What It Means To Be A Professional Birth Doula

Nov 26, 2013 by

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.

 

15 Comments

  1. Joyce Vanselow

    Here’s my thing: I’m a human being first and I respectfully treat everyone as such– FIRST! Doing so, seems to engender trust all around. THEN… I add to that and integrate in what I’ve learned (through formal training and education, trial and error, and through experience and observation) over time (including interactions w/personnel, good, bad, and ugly)- and what I continue to learn is that I’m never done learning… and that the mamas are the VERY best teachers of all skills and qualities befitting any birth-worker worth their salt, which surely keeps me from getting too big for my britches because I see how sacred even the most technical aspects of the biology and physiology of birth is. Birth is HUGE and women are powerful… and I am humbled by what I have learned about it. I offer the sum-total of that through my work, in a down-to-earth manner, in whatever context birth happens. I’m consistent and reliable and my work is excellent. This appears to be enough and if not, then that’s not about me. I’m not out to prove my worthiness to anyone or to seek approval or external validation so I can be somebody because I AM somebody. I feel good and think that there is TOO much effort to frame birth work as something to elevate and promote personnel, instead of something to illuminate birth in all its amazing glory as uniquely womanly. Does that make sense? We each come to these values and realizations about who we are in the context of our work and these are going to be worn on our sleeves along with our hearts, and appreciated according to the individual needs/wants/preferences of women, who ARE the REAL authorities, certifying our work and reinforcing the qualities and standards that create our professionalism through our work with them. (Long story short: this work is like dog food that makes its own gravy in terms of professionalism. If you are not, then you will not work.)

    • Amy Gilliland

      YES!!! Professionalism is created internally by the doula, as you have so passionately described!

  2. I like that idea “certification is not about you”. It’s not. I think that’s the stumbling block for so many who actively oppose or shy away from certifying. I think it ties in with integrity: it says something about one’s dedication to the profession as a whole and to safety for all people in the birth room when a doula pursues and maintains certification. Certification is a pledge of commitment and I feel there is a kind of sacredness to it.

  3. MissCrystal

    I agree with most of what you said. But I do not believe that being a professional means being certified. I’m a registered nurse who has chosen, even though I’ve gone through three different training courses, not to be a certified Doula. And from what I’ve seen personally, I hold myself more responsible than some of the certified Doula’s in my coalition. And I’m allowed in all of the hospitals in my city, where a lot of certified Doula’s have been told not to come back.
    I am not saying certification is bad, I just don’t think it’s a requirement of professionalism. I hope one day there will be a state and national recognized training for Doula’s. And when that happens, I’ll get certified.

    • Amy Gilliland

      I just finished a five post series outlining the dilemmas of certification so I urge you to read that. Plus not all doulas have a certification process like I’ve described available to them.

      • MissCrystal

        Thank you for taking the time out to respond to my comment. I have read your other posts about certification. And I understand where you are coming from. I still don’t agree that certification is a defining mark of professionalism.
        I have a license for my Doula business, pay insurance, pay taxes, pay for my supplies, and pay a lawyer to go through and adjust my contracts when needed. All of my expenses out, to help me do what I do, are more of an incentive to me to maintain my good professional standing then any of the certification processes I have studied.
        I do want and intend to be certified at some point. But as of yet, I’m not comfortable of holding a certification from an online company that has no one to oversee it. When certification for becoming a Doula is regulated like any other college or trade school program, I’ll be certified. Until then, I don’t see an upside to it.

        • Amy Gilliland

          I don’t disagree with you at all – certification was only 1 of the 11 criteria that doulas identified and the certification system is not meeting the needs of most doulas. Birth doula care is growing to become something people want and expect to be available, rather than a doula having to sell the idea. So our work is also being shaped in response to market forces and consumer demands (which we want). We want mothers to want doulas and demand personalized care from their providers. They are also beginning to want reassurance from an outside group about their doula’s assertions about herself. It IS a personal relationship but it is also a business relationship. New and sticky territory for many doulas. You’ve navigated this territory and found your own path to being a professional. Thank you for being a voice in this conversation.

  4. i only wish you had distinguished between a postpartum doula and a labor doula as the general public thinks a doula is a labor doula and they are two separate professional fields. Nice article. Some of the work and attitude overlap, for sure. But as a postpartum doula for 22 years and having worked with over 800 clients, i never felt i stepped into the labor doula world for a second.

