How to Become a Doula in the United States
As doulas have become more popular and well-known, an increased number of women are exploring the idea of becoming one. But becoming a doula is more confusing than it might seem at first glance.
You might wonder…
Which organization should I train with?
Should I become certified?
How do I become certified?
Does certification even matter?
How do I afford a doula training?
Can I make this my job?
What do I do once I’m a doula?
Can I attend a birth without doing a doula training first?
And you probably have many more questions than just those! Since you’re not likely to find Doula listed in a career guidance handbook, getting all your questions answered can be tricky.
Over the years, I’ve had many people come to me asking about doula training. And my answers are never short. Even then, I have to summarize the options because there’s just too much to talk about (and most people glaze over about 3 sentences in…). So I’ve finally put together this deep dive as a sister post to my How to Become a Midwife in the US article.
But before we get to answering questions, a little history and context are important.
A Brief History of Doulas
Once upon a time, not so very long ago, laboring women were cared for and supported by their sisters, mothers, grandmothers, aunts, or close female friends. Biologically-speaking, it was important that they felt safe and secure so they could relax into the intense experience of birth. As birth is a deep journey into ourselves, it’s helpful to have a guide or at least a companion.
While men were sometimes around, it was the women that understood, weren’t afraid of birth, and could offer the empathy needed for support. Women have always accompanied women during pregnancy, labor, and birth.
It would be a bit of a diversion to dive deeply into the history of childbirth in the US (and I plan to write several articles about this topic in the near future). But here’s a summary of what has happened over the past 150 years.
HISTORY OF BIRTH IN THE US
Briefly, birth became a medicalized event, attended by doctors in hospitals. Birth no longer happened in the context of communities and homes. With the medicalization came a limit to who was allowed in the hospital room. Partners were (at first) strictly forbidden and family members, in general, were seen as a problem and a distraction from the medical process.
So, our partners, aunties, mothers, and sisters had to wait outside.
Birth became male-dominated, with strict rules and a culture of “good patient” and compliance.
When the counterculture movement began in the 50s, 60s, and 70s, midwifery resurfaced after being forced underground for many decades. Women started to wake up about their rights to their own bodies and reproductive experiences. Slowly, this movement became part of the mainstream worldview in limited forms (mostly due to scientific studies showing how useful aspects of this movement were for health - e.g. breastfeeding, relaxation techniques, doula support).
The term doula supposedly originated from Ancient Greek and means “servant to women.” I’ve heard different stories of how the word actually came to be connected to our modern concept of a doula. The use of a word from ancient times doesn’t mean that Ancient Greek people used the word in that way though (just as a clarifying point and to ensure we don’t make any unnecessary assumptions).
Doulas have become more common in the hospital world over the past 20-30 years, as doctors and nurses have begun to listen to research and realized doulas were useful in providing continuous support to patients — something most hospital-based healthcare providers can’t offer.
Over the last decade or so, recognition of doulas has exploded and more and more women are hiring them to attend their births.
Why Should I Become a Doula?
If you’re here reading this post, you probably already know lots about doulas. Maybe you hired one for your own birth. Perhaps you’ve always been fascinated with birth and are trying to get involved in some way. Or maybe you’d really like to be a midwife and someone recommended that you become a doula first.
There are many paths that lead someone to the point of wanting to become a doula, none of them right or wrong. The very fact that you’re here means you’ve started to ask questions and to dream of possibilities.
I’ll admit, being a working doula isn’t for the fainthearted. But the path of supporting birth is a soulful one that attracts folks who are ready and willing to challenge modern paradigms.
Also, keep in mind that there’s no one “right” way to be a doula - only the way that works well for you, your life, and the people you support. Just because you complete a doula training doesn’t mean you have to do doula work in the way described to you. It doesn’t mean that you have to even be a doula at all.
Your training can inform other things you do, inform you on a path to activism, or help you develop products and services that are geared toward pregnant or postpartum women. The sky's the limit when it comes to “how” to be a doula. So, if you’ve got a Why you can let the How unfold over time.
How Do I Train to Become a Doula?
The first doula training organization (Doulas of North America - DONA) was created in the 1990s and many others have popped up since. Each training has a different philosophy and perceives the doula role in slightly different ways. Most trainings last about 3-5 days, with homework, reading, and hands-on experience required afterward in order to apply for certification.
When looking at a particular training, read through the organization’s value statements and get a thorough sense of the scope of practice they want their trained doulas to follow. You may or may not prescribe to their beliefs and it’s better to know that going into the training than afterward.
Once you find an organization you feel connected to, you’ll need to find a training that is close to you and at a time that works for you. This might be easier or harder depending on the organization and where you live. You might need to travel to participate, so factor this in when estimating cost.
