Thinking About Being a Doula? Tips for Doulas

Being a doula is one of the most wonderful things I have ever done in my life. I love this work. That said - doula work has its challenges, and as a new doula I wasn't quite prepared for some of the surprises that may come. As a newbie I was told that the turnover rate seems to be about two years - veteran doulas told me that they see enthusiastic new doulas jumping in with both feet and within a couple years the entire crop of new doulas has already stopped attending births. In just the last few years I've seen this proven true.

My own doula journey began with a phone call - I had four babies of my own, and we were hoping and trying for another. An expectant momma called me and asked, "Would you be my doula?" I didn't even know what the word meant, but I knew I was being invited to attend her birth and I thought that sounded AMAZING. It was a fantastic experience for me, but I also had the parents express their gratitude for my help and support through the birth. Then another friend called (shortly after that much anticipated fifth baby of mine arrived) and asked me to attend her birth, which left me equally ecstatic when I heard the parent's expression of thanks. But with five little ones of my own keeping me busy, I decided to research doula training programs and put it on the back burner to happen "Someday."

When our sixth baby was six months old my husband, knowing training could take awhile, encouraged me to go ahead and get started. My hope was to get certified and maybe attend a couple births a year... little did we know! Just six months later I was officially a doula, and it's been a whirlwind since.

For many people I think they can immediately see the appeal of attending births - it's a BIRTH. It's an incredibly intense, emotional experience. (Though admittedly I've also had some people respond to hearing about my job with, "Yikes - why would people want to be there to see that?") But assuming you think birth is pretty awesome, the appeal is obvious. In part this explains why we have so much interest and so many new doulas joining the field, only to have a quick turnover when these bright eyed and optimistic people discover that doula work is exceptionally hard. It's HARD. Physically, emotionally, logistically, being a doula is not something people should jump into lightly. I'm thrilled to see new doulas joining the professional, I've mentored many and will continue to do so. But I think we do ourselves and parents a disservice when we don't provide a better picture of what doula work entails and better support each other through the ups and downs of doula-ing. (I think "doula-ing" is a made up word, but it fits!)

When new doulas are caught off guard by some of the challenges of this work then they're going to struggle to best support parents and are more likely to stop attending births - then we all lose! I'm being very blunt here - these are the hard parts of this work, and I don't want this to ever talk someone out of becoming a doula, but I want you to be more prepared than I was. So in the interest of encouraging some candid discussions, here are some things new doulas should consider - challenges we face, and some ways to help:

Because this got so long I'm going to give you the abbreviated version first, then go into detail below.

1. Exhaustion
2. Logistics at Home/Life on Call
3. Childcare
4. Pay
5. Challenging Interactions
6. Traumatic Births
7. Physical Toll
8. Boundaries with Clients

* You will lose sleep. A LOT of sleep. Not just when attending births, but you may lose sleep when on-call. Remember having a new baby and how every little sound made you leap up because your brain was on high alert? No matter how deep you may sleep currently, there's something about knowing you're going to get that call at any moment that makes doulas (especially when we're new) stay semi-alert even when attempting to sleep. Or maybe you'll sleep great - I hope so! But I've talked with many doulas, even very experienced ones, who've admitted they've popped up to check their phone dozens of times in the night when they knew a mom was warming up and they feared they would miss hearing their phone ring. Even if you are going to bed at 8pm (ha!) you never know when you'll be called - let's say you get up at 7am and are called to a birth at 10pm and the labor goes maybe 12 hours (relatively short.) That means baby arrives around 10am and you'll get home around noonish. You've been awake 7am until noon the FOLLOWING day, 29 hours up. And that's for a pretty quick birth!

Even just falling asleep at night can be trickier because you may lay there wondering, "Is tonight the night? My bag is packed, I'm ready, what do I need to do to make sure my family is all set for tomorrow if I get called away tonight? Rides for kids, meals, my partner's work, etc?" Sleep suffers! My advice - nap whenever you can while on call, go to bed early, and be prepared to need a couple days to recover after births.