  5. Amy

    I agree 100% with most of what you say. And I think all these things can apply to someone (like myself) who only does labor support once in a while. It’s not my main source of financial income but I still hold myself to high standards as you describe them here. I support good certification standards in spite of not being certified by a professional association myself. That said, certification doesn’t guarantee anything in the long run–experience is worth a lot, and I’m a better doula than anyone just emerging from a training program who carries a certificate.

  6. Lesley Everest

    I absolutely know without a bat of an eye what you mean about simply showing up, holding a space for whatever comes up, and feeling into the mystery and ambiguity to authentically support a woman’s unfolding process. These are skills that will absolutely come with experience to the novice doula. But my work (and yours) at this point in our lives is very likely informed by FAR more than our doula training and doula experience. You do have a PhD after your name (and bravo to you for that!). To even language the way we communicate with out clients in these ways is not something that comes even with experience to many without a lot of extra curricular education (though i certainly wouldn’t speak for everyone on that). I am wondering if this model that you outline, though it is your experience and the experience of those whom you have encountered, is a bit more academically based than the reality of many a career doula’s experience. Most of these items you raise are absolutely right on, such as integrity, cultivating favourable relationships with perinatal care providers, serving your client impeccably, etc. Those would be important universal doula traits, as they are in true service to the birthing family. But when we get into the types of trainings one would “ideally” seek out, or participating in professional organization activities (having families, attending many births to feed those families, and pursuing other educational tracts often means doulas simply wouldn’t have time to commit to more work like that), that gets a bit prescriptive to me. I realize you are simply reiterating what you’ve heard other professional doulas do, so I know you’re not necessarily adding your own biases to this, but I definitely think,we have to honour and include the idea that not all career doulas are going to resonate with every point here. There are many who just don’t rally with the groups or go with the grain of typical trainings, yet serve their communities with impeccability and integrity…

    • Amy Gilliland

      With respect to #10, the communities you mention are organized groups. I was referring to feeling a sense of responsibility to something outside yourself by serving a group or community. It also means that you realize people are forming their impression of doulas by interacting with you when you are at a social event. That you recognize that responsibility and realize people are judging doulas by your behavior, and that affects how you behave. What I’m describing here is a process of IDENTITY shift that happens internally. Because of your comment I have revised and clarified the third paragraph.

      • Lesley Everest

        Yes, that is true. I don’t have time to engage in a lot of advertising (thankfully I haven’t needed to), nor am I at all enamoured with a lot of political organization building (though I honour that need…it just isn’t a personal interest) but I absolutely make sure that I behave professionally pretty much anywhere I go with respect to the fact that if I describe myself as a doula, I am very much wanting to represent those in my field well. The doulas I mentioned who work outside of a certifying organization context are also very aware of how they represent themselves. So we are in agreement with the fact that the shift of identity into representing oneself professionally out in the world is essential. If I or someone in my small, independent organization messes up, this is a profound thing we do our best to rectify, always holding ourselves to very high standards of behaviour and embracing opportunities for improvement. We are all allowed to have our personal chaotic drama, but these are parts of ourselves that are best kept private so as to best serve our clients in as centred a way as we can. I feel this shift is actually innate and logical. For a doula to continually work successfully in her community to the extent that it is her primary source of income for decades,, her professional behaviour with clients, caregivers, and colleagues (oh my!) will HAVE to be informed by a great sense of social responsibility and impeccable representation, otherwise she will be out of work. Thanks for the clarification!

  7. Amy, I appreciate so much of what you have written here and as a birth doula trainer, I would love for you to speak more to #2. As you mention in #1 much of what we do comes from self-study and I would add that much of what you mention in #2 comes from trial and error in experience. How do you reassure newer doulas that this wisdom comes from being in the arena and that all of us started at square one learning these skills?

    • Amy Gilliland

      I think it comes from telling the story and asking for other people’s perspectives. I participate in a lot of these conversations on Facebook – part of #10. But I’ve been doing it in person and over the phone for decades. The hardest part is realizing you are in over your head and that there is so much to know. There are many subtleties to people’s behavior! Doulas who stick with it learn to tolerate ambiguity and realize the purity of the doula’s gift is showing up 100% for that mother. The rest comes as you go through it and open yourself up to be taught. By mothers, by nurses, by care providers, by other doulas. It is a path you walk not a place you suddenly arrive. But you’re not alone. I think that’s what we need to communicate as a community to our novice doulas.

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