Yes, there are online programs that might be a good fit for some. If you learn well online, this could work for you. Just don’t forget that doula work is 90% hands-on and not having a hands-on experience during training could impact your ability to conceptualize various support techniques. Decide what works for you and get help from someone local if you need to practice.
Once you’ve attended the training, you’ll usually then be required to read a selection of books, do some writing and reflecting, and attend a few births (with paperwork completed to either prove that you really did or to at least help you reflect more deeply on the experience).
How Can I Afford a Doula Training?
Doula trainings typically cost $200-$1000 or more. The price doesn’t necessarily reflect the quality or value. You’ll have to do some research to find out if the program is a good fit for you financially and philosophically.
Sometimes newer doula trainers will start out charging less for their trainings and increase the cost over time as they get more experience. Others set a low price and keep it there forever. Others put a new spin on the standard doula training, then set a high price. It’s very dependent on the organization, the doula trainer(s), and the area you’re in.
If you really want to do a doula training and you’re just not sure you can afford it, you have several options. Here are a few to consider.
Contact a doula trainer and ask to organize a doula training - she might allow you to go for free or at a discount if you get a certain number of signups!
Investigate whether the person/organization offers scholarships.
If you’re crafty or good at baking, ask friends/family to help fund your training by buying your goods.
Organize an online fundraiser and ask friends/family to participate (and share so others can chip in too).
Ask the trainer/organization about a payment plan.
Take on an extra shift at work or a paid side project.
Sell something you don’t need anymore online.
Get creative with your own ideas!
Do I Need to Get Certified as a Doula?
This is a hotly debated topic among doulas. The factual, legal truth is that no, you don’t need to get certified to work as a doula. By that measure, you don’t even need to be trained.
If you’re a compassionate person who’s worked on healing your own trauma, you know lots about birth, and you have people asking you to be their doula - by all means, go for it! There’s a reason doula trainings are typically only 3 days long. You already have most of the tools of a doula just by being your kind, loving self.
That said, most of us find training useful for clarifying our knowledge and skills. If you’re new to the birth world, you’ll probably find a training to be exciting and expansive, if not altogether necessary to better understand what doulas do at a birth.
DOULAS AND CERTIFICATION
Just a quick tangent discussion on certification… Most Americans don’t understand what a certification is and its relationship to a license, and the further relationship to the law. There are some professions that are required, by law, to be licensed. A therapist is a good example of this. You can’t hang out your shingle and call yourself a therapist until you’ve done the right training, completed the right certifications, and then also become licensed. The certification is simply the way to prove that you’re ready to be licensed (AKA regulated) by the state.
For a profession like doula work, there is no state license requirement. Therefore, certifications are just certificates of completion handed out by organizations that have created them. They mean nothing to the state or the government at all. They simply communicate to the public that you’ve fulfilled that particular organization’s requirements. Some organizations might have a lot of requirements and some might have very few (or might just consider you certified after finishing the training).
In a society that’s obsessed with professionalism, the birth world hasn’t been exempt. More and more doulas are certain that certification and licensing with the state is the way to go. And they have some good points regarding being able to bill insurance and get reimbursement from Medicaid. When doulas are doing such great work at reducing birth and postpartum issues, who can argue with these folks wanting to be recognized and paid appropriately for their work?
That said, there is always a dark side to regulating a profession through state licensing. The state then gets to control how you practice, who you get to work with, and the specifics of what a doula is and is not. While we could argue the details of what doula work looks like, should we really be requiring every auntie, grandma, and sister to become licensed as a doula in order to support their loved one? I sure hope not.
But I digress… Back to how to become a doula!
Generally speaking, whether you become certified or not is entirely up to you. As long as doula work is unregulated, you get to determine what being a doula means for you and for the people you work with.
Will parents care whether you’re certified or not? Honestly, most of them won’t have a clue what that means or that it’s even an option for doulas. And if you’re a good fit to work together, none of it even matters. You showing up and offering support that truly helps is the only thing that’s important.
Can I Really Make Doula Work My Job?
This one is much trickier to answer. It really all just depends. Making doula work your full-time living can be a serious challenge, mainly because it means you have to start and run a successful business.
There are several challenges that come with on-call birth work. These include…
Childcare if you have young children - the kind of person that will step in at a moment’s notice and in the middle of the night.
Whether you have other monetary support (e.g. a spouse/partner that brings in enough money to support the family and your new business, or savings to live on while building a business).
Being on-call 24/7 - sleeping with your phone, waking up at 2am, light sleeping due to worrying you might miss a birth, having to leave family events and miss birthdays, etc.
