Become a doula in South Africa
What is a doula?
The word doula is a Greek word meaning women’s servant. Women have been serving others in childbirth for many centuries and have proven that support from another woman has a positive impact on the labour process.
A doula is a professional trained in childbirth who provides emotional, physical, and educational support to a mother who is expecting, is experiencing labour, or has recently given birth. The doula’s purpose is to help women have a safe, memorable, and empowering birthing experience.
Most often the term doula refers to the birth doula, or labour support companion. However, there are also postpartum doulas and bereavement doulas. Most of the following information relates to the birth (also called labour) doula. Doulas can also be referred to as labour companions, labour support specialists, labour support professionals, birth assistants, or labour assistants.
What does a doula do?
Most doula-client relationships begin a few months before the baby is due. During this period, they develop a relationship in which the mother feels free to ask questions, express her fears and concerns, and take an active role in creating a birth plan. Most doulas make themselves available to the mother by phone in order to respond to her questions or address any concerns that might arise during the course of the pregnancy. Doulas do not provide any type of medical care. However, they are knowledgeable in many medical aspects of labour and delivery.
As such, they can help their clients gain a better understanding of the procedures and possible complications in late pregnancy or delivery. During delivery, doulas are in constant and close proximity to the mother. They have the ability to provide comfort with pain-relief techniques including breathing techniques, relaxation techniques, massage, and labouring positions. Doulas also encourage participation from the partner and offer reassurance.
A doula acts as an advocate for the mother, encouraging and helping her fulfill specific desires she might have for her birth. The goal of a doula is to help the mother experience a positive and safe birth, whether an un-medicated birth or a cesarean. After the birth, many labour doulas will spend time helping mothers begin the breastfeeding process and encouraging bonding between the new baby and other family members.
What are the benefits of having a doula?
Numerous studies have documented the benefits of having a doula present during labour. A recent Cochrane Review, Continuous Support for Women During Childbirth, showed a very high number of positive birth outcomes when a doula was present. With the support of a doula, women were less likely to have pain-relief medications administered and less likely to have a cesarean birth. Women also reported having a more positive childbirth experience. Other studies have shown that having a doula as a member of the birth team decreases the overall cesarean rate by 50%, the length of labour by 25%, the use of oxytocin by 40%, and requests for an epidural by 60%. Doulas often use the power of touch and massage to reduce stress and anxiety during labour. According to physicians Marshal Klaus and John Kennell, massage helps stimulate the production of natural oxytocin. The pituitary gland secretes natural oxytocin to the bloodstream (causing uterine contractions) and to the brain (resulting in feelings of well-being and drowsiness, along with a higher pain threshold). Historically it was thought that intravenous oxytocin does not cross from the bloodstream into the brain in substantial amounts and, therefore, does not provide the same psychological benefits as natural oxytocin. However, more recent studies indicate that oxytocin administered nasally and/or intravenously may cross from the bloodstream into the brain. Nonetheless, doulas can help mothers experience the benefits of oxytocin naturally without the use of medication.
The presence of a doula can be beneficial no matter what type of birth you are planning. Many women report needing fewer interventions when they have a doula. But be aware that the primary role of the doula is to help mothers have a safe and pleasant birth–not to help them choose the type of birth. For women who have decided to have a medicated birth, the doula will provide emotional, informational, and physical support through labour and the administration of medications. Doulas work alongside medicated mothers to help them deal with potential side effects. Doulas may also help with other needs where medication may be inadequate because even with medication, there is likely to be some degree of discomfort.
For a mother facing a cesarean, a doula can be helpful by providing constant support and encouragement. Often a cesarean results from an unexpected situation leaving a mother feeling unprepared, disappointed, and lonely. A doula can be attentive to the mother at all times throughout the cesarean, letting her know what is going on throughout the procedure. This can free the partner to attend to the baby and accompany the newborn to the nursery if there are complications.
What about other types of doulas?
In addition to labour doulas, there are postpartum doulas as well as bereavement doula. Postpartum doulas provide support in the first weeks after birth. They provide informational support about feeding and caring for the baby. They provide physical support by cleaning, cooking meals, and filling in when a new mother needs a break. They provide emotional support by encouraging a mother when she feels overwhelmed. Bereavement doulas provide support to a mother who has been put on bed rest or is experiencing a high risk-pregnancy, miscarriage or stillbirth. They provide informational, emotional, physical, and practical support in circumstances that are often stressful, confusing, and emotionally draining. Some doulas have training in more than one area and are able to serve as more than one type of doula.
