There’s 67 Different Doula Training Organizations! Uh oh! Or maybe not?

Jun 13, 2017 by

Version 2Recently, Kim James of DoulaMatch.net reported that birth and postpartum doulas have listed 67 different training organizations in their online profiles. Why are there so many? What are the implications for our profession?

If you think about it, there are few ways for someone to utilize the knowledge they’ve gained as a doula except to train other people. While some organizations have individual recognition for a member’s achievements, that’s about it. There are no national awards and no career ladders to climb. Expansion into more lucrative positions is expected in other paraprofessions; but if you want to continue as a doula the only obvious paths are to train others or start an agency. So that’s one reason – individuals want to move forward in their career options.

Unfortunately, some people are more invested in making money than in furthering the doula profession or ensuring that the doulas they do train are qualified. Anytime price or speed of “certification” is advertised over the educational experience, I know those people have missed the point. These days it’s easy to offer an online course. The problem with online courses is that doulaing is a relationship that is based in touch, eye contact and the stimulation of oxytocin, and you can’t effectively teach most people how to relate to others in those ways unless you are also face to face. Some online courses include a Skype or FaceTime mentor, which is better than nothing. But I have had several people who took an online course subsequently enroll in my in person workshop. They were familiar with the concepts but didn’t have the deep knowledge or confidence to actually apply them with a client.

Sixty seven different training organizations means we have little unity and uniformity in training standards. Preparation could be sloppy or exhaustive. Doulas could learn its okay to judge people’s choices and that some ways to give birth are better than others, and our role is to herd people into those “better” ways. There is no standard ethical platform. No practice standards that we all agree on. There is no unifying principle that we can assume about one another.

The certification that is offered by most of these groups has no vetting. To me, “certifying” that someone is a qualified doula simply because they wrote an essay, read some books, made it to a few births and summarized them is not enough. Is anyone making sure they are good ethical people? Has the organization contacted and spoken with several of the doula’s references? Will the organization stand by its certifying of the doula if a complaint is made? I consider an organization to be a strong one when they will stand behind their doulas, stating they have been trained in the most rigorous way possible.

If consumers or careproviders have a complaint about your behavior, they can bring it to the organization’s grievance committee and be heard. They have recourse. From my checking, very few groups certify doulas at this level. What they call certification is merely the completion of a checklist of requirements. There are few qualifications for character or job performance, and no recourse for future complaints.

Because training quality is so variable, it contributes to an “anything goes” atmosphere. We look unprofessional and unorganized to outsiders. This fuels the reluctance many medical professionals have in generally recommending doulas. They may recommend an individual doula, but not doulas in general. There is no guarantee of quality and no consumer protection. If parents are unhappy with their doula’s performance, they may not have any recourse. This could bounce back to the medical person who recommended them.

Now I’ve been doing professional labor support since before the word “doula” was in use. I was a part of the conversation when the first four large scale training organizations (ALACE, DONA, CBI, CAPPA) went from an idea in someone’s head to creating certification standards. It used to be that calling yourself a “doula” meant that you could assume certain things about that person. With the differing standards and philosophies from sixty-seven organizations, that is no longer true. Because we have a diluted group identity, I see many people seeking strength in an organizational identity.

Globally, we are in a time when nationalism has become more prominent. Rather than thinking about what is best for us on a planetary or humanitarian scale, people are concerned about the well being of their own nation. They see themselves as belonging and being similar to that group, rather than to people as a whole. I see the same thing happening with doula identities. Are you a “Xxxxx doula”? Are you “Xxxxx proud”? The organizational identity substitutes for the larger sense of connection we had with one another no matter what our training and certification affiliation. Being independent and staunchly unaffiliated with any group is also an identity. While this might work for an individual or the organization, it doesn’t serve the movement as a whole.

At the same time, I don’t think this scattering of training organizations is something to get too excited about. For one thing, when I examine the histories of both social movements and the growth of professions, it seems that this diversification is a natural stage of development. It is a part of the spreading of the movement’s belief system and the increased demand for workers to do this job. It is unhappiness with this stage and the lack of uniformity in standards that usually leads to large scale organizations to create universal standards. The desire for this comes from within and without. For example, doulas who see the need to affiliate around common values and behavioral standards. But that isn’t enough. There is usually public pressure to provide standards that protect consumers and offer remedies when [in this case, a doula’s] promises are not fulfilled.

So, if I take a step back and look at things over time, I can see 67 training organizations as a positive sign of growth in the demand for doulas. It is a stage in our profession’s development. For the most part, growth has been driven by people who want to offer the service, not by people demanding the service. It’s been up to doulas to educate the public about why they would want a postpartum or birth doula. As far as I can find, no one has tried to educate the public about why they would want a doula whose certifying organization has personally screened them and who offers a grievance procedure in case there are problems. Nor has anyone, besides me, tried to guide wannabe doulas into asking questions about a trainer or training BEFORE they’ve spent their money. Several high quality trainers have mentioned that they are asked for discounts for their workshop because someone already spent their budget on a lousy one.

