Hiring a Doula: A Doula's "Stats"

This is Part Three of a series on choosing the best doula for you and your family. Are there other topics you'd like to see addressed in this area? Email me at EfferenceDoula@gmail.com, or visit my Contact Form.

I always encourage my clients and friends alike to research their care provider's stats. As in, how often do they induce, what is their cesarean rate, etc? (This is also helpful to learn about their place for birth, which has fortunately become easy to find out.) 

In the past year or so, I have been asked more and more about my rates as a doula. As in, what percentage of my clients have epidurals? What percent have cesarean births? And so on.

There's really nothing wrong with this question, and I happily answer as I keep decent records of the births I attend. But what you may not realize is that these "stats" don't necessarily tell you anything about the person you're interviewing. It may give you limited information about the kinds of births the doula has attended, but seeing how medical decisions are 100% out of our hands, you may be surprised to learn that stats don't dictate how effective a doula will be for you.

Now granted, if a doula has attended 10 births and 8 have been cesareans, I would want to know a few more details as there are many factors that may influence this kind of rate: does she regularly assist in higher risk labors? Does she get a lot of referrals from care providers with high c-section rates themselves? Did she just have a string of strange outcomes that required the surgery? Regardless, are you comfortable with her limited experience with vaginal birth?

I would be less inclined, however, to inquire about her epidural rate, as this really tells you nothing at all about how "good" a doula is. The vast majority of women giving birth today plan on having an epidural at some point during their labor, and while a person hiring a doula is less likely to plan for that option, families hire doulas for many different reasons. In other words, there is no reason to assume that a doula with a 70% epidural rate is a "bad doula." You may, however, have questions about her lack of experience supporting folks through natural births, which is a legitimate concern.

One thing to remember when hiring a doula is that no topic is taboo. It's your birth, and you deserve to find a doula that you are comfortable with! But keep in mind what questions tell you and what they might not, and if you want additional detail, just ask!  We're always happy to offer some insight, even when you haven't hired us yet.

Speaking of sharing... in the interest of transparency, my stats:

(As of 2/13/13)
In the births I have attended:

• 58.8% were first time mamas
• 33.3% opted to have epidurals
• 25% were induced
• 8.3% were cesarean births 
• 16.6% were born in water
• Shortest gestation was 38w 0d
• Longest was 42w 2d
• Shortest labor was 2.5 hours from start to finish (45 minutes with doula in attendance)
• Longest was 30+ hours (27 hours with doula in attendance)
• Smallest baby was 5lb 14oz
• Largest was 8lb 15oz
• All babies healthy
• All mamas an inspiration

Return to Efference Doula Services and Lactation Support.

Hiring a Doula: Certified vs. Not Certified

This is Part Two of a series on choosing the best doula for you and your family. Are there other topics you'd like to see addressed in this area? Email me at EfferenceDoula@gmail.com, or visit my Contact Form.


A common question I get at interviews is the question of certification. What is the difference between a certified doula and an uncertified doula?


The answers to this question are as varied as doulas themselves. First off, there's a difference in certifying organizations. While each organization has similar requirements and scopes, they may have slightly different focuses. The larger certifying organizations include:

• DONA International
• Childbirth and Postpartum Professionals Association (CAPPA)
• toLABOR (formerly ALACE)
• Birth Arts International (BAI)

I am certified through DONA International, the largest of the above organizations. My certification process included the following:

• Attend either a series on childbirth education or a day-long seminar on the process of normal labor and birth.
• Attend a weekend-long training (minimum 16 hours) on labor support.
• A self-study of a minimum of five books.
• Attend a breastfeeding class (minimum 3 hours)
• Attend a minimum of three births as the primary doula, totaling at least 15 hours of provided labor support, receiving evaluations from the parent, nurse, and midwife/obstetrician.
• Create a comprehensive resource list for expectant/new parents.

