The MamasteFit Podcast Episode 152 – Doulas 101: Non-medical Birth Wizards

Gina: Welcome to the MamasteFit Podcast. In this episode, we’re going to be talking about what is a doula? What are they not? How do you become a doula, if that’s something that you’re interested in doing? We’re going to talk about how I became a doula, and different ways that you can become one if you’re interested; what to expect with a doula training, what you should be looking for in a doula that you’re hiring, and what does a doula do or not do? Are they just a birth wizard? I don’t know. So let’s break it down in this episode.

So I am a birth doula. I did do a postpartum doula training, and I did one postpartum doula thing, and I did not love it. I did not love being a postpartum doula, but other people do. So we could like briefly touch on what a postpartum doula is? ‘Cause there’s a lot of different types of doulas out there, but we’re going to really focus on birth doula in this episode. Roxanne is not a doula.

Roxanne: I’m not a doula.

Gina: She is a midwife. I am not a midwife, I’m a doula. They’re different. They’re two separate things from each other.

Roxanne: I think that’s like a common question of, “Oh, should I hire a midwife or a doula? Or both?”

Gina: Or both. They’re not the same thing. So a doula is a non-medical birth buddy, so they’re like a labor coach, a birth wizard, but they are not medical. So they should not be like diagnosing you, they shouldn’t be doing any of your medical vitals, or your stats, or anything like that. So they’re not taking your blood pressure, they’re not doing like a fetal heart rate tracing on your baby, they’re not checking your cervix- they’re really a non-medical support person, but they can provide continuous labor support, which is really different from your medical team. So typically with like your labor nurse, your midwife, or your provider, they will have multiple patients that they’re working with. Now, a labor nurse, I think should only have up to two.

Roxanne: Yeah, they shouldn’t have more than two.

Gina: Sometimes you may be their only patient, but your midwife may be the midwife for all of the patients from that clinic that are in labor at the same time, so it could be multiple patients.

Usually in a hospital setting, the nurse and the midwife, or the medical provider, does not just sit in your room the whole time. Like they may be in there a little bit more depending on your needs, but generally they will come in, check on you, do some stuff, and then they leave to go check on the other patients as well. But a birth doula is someone that you hire, so they’re typically independently hired by you, and they provide continuous labor support. So they’re with you whenever you tell them to join you and then they stay with you until a certain timeframe or until your baby’s born, depending on whatever the contract was that you guys had. And the difference between being able to provide this continuous labor support versus more of this like intermittent support- like there’s the medical team is still always there, but they may not be in the room with you- is there are like subtle things that I can see as a doula to provide you support like immediately, versus the labor nurse waiting to see that something’s going on, or maybe there’s like a certain timeframe that they have to come in. And so I can just give like a little bit different type of support.

The other thing is that I provide a different type of support as well, and so my focus is not what is your baby’s heart rate, what medication do you need to be given, like the overall health of you and your baby- my focus is more of like your emotional support, your physical support, so helping with labor positions, helping with comfort measures, helping you understand like what is going on by helping you know what questions to ask based on the information that I know about birth in general.

So I’m not a medical support person, but I know what Pitocin is and I know what these different birth interventions are, and I know you as the person that I’m supporting, and so I can help you figure out what questions you need to ask. So my role as a doula is not to tell you, “This is what’s happening with you medically, and these are, this is what you should do.” My role as a doula is to help you understand how to communicate with your birth team, with your medical team, to better understand what is going on.

So for example, if there’s like something happening during your labor that maybe there needs to be an intervention, and I know that you personally do not want certain types of interventions, or you would like to limit certain types of interventions, whenever like the midwife or the OB or the nurse comes in and they’re talking to you about it, I can help you come up with questions. So if you’re feeling really concerned about X, Y, and Z, I can ask you or remind you of some questions that you could ask so that you can get the information from your medical team. Which, I think is something that most folks don’t think about when they come with a doula; they think like labor positions, comfort measures, or they think a doula is going to make decisions for me, which is not what I’m there for. I’m there to help you gather information so that you can make a decision, but I want you to be able to make a decision with your whole team, not just me, not just your provider making decisions for you. I want you to be able to make a decision with the whole team.

How have you seen that aspect of a doula be really beneficial versus not great as like a midwife or as a labor nurse?

