What is a doula?
Today, the word doula (if you’ve ever heard of it) is synonymous with birth support, but it wasn’t originally intended that way.
In the 1970s, anthropologist Dana Raphael felt disappointed by her personal breastfeeding experience. She wanted to know why breastfeeding was so difficult in her culture and researched nearly 200 other cultures to find out why. She found similar postpartum care patterns occurring universally:
“I had discovered that there was a physiological process (breastfeeding) that needed to have something in place in the culture or else the lactation function would not work. I don’t know of any other biological process that needs the culture to supply support... If you don’t have that support, usually you cannot feed your baby.”
Dana Raphael went on to coin the word ‘doula’ — in its modern sense — to mean breastfeeding support person. She says she was talking about her discovery when an elderly Greek woman overheard her and said, “Oh yes, that’s a doula.”
The Greek origins of the word doula are dubious; it means female slave. The response was largely negative when the new English use of the word got back to Greece years later, but unfortunately, the name had already stuck.
At Newborn Mothers, we still use the word doula so that people know what we’re talking about, but we also try to interchange it with other more descriptive and appropriate terms. Some people like to call themselves professional postpartum carers or perinatal support workers. When we developed our 12-module evidence-based training, we settled on Postpartum Education and Care Professional.
Today, a doula is typically someone who acts as a hub of support, referrals and resources for a person during a major life transition, usually related to birth. Doulas have a holistic approach that considers both mental and physical well-being. Services vary significantly but can include emotional reassurance, information based on scientific evidence, and comfort techniques like massage and nourishing food. The role is not medical, and doulas cannot treat, diagnose or cure any disease.
Perinatal support professionals are becoming increasingly common as more healthcare professionals recommend them as a valuable part of care. Moreover, the World Health Organisation guidelines recognise:
…a “positive postnatal experience” as a significant end point for all women giving birth and their newborns, laying the platform for improved short- and long-term health and well-being. A positive postnatal experience is defined as one in which women, newborns, partners, parents, caregivers and families receive information, reassurance and support in a consistent manner from motivated health workers; where a resourced and flexible health system recognizes the needs of women and babies, and respects their cultural context.
In the next part of this article, we’ll take a deeper look at the multi-faceted and extraordinary role of a doula. Throughout this post, we may also use terminology like birthworker, perinatal support professional or postpartum care provider. As you’re reading, you may like to ask yourself what term feels most comfortable for you and what you might wish to call yourself to potential clients.
So, now let’s explore what a doula is.
What is a doula?
According to DONA International, a doula is defined as “a trained professional who provides continuous physical, emotional and informational support to a mother before, during, and shortly after childbirth to help them achieve the healthiest, most satisfying experience possible.” The role has now expanded well beyond its original meaning.
The services of a doula or similar professional can significantly improve the physical and psychological outcomes for the whole family from the beginning of pregnancy through postpartum.
Research has found that continuous support from a doula is associated with decreased use of pain relief medication during labour, improved breastfeeding outcomes, and greater maternal satisfaction.
Different types of professionals can provide services at various phases in the journey to and through parenthood. These phases may include pre-conception, pregnancy, labour, postpartum and breastfeeding, and even adoption, pregnancy loss, miscarriage, or abortion. We’ll go into more detail about a few different roles below.
Birth doula
Often, when one thinks of a doula, this person comes to mind. A birth doula is hired to help the birth giver and their family through the labour and delivery process from pregnancy. There are some variations in how birth doulas choose to work with their clients, but they’ll typically meet with the pregnant person early on to create a birth plan.
A birth doula supports their client throughout pregnancy and is usually there for labour and delivery. They’ll also usually meet with the new parent once more after the birth to answer any questions, help debrief, or provide extra support. The birth doula’s job typically ends shortly after the birth.
