Tuesday, September 13, 2011

Being a Doula is Hard

I don't think I've ever found a blog that talks about how hard being a doula is, but I think I'm going to be the one to do it.

Most doula blogs talk a lot about why they love being a doula, as I've done before myself, but don't always get into just how difficult the lifestyle can be. And since I've recently inspired someone to begin their doula training, I've been thinking lately about whether or not the doula life can seem too romanticized (at least to birth junkies).

Now, don't get me wrong, I really do find doula work rewarding. But I think its important for doulas to understand that the reality is you're probably going to lose sleep, have physical aches and pains, miss events you were looking forward to, and cry.

What are some of the potential worst parts of the job for a doula?
Nervousness about being called at inopportune times, being woken up at all hours of the night, working on very little sleep, having to be in hospitals all the time, dealing with difficult care providers, being emotionally and physically supportive to someone else in their most vulnerable time, and having to be the most attentive you've ever been.
There's also the fact that doula work is not always steady, many people don't always want to pay a reasonable fee (under-appreciated), having to find childcare, and sometimes you're just treated like crap by people.

In my case, I think its the extremely emotional nature of the job that has affected me the most.

There are some truly wonderful, magical births out there that will make you feel like you're floating on a cloud. And then there are some truly agonizing and stressful births that will leave you upset, angry, and possibly traumatized. To quote a good doula friend of mine, "We become collateral damage."

Women can have post traumatic stress from birth experiences, and doulas can have it from attending births. And sometimes, the doula is hit hard emotionally, while the mother feels OK. Its not always clear what is going to upset you.

You will have births that will keep you awake at night agonizing over how it could have gone differently if only you had done ____, the mother had done ____, or the doctor had done ____. Or you may not know, and spend weeks wondering why and how. 

You will have clients who frustrate you to no end for a multitude of possible reasons, such as 1. they refuse to take childbirth education classes or read the books, because they are simply relying on you/the nurse/the doctor to get them through it, 2. read everything there is to know about the risks and complications of induction/cesarean section/whatever and choose it anyway, 3. will soak up everything you say about how they can make their own, refuse any procedure, and what is evidence-based, but then ignore it all and agree to everything their doctor says anyway, 4. get upset when you do or don't do something even though its clearly stated in your contract that they signed, and so on.

Doula work has been the most emotional work I've ever done. It has made me feel elated - "I'm making a difference!" and completely depressed - "I'm not making a difference at all." I think the hardest thing is that doula work is usually done because of the doula's passion for improving women's birth experiences. And for me, in particular, its about making a positive change in maternity care. And many times I feel myself losing the fight.

How can a doula deal with all this emotion so that she doesn't get too burnt out? Some doulas turn to things fixes such as only taking out-of-hospital births. For me, though, the only things that help are:
1. Have a doula friend or two to vent to! Bitching and moaning about U.S. maternity care or just crazy clients, or simply discussing a birth and getting help processing what happened is really the best thing you can do for your emotional health.
2. Getting online or picking up a book and reading inspirational ways in which change is being made and can be made in maternity care, and birth stories of women who had beautiful, empowered births.

What are some of the hardest parts of the job for you, doulas? And what are ways that you like to process and decompress after stressful doula-related events?


  1. oh my gosh, this post is so true. I have just completed my 12th birth, and I'm starting to realize just how hard this is. It's not bad enough to stop doing it, but I can see why doulas (and midwives) burn out at such a high rate. In one of my casual conversations with a midwife at a birth (who has been doing this for ten years!) she told me that after every birth, she goes home, drinks a glass of wine, has a big cry, has a shower and crashes into bed. The physical toll is hard too - I find myself lacking exercise, healthy eaeting habits and having higher stress. I also feel guilty leaving my daughter behind, and sometimes at 4am, all I want to do is go home and hug her...

  2. Thank you for this. No one really talks about the hard side to doula work. I sit on the board of a doula assoication in Canada and am going to share this with our membership. I totally agree, every doula needs a doula friend to debrief with. Just as we always have backup we need that debrief after a birth - good or bad.

    Thanks again,

  3. It's why I'm glad that I belong to Doula UK I have an Assessor Mentor that I can call at any time, even though I've been Doula-ing for over 5 years now.