Roxanne: So birth doulas, they’re part of the team and I think that it depends on where you’re like supporting the birth on how integrated you are into the team. ‘Cause in some places that I’ve worked, they like do not love a doula and they feel that you are…

Gina: Undermining?

Roxanne: Yes. Like, you’re just trying to like, get them to, “not do the things that we want them to do,” quote unquote. Obviously not my viewpoint, but other places that I’ve worked. Like I love birth doulas because they are going to help me support the patient in a way that I can, especially if I had more than one patient. Because I was the labor nurse that was, if I only had one patient, I was in that room a lot more, like providing the support that they wanted, especially if they didn’t want an epidural, or we were waiting until like they were more active to get their epidural and putting them into different positions. But, if a doula’s there, like they would do all of that and then I can just sit down and focus on like other things. Because as the labor nurse, and now as the midwife, my focus is, yes, on the emotional aspect of it, which is also why like I, the type of birth that I am hoping to support is out of hospital birth, community birth, because you are more into the emotional side, you have more time for that portion. Whereas when I was in the hospital, like there’s not always the time for the emotional support and like the level that I wanted to do, so when someone would have a doula, I knew that they would have that support and I didn’t have to find a way to squeeze it into my shift if I had more than one patient. It’s hard to do that for two patients.

And like one birth that I was in, I had two, one day I had two patients, both going unmedicated, one had a doula, and the other one did not have a doula. So it was nice that I had a doula because she was there supporting her through her labor, and I could just watch the baby and then focus on providing emotional support for the other one. So in that aspect, I do love a doula, to incorporate them into providing and supporting the patients. But the other, like when the other doula was like, “Oh, she now is looking more active and I think she’s going to start pushing soon,” I would like respect, we would respect her observations, ’cause then that tells us like, oh, we should make sure that everything is ready to have a baby and be close by, because she has been in these rooms for so many babies, and like you, same thing, if you were like, “Oh, she’s going to start,” like, “she’s looking like she’s shifting, she’s probably going to start pushing soon,” we would trust your observation; and then also incorporate you into the decision making.

So now like at the birth center, when we see doulas, like we are in there more often, but we still value their input into what are they like seeing that we’re not seeing? Because sometimes like the medical you could get kind of like tunnel vision. And so the whole team, including the doula is helpful to be like, “Hey, like this is what we were wanting to do,” or like, “She really wanted to do this in her birth,” and so then we can get out of our tunnel and incorporate all of those things.

Gina: So one of the things that I’ve noticed with that, and I would be curious like what the total number of hours that I’ve spent in a labor room, versus like what you have spent in a labor room, even though you supported like way more births.

Roxanne: Oh yeah.

Gina: Than I have. Like, I would be curious what that like hour comparison was. Not to be like, “I’ve done it more than you,” but like just the amount of time that I’ve actually spent in the room watching somebody labor, I think has a lot of value to it.

And so sometimes what’ll happen is, I will see that this person is having contractions at this rate and that their intensity is increasing, and I will see all of these like subtle shifts that labor is progressing- but sometimes if the nurse is going back and forth between rooms or they’re not spending a lot of time in the room, because I’m there, like they don’t need to spend time in the room.

Roxanne: Yeah. They don’t need to.

Gina: It’s too many people at that point- is they may not notice these subtle changes, and because they weren’t asking me for the information to give themselves a full picture, they start doing things without knowing that labor was progressing. So they might come in and be like, “Oh, the monitor is still showing that the contraction of the same spacing,” even though the monitor doesn’t show how strong they are necessarily, “I’m going to continue to increase the Pitocin, because the contractions look the same to me on the monitors.” But if they had asked me or they like sat in the room for a few minutes to watch the patient, they would’ve seen, “Oh, these contractions are more intense now. Maybe I don’t need to increase it right now.” Or maybe, I don’t know. So if we can gather information together, it can really help the person that’s in labor, I think have a better experience, too, as opposed to feeling like we’re on different teams like that they don’t want to take like information that I’m giving them versus the other.

