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Statement on the Divisions and Needs of Professional Doulas

Recently, Buzzfeed published an article that brought up some very significant divisions among the doula community. This has caused harm and damage to many birthing communities and is a cause for concern for New Beginnings. As a growing profession, we need to be able to collaborate within our own community and with medical professionals in order to better serve women and doulas together. Because of this, we have come out with this statement to address the concerns presented within the article, and as a call to continue our efforts of collaboration and professionalism.

While the tone of the article was divisive in nature, it brought up some concerns and problems within the doula community which need to be addressed by trainers and doulas. These concerns include the need to feel validated as a profession by our communities, being devalued by medical professionals, access and affordability to doula services, and doula wage earnings.

The need to feel validated as a profession by our communities

Doulas today are valued by only a small portion of society, typically within the natural birth community. But feeling valued is an important part of job satisfaction and the work of a doula is very time intensive with a huge emotional investment. If a doula does not feel valued within their community, that can lead to burnout.

It is difficult to determine how much doulas are valued, but current research shows that only 6% of women use doulas. And while 75% of women who didn’t use doulas had heard about doulas, only 27% would have liked to use one (Listening to Mothers III). Unfortunately, value has often been whittled down to how much money you make as a professional. That is a difficult assumption to make and is too simplistic. If you can equate feeling valued with feeling happy, current research has shown that how much money you make only helps to a certain point, and even that is minimal, but beyond that it does not make a difference. After $40,000 annual pay is reached, other factors like health and a sense of purpose play more of a role in how happy we are with our job.

Finding meaning and purpose in work increases feelings of empowerment, satisfaction, and fulfillment, but it may also be correlated with perceived value of a profession. In an informal questionnaire that I executed, I asked people what determines how much they valued a particular profession. No one mentioned how much that profession made. The most common responses included a professional who has passion and a good work ethic, and service professionals.

As professional training organizations, helping others understand the impact a doula can have and the services they provide, may help increase the perception of the doulas value. Professional and training organizations have a duty to educate the public on what doulas are and what value they have for all women regardless of childbirth choices.

Being devalued by medical professionals

Doulas not only need to be valued in the community, but also within the medical world that they operate in. Again, this is a very under researched area, but common perception is that doulas often are in conflict with doctors and nurses, and that doulas tend to over step their role. This does not really help us understand how big the problem may be, or what a solution may be.

Doulas, by most defining standards, provide non-medical support. Many organizations stress this idea when providing training to their doulas. Given some stories that have circulated of doulas who have interfered with birth, that is understandable and perhaps continues to be necessary. But, much more needs to be done in order for medical professionals to understand the value of a doula and to facilitate better collaborative efforts among all health care professionals.

It should be noted that current nursing and medical associations already have stated the value of continuous labor support.

Continuously available labor support promotes patient safety, including in the second stage of labor.” (Association of Women’s Health, Obstetric and Neonatal Nurses [AWHONN], 2011, p. 665).

Continuous support during labor from caregivers (nurses, midwives or lay individuals) may have a number of benefits for women and their newborns…Continuous support during labor has several benefits without any evidence of harmful effects”. (American College of Obstetrics and Gynecology [ACOG], 2003, p. 1449).

Nurses perceptions of doulas, provides us with some ideas of what may be done to improve perceived value. Negative associations were held by nurses who were overworked, and preferred clinical tasks and common obstetric practices. Positive associations were held by nurses who had been exposed more often to doulas. In another informal survey, nurses were asked why they should be in the room continuously with a laboring mother. Many did not know how this would help and felt very uncomfortable with the idea. They discussed how they did not even have the time to do this.

Training organizations and doulas can place an emphasis on providing education to improve collaboration among healthcare professionals, and stressing the need for nurses to be educated in the value and uses of continuous labor support.

Access and affordability to doula services

Some women cannot afford the services of a doula. Should we be concerned? There is also a dispute over the idea of the doula being a luxury. Luxury meansan indulgence in something that provides pleasure, satisfaction, or ease”. Doulas do provide ease or satisfaction, but the question lies in whether it would be considered just an indulgence versus a need.

needs of professional doulaIt is clear from the research that doulas provide important clinical benefits, perhaps even lifesaving. The most important to this discussion being the decrease in c-section rates and premature births when trained labor support is used. There is a 22% lower chance of having a preterm birth, and a 28% decrease in the risk of c-section. ACOG, the leading obstetricians association, has stated that doulas are one of the most effective tools to improve labor and delivery outcomes”. From these statistics, it is apparent that doulas provide very important clinical benefits that has the potential to have a huge impact if every woman did have a doula.

The question then arises what should we do if women want a doula, but cannot afford one. This is not a dilemma inherent to doula work alone. This is a question that is contemplated across the board in relation to health and potentially lifesaving interventions or medication. As doula organizations, we should be looking for ways to address this issue that allows doulas to be compensated fairly while providing for the needs of birthing women. This may include the use of volunteer organizations, Medicaid coverage, or sliding fee scales, but there is more that we could be doing to address this issue. We should be actively looking for ways to address the needs of doulas and their clients.

Doula wage earnings

Doulas have not been paid enough and cannot afford to support themselves. This is historically a fact. Most doulas make between $15,000 and $30,000 per year. This is not a living wage for most people, yet many doulas feel a calling to reach out to those who cannot afford a doula. As of yet, no one has addressed this problem until recently. But the solution provided is to not allow certified doula to offer free work.

Simply not allowing doulas to compete competitively by lowering prices or even offeringfree services is not a viable solution for the doula community at large because it does not address the problem; some doulas also want to provide care for women in need. Doula organizations need to come up with options that can address the need to charge a living wage and the desire to help.

Marketing education is a key piece in this. Price only matters if there is no difference between services provided, but marketable differences abound in the doula community. We can differentiate ourselves by experience, birth philosophy, special skills, maybe more luxury skills, or business structure. Business leaders have stated that business owners can attract clients by working to reach a target market, but also by establishing their value. Doula organizations should stress the importance of gaining an education in finding and establishing their own personal market value.

Thus, the solution to the problem of making a living wage and providing help to those in need lies in increasing the public and medical profession’s perception of the value in doulas, and teaching doulas marketing and business techniques.

Within in the doula community, New Beginnings respects the differing viewpoints and business models now established and encourages everyone to continue working together to work on solutions to the problems identified above. By doing so, we can promote the work of the doula and women.

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Rachel has worked as a register nurse (BSN from University of Utah) since 2004 with a work history in Labor and Delivery, NICU and Postpartum Care. She is also the founder of New Beginnings Doula Training which she organized in 2011. When she's not busy being a mother and grandmother, she can be found reading research papers related to some aspect of childbirth.

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