Why do people choose to become doulas?
Each doula has their own reason for wanting to become a doula and no two doulas are exactly the same. The list goes on and on but all of the reasons seem to stem from a place of great passion. This is not work that people do “just because”. It is important work and it is incredibly rewarding to do it. Some of the reasons are because:
They feel either empowered or disempowered by their own birth experience
Their personal birth trauma leads them to wanting to help others by providing labor support
Because they want women/birthing people to know their options
Because they want women/birthing people to feel supported enough to speak up and feel “heard” during labor and birth
Because they believe families should have gentle birth transitions and believe they can help facilitate them
Because they are passionate about birth and want women/birthing people to have the best experience possible
If you are serious about becoming a doula, these are important points to consider before you take the big step:
Doula clients are grateful and appreciative of the service you provide
Each time you are given the honour of supporting a mom in labour, it is an immense privilege
It is difficult to live life “on call” and you and your family will make great sacrifices in order for you to do it
You must sell the services that you provide before actually getting to provide them
You can work as an independent doula, work with another doula or work with/for a midwife or midwifery practice
You will need personal support with life’s responsibilities in order to be able to leave your life when a client needs you
You will want on-going professional support in order to learn the practical and business sides of doula work
You will most like not become a millionaire by being a doula...
How much could you earn as a doula?
There is a wide range of fees for doula services in South Africa. Very few people become doulas intending to get rich financially - attending births and empowering women feeds their souls. Doulas' fees differ vastly - one doula could charge R500 for a birth and the next may charge up to R3000 for a birth - that excludes antenatal classes, postpartum visits or any other extra - depending on many factors e.g. location, need for services, experience and 'add ons'.
Doula work - at least starting out - may not be consistent. You're creating a business and it can take time to become established and have a steady client base. There are busy seasons and quiet seasons and if you are relying on doula income to cover basic household expenses then it's important to remember like in any new business, your finances may not be steady. Some doulas begin this work while keeping another job, part time or full time. Once they are comfortable with the amount of clients they have then they leave the other work, but when (or if) that happens will vary. You have to charge a fee that allows you to sustain your work, rather than being so discounted that you are losing money after you subtract expenses. When setting this fee you need to take into account many factors but make sure you also include your travel time and expenses. Newer doulas are often willing to travel far to take clients, which quickly adds up to many hours in the car between prenatal and postpartum visits. Consider what your travel boundaries will be and work this into your fee. I'll reiterate again - doula work is valuable, and you need to establish a fee that makes this sustainable for you.
If doulas in your area are known and it's a respected profession then you may quickly have a reliable income. Unfortunately, in some areas the role of doulas is not valued and many, even other birth professionals, expect doulas to work for fees that end up being less than minimum wage. Far too often I've heard people say, "I'm sure you can find a new doula to attend your birth for free!" and this is obviously NOT a sustainable business plan. Your work is worth the investment to charge for!
Where can you train to become a doula in South Africa:
Please contact us for a list of doula training programs available in your area.
DOSA encourages all doulas to continue to learn and grow and acquire new skills that will enhance their business offerings and/or develop important business networking partnerships.
Registered DOSA doulas who have also completed the NCOT Perinatal Bereavement Training (12 week online training) are the only doulas eligible to apply to The Angel Gown Initiative (TAGI)to be able to provide Angel Gowns to the loss parents that they work with.
There are several conferences and symposiums that happen across South Africa throughout the year, as well as online and in-person trainings that can add value to a doula's business offering. Please join the DOSA Doulas group on FB to stay informed of upcoming events, courses and workshops.
1. Childbirth Connection
2. Hodnett ED. Gates S Hofmeyr GJ. Sakala C. Continuous Support for Women During Childbirth. Cochrane Database of Systematic Reviews. CD003766, (2003).
3. Klaus, M., Kennell, J., Klaus, P. Mothering the Mother.: Addison-Wesley Publishing Company, (1993).
4. Viero, C., Shibuya, I., Kitamura, N., Verkhratsky, A., Fujihara, H., Katoh, A., Dayanithi, G. (2010).
5. Oxytocin: Crossing the bridge between basic science and pharmacotherapy. CNS Neuroscience & Therapeutics, 16.