I’ve been in other hospitals that were definitely not on team doula because it is sometimes a little bit of if there’s a doula in the room, then people start asking too many questions, and then I have to answer all these questions- which is fortunately not every hospital, but it becomes like an extra step where okay, now I have to, explain stuff to this person and they’re not like, my authority should be enough for them. And I could see how that can be frustrating for some folks, where the monitor wasn’t picking up contractions, they’re like, “Oh, we have to keep increasing this because there’s no contractions,” and I’m like, “She’s having them. Like I could show you the timer. Like I, I can, if you just stand here for a few minutes, you’ll see that her contractions are like three minutes long ’cause the Pitocin is too high- or whatever reason, I don’t know. You’re the medical person. You tell me why she’s having four minute long contractions,” and they would just keep increasing it. And then the baby did not do very well. now whether or not those were correlated, I don’t know. I’m not a medical person, but I can make some assumptions.

Roxanne: Oh, Gina changed the tone there.

Gina: But in those situations, like I was not able to be a part of the team to provide the information that I’m seeing, and those situations I think it hurts the patient and the person that is in labor. Yeah, so I think we can all gather information.

Roxanne: I think it’s just important to know that yes, a doula is not a medical professional, but their opinions are still valid and important, and integrating them into the team has been shown to be very beneficial for birth outcomes, not just like birth outcomes of like vaginal birth, but like a positive birth experience as well. This has been studied, continuous labor support, whether a doula or somebody else- ’cause a doula doesn’t always have to be like a certified doula through like organizations, it can be like a family member or a friend who is going to continuously support you in that way during labor- and this has been shown to be so beneficial for decreasing the number of interventions that are used during labor, decreasing the rate of C-sections, so like all of these things. But the biggest thing is that people are leaving birth feeling empowered and confident, and having positive birth experiences by all of this continuous labor support, whether with a doula or a family member. And that person should be like in the discussion and be included in like the decision making, not necessarily the decision making, but that conversation, and they shouldn’t be like excluded. If someone had their mom at the birth as their continuous labor support, you wouldn’t exclude them from the conversation; and so like a birth doula should also not be excluded. And I don’t know of, I have not met a doula personally yet, that is like very confrontational towards providers.

Gina: Which, that is the other side of this conversation.

Roxanne: Which is also important, because I think that there are doulas out there, and I thankfully have not met them, who are very much, “Oh, they’re out to sabotage your birth and we shouldn’t trust anything that they recommend.” And then like their patient will develop something like that they do maybe need an intervention, or that we are recommending something, but because their doula had told them, “Oh, Pitocin is the worst thing that you’ll ever experience, and you should never get Pitocin, or it’ll ruin your birth,” then this person now has all of this fear because maybe they did develop something in their pregnancy, an induction is recommended, and they want to move forward with that induction, but they’re like, “I don’t want it. I will do everything but Pitocin,” and then it’s “We will, at some point we need to use Pitocin potentially for your labor induction.” And so then it ties like the medical team’s hands. And so that’s where I can see why medical providers, if they’ll have experience with those types of doulas who are very much like anti-medicine, anti-doctor, like that does get hard as a medical professional.

Gina: Yeah.

Roxanne: But I think had they been included in the conversation, and been a part of a team with the medical providers, I don’t think that they would have the same opinion.

Gina: So I definitely agree that there are doulas out there, which I think it’s interesting that you’ve never actually experienced it…

Roxanne: I’ve had really great experiences with every doula.

Gina: But I think it might reflect on you as a medical person as well, that they maybe haven’t had to be hostile towards you. But I do know that there are doulas out there, ’cause we’ll have people that’ll message us that are like, “This really weird thing happened with my doula, like, how do I know how to feel about it.” And I’ve interacted with some other doulas where I’m like, I’m not sure that you’re like judgment free…

So you want, if you’re looking to hire a doula, you want to make sure that their vision of your birth aligns with yours as well, would be like my first step. ‘Cause I know when I first started as a doula, like I had only had one baby at that point, and I was still holding onto a lot of trauma from my first birth, and I’m sure this is similar for other people that enter fields to be helpful, is that you don’t want other people to have that trauma too. And there are certain things for me that I associated with that trauma, and so I was more hesitant and scared of it, and I would project that onto some of my earlier clients until I like matured as a doula and was like, okay, there are times when these things are appropriate for you. And maybe some of that came from like my doula training and the background that I came from as well, was this distrust of the medical system. Fortunately, I have matured past that like pretty quickly, but there are some doulas out there that are very much, it’s us versus them, and they project that onto their clients, which then makes them very fearful.

