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How to Use Your Birth Doula Training . . . and How Not to Use It

A mini chapter about how traditional birth doula care doesn’t always translate to the world of full-spectrum doula care. This is a list of statements that many of us heard in our doula training that we initially tried to incorporate into our organizational model. Some of it applied, and some of it did not. This section is specifically geared toward people who want to become full-spectrum doulas.

“Doulas Serve as Advocates for Their Clients’ Needs and Wishes”

The word “advocate” turns out to be pretty loaded. “Advocating” can often be interpreted as making way for an adversarial relationship with medical staff in which the doula (or advocate) has to help the patients fight for what they need. We learned the hard way that our method of advocating to medical staff on our clients’ behalf has to be gentle and pleasant and, whenever possible, is best framed as a question. Once we started working with doctors, nurses, and counselors in an abortion clinic, we were able to appreciate that sometimes the clients were offered the best that the clinic could provide, even if it wasn’t always perfect. Putting pressure on the clinic to help our clients get what they ideally wanted actually put some of our colleagues in an uncomfortable position where they felt unsupported by us and unable to give the client what she was asking for—simply because it wasn’t available.

That said, advocating for our clients is part of our job. But understanding how to effectively advocate for a client as a doula—or how to help that client advocate for herself effectively—requires patience, nuance, and a gentle approach that includes the assumption that the medical staff have good intentions. Remember, fighting or “advocating” too aggressively will (understandably) upset hospital staff, and your client may suffer the consequences.

“Always Seek to Fulfill Your Client’s Requests”

This strategy can also be a great way to incite the wrath of hospital staff. We once accidentally got in between nursing staff and a midwife when a client asked for something to eat—the nurses said no, and the midwife said yes—and the result of that interaction meant that everyone was upset at us and the client.

The truth is, once your client is at the hospital, whatever part of the spectrum of pregnancy care she is there for, you have to work within the system that’s in place. That’s why it is best to meet your client beforehand to make sure that you are both aware of the policies of the hospital, clinic, or birthing center she has chosen for her care.

“Medical Interventions Are Overused and Unnecessary”

At the time we trained to be doulas, medical interventions such as induced labor, epidurals for pain relief, and cesarean births were at an all-time high. This high was pretty frightening, with some New York City hospitals reaching a staggering one-in-three rate of C-section deliveries, almost triple what the World Health Organization recommends.

Most birth doula trainings tend to emphasize the benefits of unmedicated vaginal or “natural” birth and offer tips to help your client navigate the discomfort of labor while also avoiding the “cascade of medical interventions.” In trainings, we watch videos of people giving birth in their bathtubs, surrounded by dolphins (no, we’re not exaggerating—look up the video, it will bring tears to your eyes), or in the comfort of their homes surrounded by loving partners, friends, and doulas, with candles and rose oil. Compare this to the chorus of distressed narratives of people who found their hospital birth experiences to be alienating or upsetting or who felt divorced from the experience of their labor. It’s enough to make anyone staunchly invested in natural birth.

As you’ll read in our stories, we can definitely attest to the reality that medical interventions are overused, sometimes with harrowing results. But soon we realized that “natural birth” requires a lot of mental and emotional investment from the client and, frankly, not everyone we worked with was in that space. Given that we started by doing stillbirths and births for people who had made adoption plans, our perspective changed from encouraging natural birth to asking, “What do you need to get through this?” We talk about medical interventions by helping clients weigh risks and benefits. And yes, a lot of our clients have wanted natural labors, and we try to help them achieve that. But it’s hard to talk up the benefits of an epidural-free labor when a client is having an induced stillbirth.

“Birth Plans Are Important . . . But Not How You Might Think”

When we first started out, a lot of the births we attended were ones fraught with loss—either stillbirths or people who had made adoption plans. The births were usually in hospitals—often whatever hospitals were closest to where our clients lived.