What about if we look at The Really Big Picture? Where did doulas come from anyway? We came from women helping other women to flourish during pregnancy, labor, birth and postpartum. We came from a tradition of listening to one another and respecting one another. For those of us who had no formal training when we started (like me), we learned from doing the work. We learned from going to births. We learned from listening to women. We learned from listening to one another. Birth itself is always our biggest teacher. I have hope that even if someone is poorly trained, if they are paying attention and asking to learn, Birth will step up. Birth is the most important trainer of all.

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Career Minded Participants in Birth Doula Trainings

Dec 29, 2016 by

 

career-minded-doula-training-participantsIts natural to assume everyone in your birth doula training was there to become a doula. Not so! Only about half the people are there because they want to do labor support as birth doulas. What else can my research can tell us about career minded attendees? In my Journal of Perinatal Education article, “What Motivates People To Take Doula Trainings?” (Summer 2016, Vol 25, No. 3, p. 174-183), “become a professional birth doula with my own practice” ranked as the fourth most popular answer out of eighteen possibilities. In the question where people were forced to choose only their favorite five reasons, 60% included “birth doula” but only 30% chose it as their number one reason.

Hospital Based Doulas: What about “working for a hospital program”? Only 4% chose it as their top reason, but 20% selected it as one of their top five. Some participants expected to work both independently and for a hospital, as 24% chose both options. Hmmm…there are only a handful of hospital programs that employ doulas or pay them as independent contractors in North America. So this percentage made me wonder if some trainings in my sample were being conducted specifically for a hospital based program. However, these responses were not associated with a specific training, location or doula trainer.

Midwifery and Nursing Students: Another significant presence in trainings was participants desiring to become midwives. “Want to become a midwife (or am considering it)” was the number one reason for 20%, and a top five reason for 43% of participants. For the most part, the midwifery and doula bound groups had little overlap. Only about a third of people who put “birth doula” in the top five also chose “midwife”. Midwifery bound attendees are different in other ways too. They tended to be younger, not have children, and only about half had attended a birth (not their own). Interest in midwifery was confined mostly to women in their twenties. It dropped off almost entirely in the 30-39 year olds, with resurgence in the 40-49 year old group (who had all had children and attended a birth). Another contributing factor may be that 64% of all nursing students (n=42) chose “midwifery” as one of their top five reasons, and nursing students in the study tended to be younger and childless. In my experience, midwifery students have always attended doula trainings. But only in the last eight years are many midwifery schools requiring that students take a doula training before being accepted. In this way, the training serves as a screening and preparation tool to ascertain whether people understand the importance of support skills.

Nursing Students made up 9% (n=42) of total attendees and were more likely to attend to increase their birth knowledge (72%) and to explore midwifery (71%), as indicated in their top five choices. I found it very interesting that one quarter wanted to be in an atmosphere that “believed in women’s bodies and ability to birth naturally”. For the most part they were not interested in a doula career (only 7%) but many intended to volunteer their labor support services (36% of nursing students).

In comparison, “birth doula” bound attendees usually have birthed or adopted children, tend to be more evenly distributed across the age spectrum, with about the same number in their twenties and thirties. Participants in this study adopted children at twice the average rate in the United States (12% versus 6%). I don’t know what that signifies, but it’s worth mentioning! Slightly more than half have attended at least one birth (not their own) already.

Volunteering As A Doula: Birth doulas also displayed other altruistic motivations. Ten percent chose “volunteering as a doula on my own or as part of a program” as their number one (2.5%) or number two (7.5%) reason. A closer look revealed that 23% of all people in the study chose these three reasons as part of their top five: “professional birth doula with my own practice”, “volunteer as a doula”, and “make money in a profession I enjoy”. They felt that all of these things were possible as part of their doula career. In an open-ended question, participants said they intend to volunteer for specific programs for low income women, to go to foreign countries to serve, or for their own parish or mission work. Its also possible that they felt that volunteering was part of the path to gaining experience, had a lack of knowledge of how this could affect doula businesses, or thought this was an easy way to get started. Recall, these are neophytes to the doula world – these questions were asked before they had ever taken their training or likely joined a doula group on Facebook. They probably were unaware of the divisions over the “no free births” paradigm.

Making Money: What about “making money in a profession I enjoy”? Data was collected in late 2010 and again in 2013. While the two samples did not have any statistically significant differences with one another, the birth doula world itself was going through a large shift. In the early days of doula work, the idea of “making money” almost seemed exploitative, like it was breaking some kind of code of honor. How could you benefit from someone else’s labor and birth experience? It wasn’t unusual to think of doulaing as “a hobby that pays for itself”.