So wherever you are choosing to give birth, if you feel comfortable with that provider and that provider helps you feel good, and you feel comfortable with the decision to give birth wherever you choose, your doula should support you. And, that’s whether or not they think it’s a good location or not. Because for me, like there are some providers in some birth locations that like I personally would not like to go to, but I respect that my clients may have different preferences than I, and that’s okay. People can still go and have really wonderful experiences in places that I would not like to be, and that’s okay. And so if you have a doula that is very anti other people on the team, like, “The only person you should be talking to is me. Only my opinion on this matters,” and they’re very like anti other people on the team, and they make you feel more stressed out, and make you not trust people that you have chosen to support you- that’s a red flag to me.

Now there’s a difference between you feel uneasy about the provider that you’ve chosen and they’re helping you find a different option.

Roxanne: Yeah.

Gina: Like you want something different, like this is from you. “You know what, actually I don’t feel really comfortable with my provider.” This is where like a doula can be helpful to gather information and help you find a different provider. It’s different when you feel comfortable with your provider and they are trying to create this distrust.

And sometimes you can tell with the social media content that they post, if you genuinely feel like if you told them that you wanted to do something different, that they would judge you- then they’re not a good fit for you. They’re not a good fit for you, ’cause there are some people that are really passionate about certain types of interventions or certain like medications. And if you feel like, “If I told them I was going to do the opposite of that,” if you told them, “I’m going to get an epidural,” that they would judge you, they’re not a good doula. They’re not a good fit for you.

Roxanne: Yeah.

Gina: Like you need to find somebody else. I don’t think that there is as many like that out there. I don’t know. I don’t have a number.

Roxanne: Yeah. I haven’t met one.

Gina: And I’ve had to sign stuff that says I will not be a problem in hospitals.

Roxanne: But there are hospitals that don’t allow doulas.

Gina: Yeah. So there are obviously doulas out there that have caused problems for other people that are encouraging their clients to not take medical advice, which is a problem.

So whoever you have chosen to be on your team, and this is for the provider that you choose, the chiropractor you choose, the pt, the doula, whoever you choose to be on your team, should understand that they’re a part of a team, and they should not be trying to isolate you from other members on that team, or they should not be trying to create distrust with other people on your team. And so this doesn’t apply just to the doula, this also applies to your provider or to your chiro, whoever you’re seeing. If any of them make you feel uneasy about other team members, they should not be on your team anymore, and you should find somebody else.

Other things that I, just as like a recap on what a doula does for you: one, they provide continuous labor support, so they’re with you the whole time, doing their thing. With that continuous labor support, they’re providing physical support with like comfort measures of recommending labor positions, they’re guiding your partner to know what to do as well- they don’t replace your partner by any means. They’re providing emotional support, so they’re helping you to feel safe and supported within your environment. They can provide advocacy, so they can help you gather information to then make decisions and it reminds you of different stuff as well. ‘Cause sometimes it’s hard to know, I’ll come to a birth and I’ll know that this like mom wants to have like complete freedom of movement and she’s got like an IV pole with just fluids. And I’m like, “Oh, did you want to be hooked up to fluids? Was that a request of yours?” Because I’m not going to be like, “Ew, why do you have this pole on you?” I’ll like first confirm, “Is this what you wanted?” And she’s like, “Oh no, they just did it and I didn’t think anything of it.” I’m like, “Do you want to be attached to the pole? Do you feel like you need fluids?” She’s like, “No.” And I’m like, “Okay, we can ask to see if they can take it off. There might be a reason why, like maybe they didn’t explain to you why you needed it, so we could ask about it.” She’s like, “Oh yeah, I would totally love to not have this thing attached to me.” And then it was like, “Oh yeah, it was just routine. Like we just hook people up to it.” And then she went, “Oh, I didn’t know that I could do that.” And so that’s something that a doula can be helpful for, so that you can know, what can I not do?

Roxanne: Yeah.

Gina: Or what can I do?

Roxanne: I think it is important to know that like, you can do whatever the hell you want.

Gina: Yeah. You can do whatever you want.

Roxanne: And that even though you’re in the hospital and you’re pregnant, it doesn’t mean that they get to decide what happens to your body. But having a doula there to remind you of that, that you get to decide what happens to your body is really beneficial.

Gina: Without being hostile about it. So I don’t call the nurse in and go, “Hey mother******!”