Supporting women and families through very emotionally challenging experiences on a regular basis.
Taking care of your own physical, mental, and emotional health.
Dealing with the challenges of running a business - taxes, marketing, legal, finding clients, etc.
And many others.
If you have a sincere passion for birth work and you feel a calling to serve women, then these challenges will seem like mere hurdles to overcome. For other people, these challenges will keep them from birth and encourage them to find other ways to support pregnant women and new families.
It’s important to note that some doulas have found ways to make their clients fit into other more “normal” jobs that they do. They might have a flexible job that allows them to leave to attend births without penalty. Or they might have another business that they run alongside their doula business. Or they might have the time to build up other services that don’t require them to be on-call that supports the whole endeavor. There are so many ways you can make it work if you really want it to. Keep thinking and being creative!
There’s also the concept of the right time. Sometimes you might need to take a break from birth work or pursue it more seriously in the near future. Keep reading, attending workshops, networking with other birth workers, and engaging with pregnant mamas. You’ll get to a place where you can be a doula soon!
How Much Can I Earn as a Doula?
This one is hard to answer, as well. Every city, town, and community has its own pricing standards for doula work. The typical range that I’ve seen is anywhere from $500-$1,500 per birth (lower in rural areas and higher in cities).
Now, remember that attending a birth means sometimes waking up at 2 a.m. to head out into the cold, then staying with a laboring woman for at least 6 hours and sometimes up to 48 or more hours. Birth is unpredictable and can occasionally carry on for many days.
That means lots of hours’ sleep missed that needs to be caught up on. If you tend to need 8-9 hours of sleep every night, you’re going to need a few days to recover after a birth.
Some people are able to do 4+ births a month and others like to keep their client load to 2 or less. It’s all individual. If you have a great support team to help you keep the home fires burning and an amazing backup or even partner doula, you might be able to take on more births and thrive.
Be realistic about your capacity and how you want to work. Realize that doula work is (like most “women’s work”) undervalued and often underpaid. Know that some families just don’t have a lot of resources yet still want doula support. Find your place in the doula world serving the people you feel called to serve. Then set boundaries for your own self-care while also being willing to stretch a little to help those who might need it.
If you struggle with setting prices and asking for money, take some business courses to learn how to do this and work on personal growth when it comes to money. While we all want to help make the world a better place, if we’re not caring for ourselves we’ll get burnt out quick. And then we can’t help anyone at all. Charge what you need to charge to take care of yourself and honor your own value.
What Kind of Doula Should I Become?
These days, the word doula isn’t used only for birth. You might hear people refer to themselves as a…
Postpartum doula
Breastfeeding doula
Sibling doula
Death doula
End-of-Life doula
Abortion doula
Bereavement doula
And probably others that I haven’t yet heard of!
You might be scratching your head over what’s going on with this trend. But remember that a doula is a modern version of what we would have done for each other 150 years ago… offered care and support for those going through challenging transitions!
In that light, the doula model of care is something that can be useful in many, many contexts. You might say that we need to be sharing doula education with every person who cares for another human being. And by that I mean, reminding others that it is their right to actually give care and love to others in an empathetic and compassionate way.
SO WHAT KIND OF DOULA DO YOU WANT TO BE?
If you can’t immediately answer that question, that’s okay. It just means that you need some more exploration. Many doulas end up doing training in many of these areas. Some decide that they just really love birth and so they stick to just that. Others start with birth and then end up in another area that’s a better fit for them. There are many ways to define your role as a doula and to find the right path that’s best for you.
Read lots of books. Attend workshops and conferences, as you are able. Watch birth videos. Subscribe to holistic birth magazines. Read articles and birth stories. Follow organizations and people that are asking the right questions and shaping our future in the ways you think it should go. Take the time to also listen to people you don't agree with to ensure your viewpoint is balanced.
And never ever quit learning. If there’s one thing I know about birth work is that it is a lifelong calling and you’ll never be “done” with your education. There’s so much more to experience, understand, and know. Start where you’re at and know it’s not a race. Soak up each step of the way and eventually, you’ll realize that you’re pretty far down the path!
Resources
Here are some excellent places to start with researching the doula world, training options, and understanding birth in the United States.
WELL-KNOWN DOULA ORGANIZATIONS + TRAININGS
Childbirth and Postpartum Professional Association (CAPPA)
Doulas of North America (DONA)
Indie Birth Birth Warrior Project
International Childbirth Education Association (ICEA)
RECOMMENDED DOULA + BIRTH BOOKS
Gentle Birth, Gentle Mothering
Birth as an American Rite of Passage
