Last year there were approximately 3.6 million live births in the United States. It is estimated that about 6% of those giving birth chose to use the services of a doula in 2022. This is a $5.2 billion market and there are about 9,000 registered doulas currently practicing in the US.
An Ancient Practice
What is a doula? The literal translation from Greek is slave or servant. In different cultures, doulas have been used for centuries. Doulas are women who are trained, educated and experienced in childbirth. They provide continuous physical, emotional and informational support to a person who is pregnant during labor, birth and postpartum. Doulas are different from midwives, as they offer non-medical support.
While doulas have always existed in some cultures, they gained much broader acceptance in the late 1970’s and early 80’s. Women began to become distressed at the number of cesarean births and began inviting other women to attend doctor’s appointments and births with them. Women began wanting to have more control over their own birth experience and felt the need for support in this highly “clinical” process.
Shifting Attitudes and Improving Outcomes
To understand why a birthing person might want a doula, you have to understand the medical system today. While the majority of women go into the hospital to have a routine birth—it is still considered a “treatment” and she is still called a “patient.” Despite the fact that she is not “sick,” she is being treated alongside those who are, and often with the same sort of mentality. Having a doula present helps shift the focus to the emotional, mental and spiritual support of the birthing person. This change in attitude and direction can help improve the mother’s stress levels and ultimately help produce better birth outcomes.
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There is a lot of evidence out there now that indicates women who use continuous doula support are more likely to have better birth outcomes. These women feel heard, cared for on an individual level and may have fewer negative feelings about childbirth. While using a doula is not a guarantee of a healthy and happy birth—statistically, the outcomes seem to be better.
Birth of a Business
Compassionate Beginnings Doula and Birth Services physical location in Clinton, New Jersey was opened in 2022 by Hayley Weichler. The location is just as interesting as the business founder. The former Thomas Jones Tavern was once a center of Revolutionary War activity. This historic old building is now home to several women-owned businesses. Like many newly minted doulas, this began as a one-person shop in 2017. It was Weicher’s own pregnancy story that led her to discover her true calling. When Weichler became pregnant in 2015, she had the fleeting thought to plan for a home birth, but ultimately decided to give birth in a hospital. A friend suggested she look into hiring a doula; Weichler was not familiar with the term, but soon learned that a doula could provide the support she would have been looking forward to in an intimate home birth.
Fast forward to a complication late in pregnancy, and a baby shower that never happened because of an early delivery. Weichler reflected on how overwhelming and fast everything changed. She admits that having her doula by her side eased her fears and concerns where the medical providers could not. This all led Weichler to discover her passion for helping others and a desire to learn more about the role of doulas in women’s healthcare.
Training and Certification
Once she decided to pursue doula training, the work really began for Weichler. There currently is no one set of trainings or standards in the United States to certify as a doula. There are several different organizations and they all offer different courses and certifications. It is up to the individual doula to research, register and get certified in the areas of concentration that are necessary and important to them. It is a lot of time and money to research—take the trainings, and a doula must be committed to self-education.
There are several organizations that offer doula training and certifications. Doulas of North America (DONA) is one of the oldest and largest, founded in 1992. ProDoula is another organization that is in the forefront with cutting edge trainings and certifications. CAPPA, Childbirth and Postpartum Professional Association, is yet another organization that has been recognized for certification programs since 1998. These are just some of the key organizations—there are others. It is the doulas responsibility to educate themselves and to put together a training program with a well-rounded background since there is no one industry standard.
Weichler began her solo doula practice in 2017. She quickly discovered that, “to be a doula, you must have doula friends.” Since the very nature of the business is the unpredictability of birth, it helps to have “a built-in mentoring system, constructed of many doula minds.” Over the course of her first five years, Weichler estimates she participated in 80 births and worked with countless others doing prenatal yoga. What Weichler also discovered was that “doula burnout” is real. Constantly being on call for births, being the emotional, mental and spiritual support for each client, knowing the ins and outs of childbirth, as well as local hospitals policies and protocols—that’s a lot of stress building up for the doula year after year. Exhaustion and burnout can happen if a doula doesn’t have the support systems and the ability to take a step back and re-group.
Re-birth and Growth
Weichler saw this moment as an inflection point. She could either; stop doula work completely, take on less clients and continue in her solo path or take the next step and grow the business bringing on more doulas. She chose Door # 3 and the rest is history!