Roxanne: “Disconnect her IV!” No.

Gina: I will say that there was only one time in my whole doula career that I felt like I was very hostile towards a nurse- which I’m very proud of, ’cause there’s definitely other moments where like hostility could have been justified; however, I don’t want to bring that type of energy to someone’s birth; I don’t want to be the person that causes like tension in the room- where a nurse wanted my client to get in the bed to monitor. So, this lady is in transition, she’s getting ready to push this baby out, and she is like not wanting to sit down, which I don’t blame her- I don’t want to sit down either at that point in my birth. And the nurse was like, “I need you to get in the bed because I need to get a good strip on this baby,” and I’m like, “I feel like you could just hold it, I’m not a medical person though! I feel like you could just hold it there?” And she said, “If you don’t get in the bed and your baby dies, that’s on you.” Something along those lines, like she, she brought up, “your baby could die.”

Roxanne: From not being monitored?

Gina: Because they weren’t being monitored. And I was like, “Whoa! Do you feel like that was appropriate to say? I feel like you can just hold the monitor against her belly if it’s really important for you to get like a good tracing.” And then she just looked at me and I was like, “I’ll hold it there if you need me to.” And then she left, after that point, ’cause I think she realized that she’d done fucked up. And then she was super nice the rest of the birth, which was not a very long birth.

But, I don’t want to be the person that brings hostility to the room as a doula. And so you gotta be mindful with like how we are speaking to other peoples on the team when we are just bringing up suggestions.

Roxanne: Yeah.

Gina: Or, “Do we need to do this in this way?”

Roxanne: Yeah.

Gina: If we do, let’s just explain why, because they’re unsure on it. So I can really help to facilitate communication as a doula as well.

Roxanne: Yeah, which I think is huge.

Gina: Because sometimes we just forget.

Roxanne: Yeah.

Gina: Oh, this person doesn’t understand what is happening?

Roxanne: The tunnel vision, or we just, as a medical professional, you just have done this literally every day, 14 times a day. And that sometimes, like you forget that people don’t know what this is, and this isn’t a routine thing that happens in other people’s day. So it’s nice to have that reminder of, “Hey, what are you doing?”

Gina: Yeah. Or, you have to think about like the hierarchy of things as well. Someone may not feel comfortable like saying that they don’t understand in a position where they feel like they’re maybe like inferior or they are subordinate to like the provider. And so they may not feel comfortable asking questions sometimes. We are all equals, everyone. The person that is in charge is the one in labor.

Roxanne: Honestly.

Gina: Actually, you’re the one in charge. But, yeah, having a doula there can be very helpful to remind people about things to facilitate that communication.

And the last thing that, there’s lots of things that doulas can be helpful for, but one of the last things that we can be really beneficial for is resources and networking, because we typically are well connected within our areas, and we can find things that you need, or that you’re seeking, or that you’re looking for. So I’ll have folks that’ll message us, be like, “I want to give birth,” yeah, I want to give birth, everybody wants to give birth! “I would like a birth location with this. This is my vision for my birth.” And I’ll be like, “Okay, if that’s what you want, these are some of the providers that I would recommend in our area for you.” Or, “Okay, I would not recommend this one, but the other rest are fine if this is what you’re looking for in your birth.” ‘Cause sometimes just having a connection in the community can be really helpful for folks. So if you were trying to figure out something in your area, like I don’t know who to see for pelvic pt, or I don’t know who to see for this or that, sometimes just working with a doula can help you with that kind of stuff too.

Roxanne: They have all those connections, yeah, in your area.

Gina: Even if you’re not going to hire them, sometimes just asking them the question can be really, they usually will answer you like, but you may, maybe hire them if you want, but you like them.

Roxanne: Yeah.

Gina: So overall a doula can provide a lot during your birth. They don’t replace your partner. But, sometimes there is a financial barrier to hiring a doula, which can be sometimes more challenging. Some insurances do cover doulas, or they’ll reimburse partially for some. So for us, with like we are, we have military insurance with Tricare, they will cover a certain portion, I’ve had other insurances that will cover it. But you might need to be certified through a certain organization to get coverage as an insurance.