Entangled in this process is a whole host of workshop fees, membership fees, material costs, etc. That being said, the monetary expense of certification alone may be prohibitive to many. Some doulas choose instead to just pay for the labor support workshop and leave it at that, or even learn skills on their own. Others certify for a period of time, but they choose to let their certifications expire when they no longer see the value in maintaining them. Some communities (Greensboro included) have volunteer doula programs with lower-cost trainings, such as the one provided by our local YWCA. Some organizations provide scholarships to minority groups who will be creating low-cost doula networks in their areas; still, I have heard these scholarships are difficult to come by.

This is the key difference between "uncertified doulas" and "doulas working towards certification." While uncertified doulas may have all the training and experience of one who has certified (and therefore similar fees), doulas working towards certification are less experienced but generally offer their services at a much lower rate.

In other words, a doula who chooses to forgo the certification process is as capable of being a strong supportive presence at your birth as one who is certified. Certification does provide a certain "authenticity," there is a clear scope of practice as dictated by the certifying organization, and maintaining certification requires us to stay abreast of new research and techniques. If this is important to you, you might want to choose a certified doula. If this is not as important to you, you trust your doula to be honest about her training and experience, and you find an uncertified doula that really clicks with your family, then hiring an uncertified doula may be the right option for you.

I have chosen to maintain my certification with DONA because I personally value the credential. But others may not (or they may not have the means to get it). No matter what the reason, there is no doubt in my mind that you could receive wonderful labor support from an intentionally uncertified doula just the same as one with letters after her name.

Return to Efference Doula Services and Lactation Support.

Hiring A Doula: How To Interview A Prospective Doula

This is Part One of a series on choosing the best doula for you and your family. Other topics you'd like to see addressed in this area? Email me at EfferenceDoula@gmail.com, or visit my Contact Form.

I've been to several interviews recently where I was the first doula the family had ever spoken to. While they obviously knew what a doula was and what we do, they were unsure of additional questions to ask. Listed below are several things you might want to ask a potential doula during your initial consultation.

1. "Tell me about your training/education." An easy starting question, this will give you an idea of your potential doula's expertise, plus a look at how we came to call ourselves Doulas.
2. "Are you certified?" Less important than you might think (see a more in-depth look at certification next week), a lot of families desire a doula that holds a certain credential.
3. "How many births do you attend per month?" This is a very important question because obviously, babies don't always come when it's convenient! If your doula takes on more than one client per month, be sure to ask if she has a backup in case of overlaps. If continuity of care is important to you (i.e., you definitely do not want her to send her backup), you may choose a doula that has a smaller client load.
4. "Do you offer anything besides labor support?" While this is not always important to expectant families, a growing number of doulas have multiple areas of expertise. If you would prefer a doula that also specializes in massage therapy, belly casting, placenta encapsulation, breastfeeding support, or one who rents birth tubs, this is a good question to ask. Many provide these services at a reduced rate to their birth clients.
5. "What is your fee, and how is it paid?" A doula's fee varies by experience, credentialing and location. Many require a deposit to be paid at the time of hire. Be sure to ask about reimbursement in the event that she fails to provide services. Lastly, if her fee is prohibitive to you, don't be afraid to ask for a reduced rate; many doulas take on lower-cost clients when they can, and can at the very least refer you to someone who may be able to meet your needs.
6. "Do you have experience with _____?" Do you have special considerations that would narrow your search? Some expectant parents want a doula that has experience with specific scenarios such as VBAC, waterbirth, multiples, pregnancy after loss, or just attending births with a specific care provider. Any special consideration that you would like your labor support person to know about, just ask.
7. "Why did you decide to become a doula?" This is a favorite topic of conversation, as all answers will vary slightly. While nearly all of us got into it because of our passion for birth, we all come to the table with different backgrounds that influence how we'll answer this question, giving you a better idea of who we are on a personal level.
8. Anything else you think is important! Have them clarify what, exactly, they do prior to and during labor. Will they accompany you in the event of a c-section? An epidural? How will they work alongside your significant other? Ask about their personal experience giving birth, if that is important to you. Very few topics are off limits for your average doula.

If at any point you feel your interviewee does not meet your specific needs, don't be afraid to ask for referrals. Our area has a vibrant and diverse doula community that is generally non-competitive and desires the best fit for all expectant parents.

Return to Efference Doula Services and Lactation Support.