Postpartum doula
Ideally, postpartum care is booked and arranged during pregnancy, offering families peace of mind. Expectant parents often meet with their postpartum care provider at least once before the baby is born. They may create a postpartum plan together or discuss the family’s needs to ensure a smooth transition. However, the main work of the postpartum doula begins after birth.
Some doulas offer combined services and continue their role as doulas throughout pregnancy, birth and postpartum. This is called continuity of care and is associated with excellent outcomes for families.
Today, mothers can be sent home from the hospital within 4 hours of giving birth, financial pressure sends parents back to work long before they are ready, and extended family often live too far away to help.
It’s clear this isn't working. One in three women don't reach their own breastfeeding goals, 80% of couples experience a moderate-to-severe crisis in the transition to parenthood, and one in five mothers experience postpartum depression. The leading cause of maternal death is suicide.
In traditional cultures studied by Dana Raphael, women return to their extended family after childbirth and rest for 40 days. New mothers are fed, nurtured, and nourished. If this care is not provided by the community it must be replaced with professional services, including doulas.
Postpartum education and care professionals provide companionship and emotional support, as well as information based on scientific evidence and referrals to other professionals when necessary. Having a baby is a big adjustment for everyone, and postnatal caregivers can support partners, siblings, and extended family during the adjustment. Postpartum doulas try to build a community for the new family by connecting them with educational classes, social groups, and other professionals.
Adoption doula
Doulas can assist even if their clients aren’t the people physically giving birth. An adoption doula assists families undergoing the process of adopting a newborn. They function similarly to a postpartum doula and assist the family with adjusting to life with a newborn baby. They may provide support around specific areas of need, such as inducing lactation so the adoptive parents can breastfeed, safe sleeping, and understanding normal newborn behaviour.
Grief and loss doula
Some doulas support people through stillbirth, miscarriage, abortions, and infertility. There are even death doulas, to provide emotional support to people with a terminal illness and their families.
At Newborn Mothers, our training and membership is specifically focused on the postpartum period. However, many of our graduates and friends work in one of the other roles discussed above aswell. You can listen to a diverse range of experiences on the podcast, where we chat with doulas and professionals of all kinds.
Doulas are never medical professionals
It’s important to remember that no matter the type of doula, this role is not the same as a licensed medical professional. For example, a postpartum support professional does not replace the function of an OB-GYN, midwife or paediatrician. They are not there to make medical decisions for the client, but rather support the families to collaborate with appropriate health care professionals and make informed decisions.
Doulas offer support-based services such as:
Emotional support
Evidence-based information and resource recommendations
Referrals to classes, groups or other professionals
Practical support like cooking and household organisation
Support for the father/partner, siblings and extended family
Support with asking for help and setting boundaries
Comfort, rites and rituals
Some doulas have particular skills they can include, like massage or breastfeeding support
How much does a postpartum support professional cost?
One of the first questions you may ask when thinking about starting a career in postpartum work is how much is it going to pay? Doulas sometimes charge by the hour, and sometimes offer packages of support that include one-on-one support, groups, online education, gifts, access to a library of resources, and more. How much you work with a family will be up to you. Often, families will choose anywhere between one to three days a week, for between 6 and 12 weeks after birth, or even more.
The fee you charge depends on your skills and experience, where you live, what’s included in your support package and how many hours you provide your clients. Some of our graduates prefer to provide customised packages of support to ensure the best quality of care, rather than booking one hour at a time.
As a rough guide, the overall cost of a postpartum professional in Australia can range from $800-3000, with an average of $1200.
According to the International Doula Institute, in the US, doula rates vary based on cost of living, being more expensive in larger cities and less expensive in smaller towns. Doulas can cost around $35-100 an hour, although many doulas prefer to offer packages of care, rather than charge by the hour.
Similarly, in Canada, the cost of a postpartum professional depends on the city's cost of living, with the overall price typically falling between $600 to $3,000.
Keep in mind pricing varies considerably and clients can generally find some kind of support within their budget. Some doulas offer online support like recipe books, educational groups or online courses available for under $100 and some doulas offer premium and extended live-in care which could cost $10,000 or more.