    I have recently become an Assessor Mentor myself and one of the things that I stress is the importance of de-briefing the births as Doulas. We carry a lot and we carry it silently. We give a lot of ourselves and sometimes sell ourselves short when we explain what we do. Not every one can be a Doula, though many want to. This is the hard side of the reality, but, as with all things, it is what you put in place to support YOURSELF that tells with time.

    Personally, I call a Doula friend (or two) and I sink a glass of red (I've always done that) and play some music. I allow myself to be still. More recently I've taken a couple of months off a year for just such a reason. In fact there was a FB thread (forgive me for not remembering who started it) where Doulas from across the globe talked about how THEY de-stressed/briefed from births and how they also take a couple of months off a year to recharge their batteries.

    Thank you for your post and I do hope that you have a "Doula UK" that YOU can fall onto.


  4. Oh what a great post! And every word of it is true. Being a Doula is so difficult in so many ways. Rewarding and incredible in many ways (and SUCH an honour), but its no longer for me, and hasn't been for 5 years now. My hat goes off to Birth Doulas everywhere. Physically its tough, but I can handle that. Its the emotional stuff. There are a GREAT many wonderful births, but the difficult births were just so hard on me emotionally. I still work with pregnant women/new moms and don't ever want to give that up! I try and prepare them as best as I can for "their own unique" labour and delivery in my prenatal yoga classes, and I hugely enjoy hearing all their birth stories after baby arrives (at baby yoga.) I enjoy providing space for them to share and connect with other moms in their community which is so important too. I haven't sworn off going to births again (i often miss it), but not as a business. I burn out too easy as a Doula. YOu doulas are such amazing humans! Just like the precious momma's you support! My advice to any Doula would be to have support from other doulas to debrief, and a therapist if needed! (i'm not joking)

    Remember your own self care! Looking forward to reading the rest of your blog!

  5. Just wondering what clients get upset for you doing or not doing despite the contract.

    I have the "you will likely follow your doctor's suggestions to the tee" talk with my clients. I want them to know up-front that it is very likely that no matter what they decide for themselves or with me, when the doctor suggests something, they will follow her blindly. That's the nature of the beast. So we talk about how to get to a point that the doctor won't recommend X without really meaning it.

    Finally, I agree with Lori above about therapy. We are putting ourselves in an emotionally rich environment; you nailed it, Emily, when you said that we are as subject to PTSD as the moms. We see things that can't be unseen, and in some ways our job is to prevent the parents from seeing and experiencing the worst of it. Your university should have a free or inexpensive counseling program. Even if they can't talk about birth from lack of experience, they can address some of the underlying emotional aspects from dealing with clients.

  6. I attended a unexpected full-term loss last year (placental abruption). Another local doula happened to come to the hospital that day, not with a client but just to drop something off for a nurse-friend. We ran into each other, and she just held me while I cried. Her kindness helped me finish serving that mother.

  7. I am so thankful that you posted this. I think we, as doulas, dont get to talk about this enough.
    I already feel better supported for just having read this post and the comments.
    I work in a partnership with another doula, and have found this incredibly helpful when things are tough or when I need to debrief. We even try to do births in tandem if the family is ok with it.
    Just like midwives, we need back-up support too.

  8. Thank you so much for writing this. It's refreshing to hear both the good and the ugly. I have been a doula for a year now and there have been moments when I am either angry at myself or angry with the client. It's hard sometimes. Thanks for sharing honestly.

  9. I think a lot of us don't talk about it because we are led to believe we need to just take it. We need to help these women, we need to realize we can't be their bodyguard, but we are supposed to be happy with what happens. If we complain, it means we did something wrong. If we complain, it means that we don't love what we do. And the thing is, we need to be able to talk about the hard births. We need to be able to talk about the times where a woman is violated and we have to stand by and watch because we can't stop it. We need to be able to talk about how emotionally hard being a doula is.

    I had to stop hospital doula work because it was too hard. Seeing women victimized, seeing women scream no while the doctor does it anyway, seeing women drugged for no other reason than it is easier for the doctor to handle. It became too hard. I wasn't helping anyone anymore. I was destroying myself.

    Doula work isn't all rainbows and unicorns. Doula work is hard, both physically and emotionally, and we need to learn to say it out loud, to have others understand.

