ACOG & SMFMDoulas! Just what the doctor recommended.

Did you know that this week the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) issued a joint statement: Safe Prevention of the Primary Cesarean Delivery recommending doulas?  See excerpts below:

Increasing women’s access to nonmedical interventions during labor, such as continuous labor and delivery support, also has been shown to reduce cesarean birth rates.”

Published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula.”

“…the presence of continuous one-on-one support during labor and delivery was associated with improved patient satisfaction and a statistically significant reduction in the rate of cesarean delivery.”

Given that there are no associated measurable harms, this resource is probably underutilized.”

You can read the full statement here.

This is something that doulas have known for years but it is wonderful to see that the medical world is noticing positive results from having us present.  Many area Obstetricians recommend their patients to our care and with this new statement I expect many more to follow.

When doulas and doctors work together towards improving maternal health outcomes incredible things can happen.

Tips for Doulas

If you are a parent of a child on the autism spectrum then I know that you don’t really have much time to read this.  Maybe you are thinking of becoming a doula but unsure if you can make it work with your family, or maybe you already are a doula and have been wading through the guilt and meltdowns as you are gone for hours.   I want to share some tips with you that worked for my family and I encourage everyone to comment and leave your own tips because we can learn so much from each other.   I recognize that each child is unique and the very word “spectrum” entails a wide range of unique delights and challenges.

  1. Weekly calendar of each days plan-  You can include the name of the person they will be with or the place they will go.   If your child doesn’t read then you can have a picture of symbol assigned to each person. Make sure it’s large enough to see easily and in a room where they can easily access it.  Lots of spectrum children are very visual and being able to view it as often as they need to can calm them down.  Not knowing what is coming up next is a common cause for anxiety.
  2. Verbally tell them each morning- You wrote down the plan on the calendar, but a reminder in the morning before they head to school, or at breakfast before you start your day.  Just a quick, “remember that today is Auntie day, so if my client calls me then Auntie will pick you up from school.”
  3.  Share the Plan- Be sure the other family members in your home know the plan so they aren’t forced to come up with a different plan in your absence. You may not be able to answer your phone or receive a text if the labor is very intense when they try to reach you. (This tip is from my husband who may have dealt with more than one meltdown from changing the plan because I forgot to tell him what it was.) 
  4. Special Treats- I am not above bribery.  This could be a treat while you are away, like watching a favorite movie, ordering pizza or favorite food, perhaps a special fidget or weighted pillow that only comes out when you are away.  The point is that they can look forward to this treat happening once you do go to the birth so they aren’t dreading you being called to the birth.
  5. Reliable Childcare- We all know that when plans change it can end in enormous and long meltdowns.  Be sure that you have care arranged from someone who isn’t going to flake and also someone who knows how to care for your child’s unique needs.  This may mean that you are paying an on-call nanny, or perhaps you have rock solid friends who you trade with.  I wouldn’t recommend relying completely on your spouse if you plan to doula as a career because they can only miss work so many times before it’s a problem.   Think you can’t afford childcare?  Guess what, you aren’t charging enough.  Raise your rates so that it doesn’t cost YOU to attend a birth.  Even doulas who are working toward certification can charge for their services.  (You may be able to get care through state services if your child has an official diagnosis of ASD.) 
  6. Self Care- You know that on-call nanny I mentioned above? Maybe you use her for an extra hour or two for yourself (or a date with your partner) the day after a birth.  Being the parent of a child with autism can be both emotionally and physically draining.  Guess what, being a doula can do the same thing.  Be sure that you are taking time to fill yourself back up after a birth.  Chances are good that you will be hyper right after the birth (even if it was 24 hours long) but once the adrenaline runs out of your system take some time to recharge.   Maybe you skip the nanny and instead your kid binge watches Dora The Explorer while you have a cup of tea and read a book.  Whatever you have to do to make some self care time happen, it will be the thing that keeps you able to continue doula work for years and years.


This may seem like a lot to do just to go to a birth but try not to get overwhelmed.  The thing is, that parents of kids on the spectrum actually make incredible doulas.  They are already used to tuning in to another person’s needs, a person who may not be into verbal conversation.  During labor, many people go into that instinctual part of their brain and are no longer up for talking or answering questions.  You will need to tune into them, to see their needs rather than hear them.

Many kids on the spectrum are overwhelmed by their own emotions and have trouble making since of them or knowing what to do next.  If you have ever seen someone in the transition stage of labor then you may have seen anger, fear, sadness, and many other emotions emerge and often this can be overwhelming and scary to the person experiencing it.  “Why am I crying, I am sorry, I don’t know why this is happening.”  I hear it often at births, and you most likely already have skills to help them through this to accept the emotions and even the tears coming out of them.  Meltdowns and Transition are very similar, a loss of control and overwhelming emotion.  Your personal experience of being a parent is going to be such a benefit to your clients.

I hope this was helpful to you. Please leave comments of things that have worked for you or your child as you pursued your career as a doula.


Why I love Birth Arts International


Years ago when I was looking into becoming a doula I quickly realized that I had a lot of options on organizations to certify with.  I spent a long time researching each organization to find the one that was the right fit for me.  It seemed that there were many excellent choices but after carefully looking at my options it was clear that Birth Arts International (BAI) was the perfect one for me.

The very name, Birth Arts International, the ART of it called to me.  The fact that this was going to be more than a job, that it went deeper than that because there was something in me that was moving me towards this career. I felt that it required tapping into parts of myself in order to truly do the work of a doula.  I knew that I would be going into the most intimate of times with families and that this journey was an artistic one that would require flexibility, creativity, and trust in the process.