* Which leads to the next point, and I've written some more extensive blogs about this in my Tips for Doulas. Logistics - most jobs you have a pretty good idea of when you need to be at work and how long your shift is. Not doula work! You've got about a 4 week window of when you'll be called in (38 to 42 weeks is the average on-call window for doulas) but you've no idea when that call will call, what time of day or night, and when you leave you've no idea how long you'll be gone for... maybe it's a fast birth, but maybe it's 24+ hours. What do YOU need to be ready to be away for that long? (That's a topic discussed in my doula bag post.) And what do you need to do to have your home and family prepared? What about commitments to other people, appointments you've scheduled, or if you work at another job and have shifts during that time? The logistics can be really, really tricky - and really draining, not just for you as the doula but for your children, your partner, your other employer, and even friends and family that may have to have you miss special events because you're suddenly called away. You will miss big life events, you will have your kids cry because of this, YOU will cry because of this. Even when you feel so sure about this work and you are thrilled to be at the birth, you will also ache for the hurt it can cause those you love when you're not there for something that's special for them. It's a very real sacrifice and challenge to sort out the logistics of being away when you're a doula but there's really nothing that can prepare you for the emotional cost, apart from communicating with your family and loved ones about this.

(Those links will take you to some Tips for Doulas posts for my subscribers. If you are not a subscriber then it will take you to a page to learn more!)

* While it fits into the logistics category I'm listing this separately because it's the one I hear most often amongst new doulas scrambling for options, and it's also the reason I hear most for why many women don't pursue doula work - childcare for their own little ones. It's tricky enough being on-call to run out the door for labor at any time, day or night. Having reliable childcare able to also be ready with very short notice to keep your little ones for an uncertain amount of time can be a daunting task. Presuming you are able to find this, then having back up for childcare in case they aren't available, there's still the issue of financially compensating them for this service. This absolutely must factor into your business expenses and for newer doulas who may be charging a discounted fee (or not charging?) then you are losing money to attend births. Search for good childcare, have multiple back ups, and compensate them well.

* On the topic of finances, doula work - at least starting out - may not be consistent. You're creating a business and it can take time to become established and have a steady client base. There are busy seasons and quiet seasons and if you are relying on doula income to cover basic household expenses then it's important to remember like in any new business, your finances may not be steady. Some doulas begin this work while keeping another job, part time or full time. Once they are comfortable with the amount of clients they have then they leave the other work, but when (or if) that happens will vary. You have to charge a fee that allows you to sustain your work, rather than being so discounted that you are losing money after you subtract taxes, childcare, expenses, etc. When setting this fee you need to take into account many factors but make sure you also include your travel time and expenses. Newer doulas are often willing to travel far to take clients, which quickly adds up to many hours in the car between prenatal and postpartum visits. Consider what your travel boundaries will be and work this into your fee. I'll reiterate again - doula work is valuable, and you need to establish a fee that makes this sustainable for you.

If doulas in your area are known and it's a respected profession then you may quickly have a reliable income. Unfortunately, in some areas the role of doulas is not valued and many, even other birth professionals, expect doulas to work for fees that end up being less than minimum wage. Far too often I've heard people say, "OH, I'm sure you can find a new doula to attend your birth for free!" and this is obviously NOT a sustainable business plan. It's an assumption I still see impacting doulas, whether new or experienced, and one I hope we can overcome as doulas are birth professionals and their work is worth the investment.

* Because some people still don't see doulas as professionals, you may have some negative interactions with everyone from offended in-laws wondering why you are in the birth room when they're not invited to hospital staff who feel that you're making their jobs harder to OBs (and midwives!) who tell parents to not hire doulas to partners worrying that you are taking over their role at the birth. You may have clients that are unhappy with their birth and feel you are in some way accountable. You may offend care providers or other doulas, however inadvertently. There will be at some point, however kind and well meaning you are, someone that you upset and offend and some awkward (or ugly) confrontation that you have to deal with. This applies to anyone starting a business, but in the world of birth this can make for some even more emotional and challenging conflicts. I've seen it happen to the sweetest doulas you can imagine, and it can very much deflate their enthusiasm for the work. Be professional, be respectful, and try to not take things personally when emotions are heightened. Your kindness and positive interactions will help establish your great reputation.