    Thank you for writing this post. Doulas that aren't able to say this will be so grateful that someone has said it. Thank you.

  10. Thank you all for commenting! Its really great for all of us to hear other doulas thoughts and commiserate with one another, even if just over the internet. And its nice to hear you all feel the same way I do!

    @Mars you are so lucky and I am jealous of your doula organization and network!

    @PhDoula re: contracts - for example, scheduling a non-medically indicated induction without consulting my schedule even though I put that in my contract as a responsibility of the client to do so, and then getting mad at me when I pointed it out. that's the short version of it, anyway.

  11. Hi - thank you so much for sharing this. I think there is often some sort of (self-imposed?) taboo to pointing out the difficulties of doula work and so I appreciate your courage and willingness to be vulnerable. I, too, have been to my share of difficult/traumatic births and have found the support of my sister doulas to be invaluable during those times!

  12. I have been a doula for almost 7 years. I thought it was just me who found this work not only rewarding, but extremely challenging. I have experienced both the "walking on a cloud" feeling of a wonderful birth, to the " I'm never going to do this again" upset and exhaustion after a particularly challenging birth or challenging mom and dad. I haven't given up yet, and I still do hospital births, but would prefer to just do home births, because it is so hard to stay within my boundaries as a birth professional when I have to witness the crap that hospitals put moms through. Hang in there ladies, We all make a positive difference, even if we forget that at times.

  13. There's a website I read that includes some of the challenges of the doula lifestyle, in this case to help the clients understand why the doula's fee is reasonable. It has a lot in common with what you wrote. For the record, I have no affiliation with the site.
    Sara in Beverly, MA

    Link Here

  14. Thanks, Doulalee! :) You hang in there, too.

    @Sara in Beverly I have seen this! And I really like it. I have a much shorter version of it on my doula business site, and I encourage everyone else to put some form of it in their information as well.

    I hear a lot that doulas are under appreciated, and that many clients try to get out of paying full fees sometimes. Maybe if we all say it, it will get dispersed!

  15. I really appreciate this piece, thank you so much for writing it. I often have the feelings you've expressed, but I really felt that it was only me. People so rarely talk about the downsides of being a doula, especially the specifics, like agonizing over the way something turned out weeks afterward.

  16. Thank you so much for posting this! I wholeheartedly agree that it is hard, painful emotional work. People say to me all the time, "You must love what you do! You get to hold babies all the time." If only.....
    My 40th birth was my worst and it took me a long time to work through the trauma of it. In the end the family left the hospital with a beautiful, healthy baby but the trauma they suffered to get there was not something I ever want to be a part of again. I don't think we talk, speak, or write nearly enough about the vicarious trauma that birth workers suffer. After this particular birth, I searched the web, the birthy magazines, my books, etc. and came up lacking for good information about how to process through this kind of trauma. I am glad you are talking about it. Obviously it has hit a nerve. :)

  17. Becoming a doula is hard, I agree completely. Sometimes your clients are not cooperative at all and are extremely demanding. Take a deep breath and rely on your doula training. Patience and communication are key to your career as a doula.

  18. As someone seriously considering becoming a certified doula, it is SO HELPFUL for me to read all of this! I have worked with parents and children for years, and was wondering why nobody was talking about the challenges, and honestly the downright upsetting aspects of it! Very refreshing to have an honest look at what its like from experienced doulas!
    Question to all of you seasoned doulas out there: Was it difficult for any of you to find a client base in the beginning/to start making a profit? I'm honestly pretty nervous to throw time, money and a lot of emotional energy into something that I can't make a profit from. I want to help and support women, but I also have to support myself and family as well and really want to make sure that this is an effort worth while!
    Thanks lovely ladies!

  19. I am thankful I've found your blog. I have been considering going into the Doula field. I am already an Adoula (spiritual Doula) but was wanting to combine the two. But In the last week I've been wondering just how much this takes out of you, being a Doula. I haven't said NO to this potential, but I appreciate your honesty. Being perimenopausal myself now, I find that things stress me out and my body doesn't know what happened with just life itself. How will moving into the Doula world be accepted by my body. Decisions... I will be following your blog as I continue my journey, wherever it takes me. Cheers!!


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