A doula is a birth and postnatal companion, who provides sustained support to the mother or couple and new parents during the time around childbirth. In view of her lay status, it is not mandatory for the doula to undertake any formal training, in effect she may simply be a relative or friend of the mother-to-be. The fact that she has completed a short course in basic preparation to work as a doula however opens the door for her to charge a fee for her services if she wishes. This period of basic formal learning and skill development should not be confused with professional training where an extended period of study leading to qualification and statutory regulation, as in midwifery, is the outcome. While it may improve the standard of her knowledge and listening skills for example, the real essence of the doula comes from within herself and is not necessarily something that can be taught. As most women do choose however, to undertake a short programme of study before setting themselves up to offer support to the birthing family, let us explore what a doula might need to know, and why.

We understand from research studies that having the support of a doula can improve birth and parenting outcomes as well as the mother”s overall satisfaction with her experience (1,2). What has not yet been examined is exactly that which makes her support effective. Sheila Kitzinger sees the developing doula role as ??an opportunity to use skills which have not previously been recognised as marketable – understanding and insight, sympathy, warm friendship, a capacity to communicate effectively and at an intimate level?? (3). As we have already established, these skills are not necessarily ones that can be learned through instruction however, as Michel Odent remarks ??If the focus is on the training of the doula rather than on her way of being and her personality, the doula phenomenon will be a missed opportunity.?? (4).

Some women just doula, often without knowing that what they do has a name, supporting expectant and new mothers is an integral part of their way of life. These doulas have not necessarily undertaken any course of learning, they instinctively work in response to what the mother needs, gleaning whatever additional information they require from books, conferences, online resources and personal communication within the birthing families network. But there are other women who are truly drawn to doula-ing, yet do not have the confidence or the resources to simply start doing it.

In my experience as a doula course leader or “trainer”, I regularly point out to prospective students the questionable issue of “training” as a requisite. Despite suggesting that, as doulas, we are simply women supporting women, mothers supporting mothers, they still feel that they would prefer to do some preparation work. I often wonder how far this reticence stems from a generic lack of belief in our own abilities, as women, as mothers, even as birthers. In addition, there is frequently an impression that they are not “allowed” to work as doulas until they have undertaken a “training” course or acquired a “qualification”. While the latter is not the case, in the light of such anxieties, it perhaps does seem appropriate that a certain level of learning and understanding is undertaken by new doulas, over and above personal experience. And, perhaps more significantly, that the new doula has the opportunity to begin to debrief and reflect on her own journeys of birth and parenting within a safe environment.

Without taking the time to acknowledge and process, particularly traumatic, personal birth or mothering experiences, new doulas may carry their unresolved issues into the birthspace or “babymoon” of another mother or family. Not only is this inappropriate to the supportive role, but the doula is also vulnerable to continuing to attract mirror situations to her own unfinished issues until she does make a commitment to addressing them within herself. Working as a doula is not about the doula, it is about the mother and her family, and a doula who does not take care of herself is not only unable to wholly support others, but she runs the real risk of burning herself out.
A doula course can be a way of identifying these women, and it is the doula course leaders responsibility not only to the student but also to the public, to support them to find the direction that is right for their doula journey at this point. This may be to help them find a way of processing their difficulties in a more appropriate supportive setting, with a view to them developing towards being ready to offer support to others at a later date.

The doula course can prepare the student to practice excellent listening skills, to understand the importance of protecting the birthspace so that the labour remains undisturbed and the mother is therefore more likely to enjoy a physiological birth. It can prepare her with tools to calm and encourage a nervous father-to-be or support a new to breastfeeding mother. It can also inform her about the practicalities of setting up as a self employed person, give her ideas on how to let her community know about who she is and what she does, and guide her in knowing how to establish clear working boundaries with the birthing family. Yet when she has completed her course, her learning does not stop there. As she sets out to start working with her first families, the novice needs mentorship from an experienced doula, someone who is her own doula, whether on an informal or formal basis. She needs to know that there is someone she can call on to debrief the distressingly difficult birth she has just witnessed, or to guide her when the new mother she is working with is struggling to engage with her new role. Even experienced doulas need a trusted peer to turn to when a situation touches a nerve, which it does or will. Doulaing is a way of life, and life always throws sideballs from time to time.

There is no standardised system for the preparation of doulas, which may be seen as a positive situation for, if the ideal is that there is a doula for everyone, diversity in her learning and experience is surely the key? A woman coming into doula work would be well advised to choose her preparation course carefully, ensuring that the philosophy behind it resonates with the way she lives her life and that the programme leader is sympathetic to the true essence of the doula. Given her inherent nature to “be” rather than to “do”, it could be suggested that a course based on honouring the celebration of childbirth with quiet humility and integrity, where the student is encouraged to work in a way that mirrors ongoing reflection and commitment to service and community, would be preferable. A programme geared towards “training professional workers” however, offering the doula official accreditation and encouraging aggressive approaches to marketing, is possibly missing the point? There is no place for ego in this work, new doulas spawned from such origins may quickly find themselves estranged from the grassroots ethics and principles of the doulas true essence. There seems little doubt that the dynamic of doula-ing changes when a doula is chasing money, and therein the integrity of her role is surely lost.

A doula preparation course is perhaps therefore as much about the doula pursuing her own personal journey as it is about initiating her vocation as a birth or postnatal companion. It is about encouraging a reflective attitude and community spirit, a presence of mind and careful action, and nurturing the confidence that it is enough just to be herself. These are lifelong lessons for which no academic qualification or professional certification can provide, and at the very least, the novice doula can rest assured that she will enrich her life experience through this learning and sharing.

1) McGrath Susan K. PhD & Kennell John H. MD A Randomized Controlled Trial of Continuous Labor Support for Middle-Class Couples: Effect on Cesarean Delivery Rates Birth 2008; 35 (2), 92-97

2) Berg M & Terstad A. Swedish women”s experiences of doula support during childbirth Midwifery 2006; 22, 330-338
3) Personal communication with Sheila Kitzinger, author and childbirth activist 2009
4) Odent M (2002) The Farmer and the Obstetrician London: Free Association Books p123

Further Resources:
Doula UK
Scottish Doula Network
Australian Doulas

This article is an edited extract taken from Adela Stocktons upcoming publication, Gentle Birth Companions: doulas serving humanity, a pioneering book about the global doula movement outside the US. Adela can be contacted through her website.