Most doula trainings will encourage the use of “birth plans” so that the doula can have a clear understanding of the client’s goals and desires during the labor and delivery. We found pretty quickly that our birth plan was an important educational tool to help our clients understand the birth process. We learned the hard way that part of helping the client to understand the birth process is helping them to confront their fears. Running away from hard topics, like finding out why a client is abjectly terrified of getting a C-section, will not serve your client well if those issues come up at the time of the birth or the procedure. Figure out a way to manage fears in advance and come up with a plan.

“Doula Work Is Intuitive (and Comes with Experience)”

Yes. This fact is both very true and very unnerving to most new doulas, whose “doula intuition” is still in the early stages of development. Be patient with yourself along the way, and keep in mind the wise words of doula Christy Hall, “Remember, you’re better than nothing. You’re probably better than a lot.” Be transparent with your client that you’re new; the intuition shines through eventually.

“Know That You Don’t Know Everything”

This has continued to be relevant. “You don’t know everything” is a statement that is often heard in trainings, a reminder to approach doula work with humility. The truth is that we walk a strange line between being “nonmedical providers” and “knowing a lot of accurate medical stuff.”

“Always Pack a Doula Bag”

The things our clients need during labor can be radically different. We learned about the famous “doula bag” at our trainings and highly recommend bringing the following items to a birth: ice packs, hot packs, bendy straws, hair ties, essential oils, face masks, latex gloves (in case things get unexpectedly messy), tennis balls and various other massagers, snacks for both you and your client, extra socks, breath mints and a toothbrush, as well as visualization and hypnobirthing exercises.

We would also like to add the following to the birth bag repertoire: trashy magazines to read with your client—especially if she gets an epidural—ditto for nail polish, a list of local resources that can help your client get on her feet, LUNA bars in every flavor they produce, a neck pillow, cash for the hospital diner where you will invariably eat your victory meal when it’s all done (our menu favorite is spanakopita and french fries).

“Doulas and Doctors Go Together Like a Fish and a Bicycle”

We were warned at our birth doula training that there would be some antagonism between doulas and doctors when we started. Many hospitals don’t have supportive policies to facilitate a client-centered labor. Instead, birth is often treated as inherently high-risk, and it can be frustrating or even heartbreaking for the doula to witness. To that end, many (especially new) doulas can be a little overzealous in their desire to “advocate” for their clients (yep, there’s that word again). It can be a mutually contentious relationship.

When we started in our first clinic, we expected to be greeted by some skepticism, but were relieved to find out that the doctors were our biggest champions. Our relationship to the doctors became one of the most important parts of our work, as it enabled us to build a strong client-care team with them.

“All Doulas Should Become Certified”

The large birth doula training organizations offer certification as a professional standard. In order to become certified, a doula must attend a certain number of births that result in vaginal deliveries, receive good reviews from delivery staff and birth parents, do a take-home test or write an essay, and complete a reading list. There are also fees and dues associated with maintaining certification status.

When we left our birth doula trainings we were prepared to pursue certification. Later, we reevaluated those goals, and we opted to not become certified. We are clear about that with our clients. No one we’ve worked with has been bothered that we’re not certified. Choosing certification is a personal decision, and we completely respect the many reasons why doulas choose to become certified. But we believe that it is not certification that makes a good doula.

“Running a ‘Doula Business’ Is the End Game”

Ha ha. Ha, ha, ha, ha, ha.

Many doula trainings emphasize “the doula business” as part of their core curriculum. That’s not our story. Maybe it goes without saying that we started a nonprofit for doulas because we found out quickly that asking people for money was not our strong suit. Moreover, the New York City doula “scene” was becoming saturated with doulas, many of whom were attempting to make a living from it. More importantly, we—along with many of our doulas—feel strongly that the “activism” aspect of our work, including not asking low-income clients for money, is what drives us.

But let’s be clear. Doulas as a population aren’t the 1 percent. We don’t know of any doulas who are making loads of money in their work, nor do we know any doulas who got into the work because they were looking for fame and fortune. We don’t disagree that it’s work that deserves to be paid—it does. It’s more a question of who pays: the client, a nonprofit organization, or a larger institutional structure, like Medicaid or insurance companies.