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Doula work a labor of love, does not deliver financial rewards
ANN ARBOR, Mich.—Doula work delivers love, not money.
In the first known national study of doulas, University of Michigan researchers found that while 96 percent of doulas find their work rewarding on a personal or emotional level, only one out of three find their work rewarding financially. The average gross annual income of a certified doula in 2002 was $3,645.
The word doula is from the ancient Greek term for woman servant or woman helping another woman. Today it's used to describe an increasingly popular paraprofession as a supportive caregiver during childbirth.
The use of family members or friends helping women with childbirth declined in Western countries as women turned to hospital delivery rooms. But now, for a fee, certified doulas are part of maternity care teams. About 5 percent of women giving birth in the United States used a doula in 2002, and they are part of a movement that includes midwives, childbirth education and family birthing rooms—all aiming to humanize the birth experience, said Paula Lantz, lead author of a study appearing in the new issue of the journal Women's Health Issues.
Lantz noted that more than a dozen studies have shown that providing continuous emotional support during childbirth can reduce the length of labor and need for interventions such as forceps and caesarean sections.
"Historically, it's interesting that doulas are emerging as another way to push back against the medicalization of childbirth," said Lantz, associate professor of health management at policy at the U-M School of Public Health.
With assistance from five professional doula associations that certify doulas, Lantz and her collaborators surveyed about 1,000 doulas nationwide, focusing on those who are certified through the associations or who have begun the certification process.
Among their findings about doulas:
• Most doulas are white—93.8 percent—with an average age of 40 years. Most are married women who have given birth before.
• About one-half said they had a college degree or more, and about 30 percent of them have a household income of $75,000 a year or more.
• About three quarters of doulas have paid jobs other than their doula practice, working an average of about 25 hours at those jobs.
• The vast majority are in solo practice, with an average number of 60 clients served during their time as doulas. They help an average of nine clients a year deliver babies.
About one quarter of respondents said they were planning to become a midwife in the future, indicating that being a doula might be a transitional career for them.
Lantz said several things point to challenges for the growth of doulas, including the prevalence of doulas planning to go on to be midwives and the low pay of the job, making it something women might choose as a second job or while they take care of their own children.
"It is likely that doula work will not become more financially lucrative or appealing unless more people are willing to pay for these services and/or third-party reimbursement becomes more common," the authors wrote in their article.
Only 10 percent of doulas reported having been paid by third party, usually for having provided "labor support" or "prenatal education."
In addition, many doulas report that they do not feel supported by physicians, and there are some debates regarding what doulas should and should not do with their clients, Lantz said.
Doulas are not supposed to provide medical care. They focus on continuous emotional support to clients, giving help with positions and breathing, words of encouragement, and massage during labor.
Lantz's co-authors are Sanjani Varkey and Robyn Watson at the School of Public Health, and Lisa Kane Low, with joint appointments in the School of Nursing and the Women's Studies Program.
The research was funded in part by a $25,000 grant from the Walter McNerney Fund at the University of Michigan.
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