Compassionate Beginnings Doula and Birth Services is truly a full-service agency. Weichler now works alongside two other birthing doulas so there is never any worry that if someone goes into labor unexpectedly there will be a doula present for the birth. Additionally, she found the need for more doulas to adequately support the demanding needs of the parenting community.
Postpartum is Real
Services don’t end with birth here. There are also 3 postpartum doulas on staff as well. As there are now a lot more conversations around postpartum depression and perinatal mood and anxiety disorders, there is a more supportive environment for parents after the birth process. With statistics like one in seven women have some form of postpartum and 50% go undiagnosed, it’s not surprising that more light is being shed on this phenomenon every day. Maybe it’s because our society is so fragmented, we no longer have the “village” to care for our baby when it arrives. Everyone cares for and about the new baby, quite often it’s the new mom who is forgotten.Postpartum disorders are real, it’s clinical and every year, 24,000 women are at risk for maternal suicide from postpartum. There is help available—if you or someone you know is suffering, there are resources available.
Government Recognition of Doulas in the Healthcare Industry
The doula movement is definitely growing. Racial disparities in birth outcomes are no longer just “theoretical”, they are documented. Evidence based studies consistently show improvements in decreased premature births, less cesareans and less pain medications administered. Doulas are not wizards; they understand their role and they know they can’t own the birth outcome—they are there for support. Having someone who individually answers all your questions and concerns throughout the magical journey of childbirth really is empowering. For a birth mother to have someone who knows their triggers and how to calm them—that is everything.
The current administration recognizes the importance of doula work and is putting steps in action to expand and diversify the doula workforce. Although there are issues with Medicaid payment amounts and processes, the fact that doulas are covered is a positive message from the healthcare industry. It is a bit ironic that the pandemic actually increased the popularity of doulas. In late June of 2020 the Governor of New Jersey deemed doulas “essential workers” and they were allowed into delivery rooms again after initially being shut out due to covid restrictions.
I asked Weichler about her experiences in the hospitals and with doctors. She was very honest; and said you can’t generalize. “Some ignore you; some include you. Sometimes, if we have worked together in the past, they ask my doula opinion.” Weichler has also been asked questions by eager Residents making their rounds about the role of a doula in birthing these days. Doulas really can be of assistance in the hospital setting. They can provide an extra set of hands to help care for a patient who needs a position change, a glass of water or has a question when interventions are offered. They have gotten a chance to know the birthing family, attune with their needs and personalities and learn their priorities and preferences for their birthing experience. All this helps empower them if uncontrollable circumstances arise. Doulas don’t replace nurses or partners in the room—they supplement.
Compassionate Beginnings Doula and Birth Services views the birthing process with a wide lens and offers services for the full range of the experience. They begin with classes and workshops on childbirth and newborn care. There are birth and postpartum doula services. Postpartum support can be either/or day and night support. There are breastfeeding classes, infant and child sleep consulting services and even birth photography. Placental encapsulation is also available for those that are interested. Weichler’s vision was to create a comfortable space for the community to find any and all the support services for a healthy and happy birth and postpartum experience in one location. When I asked her what’s next, she already had the answer. They are putting together a more structured bereavement support program. And she is laser focused on training the doulas of the future. This full-service agency approach is a new and innovative way to engage the community in this ancient practice.
There are lots of myths and misconceptions floating around about doulas; they only support natural childbirth, they’re only for hippies, they will replace your partner, they only do non-medicated births, they don’t support cesareans, etc. None of these are true. Doulas are part of the birth care team. Just as the doctors are there to perform a specific role—so are the doulas. They provide a strong link to the birthing parent’s spiritual, emotional and mental support. They provide information to help with the process and they are present to provide care and assistance. It’s an intense relationship and a huge responsibility. It takes a very special individual to become a doula. It takes an amazing business person to shape this calling into a thriving business that benefits an entire community.
About the Author/s
Sue graduated from Rutgers University with a B.A. in English back when you could still get a degree for reading great literature. She spent nearly 40 years working in the Sales & Marketing field with companies ranging from non-profits to small businesses to Fortune 100 Corporations. Most recently retired after nearly 20 years with S & P Global, she is now free to pursue her true passions for hiking, writing and photography. Sue was born and raised in New York State. As a New Jersey transplant, her passion for the special blend of culture and nature that is uniquely Jersey is what Sue loves to share with the world. She has one grown son that she is insanely proud of. Her husband of many decades is an amazing partner both in life and hiking. When not out exploring, Sue is most likely at home reading a novel with her dog.