What is a doula?
A doula provides emotional, physical, and spiritual support for expectant mothers and their families during pregnancy, labour, and the postpartum period. Building on the role of the traditional Aunty, Aboriginal doulas can assist in honouring traditional and spiritual practices and beliefs associated with maternity care and support the language and cultural needs of the woman and her family.
Additional benefits of the continuous, supportive care that a doula provides during pregnancy, labour, and the postpartum period include:
• ensuring the expectant mother and her family feel comfortable and supported and fully understand their maternity care decisions;
• assisting her and her family to communicate their expectations, hopes, fears, and any concerns about the birth of their baby;
• supporting her to find her strength and place of power in giving birth;
• encouraging and providing reassurance to her partner and family, so they feel more confident in being involved in providing support;
• helping to create an ideal atmosphere for the birth, breastfeeding, and attachment/bonding between the baby and her and other family members;
• providing the new mother and her family with emotional support and information following the birth, in the home and in the community; and
• connecting and referring the mother and her family to additional supports if needed.
For Families
How do I access doula services?
• Ask your doctor, midwife, nurse, or local health provider to assist with a referral.
• Contact the Doula Services Association’s Referral Line at 1-877-365-5588 (toll free) or 604-515-5588 within Vancouver.
How much do doula services cost?
Doula services in BC are not covered as a part of the Medical Services Plan (BC Services Card/Care Card) or First Nations Health Benefits. Doulas are self-employed and work independently or as a part of a team. The cost for doula services varies. As an estimate, for three to four visits, doulas on average can charge between $500 to $800 for their care. Families often pay for these services themselves.
Some prenatal programs include the support of a doula at no cost—check with your local health provider or health centre to learn more.
If you need financial assistance, the BC Association of Aboriginal Friendship Centres (BCAAFC) offers the opportunity to apply for funding for expectant Aboriginal families so they can access doula services. For more information, visit BCAAFC's Doula Support Program. http://www.bcaafc.com/index.php/initiatives/doula-support-program
For Service Providers
1. Doulas
Becoming a doula
Do you love to support community members?
Do you love to support women in your community who are pregnant?
Have you experienced giving birth or providing support to someone who is expecting a baby?
Have you experienced supporting a woman during labour and childbirth?
If you answered yes to any of these questions, then you should consider becoming a doula. Being a doula can be an extremely rewarding experience. We recommend reading What to Consider Before Becoming a Doula to ensure you understand what is involved in becoming and practicing as a doula. These considerations are based on the Tripartite Aboriginal Doula Training Initiative, a pilot program which was conducted in Island Health and Interior Health.
Training and Certification
There are a number of organizations that offer training to become a doula. First Nations Health Authority does not promote one program over another. The list below is provided to assist in the search for an appropriate program to meet each individual's learning needs. If you know of additional courses in your area, please let us know, and we will add to the list.
• College of the Rockies www.cotr.bc.ca/doula/
• Douglas College http://www.douglascollege.ca/programs-courses/continuing-education/perinatal/perinatal-career/dona-doula-training
• Mothering Touch www.motheringtouch.ca/classes/doula-training
• Pacific Rim College www.pacificrimcollege.com/faculties-programs/program/holistic-doula-certificate
While certification is not mandatory to practice as a doula, having certification from DONA (Doulas of North America) shows that the doula has met a high international standard, which helps ensure expectant parents, their families, and their health care providers that the doula will adhere to the highest standards of conduct and ethics. Having DONA certification may be preferred by women and their families or organizations. It is also increasingly recognized within the health care system.
Visit the DONA website at www.dona.org/develop/certification.php for specific requirements of DONA certification.
If DONA certification is important to you, please ask the coordinator of the course/workshop that you choose if it is DONA certified. There are a number of DONA certified courses across BC—you can the following search tool www.dona.org/develop/find_a_workshop.php to find DONA certified courses/workshops by selecting the CANADA – British Columbia search option.
Read about one doula's story about her certification process.
Doula Associations
Being a member of a professional doula association can provide new and experienced doulas with a way to connect with similar individuals supporting families during the perinatal and postpartum period.
Some doula associations include:
There may be additional sub-regional associations; doulas are encouraged to look for a local association, or even start their own.
*Note: In order to be a member of the Doula Services Association, it is necessary that you have completed a DONA certified workshop or course, but full DONA certification is not required to be a member.
Resources
Please see the following video to learn more about the roles and work of doulas and midwives, hosted by the UBC Learning Circle
The Tripartite Aboriginal Doula Initiative was developed in 2011 in response to a recommendation made in the Transformative Change Accord: First Nations Health Plan to improve maternal health services for Aboriginal women and "bring birth support close to home and into the hands of women." The initiative was a partnership among the federal government, provincial government (represented by Perinatal Services BC, an agency of the Provincial Health Services Authority), and the First Nations Health Authority. The Tripartite Aboriginal Doula Initiative was a demonstration project conducted in the Vancouver Island and Interior regions that trained 31 women during 2011/12.
There were a number of resources that were developed as part of the Tripartite Aboriginal Doula Initiative.
You can support your doula practice with the following:
Printing Notes:
- The Flyer is best printed in colour.
- Both the Postcard and Thank You Card can be downloaded with or without crop marks. Crop marks help you cut the cards to the appropriate size.
- The Postcard is double-side and two per page. It is best printed in colour and on card stock or heavier paper. Select "Actual Size" not "Fit" in printer settings and "Double-sided" or "Print on both sides." Cut along the crop marks (+ and -). If you are using the version without crop marks, just cut across the middle to make two postcards.