For me personally, I have let my certification lapse because a doula certification is made up. So there’s no licensing organization, it is just a random person decided that this is my certification for doula. So there’s no like big overarching governing body that says what a doula needs to be certified. Each organization has their own thing. But certain organizations have enough prestige to them to where they have some sort of like contract- I don’t know how it works- certain ones are approved with insurances. And so if you are looking to become a doula, sometimes being certified in those organizations can be helpful, and I don’t know what all of them are that are with insurances. I know the one that I certified with originally is, but there are other ones that are, because I think there’s a few options. And if you are somebody that wants to have your doula covered, checking with your insurance of what kind of qualifications or certifications they need to have, if they cover it at all, can be really beneficial as well.

There are some like scholarship programs out there, some hospitals have non-profits, volunteer doulas that’ll work with you. And so there are like different options. Sometimes you can find like a new doula that’s like trying to get certified, sometimes they’ll do discounted services to try to get their certifications in- but then you’re, they don’t have as much experience. And so trying to like figure out the financial aspect of hiring a doula can sometimes be challenging. Obviously like it’s easy for me to say, “Oh, it’s totally worth the investment, you should totally do it.” But it can still be pretty pricey depending where you are. Some areas, doulas are like thousands of dollars.

Roxanne: Yeah.

Gina: Some areas, they’re not as expensive.

Roxanne: I think it helps that your birth location could also sway whether or not you would want a doula, ’cause in community birth, our birth centers, they do provide a little bit more one-on-one support; but for like home births, like usually they’re only going to go to one person’s house, but they’re probably not going to show up to your house in early, early labor unless you really need a lot of support, so they may not provide as much continuous labor support with home birth. But in the birth center they also could have more than one person laboring there, so you may not get one-on-one support. But they may not be as high of a demand if you are giving birth in the community setting versus a hospital, ’cause they may not have anybody to provide continuous labor support in a hospital. But there are like lots of other programs, like nonprofits that will pay for a portion of the doula fee, or all of the other options that Gina listed to make it more affordable.

But I do know there are like sometimes like friends and family who love birth, and love you, and what to support you, that will do certifications, or do the childbirth education courses with you so that they’re able to support you as well. ‘Cause sometimes having someone other than just your partner can be nice, but also know that if you don’t want other people in your labor space and you just want your partner, that’s also okay and like they can be your doula. 

Gina: I think my controversial opinion on this is that you could give birth without a doula and that you’ll probably be fine. I don’t think it’s like a mandatory like expense that you need to take on if it’s going to put you in debt or…

Roxanne: Don’t put it on the credit card.

Gina: There’s plenty of ways to learn as much as possible, and I would say at a minimum, finding a provider that you feel like you can truly trust to help guide you during your birth, that wants to listen to you, that takes your questions like seriously is like a really good sign that you’re probably going to a birth location that like they’re going to be supportive of you. If you’re seeing a provider that is annoyed by your questions and like frustrated that they have to answer anything, or every time you ask a question, they just dismiss it, that would be a red flag to me that if I’m not going to hire a doula, I need to find a different provider potentially, if you have that option, by any means.

Some doulas will also do trades, where like they’ll do like a service trade with you.

Roxanne: Oh yeah.

Gina: If you can do something that they want, then sometimes you could swap services.

Roxanne: Yeah, I know. I need a trade like that.

Gina: So it’s like you can do… I had one lady that did like nutrition coaching, and like she offered nutrition coaching for me in exchange for doula services.

Roxanne: Obviously Gina’s doing real well with the coaching.

Gina: I’m really crushing the nutrition aspect of my life!

But there are different options out there. So I would say like finding a doula that has like a price range that works for you. Sometimes newer doulas will have lower rates than more experienced ones. Like, figure out if there’s like a trade that you can do- if this is something that’s really important to you. But, don’t put yourself into debt to hire a doula. I don’t think that they’re mandatory by any means. I think they can be really helpful, for sure. But at a minimum, choosing a provider that you feel very comfortable talking to would be like my bare minimum. Even if you’re going to have a doula, you’re going to have a better experience if you have a provider that you feel like you can talk to.

So now let’s talk on the quicker side, how do you become a doula?

