What It Means To Be A Professional Birth Doula
There is a line between doulas who are professionals – where this is the source of their livelihood and the mainstay of their lives next to family and self – and other women who doula occasionally. Not all doulas are professionals nor is it a goal for all doulas. There is a place for all kinds of doulas and we need everyone if we are to reclaim our understanding of birth as important in women’s lives. We lost it in the last century and taking a doula training or doulaing friends and family is a way to reclaim that.
Being a professional does not diminish the spiritual value we find in our work or the fact that many of us find it to be a calling. We would be diminished in some way if we could not be doulas. We have the joy of being in a life situation that enables us to do work we are passionate about, change the world for another family, and create income at the same time.
In my writings, I frequently use the term “professional doula”. It is on a lot of web sites – even in the names of international organizations. But no one has really defined specifically how it applies to our profession. So I analyzed data from my 60 doula interviews, sifted through what I was reading on social media, and read through several books on professionalism. This is what I have come up with to describe the internal identity and behaviors exhibited by doulas who consider themselves professionals. I’d also like to introduce the term “emerging professional”, to represent doulas who are growing to meet professional standards. So what does it mean to be a professional doula today?
1. To be a professional means that you have completed education and training to gain the necessary knowledge and skills recognized by others in your profession. Much of doula education is self-study, reading books and completing assignments, combined with taking a workshop and using hands-on skills correctly. Training may involve working with a mentor and on the job training without any supervision. Improvement comes from appraising our experiences and evaluations from clients, nurses, midwives and doctors.
2. To be a professional means you have acquired expert and specialized knowledge. This goes beyond learning a double hip squeeze in a workshop. It means making sense of people’s conflicting needs in the birth room; intuiting when to speak and when to keep silent; how to talk to a physician about the patient with a sexual abuse history; how to set up a lap squat with an epidural; and so forth. Competence and confidence grow in interpersonal and labor support arenas. Any additional service you offer to clients means that you have additional study, experience, and possibly mentorship or certification to use it appropriately.
3. To be a professional means that you receive something in return for your services. For many of us that is money or barter goods. However there are doulas who receive stipends that prohibit receiving money for any services performed. They may request a donation be made to an organization instead. If they meet the other requirements for professionalism charging money should not be the sole criteria holding them back.
4. To be a professional means that you market your services and seek out clients that are previously unknown to you. You consider doulaing to be a business.
5. To be a professional means that you hold yourself to the highest standards of conduct for your profession. You seek to empower and not speak for your clients. You give information but refrain from giving advice. You make positioning and comfort measure recommendations that are in your client’s best interests. Your emotional support is unwavering and given freely. Your goal is to enhance communication and connection between her and her care providers. You seek to meet your client’s best interests as she defines them. Several doula organizations have written a code of ethics and/or scope of practice in accordance with their values. They require any doula certifying with them to uphold them. But signing a paper and acting in accordance with those standards are two different things. Even the values represented by various organizations are different. Holding yourself to the highest standards is shown by how you behave.
6. To be a professional means that you put your client first. When you make a commitment to be there, you’re there. If you become ill or have a family emergency there is another professional who can seamlessly take over for you. You keep your client’s information and history confidential. Confidentiality means not posting anything specific or timely on any social media. Your responsibility to their needs and not your own is a priority.
7. To be a professional means that you cultivate positive relationships with other perinatal professionals whenever possible. You respect their point of view even when it differs from yours. You seek to increase your communication skills and to understand different cultural perspectives. You keep your experiences with them confidential and private. You learn from past mistakes.
8. To be a professional means that you have a wide variety of birth experiences and feel confident in your ability to handle almost anything that comes along. Other professional doulas respect you and make referrals. Note that I did not include a number of births. Because of life and career experiences, some doulas will arrive at this place sooner than others.
9. To be a professional means that you seek out and commit to doula certification that promotes maximum empowerment of the client, using non-clinical skills, values and promotes client-medical careprovider communication, and requires additional education before offering additional non-clinical skills. Certification means that you are held to standards that people outside your profession can read and understand. Not being certified means there are no set expectations for that doula’s behavior. Some doula training organizations have very loose certification standards with no specifics behaviors listed, just general attitudes. Certification with behavioral standards that can evaluate whether the doula acted according to those standards is important for furthering the professionalism of birth doula work outside our own individual spheres. It means that a doula is accountable to someone outside of herself and her individual client. (In other words, certification in the context of professionalism is not about you, but about how it affects other people’s perceptions of you AND our profession as a whole.) Having said this, not all doulas have certification like this available to them.
10. To be a professional means that you seek to improve your profession by serving in organizations, representing your profession at social events, and assisting novice doulas to improve their services. You balance your own desires and needs with the actions that further the doula profession – such as certification. You know that when you get better – increase your skills, knowledge and integrity – you make it better for all labor doulas.
11. To be a professional means that you have personal integrity. Integrity means that your values, what you say, and how you behave are congruent with one another. Sullivan has written:
“Integrity is never a given, but always a quest that must be renewed and reshaped over time. It demands considerable individual self-awareness and self-command…Integrity of vocation demands the balanced combination of individual autonomy with integration to its shared purposes. Individual talents need to blend with the best common standards of performance, while the individual must exercise personal judgment as to the proper application of these communal standards in a responsible way.” [p. 220]
“Integrity can only be achieved under conditions of competing imperatives. Unless you are torn between your lawyerly duties as a zealous advocate for your client and your communal responsibilities as an officer of the court, you cannot accomplish integrity. Unless you are confronted with the tensions inherent in the practice of any profession, the conditions for integrity are not present: “Integrity is not a given….”
In a doula context, this means that when you are in the labor room trying to figure out what the right thing is to do and struggling with it, you are having a crisis of integrity. “Do I say something to the medical careprovider (MCP) or do I keep my mouth shut? Have the parents said anything on their own behalf? Do I just let this happen and help them afterwards?” What value takes precedent: empowerment of the client or allowing an intervention to occur that may affect the course of the labor? How will each potential action change my relationship with the MCP? Situations like these are true tests of integrity that require us to rank our values of what is most important.
Sullivan, William M. (2nd ed. 2005). Work and Integrity: The Crisis and Promise of Professionalism in America. Jossey Bass.
How does this fit with your definition of professionalism for doulas? What parts do you agree with? If you disagree, consider why – is it my wording or the spirit of what is written? Let me know – let’s keep talking about this!
Here is a pdf copy of this post to print or for your doula discussion group.