Labor Support – You Mean That’s A Profession?

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In my twenty-five years of offering labor support professionally, there is one persistent challenge that our profession still faces:  that of legitimacy.  While people may be more knowledgeable about what the term doula means, they are still befuddled by what we actually do.  If you asked someone who already knew what a doula was, what a doula actually did, they would be hard pressed to describe it accurately.  Most people think (even those we think should know better) that doulas pat laboring mothers on the back and tell them everything will be okay.  Our clients have learned through direct experience that birth doula support is skilled caregiving.  But even their descriptions are limited by their own birth experiences.

Doula care requires a large skill set.  It requires being able to accurately perceive the needs of people you do not know well and sensitively and contingently respond to those needs in a timely manner.  Doulas need to have many physical and emotional support skills at their disposal in order to effectively apply the correct strategy.  Effective communication skills with a wide variety of people are necessary for a doula to excel.  Birth doulas also know how to navigate the complicated obstetrical health care system in their area.  One of my main purposes of my research has been to illustrate the sophisticated nature of doula skills (Gilliland, 2011).  Caregiving is a skilled profession, and doula support is professional caregiving.

However, most people do not recognize doula care as a skill.  Even if they do, that does not mean that our caregiving has value.  There is a long history of disregarding professional caregiving in the United States.  Many of the other caregiving jobs are not well paid and are often held by people not native to the U.S.  Most Americans do not want these kinds of service jobs – they feel they are beneath them.  The fact that most doulas are white and from middle and upper classes (Lantz, 2005)  has not made us immune from this struggle to recognize the value of giving care.

Then there is the idea that all women are natural caregivers.  Besides being sexist, it is not true!  Many of us can think of women who have few caregiving skills and men who seem to possess them innately.  But perhaps the most insidious part of this idea is that if doula support is something “all women” could do if they wanted or needed to, it makes it easy to devalue.  The more common a skill is, the less it is valued. It is also a career pursued almost entirely by women, which also gives it less status.

If we bring all of these ideas together, it is easy to see why the majority of the public doesn’t value doula work.  All women could do it if they wanted, it’s a job few people want, has little status, and it does not require any special skills.  While women pregnant for the second time may have a better understanding of what a doula has to offer, they may have paid a high price for that knowledge.  If we want to be recognized by medical caregivers, insurance companies and first time parents as a necessary service, we need to increase respect for our skills.  The first twenty years has been about getting the word out – now we need to make certain people know what that word means.

(This blog entry was originally published in June 2012 in

Gilliland (2011), After Praise and Encouragement: Emotional Support Strategies Utilized By Birth Doulas in the United States and Canada, Midwifery, Volume 27 (4) p. 525-531

Lantz, P., Kane Low, L., Varkey, S., Watson, R. ( 2005) Doulas as paraprofessionals: Results of a National Survey. Women’s Health Issues15:109-116.

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