Doula as a profession

A doula is a professional who performs the roles and duties of a healthcare worker. A doula is not exactly a healthcare worker but assists individuals during the maternity period. In addition to performing the role of a friend and caretaker for their clients, doulas may also extend support to their client's family members and friends. A doula's primary goal is to give their clients a sense of comfort and safety. This, in turn, complements the medical care and attention provided by the client's doctors or healthcare professionals. It is a highly specialised profession and they require advanced doula training to be successful in the profession.

Doulas cannot provide medical advice or administer medicine, as their duties differ from that of a physician. Individuals who become doulas have undergone advanced doula training and certification. However, this advanced doula training and certification process differs in different countries. While there are doulas who provide their services for payment, there are doulas who work as volunteers. Doulas receive different training sets for different duties they must perform. Hence their degree of professionalism varies. 

Healthcare organisations worldwide have researched doulas' duties, contributions, and functions. The results were shocking. There is a significant benefit to their clients owing to their presence. For example, people who receive assistance tend to have a better physical and mental labour experience. The benefits and employment of doulas in other assistance fields are not well documented. Still, they create a sensation of well-being and improve their client's needs with medical attention.

In this article, let's look at doula as a profession and the effect advanced doula training has on a new mother's life during pregnancy.

History

Having a friendly presence for support during pregnancy has a long history. Many prehistoric stone paintings depict the existence of such practices. But it was only in the 1960s that doulas became a practice professionally. It was after the 'natural birth movement in America. American women began to feel the need for a low-intervention birth process. They sought the attention and care of family members or companions with practical knowledge regarding pregnancy and raising children. 

In 1970, cultural anthropologists Dana Raphel and Margaret Mead set up a Westport human lactation centre. Before this, they published an anthropological study in which the term 'doula' was featured for the first time. Raphel stated in the study that having female assistance during birth cycles was common among females of all species. In the case of humans, this role was played by a friend or a member of the family. The term doula was coined from a Greek word of similar iteration that roughly translates to 'female caretaker'.

The term was generalised and gender-inclusive after two physicians, John Kennel and Marshall Klaus. They performed clinical trials to verify the outcomes of a doula-attended birth. These physician duo later cofounded the DONA or Doulas of Northern America. The research and findings of these physicians helped in the professional training and certification of doulas. They became the first organisation to provide such training. By 2004, Merriam Webster, American Heritage and Oxford dictionaries accepted the term doula. After persistent efforts from DONA, which had by then attained international status.

Nature of Support

Birth

Birth companions, post-birth supporters, birth coaches etc., are also names used to denote the person and function of doulas who focus on the birth. A birth doula provides continuous support and cares pre-birth, during and after pregnancy. A doula may offer company to their client during the delivery and without the client's partner. Unlike family or friends, a doula possesses definite knowledge of labour-related affairs. For example, they provide the right massage required to stimulate the fetus or help the client maintain proper body posture and provide company and the warmth and affection of human contact. Additionally, a doula also advocates for their client's bodily needs to the family members and the healthcare teams. 

Ideally, the relationship of a doula with a birth-focused client begins several months or weeks before the scheduled delivery. This is required as ample time is needed to form a bond between the doula and the client. They use the time before delivery to building a proper rapport. During this period, doulas reassure the family members regarding their fears and concerns.

Benefits of Having a Doula

There are several benefits to having a doula:

• Improved health conditions of both the mother and the child. 
• Fewer complications arise from the possible health setbacks of caesarean and complications caused by it.
• Lesser consumption of medication and lesser use of tools needed for foetal extraction. 
• A significant reduction in the time spent in neonatal ICU cells. 
• Increased period of breastfeeding. 

 The benefits in consideration are also subject to whether or not the doulas provide continuous assistance. It is more likely that the doulas get familiarised with the specific cultural and social setting in continuous service. 

In the United Kingdom, in 2017, published an official position through the Royal College for midwives. It supported the decision to hire a doula because the doula does not provide medical care. 

Pregnancy Doula Training and certification

Although there are no laws requiring a trained doula to possess a certificate, pregnancy doula training can help doulas by giving them clear and concise knowledge of their field and providing their clients with the confidence that they are under the care of a certified professional. In Northern America, the pregnancy doula training includes a seminar of a maximum of three-day duration and prior knowledge of some of the procedures and exercises for the limbs and breathing techniques that helps in relaxation. 

Certification happens at any level, such as local, country-specific or international. Some countries also require a positive attestation from certain healthcare experts. Certification also demands a record of the time spent learning maternity and infant care and an exam in the written format. Some doulas complete their certified doula training with the means of distance education.

Websites like doula match help clients find certified doulas to help them with childbirth. Such websites encourage the certification process, which is beneficial for both clients and doulas they hire. Doulas who don't receive formal pregnancy doula training may face problems when there is a medical emergency. 

