What’s a doula?

When I introduce myself as a postpartum doula I often get a blank stare and the question “What’s a doula?”, which tells me it’s time to buckle down and break out the infamous doula elevator speech. In this blog, we will learn about the doula career broken down into job description, doula experiences, commitments and salary, and what a doula may do that can go unnoticed.

Job Description

Some say a doula is a childbirth coach, some say birth companion, and others describe a doula as a postpartum cheerleader, there are many ways to describe a doula. The truth is, trying to convey all emotions, physical work, the happiness, the sadness, and rollercoaster of everyone’s unique birth and postpartum experience is impossible.

In simple terms, doulas help parents by providing unbiased physical, emotional, educational, and sometimes spiritual support prenatally, during birth, and postpartum.

Doulas learn about their birthing parent(s), which involves consultations and prenatal visits to discuss plans and goals during and after birth. With that being said, fathers and ALL supporting individuals must be acknowledged and feel involved. The doula’s job is not to replace the birth partner, but to guide a deeper connection between the parents as they begin their journey. Doula’s provide resources to families to ensure they can tell their birth and postpartum stories with strength and confidence.

Here are some essential skills to build when becoming a doula:

• Childbirth experience (not required) or taking a full, integrative doula training program

• A calm, supportive, and reassuring presence during stressful situations

• Continuing education on prenatal, childbirth, and/or postpartum care

• Provide evidence-based information to clients in need of resources and referrals

• Communication and organizational skills

What’s being a doula like?

Although every doula has a different reason to pursue birth work, there are things we still have in common. Based on the doula, some take 4 to 6 clients a month to create a full-time career, while others take clients occasionally for supplemental income. As far as managing client loads and doula work, everyone has something that works for them.

For myself, I plan to take 2-3 clients a month. For many, this is a sweet spot that allows for strong time management between clients and daily life. Being a career doula is both rewarding and challenging. Here are the top five things that I enjoy most about doula work so far:

1) Being a doula is incredibly humbling

The life of a doula is a mixture of new experiences because not every birth or postpartum journey is the same. Since changing my career, being a doula has brought me so much patience in all areas of life. Everyone has their own story, so my expectations are constantly changing.

2) Flexible hours and tailored workload

Schedules are tailored and completely flexible as far as booking goes, however, when baby decides to come is not! Something I wanted in a career was flexibility, and being a doula has allowed me to do what I want when I want.

3) Building and sustaining lifelong relationships

So far, most of my clients have become close to me. Not being from Houston, families love to show me around and invite me to events in the community. The birth community has many wonderful people, which helps me connect and build relationships with families and other doulas!

4) Constantly learning new things

Like many careers, being a doula offers many opportunities to continue education and stay active in your community. Even though I’m still in the process of becoming certified, I am always looking at other certifications and classes to take to better support my families and give information to other doulas.

5) Finding skills that you didn’t know you had!

Within minutes of a shift, I bust out a new skill I didn’t know I had. All. The. Time. Since training to become a doula, my listening skills are better, I communicate with ease and strength, and truly help people with my words and ears.

Supporting women has helped me learn that these five things have helped me increase a family’s sense of confidence and satisfaction. I’m continually striving to provide a sense of safety and belonging to everyone.

“Doulas are worth their weight in gold”

Being a doula is work from the heart. However, to make it a sustainable career and avoid burn out, doulas need to charge their worth. Depending on location and your doulas experience and education, hourly pay ranges from $30-50/hour. Connect with fellow doulas or even search Doula Match to peek at the salary range in your area. As skills, knowledge, and experience grow, that fee will increase.

As a doula, you have to consider the amount of time spent with each client counting prenatal visits, birth, and postpartum. Understanding the average amount of time spent should factor into the fee. In addition, consider the number of clients there are each month. Overloading your calendar might cause conflict. Know that 4-5 clients a month is considered a full-time schedule.

Intangible costs, like being on call continuously, missing out on vacations, birthdays, holidays, and other special events is something every doula will experience. Having a phone on you 100% of the time is necessary as well as not being able to go away for a spontaneous weekend, to lunch more than an hour away, and getting used to being awake through the night are common.

Almost half of a doula fee will go to business expenses such as gas to and from meetings and births, cell phone usage, babysitters, training and certification, professional memberships, websites, marketing, and other things.

Oh! And don’t forget to save 30% of that fee for taxes as doulas are considered independent contractors.

For the sake of cost, I encourage you to read through The Cost-Effectiveness of Professional Doula Care for a Woman's First Two Births: A Decision Analysis Model to gain better insight on the impact doulas have economically. With efforts to improve maternal and infant mortality and morbidity, particularly for Black families and families of color, insurance companies, state Medicaid programs and other health care services funding programs all around the USA are exploring (and in some cases have already initiated) doula care as a covered benefit.

This study reviews a theoretical model that looks at cost-effectiveness and savings when a women has professional labor support for the first birth and continues to look at the impact it has on the second birth:

Having a professional doula with a woman during her first labor and birth could be both cost-effective and cost-saving when reimbursement for this care is less than $884. Doula support costing $884-$1360 remains cost-effective because the additional expenditure for care is accompanied by higher quality-adjusted life years.

When the model was adjusted to include contemporary cesarean rates (26% in this population), doula support was both cost-effective and cost-saving when reimbursement for this care was less than $1153, and doula support costing $1153-$1808 remained cost-effective. Given the limitations of a decision analysis model, this estimated cost-effectiveness threshold is likely conservative.

If a professional doula provided care during labor to all low-risk nulliparous women in the United States using the current cesarean birth rate, this model estimates that this would result in $247 million in savings and 10,483 additional QALYs every year.

This cost-effectiveness analysis adds to the literature supporting the integration of professional doula support into a woman’s first labor and signals the need for increased doula care reimbursement.

Okay, but what does a doula REALLY do?

Let’s be honest. There are a lot of things that doulas do that go unnoticed until the time comes. Aside from everything covered above, doulas take on more specific roles and tasks to support parents:

• Help parents sift through mountains of information to find things relevant to them

• Find out what is really important to the birthing family

• Taking calls and texts to answer questions from clients at all hours

• Being the village that not every family has

• Reminders for self-care for both the birthing person and their partner

• Navigating through unexpected changes

• Working through challenges as they come up

• Helping parents become more prepared

• Helping the birth partner be as involved as they want to be

• Supporting breastfeeding

• Giving reassurance

• Listening without judgment or bias

• Being fully present for the mother, helping her work through fears, discomfort, and moments of uncertainty without any attempt to dismiss, dumb-down information, avoid questions, or block them

There are many creative ways to put yourself out there, especially if you’re considering becoming a doula! If you’re planning on hiring one, there are a number of resources for families seeking support and tons of research to back the benefits of receiving proper support while you heal. Remember to research and understand the all-encompassing career that it is!