Doulas as childbirth paraprofessionals: results from a national survey

Fourteen randomized trials have demonstrated that continuous caregiver support during childbirth can lead to shorter labors and decrease the need for intervention. In response, there has been a significant increase in the number and use of doulas as paraprofessionals who provide social and emotional support to women during labor/birth for a fee. We conducted a mailed survey of a nationally representative sample of certified and certification-in-process doulas in the United States (n = 626, 64.4% response rate) to gather some descriptive information on their sociodemographic backgrounds, practice characteristics, and beliefs/attitudes on a number of salient issues. The survey results suggest that, in 2003, doulas were primarily white, well-educated married women with children. The majority of certified doulas worked in solo practice and provided childbirth support services on average to nine clients per year. Very few doulas were earning more than 5,000 dollars per year from this work, and only 10% of certified doulas reported receiving third-party reimbursement for their services. Thus, while almost all doulas found their work emotionally satisfying, only one in three saw their work as financially rewarding. Doulas also reported challenges in getting support/respect from clinicians and in balancing doula work and family life. In addition, one in four doulas reported that they were preparing for a career in midwifery. Doulas can play an important and unique role in the childbirth process and reap many personal rewards engaging in this type of work. However, a number of financial, personal, and professional challenges present significant obstacles to the growth of doulas as childbirth paraprofessionals in the United States.