A novice to expert analysis of skill development in birth doulas

This study applies the Benner interpretation of the Dreyfus Model of Skill Acquisition to birth doulas.

Sixty-five doulas participated in open-ended interviews in five waves between 2002 and 2022. Constructivist grounded theory methods were used to collect and analyze the data. Participants attended over 25 births, spoke English fluently, and did not utilize any medical skills. The doulas ranged in age from 22 to 65 and practiced in a variety of areas and settings in the United States, Canada, and the Netherlands.

The Benner model was relevant. Birth doulas grow similarly to nurses from novice to expert, including the development of intuition. However, the skill set is different. As they improved in skill acquisition, birth doulas showed advancement in information processing; confidence; decision-making; communication; self-awareness; client and staff relationships; professional detachment; definition of an ideal birth; management of witnessing medical maltreatment and feelings of overwhelm; the ability to read client cues; anticipation of labor events and staff responses; managing the challenges of a professional doula lifestyle; sense of identity, the maturation of expert intuition; and awareness of when they had power to influence a situation. Swiftness in development depended on the variety of birth experiences and locations; the doula's ability to reflect and find meaning; and life and career background.

Birth doula work is more complex and multifaceted than previously thought and requires growth in specific skill sets to be successful. Effective birth doula work requires sophisticated emotion management, analytical and communication skills, in addition to labor support skills. Public perception that anyone can be a doula is erroneous. It is a separate profession from obstetrical nursing, although some skills may overlap. Rather than continually training new people, programs could concentrate on removing the challenges to continuing birth doula work. Doula programs should address the challenges of each stage, thus encouraging greater expertise and retention and growth of an experienced workforce.