The next step in our professional evolution was a push to make birth doula work viable economically. It required a shift in how doula services were perceived by parents, perinatal professionals, as well as doulas themselves. I consider this period of time, from 2010 to 2015 to be a time of commodification[i] [ii] in the birth doula profession, most notably from the influence of ProDoula and their beliefs and paradigm. This shift in business professionalism has made “making money in a profession I enjoy” much more likely today. My point is that this was an emerging idea at the time of the first sample, and was much more established three years later at the time of the second sample. However there was no difference in the two time periods. Why?

First, these are not members of doula communities, but outsiders. It was fairly rare at the time to join a large doula group on Facebook before taking a training. Today, (by my own observation as a doula trainer) that is often the first place an interested person will visit. Two, commodification and the presence of doulas in the labor room are now assumed to be normal by non-doulas. Three, only DONA International trainings were sampled (2 countries; 19 states, 3 provinces; 38 trainers; 46 trainings; 467 participants; 85% response rate).  So these research findings likely only apply to trainings that also have an open focus (see “Take A Doula Training, Change The World” for more information on generalizability).

Now that I am a Research Fellow at the Center for Child and Family Well Being at the University of Wisconsin Madison, I am looking forward to interviewing a younger cohort and comparing the First Wave and Second Wave of birth doulas in future studies.

Perinatal Professionals: How about the childbirth educators? Only 14 out of 467 people identified as childbirth educators (CBE), but 63 people said they were taking the training “to enrich their childbirth education practice” as one of their top five reasons. Two things come to mind. First, people may consider the doula workshop to be part of the preparation to become an educator. Second, rather than focusing on becoming a CBE who teaches classes, their intention was to informally educate people about birth.

Ten participants were postpartum doulas and all of them wanted to become birth doulas. None were using the course to enrich their postpartum doula practice. But 14 people who were not PP doulas were taking it to enrich their future practice as postpartum doulas.

Nurses: Labor and delivery nurses made up 2% (n=10) of the sample, but nurses with no perinatal experience made up 4% (n=19) of the sample. Almost all of this latter group felt the workshop would make them more desirable candidates for labor and delivery positions, as indicated by choosing “add to my resume”. Seven chose “want to become a midwife” as their number one answer. A smaller number wanted to become birth doulas. Why weren’t there more nurses? As a doula trainer for twenty years, I can say that in the first seven years we had many OB nurses in trainings. But now nurses have other options to learn labor support skills at nursing conferences or workshops and earn CE credits. I also teach these workshops.

Non-birth professionals: Almost one fifth of participants (19%) taking trainings had no intention of becoming doulas, midwives, or labor and delivery nurses, as indicated by their top five reasons. Five percent chose “help women have better births not as a doula or birth professional” as their number one reason. Many had incidental contact with pregnant people and wanted to enrich their knowledge and support skills. They also wanted to be more informed listeners. In the open ended question, several listed their related occupation as social workers, home visitors, case managers, day care providers, or yoga instructors. This is a really important group. As I mentioned in my previous blog post [LINK], these are the outer rings of people who can pass along birth knowledge and listen attentively to birth stories. They extend our sphere of influence outward and change the conversations about childbirth to more meaningful ones, simply because they understand that support matters.

So far we’ve covered people who are in a training to advance their career aspirations, and those who want to increase their knowledge about birth and be inspired for change. In my next post I will cover a third group, who have a small but powerful influence over how a workshop actually unfolds. These are the people who are coming for healing from past births.

 

[i] Commodification is the transformation of goods, services, ideas, people, or other entities that were not previously considered goods for sale into a marketable and saleable item. It implies some standardization.

[ii] An interesting article on the commodification of women’s household labor, which has bearing on the internal and external struggles for legitimacy of the First Wave of Doulas (late 1980’s to mid 2000’s): http://digitalcommons.law.yale.edu/cgi/viewcontent.cgi?article=1126&context=yjlf

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Take a Doula Training, Change the World

Nov 9, 2016 by

take-a-doulatrainingchange-theworldAlmost ten years ago I noticed many happy participants at the end of trainings but few people actually went on to become doulas. Being a researcher I decided to do a study, which was recently published as “What Motivates People To Take Birth Doula Trainings?” in the Journal of Perinatal Education, Summer 2016, Vol 25, No. 3. While I can’t repeat what was written for JPE because of copyright restrictions, the blog allows me to explore the findings of this research project in a more intimate way. This first post covers people’s desire for social change by taking open birth doula trainings; part two will focus on professional motivations; and part three will focus on personal reasons.

From 1997 to 2007, most people came to my workshops to become doulas. They traveled hundreds of miles and most people set up practices or attended births in some way. Sprinkled in were attendees who’d had difficult births or were from related occupations. By 2008 I was convinced there was something else going on – why did it feel that fewer people were headed down a doula path?