You can literally just show up and be a doula. There’s no, like I said, there’s no licensure involved with it. Like you can just wake up one day and decide, “I’m going to be a doula.” Now, whether or not clients will hire you if you just wake up and say, “I’m a doula,” is like a whole nother scenario. And so this is where getting some sort of certification can be really helpful. And there’s a lot of different like doula organizations out there. There’s DONA, who like I certified through. There’s Pro Doula, I think ICEA has one. So there’s so many different like doula agencies out there. And so what I would recommend is if you’re just starting out, is to find an agency that can be covered by insurance, ’cause this can sometimes be a marketable point for you. And so you just pick whichever one you want to do based on what their certification requirements are, like what their continuing education requirements are. Do they have a membership fee that you need to pay? What do they cover in their doula curriculum, and what is required to become it?

And so I’ll talk specifically about DONA because that’s the one that I personally use, which I think is like, Doulas Of North America. It’s one of the largest organizations and I think one of the oldest ones. I think it’s the one that like Penny Simkins founded as well. So there’s, I know that one’s covered by a lot of insurances. And again, it’s one of the oldest foundations, so people are like sometimes more familiar, if they know what a doula is, they’re like more familiar with DONA. But there’s so many out there, you don’t have to do DONA by any means.

For DONA, there is a birth doula course that you can take. It’s like a weekend course, I think it’s three or four days long, where you just like get word vomited all of the stuff for birth. So you learn what different interventions are, you learn comfort measures, you learn some labor positions, but it’s pretty like basic, like ground level stuff. So you are just learning the foundational shit. But with the doula certification, after you take the weekend course, you then have to go through a whole certification process where you have to write an essay, you’ve got some books to read, and then you have to attend three births. Now, they can be paid or they can be free births. And so this is sometimes where you can find someone that has like a little bit of experience but maybe provides like really low cost services during this certification phase.

So during the certification phase, you attend your three births, and this is where you start really learning stuff as a doula, ’cause you start getting exposed to different scenarios where intervention was actually needed. So it’s not just, “Pitocin is bad,” it’s, “Oh, actually I’ve been in a few situations where this Pitocin was really good. But I’ve also been in some situations where Pitocin wasn’t so good and maybe had adverse outcomes.” And so then you start experiencing different things from the perspective as this like doula, but you’re not like the medical personnel, but you get to start learning a lot of different stuff from the perspective of the family, because I’m in the room with them the whole time.

Roxanne: Yeah.

Gina: And they’re like, “I had a question on that thing.” It’s like, “Oh. That is something that a family member’s going to want to know. So now I know this is an important question to ask when we have the provider in here,” who maybe didn’t know that this was something that people are wondering about after they leave the room.

So with the DONA certification, you do those three. You have, someone has to sign off on them, so usually it’s like the midwife, or the OB, or nurse signs off on your little sheet; says how you did. They’re like, four stars, five stars, this person sucks, don’t ever certify them.” Most of the time they’re like, “They were fine.” And then you submit your packet. There is a fee to submit a packet for DONA. I believe there’s a fee for all the other ones as well, I’m not a hundred percent sure. And then there was CE requirements, so every three years you had to re-certify with a packet where you essentially submit what courses you’ve been taking over the years, and then you pay like an annual membership fee. The reason why I let my DONA certification lapse is not because I don’t take my doula certification seriously. It’s that I didn’t find the membership was doing anything for me and that being certified was bringing me clients, ’cause people were just hiring me for me. So I let it lapse ’cause I didn’t want to pay the extra a hundred bucks, a hundred bucks a year. However, anybody that wants to use my services with insurance cannot now, so then I refer ’em to other people- but I’m also not taking as many clients, or really any clients now. so my desire to maintain my certification is less important.

Other things that we can do after you got your certification is if you’re trying to figure out, okay, how do I get experience now? Nobody wants to hire a brand new doula. Some people do. One place that you can go to get some more experience is you can work for a doula agency. And so they essentially find the clients for you, and then you usually like tag team births. I don’t think the pay is as good in most agencies, unless you’re like a senior doula, as if you were like independent. However, you can make $0 independent if you don’t have any experience, versus working with an agency. So sometimes I’ll recommend that to folks who are brand new to doulaing, is to join an agency. And sometimes you get like the mentorship with it, you get the clients and the experience, and you have like other doulas that you can ask questions to, which can be super beneficial as well.

