Doula originally means "a woman who serves a woman" in Greek.  Now it is used for a person or a profession that offers continuous physical and emotional support during labor and birth. 

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Doulas are different from midwives.  They do not practice medical treatment or offer advice.  Doula holds a space for the birthing person and family so that they feel comfortable and are able to focus on their own birth process.

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Each doula comes with different background and skill set.  Many use certain items such as a birth ball (a large ball for pregnant women to sit on) or Rebozo (long cloth that can be used to wrap around a body)  to help repositioning and making rhythmic movement.  They offer comfort measures such as breathing guidance to the birthing person as well as partners and family members. Doulas provide necessary support according to the situation.  Sometimes that means helping clients to actively participate in the birth process, be an advocate for the clients, and be a bridge between clients and medical staff.  Sometimes it means just sitting by their side and giving a caring nod.

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There have been two main types of doulas; Birth doulas and Postpatrum doulas.  However, in recent years, Doulas have evolved and are becoming more diverse in terms of what support they offer.  Now Doula support is considered more broadly, not just around childbirth, but for any life events that needs emotional support.  A few examples of such diverse support are; fertility support, antepartum support, pregnancy loss and death doula support. 

Every birth is unique and it is difficult to know what to expect.

If clients have concerns, doulas will honor their feeling and walk with them in figuring out what ways they can take so that the clients can have confidence in their birth.  Doulas will be with the clients without any judgement, and try to see things in client's shoe.  By having doula on their side, clients and family will be able to concentrate on the birth process with peace of mind, and effectively find their own strength in them.  As a result, the childbirth accompanied by Doula tends to make the mother feel satisfied.

 

There are many research findings on Doula with positive effects on birth and the family

• Breastfeeding is more successful / relationships with partners are better / attachment to babies tends to increase / abuse is less likely to occur / postpartum depression is less likely to occur

• Shortened delivery time / Decreased cesarean section rate / Decreased usage rate of labor-promoting agents and pain-relieving drugs / Less medical intervention such as episiotomy and forceps / suction delivery

Doulas do:

• Provide emotional and physical support for pregnant women and their families

• Provide evidence-based information

• Strive to improve communication between medical staff and pregnant women / family members

 

Doulas do not:

• Perform medical practice (blood pressure measurement, body temperature measurement, fetal heart sound measurement, pelvic examination, etc.)

• State your opinion on medical practice

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The existence of a person who accompany and supports birth has been around the world since ancient times, but Doula as a profession has a long way to become accepted in the community.

However, the importance of having someone other than medical personnel at birth, the importance of knowledge and experience in breastfeeding and various options related to birth are being widely recognized.  And birthing people are increasingly becoming more aware of their right to choose their desired birth and to actively participate in their own birth.  To do so, having doulas as their advocate has become very important.

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Many doula accreditation organizations around the world have certification programs for doulas.  There are many other trainings which will help broaden doulas' scope of work such as lactation consultants and childbirth educators (educators on pregnancy and childbirth; teaching parents' classes, etc.).  However, in many countries, doula trainings are not regulated; therefore, those who have been certified can be accredited by each institution, but it is not an officially recognized qualification by the government.  In other words, it is possible to claim oneself as a doula who has knowledge and experience without being certified.  For some clients, certification guarantees the quality of a doula, while others think personality and experience are more valuable than certification.

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There is no birth doula accreditation body in Japan yet.  As for postpartum doulas, the Doula Association (* an organization different from the Japan Doula Association, the predecessor of Doulaship Japan) started postpartum doula certification course in 2012.  Doulaship Japan (then Japan Doula Association) has sponsored Birth Doula Workshop in 2016, a first of such kind in Japan.  This was not an accredited course, so those who wanted to become certified doula had to seek further education through foreign accreditation bodies.

 

Here are the major organizations that train and certify doulas and childbirth educators in the United States.

• CAPPA (Childbirth and Postpartum Professional Association): http://www.CAPPA.net

• CBI (Childbirth International): http://www.childbirthinternational.com

• DONA (Doulas of North America): http://www.dona.org

• ALACE (Association of Labor Assistants and Childbirth Educators): http://www.alace.org

• ICEA (International Childbirth Education Association): http://www.icea.org

Most of them offer online training.

