Is It Time for a Paradigm Shift? Re-thinking the Work of Birth Doulas

Photo by Alex Boyd on Unsplash

(Originally published by PALS Doulas in 2018 and republished by ICEA.org in 2019).
As birth doulas, our hearts are full when we can be fully present for a family when they need us, before their babies are born and for every single waking moment during their labor and birth. We work tirelessly: physically and emotionally putting every ounce of ourselves into making sure that birthing parents and their partners feel continuously supported. After all, that’s what the research says: birth outcomes improve with the continuous support of a doula. Let me say that again, “birth outcomes improve with the continuous support of “a” doula.”

I believe that most doulas know that in order for new parents to feel successful, they need to have a tribe. We talk about the importance of having a birth team. We ask them who will be there for them in the postpartum period. We help them plan and give them good resources, knowing that birthing and new parenting should not be done alone. We also remind them of good self care, both in labor and birth and after baby comes, because taking care of themselves is vital to their success. Without good self care, self compassion, and a little help from the community, new parents can easily get overwhelmed, exhausted and burnt out. The magic and joy of birth and parenting can be lost in the fog of overwhelm. And yet, we as doulas in this current paradigm of a sole doula supporting families, have a hard time walking our talk.

My own birth experience was the reason why I wanted to become a doula. I experienced an awakening with my daughter’s birth. My labor didn’t go as planned, as is the way with most labors. I had envisioned a peaceful water birth at my local birth center, with no interventions. But my water broke first, and contractions were taking their sweet time coming. My dreams of a peaceful water birth started to fade as we neared the 24 hour mark and I heard my midwife faintly suggest, “I think we should transfer to the hospital to see if we can get things moving along, but it’s up to you.” I cried. But I felt like we should go.

On the short 20 minute ride to the hospital, I accessed a part of myself I had never fully found before, a deep inner knowing and a complete trust and connection with my body. I asked my baby girl for her help, I visualized my body opening, and I surrendered. After being monitored for a while at the hospital, both the doctor and my midwife decided that my contractions were strong and we could wait and see. I continued to quietly visualize my body doing its job while my midwife’s soothing words helped me ease into contractions and my best friend, mother, and partner took turns physically supporting me. Only a couple of hours later, I wanted to get into the tub to help with the contractions. My midwife checked me first and said I was almost fully dilated!

I used all of my strength to birth my daughter into the world. And then I knew. Birth was powerful. Birth was a rite of passage. Birth was the place we could meet our deepest inner strength. I wanted to be a part of helping women to believe in their own strength, to trust their intuition, and to feel like they were supported and held in their most vulnerable and most powerful transformation.
With this passion building in me, I took birth doula training when my daughter was a little over a year old. I was pumped up to be a doula.

And then I had my first client.

It was hard for me to leave my daughter with just anyone for long periods of time and so I chose to have my elderly aunt, dearly loved by my daughter, watch her. I supported that first mama with all my strength, body, mind and soul for 18 hours before her baby was born. When I got home, not only was I exhausted, but my aunt was, too. It took me days to recover from losing sleep, which made it harder for me to be my best self for my daughter, and it quickly became clear to me:

I can’t be a doula.

I didn’t have childcare options that wouldn’t leave the caregiver and my daughter feeling burnt out, and I didn’t have the physical strength, or even the right nutrition and self-care practices in place for birth to not take everything out of me.

It’s been a long 4 year journey, and I have gone back and forth with wondering if I should finish my certification. I’ve been on a deep discovery of what it takes for me to feel physically, mentally and spiritually fit enough to withstand the power needed to tirelessly support and be responsible for being that ONE person who research has proven can improve a birthing person’s outcomes.

As doulas, how often do we feel like we can take care of ourselves while supporting parents in labor? How many of you feel like you can take a rest when you feel tired, eat when you feel hungry, meditate when you need to recharge while at a birth? I would say most likely, you don’t feel that way, because you know what the research says: Continuous support… And you feel responsible to live up to that expectation. You know its power. You want to be able to give that and you will make sacrifices to make that happen. At least that’s how I feel.

Something got stirred up in me recently when I read We Were Doulas Before They Were Doulas. The article talks about Danette Jubinville, an indigenous woman from Vancouver, Canada, who after the birth of her daughter was inspired to advocate for indigenous-specific birth care. She had a team of indigenous birth workers by her side during the birth of her daughter, which helped her feel like birth was the happiest moment in her life.  In trying to start a birth workers collective and secure grant funding, she came across a road block. The government in Canada needed her birth workers to be “certified.” They required the birth workers to take DONA International Doula Training.

While she found value in taking the DONA training, she didn’t feel it was culturally appropriate and said, “One of the tensions with the DONA approach is that they have a narrowly defined scope of what a doula is. It forces you into this box of being an individualized birth worker.”

Jubinville says that Indigenous Birth Workers often work together and “during her own birth, the women took turns sleeping, eating and supporting her through a long stormy night.”

Let me repeat that: they took turns sleeping, eating, and supporting her through the night.

These thoughts have been stirring in me since I read that article. The way that she described her support team helping her celebrate her labor and her birth was absolutely beautiful, and I keep picturing what that must have looked like: several doulas working together to peacefully and compassionately support the birthing person and be a true part of a birthing team. (Read the full article to really get a picture of what this looked like!)

In our movement to make sure that there is “a doula for everyone,” have we forgotten our roots? Have we forgotten what is sustainable? If we were to take a look at every culture in the world, I bet if they don’t still have more than one woman working together to support a birthing woman before and after the baby comes, they used to. Even in colonial America, more than one woman was there to continuously support the birthing mother before, during, and after birth. Have we made a mistake to train doulas to be “individualized birth workers” if that means they find themselves sacrificing their own health and self-care?

Some doulas have tried to make this work easier by starting collectives or doula partnerships where on-call time is split. Some doulas write their own support into their contracts; for example, “I may call my back-up doula to relieve me if I have been supporting you for more than 18 hours.”

Personally, I tried to start a doula partnership, hoping it would be a model that would allow me to do the work, because I wouldn’t be on call all of the time. But I still would have been putting absolutely everything into the births I was called to for however long it took. Often I was so dedicated to continuous support that I might not have a proper meal or be able to take a break. My partnership never got off the ground. We gave up because it was hard to find clients. We had a feeling that people were uneasy with the thought of not knowing who would come to their birth.

We as doulas have trained the public so well. We have told them that knowing who will be at their birth is important, that continuous support from that one doula will help them feel supported, relaxed, and empowered. And I know this to be true.

But what if they knew there would be a team of doulas there to support them?
That there would never be a moment where their voice was not heard or they didn’t feel held? What if the doulas worked together seamlessly and knew they could meet both the birthing person’s needs and their own needs? How valuable would this work be if it was more sustainable for doulas?

Is it time to shift the way we train doulas and how we think about doula work?

Resources: Cochrane Review on continuous support during labor.
Article: We Were Doulas Before They Were Doulas