Now when it comes to the continuing education, because the doula course is like bare minimum, it’s like ground floor stuff- you’re going to learn the most from like hands-on experience at births. However, you can also take other courses to learn things. And, this is where we’re I’m going to toot our horn: our pelvic mechanics course is pretty good to help you understand the labor positions. Because as a doula, that is literally your main tool to support somebody’s labor progress, is positioning like that is literally why most people hire doulas, is for labor positions and for comfort measures. And so if you are not savvy on how the pelvis moves, you are doing a disservice to your clients. So get savvy on it. And the good news is, we have a whole course that tells you how to do it. So our pelvic mechanics course for birth professionals and for movement professionals, it’s going to break down in a really in depth but digestible way, on how you can create space in each part of the pelvis and resolve issues and labor with movement as well. So I think that is really, important for doulas.

Roxanne: I mean, really it’s good for all birth professionals.

Gina: It’s good for all birth workers. But if literally your only tool in birth is movement and making somebody feel good, and you don’t understand movement, you are doing a disservice to your clients, and I’ll be bold in that statement. So take our pelvic mechanics course.

Spinning Babies is another great option that does like movement stuff, that they have like in-person workshops that are all over the place much more frequently than ours. We have once a month in-person workshops, but they’re like on the east coast near us. We do have some that are in different places, but we do have an online course you can earn credits for. You can earn nine nursing credits or nine ICEA credits for the online course. So there are ways to earn continuing education with us as well. So that is all the stuff on doulas.

Roxanne: Yeah. So just to recap. Nonmedical professional that provides continuous labor support both emotionally and physically with labor comfort techniques, positions, and the mental stuff, advocacy. 

Gina: They help you find information to make decisions. You make the decision. They don’t make them for you. They’re a member of the team. If they are a hostile member on that team and making you try to isolate yourself from the other team members, they’re not a good doula. But vice versa, they should be included in your team, and so if you’re seeing a provider that is, “Ew, doulas,” maybe not a great provider…

Roxanne: Yeah.

Gina: …to be with.

Roxanne: Especially if you have a doula on your team.

Gina: Yeah. So every member on your team should be supportive of the other people on your team, and none of them should make you feel like you can’t trust other people on your team. If you’re hiring a doula, interview them, interview a bunch of different ones to see who’s a good personality fit.

I am not a good personality fit for every single person.

Roxanne: What?

Gina: I know, it’s hard to believe. I’m not the best doula for every person. Certain types of people are going to like me better, and certain types of people are going to like other types of doulas a little bit better. Like their personality, like the things that I do, like I don’t bring like crystals and stuff to birth and I don’t diffuse a lot of oil. Some people really want that on their birth. I had not that doula for you. If you want me to meditate with you the whole time, I don’t even know how to meditate.

Roxanne: Gina needs to meditate.

Gina: I need to meditate.

So interviewing a bunch of different doulas to see who’s a good personality mix or match for you, who has the same vision for your birth as you do, including the vision that may change, just in case, and is not going to judge you for your plans changing. That’s going to be really important. So check out their social media to see kinda what kind of content they’re posting, how they’re posting that content to get a good feel for their personality, interview them, interview a few different doulas. And then figuring out like what certain aspects of your doula are really important to you. You can ask them about their training. You can ask them on what type of education they’ve done. Are they certified? If they’re not certified, like what type of experience do they have? If they are certified, what type of experience do they have? If you’re looking for a vbac, finding a doula that’s very experienced with VBACs can be really important. Finding doulas that are really experienced with home birth can be really important. It’s going to be an individualized thing for you.

So I hope this episode was helpful for you to understand what is a doula? What is not a doula? How can they be best integrated into your birth team? And then how do you become one, if you want to be one? We will be doing a whole episode on how to become a midwife, and how to become a labor nurse.

Roxanne: And what are they?

Gina: And what are they? So if you are super interested in those topics, let us know in the comments below so we can prioritize either the labor nurse video first or the midwife video first. And thanks so much for joining us!

And so if you would like more support during your pregnancy, your birth, your postpartum- check out our online education courses. We have our childbirth education course, which is a great compliment to preparing for your birth. If you can’t afford a doula, it can be a really good place to get as much information as possible to support you and your partner during your birth.

If you want more movement support, we have our prenatal fitness program, our postpartum fitness programs, and then of course, our education courses for professionals all on our website at mamastefit.com. And you can use code STORY10 to get 10% off any of our online offerings and happy to answer any questions that you have.

So thanks so much for tuning in, and we’ll see you next time.