DONA International, CAPPA, Birth from within, Birth Works, Hypnobirthing, ICEA and Elearn college are major organisations that offer certified pregnancy doula training courses. 

While the absence of standardisation in pregnancy doula training courses may lead to doulas undergoing different training procedures and fulfilling different criteria, there are tools for ensuring proper training. Websites such as doulamatch.net and researchers such as Amy Gilliland have successfully compiled an itinerary that any aspirant must look for to become a professional doula.

Challenges and Motivation

In a 2004 survey performed across America, it came to light that doulas faced some challenges. This included indifference from professional health care clinics, difficulty balancing work obligations and family life, etc. As for volunteer doulas, they found it difficult to deal with the fact that individuals had no clear understanding of a doula's duties and expected them to perform tasks for which they had no medical training. Clients expect Doulas to navigate the role of playing the intermediator between their client and the healthcare system. This requires them to have a say or be aware of the health care environment that their clients choose.

A 2010 survey in Canada revealed that most doulas did not work for monetary gains. Instead, they were motivated by interests such as a desire or genuine need to support people in childbirth. Many doulas see their profession not as a job that would earn them money but in a more communal sense. They strengthen each other by providing care and assistance for their ethnic, racial and cultural groups. Volunteering doulas saw their duties as a means of strengthening their practice. Many see this as an opportunity to gain a path to professional nursing.

Antepartum

A doula offers antepartum assistance to someone who cannot afford the luxury of being mobile. This is when they are advised to take bed rest due to a high-risk pregnancy or any other complications. Antepartum doulas can help by providing practical assistance along with emotional support.

Postpartum

The services of a postpartum doula overlap with services provided by medical professionals such as newborn specialists, maternity nurses, lactation consultants etc. Generally, a postpartum doula assists mothers after they give birth. Their services may include practical and emotional support. The doulas hired for birth services usually perform the postpartum duties, too. Postpartum doulas provide infant care, information on raising an infant, and breastfeeding support. 

Being a profession on demand, plenty of postpartum doula training courses are available. It is sometimes a part of some doula training courses, or sometimes postpartum doula training programs are given as a specialisation. 

With the emergence of technology, postpartum doula training programs were only available online. There are plenty of postpartum doula training online programs. These online doula training courses bring the advantage of convenience and expenses. 

Full-Spectrum

The 'spectrum' in 'full-spectrum' refers to the diverse existence of gender and sexuality and the several pregnancies associated experiences.

Doulas in Full-spectrum identify more like activists than medical professionals because they assist in abortion, stillbirth, miscarriage, homosexual family planning, fertility, adoption, etc. They extend their services to transgender males, females, or individuals who do not conform to genders. Abortion doulas provide emotional, practical and physical support to couples who have to undergo an induced abortion. 

Doulas, in full spectrum, thus emphasise the upliftment of human rights and the hope to end societal stereotypes.

Critical Care

Doulas engaged in urgent care offer their services to critically ill clients or at an end-of-life stage. Critical care doulas usually work with a medical care service like palliative care. Or they may work as volunteers. They help in making the final days of an individual peaceful and comfortable. Therefore, their roles are to perform physical duties such as arranging the bed, altering their posture, or providing emotional support.

Integrating Duolas informal healthcare

Birth Doula

In most cases, a doula's services are not reimbursed by the insurance agency or healthcare provider. Hence, hiring the services of a doula is more common for clients who fall in the middle or upper-class category. Since doulas can lower health disparities and cut maternity costs, there are persistent efforts to include doula services under reimbursement programs.

There has been an upswing in demand for doulas in the UK even though the NHS promotes midwifery services for minor to small-risk pregnancies.

Advanced Doula training is the most common course among aspirants. There are two kinds of people who go for birth doula training courses. The first ones are the aspirants, who consider it a point to grow their career. Secondly, some individuals like birth doula training courses to help their relatives or friends.

Community-based doula

Doulas, who offer community-based services, function among underserved communities. They usually promote a feeling of cultural oneness, improving the community's living standards in the long run. Their services are most often a low-cost alternative to medical assistance. They include frequent visits, education, preparation for birth, keeping tabs on emotional health and taking care of their food security requirements.

Community-based doulas also look out for policies that offer government support to these underserved communities.

Prison doulas

Globally, there has been only a rise in jailed prisoners annually. This means that the number of pregnant women getting incarcerated has also increased. In addition, not many policies are there to recognise the needs of a pregnant prisoner. As a result, organisations of prison doulas work to provide childbirth education, prenatal care and breastfeeding support in prisons. They also push for demands such as the unshackling of pregnant prisoners. They are, in effect, challenging the dehumanising environments that have come into being through the loopholes in the legal system. 

Conclusion

A study we conducted last year helped us find that the women who availed doula services said they had a better experience during the maternity period. They felt increased levels of happiness and emotional support during labour. In addition, giving birth to a child is an important aspect of a woman's life despite the conditions. So, getting a doula who has undergone advanced training is very important for a woman.