The next thing that spoke to me was the autonomy that BAI allowed for.  I was interested in learning even more ways to help and heal people and as long as I was properly trained, I would be able to bring those skills to births without breaking rules on scope of practice.  This has allowed me to study other interests of mine including aromatherapy and craniosacral therapy and I  have the ability to bring in more things to my practice if I discover something else that I am curious about.

Once I became a student I was instantly sure that I had chosen the right place to be.  There was such a warm and supportive feeling from the student group.  Demetria Clark, the Global Director of BAI was always available to answer my questions and encourage me along the way.  There has been new material, webinars and worksheets added for students often and as new information becomes available BAI has always been quick to share and discuss it. This could be anything from a new comfort technique to help our clients, the latest ACOG recommendations, or things that help us build our business in the ever changing world of technology and social media.  In every aspect of building a doula career, from having the skills I need to knowing how to market them, I feel like BAI has been there to show me the way.

Another reason that I choose BAI was because I wanted to feel very solid in my skills and though it was a little intimidating, BAI came with a rigorous workload (with a flexible schedule.)  At the time when I was looking at programs, I noticed that BAI required more work than other organizations.  I would have to read more books, do more assignments, and even attend more births to become certified. My certification would not expire though, so once I was finished that couldn’t be taken away from me.   Despite having had my own children at this time I still felt like I knew so very little about birth and I wanted all the education that I could get.   I am glad that I didn’t let the intimidation of the work load stop me because I grew so much going through the curriculum. Reading the books, each one showing me more to a world that had previously only had one level.  As I worked through the writing assignments and was challenged to explore how I really felt about birth and nature something began to happen to me.   I began to grow roots working through that curriculum.  Deep roots that I draw from in my work now, these roots help me trust birth, help me believe in the person who is birthing.  When I am in a tough situation with a client, when things seem to be taking a turn for the worse, I can breath and draw strength from the roots that grew through my journey with BAI.  Those roots still grow deeper even now, as I am still part of that community, only now as a trainer.  I still learn things all the time though, we never really stop being a student and I am always seeking new knowledge and understanding.

I am so thankful that I made the decision to train with BAI and even more thankful that I have the opportunity to share BAI with aspiring doulas.  It has been such a great community to grow in and perhaps it’s not for everyone but I can’t imagine being anywhere else.

Doulas Working for an Agency

These days doulas have a lot of options for how to operate their business.  You can be completely independent and have a solo practice where you are the only doula in your business.  (You should always have a backup doula, even in this type of business, but the main person you are promoting is yourself.)   You could work as a team with another doula, do interviews together, and share a call schedule.   You could work for a hospital in a volunteer program or  some hospitals  offer a paid position with rotating call schedule.  There are many ways you can run your business in addition to these.  One of those options  is to work with an agency.

Today I’m going to focus on agencies because it seems there are more and more popping up everyday and some of them are not following the legal rules when it comes to how they treat their independent contractors.   Now, if you are being offered the opportunity to be an independent contractor, not an employee, this means that you will still  be operating your solo practice in addition to clients from the agency.   You still will be promoting yourself, taking personal clients outside of the agency, and when you work with the agency clients, you do so in a way that is chosen by you.  How many prenatal visits you do, what you wear to a birth, even what you charge is all decided by you.

Recently I partnered with two other doulas  to start the first agency in our area.  We had a vision for helping doulas have a sustainable income that would allow them to keep doing doula work without having to get a second job.  We also wanted to make it easier on families who didn’t have time to contact lots of doulas and have multiple interviews in order to find the right one.

We set out by looking at how other agencies were modeled and initially figured we would take the pieces we liked from each one and then build our own.   The next thing we did was to meet with a business lawyer, and that lead to meeting with an employment lawyer.   After that meeting we realized that we had to restructure a lot of what we had planned.    What we learned was that  a lot of agencies  are running businesses in a way that breaks the rules of employee vs independent contractor and they are treating their IC’s as employees but not giving them the perks that come with being an employee.  I don’t believe they are doing this on purpose, if we hadn’t met with the employment lawyer then we wouldn’t have known any better either, but the fact is, it’s happening and you might be offered to work with one of these agencies.  You might even be thinking of starting your own agency.

The line between employee and independent contractor is very fine.  Crossing it is unfair for the doula and very dangerous for the agency.  Let’s say the doula gets injured on the job, maybe she lifts a mom and hurts her back.  She goes to the emergency room and they ask, “were you injured on the job?” “Yes.” “Where do you work?”   The doula says, “I was working for so and so agency.”  That hospital is going to then look for workers comp insurance.  Now, if they are an employee then the agency would be paying for that insurance.   However, they are an independent contractor and so the agency didn’t pay that.  The next thing that will  happen is an investigation to see if the doula REALLY is an independent contractor.   So, she works exclusively for the agency, isn’t allowed to get other clients, or is punished for getting other clients.  She is told what to wear and how to do her job.    Guess what, it doesn’t matter that her contract said independent contractor, she is an EMPLOYEE and the agency is 100% responsible for her medical bills.

There are also tons of federal tax issues, social security, and unemployment insurance.  The punishment for those who break the rules is very costly if they are caught, and it’s not fair to the doula that they be treated like an employee on the working end of the deal and yet not have the benefits I named above that come with being exclusive to a company.

I have created info graphic below so that doulas can see where they stand and make sure they know their rights when working with an agency. I also want to inform fellow agency owners so they can  better understand the laws when decided how they want to operate their agency.

(When starting a business it is always best to consult with a lawyer for the laws specific to your state. This blog was written based of my own personal experience in the United States and is not to be used as legal advice.)