So, for three trainings I used my own participants for a pilot study. I had people brainstorm all the reasons why they were there until I stopped reading anything new. There were 18 unique reasons. Dang! Now, I wondered how popular each one was, and if this trend was happening outside Wisconsin. I tested on my own workshops again by making a survey to complete before the workshop began. I did that for a year, refined the survey, and then decided a wider investigation was possible.

Next dilemma: Who would volunteer to distribute the survey, and be committed enough to do it correctly? How could I get a diverse enough group in order to generalize any findings? I turned to other DONA International doula trainers, who were willing to implement my persnickety procedures so that everyone was doing the same thing. I am grateful to the many trainers who helped. In the end, the survey was answered by 473 people who took one of 46 DONA birth doula workshops offered by 38 different trainers in 18 U.S. states and 3 Canadian provinces. Data was collected in Oct-Dec or Jan in 2010/11 and 2013.

What I suspected all along was true: people were attending for many reasons and career advancement was clearly important to most attendees. But the proportion is what surprised me. No matter which statistic I cite from the study, what emerged is that only about half the people in those trainings were there with the intention of becoming a birth doula with their own independent practice. And only an additional small percentage intended to become a doula in another setting, such as volunteering or working for a hospital or other program. Remember, this is for trainings where registration is open to anyone[i]. I thought it would be about 70%, but here it was at less than 50%.

The Survey: First I had people choose ALL their reasons for attending from the list of 18 reasons (ALL). Next, they had to choose their top five reasons and rank them in order. Then I could compare what reasons were popular with ones that remained important. “Becoming a birth doula” only ranked for about half the people whether I was looking at all the reasons (tied for third place), the top 5 reason, two 2 or even #1. So why else were people there?

By far the main reason all people were taking a doula training was for social enrichment, not for any professional or personal reasons. “Increase my birth knowledge” was chosen by 74% in ALL, was in the top 5 for 65% and the top 2 for 37% of attendees. This means it was the prime motivating factor.

So what, Amy? Duh. That was my first reaction.

However, when I examined this issue more deeply its significance became clear. It means people are seeking out real knowledge about birth – learned knowledge from those who have been sitting with birthing people during their whole labors, over and over again. People gave up two to three days of their lives to acquire it! This means doulas’ views of birth are spreading. Birth doula workshops are often accessible, welcoming and oxytocin inspiring. Pregnancy and birth are powerful and meaningful to us. We’re attracting people who want this knowledge, and whether or not they actually use it doesn’t matter. Why? Because it changes the conversation about birth in the general public. The doula training has become a medium for transmitting a powerful vision of birth as a laboring person-centered and/or woman-centered one that deserves support.

This interpretation was strengthened by the popularity of two other reasons: “knowledgeably discuss birth issues with all women” (tied for #3 with becoming a birth doula in ALL motivations, and ranking 6th in people’s top 5 reasons), and “want to be around women who believe in women’s bodies and ability to birth” (#2 in ALL motivations, and #4 in the top 5).

This strong desire for inspiration and enrichment was not focused on the individual, but to “help women have better births (not as a doula or birth professional) (#10 in ALL, and #11 in the top 5). In other words, when analyzed as a separate group people who didn’t want to become birth doulas wanted to understand birth more comprehensively and from a perspective they couldn’t get from a book. They wanted hands-on learning but also to comprehend birth by focusing on the needs of the individual persons who are laboring and being born. Doulas put the persons at the center, not the process of birthing, and this is very different from other perspectives in our society. Even midwives need to pay equal attention to both.

Every birth is a symphony of social forces: majority culture values, neighborhood influences, family needs, the home/hospital atmosphere, the effectiveness of the body’s processes, and the individual wholistic needs of the laboring parent and the child. Through open doula trainings, we export the message that caring is a skill, it is not innate or inborn simply because of gender, and it is a skill that can be learned. We also emphasize meeting the needs of the individual over the system the person is birthing in, which is contrary to institutional values.

These messages are revolutionary and have already created social change simply by being enacted by doulas for the last thirty years. As more people grow to see birth the way doulas do, the demands they make on our institutions to humanize and be more rewarding and supportive places for staff to work will change, along with positive results for mothers and babies. The change has to be comprehensive – not just for patients but also for those who care for them. Doula trainings have become another significant medium in our modern society for the message that caring for individuals needs to be placed front and center in our birthing institutions.

 

[i] These results likely apply to other face to face trainings where general knowledge is emphasized. However they probably do not apply to workshops where a substantial part of the curriculum is devoted to a specific interest, especially if that is the reason people sign up. (Ex: shared religious beliefs about birth, a particular method of labor coping, or a desire to build a financially successful doula business).

This is Part One in a three part series about what motivates people to attend birth doula trainings.

 

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