Whilst some prospective clients may think the fee expensive at first, it can be helpful to remind them to weigh up the investment against the cost of NOT having postpartum support. Families who are cared for during postpartum adjust to their new roles more smoothly, feel more confident and may be at lower risk of postpartum depression. These well-supported mothers have a better chance at meeting their breastfeeding goals, and are referred to appropriate professionals and services more quickly, preventing things from spiraling out of control. Postpartum support can have lifelong impacts on the health and well-being of parents and babies and is worth investing in. See DONA International’s Position Paper for more information.
How long do postpartum professionals stay with their clients?
How long you provide postpartum care for a family is entirely up to you. You’ll typically agree on the length of services before you begin and put a contract in place. According to the American Pregnancy Association, a postpartum doula is usually with a family for 1-5 days a week, for a couple of weeks to a couple of months.
Your length of service to a family can vary depending on many factors. If the new mother has multiple children, a challenging birth experience, little family support, or is having trouble breastfeeding, she may wish you to be present longer while she adjusts.
While the postpartum period is generally considered to be about six weeks long, we at Newborn Mothers strongly advocate for expanding our concept of postpartum care beyond that time. The first 1000 days is a concept that refers to a stage of human development that has lifelong implications for mental health and social and cognitive development. And we now know that postpartum depression is more common four years after the birth of a baby than at any time during the first year.
Graduates of our Newborn Mothers Postpartum Education and Care Training know how to connect families with excellent resources, community and professionals, as well as equip new parents with healthy habits and strong boundaries so they are cared for well beyond the early weeks or months. Long-term support for families provides strong foundations for lifelong health and happiness.
Do doulas need qualifications?
The doula industry is largely unregulated, and while doulas are not licensed medical professionals, there are many options for certifications and training. Requirements are dependent on where you live, but in most places around the world, you can practice as a postpartum professional without any training at all. Different countries also have different educational terminology; for example, the word certified has different meanings depending on where you live.
In our experience at Newborn Mothers, most doulas are life-long learners and will usually complete a variety of different training programs throughout their careers. We have graduates who started out with no experience before completing our course and others who came to us as successful professionals who wanted to hone their skills.
Generally, doulas love learning and want to provide the best quality care to their clients. Completing training courses will improve your skills and confidence and help you hone your natural passion for helping families.
Regulation and registration of doulas
While technically, no training is usually required to become a doula, there may be some laws depending on where you live. Australia is one of the only countries with laws in place regarding doulas; for example, it’s against the law for a doula to provide any clinical care during labour or birth.
Only two states in the US have laws in place: Oregon and Minnesota. According to Trainingdoulas.com, in the rest of the country, non-certified doulas can practice without any regulations since they do not provide medical services.
Similarly, in Canada, doulas don’t require certification to practice in any province, and post-secondary education is not required to undergo doula training.
The world of doula regulations has been a grey area for years. It’s essential to have clarity around working safely within the scope of your role. We encourage you to only provide information based on scientific evidence, and never give medical advice.
No matter what you call yourself—doula, postpartum care professional, or something entirely different—your role is a valuable one. Families need and deserve support to thrive during life’s big transitions.
Changing the experience of postpartum
Newborn Mothers Postpartum Education and Care Training is for anyone who feels called to work with new families during the life-changing transformation of becoming parents. The World Health Organisation has acknowledged that the postnatal period is a critical life phase for mothers and newborn babies; however, it’s also the most neglected period when it comes to quality care.
Our ultimate wish with our Postpartum Education and Care Training is to provide the tools and skills you need to support families while developing the business know-how you need to get clients and get paid. Many Newborn Mothers graduates have gone on to create fulfilling and sustainable careers—you can listen to their stories here.
If you would like to change the way people experience the transition to parenthood, learn more about our evidence-based training here.
