits that doulas provide is on the rise. A 2012 survey titled “Listening to Mothers III” reports that while only 6 percent of women surveyed in 2011 and 2012 received supportive care from a doula during childbirth, 27 percent of women understood the scope of care provided by a trained labor assistant and expressed retroactive interest in having a doula present at their birthing experiences.

Having more maternal support during childbirth goes beyond a desire for better access to healthcare: it’s also an issue of social and financial equality. Data from the Society for Maternal-Fetal Medicine (SMFM 2019) shows that the United States has the highest rate of maternal death compared to other developing nations and shows that the maternal mortality rate in the U.S. is higher for women of color. Statistics published by the Centers for Disease Control (CDC) confirm the racial and ethnic disparities that exist in maternal healthcare and states that there are “significantly higher pregnancy-related mortality ratios among Black, American Indian, and Alaska Native women.” (CDC 2019).

The Doula Medicaid Project has responded to these statistical inequities through legal advocacy and education in support of the expansion of doula services for low-income women in the United States. Further support for doulas comes from cost-effectiveness studies published in the Journal of Midwifery & Women’s Health and Birth: Issues in Prenatal Care, which calculate that families and health insurance companies can save anywhere from $929 to $1,360 per birth due to the drastic reduction in complications when a doula is present during childbirth.

As Dr. Neel Shah—an MD and an assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School—told the New York Times, “It is important to remember that people have goals other than simply emerging from childbirth unscathed. Safety during labor is the floor of what people deserve. What we should all really be aiming for is the ceiling: care that is not just safe, but also supportive and empowering.”

The community-oriented care provided by doulas in tandem with other birth medical personnel increases the likelihood that all mothers and newborns can have the healthy birth experiences they deserve.

Read on to learn more about how to become a birth doula.

Doulas are non-medical birthing and postpartum professionals who are primarily dedicated to the physical and emotional well-being of a mother and her newborn baby. Professional doula responsibilities include:

• Meeting with a mother and her birth team during the third trimester prior to labor and delivery
• Providing one-on-one supportive care for the mother during labor and delivery
• Creating a calm birthing environment
• Providing pain management and breathing techniques
• Giving light massage
• Preparing a birthing tub
• Offering positioning and movement techniques during labor
• Supporting birth partners
• Advocating for the mother’s birth preferences (i.e., whether she wants a medicated or non-medicated birth)
• Facilitating communication between mothers, partners, and medical care providers
• Helping families process their birth experiences
• Teaching newborn care techniques
• Empowering mothers and birth support teams to ask questions

There are two main types of doulas: birth doulas and postpartum doulas. These specializations are designated by DONA International—the leading organization for doula training, certification, and continuing education.

A birth doula is present during labor and delivery and gives emotional and physical support to women in labor through pain management and breastfeeding techniques. Birth doulas perform their work wherever babies are born, typically in hospitals, birthing centers, midwifery clinics, or in client’s private homes for home births.

A postpartum doula supports the emotional and physical needs of women in the weeks following childbirth. Postpartum doulas make house calls or assist mothers who are experiencing extended stays in the hospital. They support families by providing emotional support during the fourth trimester (the three months following childbirth) and teaching techniques in lactation and newborn care.

In cases of miscarriage, stillbirth, abortion, or postpartum depression, they provide specialized emotional and physical support to grieving mothers and families.

Doulas with certification from DONA International are represented by 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

While there are no specific prerequisite requirements for admission to DONA International doula training workshops, individual trainers may require workshop participants to complete an application stating why they are interested in the profession and listing any specific skills or certifications they have. They may also assign reading or listening from books or audio lectures so aspiring doulas can prepare themselves with a base level understanding of the profession.

DONA International requires doulas seeking certification to first enroll in a training program and become a member of the organization before they can become eligible to pursue certification as a doula.

While there are currently no accreditation organizations for doula programs, there are organizations that provide training, certification, professional support, and advocacy for the profession. Here’s a list of some of the leading doula certification programs:

• DONA International: a certification and professional organization for doulas worldwide
• Childbirth and Postpartum Professional Association (CAPPA): an international certification organization for doulas, childbirth, and lactation educators
• International Childbirth Education Association (ICEA): an organization that supports maternity and newborn care educators and healthcare professionals
• NAPS Doulas: an organization that certifies postpartum doulas
• Pacific Association of Labor Support (PALS): a doula certification association offering four pathways for aspiring doulas

DONA International Birth Doula Training Workshops

In-person birth doula training programs are offered by 165 DONA-approved doula trainers worldwide. In these evidence-based training workshops, participants typically attend a two- or four-day workshop and sometimes complete additional required coursework in doula training.

Topics covered can include the significance of labor in a woman’s life, doulas and partner care, cesarean births, the role of a doula in medicated births, vaginal birth after cesarean (VBAC), and doula business seminars. Longer training programs often include additional childbirth education and breastfeeding education components which are required for doulas who want to pursue certification.

The cost of birth doula training workshops ranges from $400 to $700 US dollars and may or may not include required textbooks.

• Location: Locations vary worldwide
• Duration: 16 or more hours
• Accreditation: DONA International
• Tuition: $400 to $700

DONA International Postpartum Doula Training Workshops

In-person postpartum doula training programs present current best practices to support postpartum mothers and their families process their birth experiences. The workshops can last anywhere from two to four days with the longer workshops typically offering classes required for DONA International certification.