* Many births are gorgeous and perfect and you will cry tears of joy and walk away feeling like you're on a cloud. Everyone will be thrilled, the care provider will be compassionate and attentive, the parents will feel respected and heard, and you will know you have done a wonderful service. Some births are... not like this. Parents may feel their wishes are ignored, you'll work with less than caring "care providers", extended family may be unsupportive, mistakes will be made, there will be rude comments, you'll see things happen that you know could have been prevented, and you may doubt yourself and wonder what you should have done differently. Some births are just hard, not because things didn't go as planned but because the parents weren't treated with respect and in many ways those are the most devastating. Even when everyone is on board and working as a team, some births have intense complications that can leave everyone in the entire room feeling devastated and traumatized. Birth is emotionally intense in good ways - but when things go wrong, birth can be absolutely crushing as well. You need someone to decompress with, a doula mentor or peer you can talk with and confidentially process experiences so that you can learn and heal and go back to serve!

* Apart from the emotional toll that some births can take on you, births can be hard physically! You'll be on your feet for hours, providing counter pressure with hip squeezes, massages, supporting mom's weight, squatting, kneeling, leaning over tubs. You'll be suprised at how physical labor is for YOU and the mom's partner. Doulas have commiserated over neck and shoulder cramps, aching backs, sore legs & hurting feet. Not that our physical challenges in any way compare to the laboring moms, of course!! But you'll want a chiropractor and massage therapist lined up for helping adjust your body after attending a long labor. Until then, an epsom bath soak and staying hydrated can help!

* Boundaries - post about that here. I've been so blessed by the sweet, gracious, beautiful families I've had a chance to serve. Many have become dear friends and I feel honored to be part of their journey. However... I've heard some really, really concerning stories from fellow doulas about situations that ranged from concerning to shocking. I think it's important for every doula to remember that she is creating a business and must establish clear boundaries both professionally and personally. Sometimes doulas, despite doing everything they can to communicate clearly, may end up with miscommunications or other issues with clients that can leave them in a rough situation. Sometimes the birth may not go as planned and parents feel the doula was in some way accountable and feel angry. I've heard of this being expressed all the way from negative reviews online to threats of lawsuits. Moms may be have questions & if they are unclear on when is a good time to call about non-labor related topics may be contacting the doula around the clock with things that could be answered during the day, rather than at 3am. This can leave a doula exhausted when she's being texted or called at all hours. (We want to be there for our clients, of course! But calls about treatment for heartburn don't need to come in the middle of the night.) Some clients may not make payments in a timely fashion despite the contract explaining this, leaving the doula having to attempt to collect or working without being paid. Running a business comes with situations like this, but in the world of birth work there's an added element of clients emotionally relying on their doula for support and some element of us being accessible around the clock. If you are unsure of what boundaries you want to establish then you may end up feeling overwhelmed, sleep deprived, and taken for granted. Decide what your guidelines will be and express these to clients, because you teach people how to treat you.

* Another note - over and over I meet aspiring doulas who've recently given birth (often within the previous year or two) and they fall into one of two categories. Either their own birth was so amazing that they desperately want to attend other births and share their passion (which is great!) or they've had a rough birth, were unhappy with how they were treated or what the outcome was, and want to become a doula to help other moms have a different experience. In the latter case, ideally they've already worked through the trauma of their birth and are at a good place emotionally. Admittedly sometimes they are not in a good place to support other moms and are entering the birth rooms with their own agenda - and that's not fair to the clients. Whether these new moms are coming to the doula world after a beautiful or challenging birth, often they're not fully aware of the issues above - in combination with having a little one at home, possible a nursing baby, it can make doula work even more complicated. They'll attend a few births that are relatively quick (under 10 hours) and they're loving doula work and it's wonderful! Then they have a marathon birth, their partner and family are struggling with them being away for so long, and suddenly there's much less appeal to being on call at hours and away for days at a time. That's absolutely understandable, and of course your family's needs must come first! But it's an issue to be mindful of when you are deciding what the best time is to begin your doula work. To help address some of this challenge you may want to decide how will you handle being away from your baby for long periods of time? If nursing will you be able to pump at the birth? Will your baby take a bottle? Do you want to set restrictions for how far from home you'll travel while your baby is young? If you have one child and are training as a doula, will you have more children? Are you comfortable going to do doula work while pregnant, and until what point? How long would you take off for maternity leave? Is this the best time for you and your family for you to begin doula work? If your own birth was rough, have you taken the time to work through the experience and seek counseling if necessary?

Doulas, what would you add to this list? What things do you wish you had known as a new doula? I would love to hear from you!

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