 

Although it differs for each organization, the general procedure up to Doula certification is

• Participate in the workshop

• Pass the descriptive test (often open books)

• Become a member of an organization

• Read designated books

• Attend parents class

• Witness some births and submit their reports or third-party evaluations

 

Some organizations require to complete the program within certain years, and there are organizations that do not have a time limit.

Of course, there are many countries other than the United States where Doulas are active, and they have their own doula programs.

Anyone who wants to help a pregnant woman can be a doula.

 

However, if you want to support multiple births for a long period of time as a professional, you need to be prepared.  In such case, a question "I wonder if I am suitable for a Doula" should be considered by anyone before taking the first step.  It is not easy to say what is right or what all doulas should be, but for reference, let's listen to what our predecessors say.

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Benefits of Doula as a profession:

1. It's a very rewarding job.
   What you are doing has the potential to change the world through community you grow.

2. If you are a self-employed doula, you can control your schedule however you like.

3. This can be an ideal job for mothers who want to work and have flexibility.

4. Doula is a good starting point to expand your career path.
   For example, you can add or diversify your skills as lactation consultants, childbirth educators, midwives, nurses, the list goes on.

 

Disadvantages of Doula as a profession:

1. It is a physically demanding job that is irregular, on demand, and sometimes can be very long.

2. It can be financially unstable because it is irregular nature.

3. As with any job, it requires an initial investment (time and money to be certified).

4. It can also be a heavy burden for Doula's family.

 

(Excerpted and edited from Inspired birth and families – Doula program http://www.inspiredabq.com/doula-services/ )

"Should you be a Doula?" (Excerpt from Doula.com (www.doula.com))

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First of all, Doulas require an ability to be close to the feelings of others.
In addition to studying for certification, Doulas need to maintain a high level of motivation to constantly incorporate new knowledge. Also, if you don't like blood or fluids, it will be difficult for a Doula to work unless you overcome them.  Doulas don't deliver babies themselves, but being involved in birth is an environment that is always surrounded by bodily fluids.

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In terms of income, Doula is not very successful. A small number of doulas earn around $ 30,000 a year, but the average income is around $ 5,000 a year. Not suitable for those looking for a high-paying job.

 

Here are six questions for anyone who wants to get started as a Doula.

1) Do you have flexible lifestyle?

Being involved in childbirth means that work comes at any time. You must be able to be on call for two weeks before and after the expected date of delivery. Sometimes the call comes during holidays or at midnight.  Birth can progress very fast, so you should rush to the client as soon as possible.  Or, it can also take several days.

 

2) If client calls, can you be immediately available? 

If you have children or family members who you are taking care of, can you immediately ask a sitter or caregiver?  Is it possible if you have to stay with the client for half a day to a full day or more? If you  have work other than Doula, can the your co-workers understand the situation where you have to answer the client's call immediately? And most importantly, are your family cooperative for your  doula work?

 

3) Do your own birth experience and experience as a parent get in the way?

It's a delicate topic, but it's important. Can your own experience be a hindrance to offer non-judgemental support for your clients?  In order to treat clients and medical staff fairly, we must digest our experience properly so that it does not interfere with communicating with others or making decisions.

 

4) Can you clearly convey your opinion and not being intrusive?

From their standpoints, Doulas sometimes give opinions to the clients or for the clients. It is necessary to communicate the needs of clients firmly while building good relationships with medical staff and family members.  Doulas need to speak out when necessary, but must avoid over-asserting in response to the situation.  Always recognize that it is your true role to achieve the birth that your client wants, not the one that Doula wants.

 

5) Are you healthy?

Doula's work can be lengthy. You need to have the physical strength and endurance to continue to be present for a long delivery.  Keep in mind that you will be called to the next delivery soon afterwards.

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6) Is there any resistance against touching the body?

Touching the body is very important part of the work of Doula. Many clients ask for contact, such as holding their hands, rubbing them, supporting them to maintain a comfortable posture, and holding them.  Let's be willing to provide it.

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These are a lot of conditions, but the most important thing is that you are ready to do your best for your clients.

Obviously, becoming a doula is difficult in terms of time and money. The energy to work as a doula is important.  Many women become doulas, but not many sustain.

But some thinks there is no other job as wonderful profession as a doula.

One of the doula had to say.
"Doula is the only profession that makes me so excited to get a phone call and go to work."