Topics included in postpartum doula training workshops include effective listening, emotional issues from birth, physical changes, breastfeeding, postpartum mood disorders, integrating a baby into a family, and loss and grief.

Costs for DONA International-approved postpartum training workshops range from $400 to $700 US dollars and typically include DONA International training materials. Additional reading materials may be required.

• Location: Locations vary worldwide
• Duration: 16 or more hours
• Accreditation: DONA International
• Tuition: $400 to $700

International Childbirth Education Association (ICEA)

The ICEA offers online birth doula workshops to aspiring birth doulas who choose to pursue certification via their traditional pathway. This certification pathway is designed for those who have little to no previous experience as a birth doula or birth professionals who want to formally expand their knowledge and services.

Applicants must first enroll in an ICEA doula certification program to be eligible to register for the online workshop. Additional fees are required for the online option. The curriculum is divided into six parts: introduction, labor overview, labor process, comfort measures, family integration, and coping with the unusual.

• Location: Raleigh, NC
• Duration: Two to three days or more
• Accreditation: International Childbirth Education Association (ICEA)
• Tuition: $24 to $218 (depending on the country of residence)

International Doula Institute (IDI)

The IDI offers an online doula training program to become a certified doula (CD) and earn professional credentials to help mothers and babies from an online learning platform.

Students in this program can expect daily and weekly lessons taught by childbirth experts such as doctors, nurses, midwives, dietitians, and doulas as well as assignments and assessments in multimedia format. Aspiring doulas have access to a doula trainer via phone and email for one year after signing up for the certification course. Doulas with previous training or certification get a discount of $150 when they register for this program and can begin seeing clients and using their professional credentials within 14 to 30 days of completion.

• Location: Locations vary worldwide
• Duration: One to 12 months
• Accreditation: International Doula Institute
• Tuition: $790 (birth doula certification)

The short answer is four days to four years. Most doula training programs last two to four days, with the longer programs typically including additional courses required for future certification, such as childbirth education and breastfeeding basics.

DONA International training workshops remain valid for four years from the date of completion and allow aspiring doulas time to complete the requirements for certification, including supervised birth experiences and doula business webinars.

Step One: Enroll in a DONA International-approved Birth Doula Training (16 Hours or More)

DONA International (formerly Doula Organization of North America) provides in-person training workshops for birth and postpartum doulas which last 16 hours or longer. This training is valid for four years from the date of completion.

Step Two: Invest in DONA International Membership

Becoming a member of DONA International costs $100 and gives doulas who have completed a training workshop two benefits: professional affiliation and the ability to purchase a doula certification packet at a discounted rate.

Step Three: Purchase a DONA International Birth Doula or Postpartum Doula Certification Packet (Up to Two Years)

The doula certification process begins by purchasing the DONA International doula certification packet for $110 within four years of completing a doula training workshop (see step one).

Certified doulas have two years from the time of packet purchase to submit their application to DONA International for birth or postpartum doula certification.

Step Four: Get Professional Experience (45 Hours or More)

To apply for birth doula certification, a doula must serve as the primary doula at three separate births and spend a minimum of 15 hours on each birth experience. Documentation in the form of a service contract with the family and evaluations by other birthing professionals are required; pre-labor meetings with the family can also count towards the 15 hours required for each birth experience.

Step Five: Fulfill Coursework and Home Study Requirements (Two Months or More)

In addition to gaining three supervised birth experiences, there are additional coursework and home study tasks required for certification. A complete list of the requirements for birth doula certification is available from DONA International.

Once all of the required certification materials have been received by DONA International, applicants can expect to learn about their doula certification status within one month.

Step Six: Become a DONA International Certified Doula (Two Months to Two Years)

Congratulations on becoming a certified doula! Certified doulas are eligible to practice their craft and use the following professional credentials:

• CD (DONA) – Certified birth doula
• PCD (DONA) – Postpartum certified doula
• CD/PCD (DONA) – Certified birth and postpartum doula

Step Seven: Apply for Recertification (Every Three Years)

DONA International certified doulas are required to apply for recertification every three years and pay an $80 fee. Continuing education requirements vary for each certification:

• Certified birth doulas: a minimum of 15 contact hours of continuing education in birth or a parenting-related field.
• Postpartum doulas: a minimum of 18 contact hours in areas related to the perinatal or postpartum period including birth, breastfeeding, postpartum mood disorders, or early parenting.

Currently, there are no state licensure requirements to practice as a doula in the United States. Doula certification is required for employment by many healthcare organizations and highly recommended by professional organizations to ensure that best practices of doula care are provided to mothers and babies. This is also done to support the future development and legitimacy of the doula profession.

Payscale.com (2020) reports the average annual salary for certified birth doulas in the United States as $40,000 and states that certified doulas report a high level of job satisfaction.

Salary data varies depending on certification, years of experience, and cost of living in a specific area.

Rachel Drummond, MEd

Writer

Rachel Drummond has written about integrating contemplative movement practices such as yoga into healthcare professions since 2019, promoting the idea that mental and physical well-being are critical components of effective patient care and self-care in the high-stress world of healthcare.

Rachel is a writer, educator, and coach from Oregon. She has a master’s degree in education (MEd) and has over 15 years of experience teaching English, public speaking, and mindfulness to international audiences in the United States, Japan, and Spain. She writes about the mind-body benefits of contemplative movement practices like yoga on her blog, inviting people to prioritize their unique version of well-being and empowering everyone to live healthier and more balanced lives.