- The Thank You Card is best printed in colour and on card stock or heavier paper. Select "Actual Size" not "Fit" in printer settings. Cut along the crop marks (+) and fold along the middle to make a card. If you are using the version without crop marks, just fold across the middle to make a card.
The following are culturally appropriate resources for doula program instructors and professional development programs managers:
2. Organizations
If you are part of a health organization or community that would like to recruit and retain a doula as a part of its local health program, please review Recruiting and Retaining a Doula. This
document highlights important considerations based on the Tripartite Aboriginal Doula Initiative, a pilot program which was conducted in Island Health and Interior Health. Please also see the accompanying document What to Consider Before Becoming a Doula.
What to Consider Before Becoming a Doula
A doula provides emotional, physical, and spiritual support for expectant mothers and their families during pregnancy, labour, and the postpartum period. Building on the role of the traditional Aunty, Aboriginal doulas can assist in honouring traditional and spiritual practices and beliefs associated with maternity care and support the language and cultural needs of the woman and her family.
Being a professionally trained doula can be an extremely rewarding occupation. If you are thinking of becoming a doula, you are encouraged to review this document. The information below will help you understand what is involved in becoming and practicing as a doula and help you be successful as a doula.
1. Time Commitment
It takes commitment to be a doula. Before embarking on this career choice and enrolling in a training program, a doula is encouraged to become familiar with the training and certification process and requirements, including study time, practical experience, and administrative paperwork. Certification is not mandatory to practice as a doula, but having certification from DONA (Doulas of North America) shows that the doula has met a high international standard, which helps ensure expectant parents, their families, and their health care providers that the doula will adhere to the highest standards of conduct and ethics. Having DONA certification may sometimes be preferred by women and their families or organizations. It is also increasingly recognized within the health care system. Visit Doula Training and Certification on the FNHA website for more information, contact the training and certification organizations to find out exactly what their requirements are, and talk to other trained doulas who have already completed the process to get a sense of what the time commitment, expectations, and limitations are.
Babies come at all hours, which makes doula work unpredictable. A doula will need to work flexible hours, including evenings or weekends as necessary and be available on call 24 hours a day, seven days a week to support families.
Depending on the emotional, physical, and support needs of the expectant mother, a doula may need to commit varying degrees of time with each expectant mother and her family.
A doula may go long periods of time without clients in smaller communities where few women may be pregnant at a given time.
A doula may face challenges around time management and competing priorities, for example, doula practice, other work, and their own family obligations. It is imperative that a practicing doula have a back-up doula to assist clients in case of an emergency or if personal time is needed.
2. Financial and Infrastructure Requirements
A doula may need to obtain adequate funding to cover costs for training and the delivery of doula services, including: training registration fees and textbooks; transportation, telephone communication, and parking; and doula awareness building materials and events. It is suggested that a doula reach out to community partners and organizations to seek financial or in-kind support, including available grants.
It might be challenging to secure appropriate meeting spaces for clients. A doula can connect with a friendship centre, health centre, or community-based organization to set up an agreed to and available meeting space.
It is important for a doula to be knowledgeable about existing community resources that can further support mothers and their families. A doula should connect with community groups for support and to build awareness of doula services.
3. Personal and Professional Support
It is important to have a strong personal and professional support network, including your family, friends, and co-workers.
A doula should reach out to existing doulas, as support from other doulas can be very helpful. A doula can look for networking and professional development opportunities with doula associations, join their email lists or Facebook groups, and attend their education events. Being a part of an association enables a doula to learn from existing doulas who are practicing—their success stories, how they have overcome challenges, and what advice they have.
Some doula associations include:
There may be additional sub-regional associations; doulas are encouraged to look for a local association, or even start their own.
It is also helpful to connect with Elders in your community for support, to be your mentor, and to learn more about local birthing teachings, traditions, and practices. Strong personal and professional connections with other health care providers within the community are also extremely beneficial to ensure referrals and offers a way to increase professional development opportunities in maternity care.
4. Communications
A doula must have reliable means of communication, including good cell phone coverage and an adequate number of minutes—this will help to ensure timely and quality care for families. Know that in some communities, cell phone reception is unavailable, and clients may not have cell phones, either.
However, the client may also prefer other ways to communicate, including email and Facebook. What is important is for a doula to ensure a timely response to requests, whether by phone or email.
5. Travel
A doula should have a driver's licence and access to a reliable vehicle or access to adequate public transportation. A doula needs to be able to travel to meet and help expectant mothers and their families. Long distance travel might be involved to assist women in other communities who might have limited access to a doula.
6. Physical Requirements
Fitness and endurance are factors to consider before participating in training. A doula may need to stand for extended periods, lift, bend, and reach. A doula may also need to go without sleep for as long as the labour takes.
7. Building Relationships and Increasing Awareness
The key to sustaining a strong doula practice is by building meaningful relationships within communities. This will increase awareness about doula services and help reach potential clients. Building relationships is not a one-time activity but rather an ongoing aspect of doula work—a doula needs to be willing and prepared to do this networking and promotional work. This can be done by participating in community events and connecting with other health care providers.
If a doula has pre-established relationships and connections within communities, it is likely the doula will find it easier to network, promote their services, and reach clients. If a doula is new to the community or does not have those relationships yet, there are many ways to build a strong community network. The following are recommended strategies to build relationships and promote doula services.
a) Doula Awareness Materials
An effective way to build awareness of doula services is to have something to leave in the hands of people, so that they can read, learn, and remember the benefits of accessing doula services. It is important that this information is clear, concise, and engaging as health literacy can be a challenge for some people.
It is recommended that a doula have promotional material on hand, including:
• a flyer or handout (see Doula Resources on FNHA website for a sample) describing what a doula is, the benefits women and families will experience when they have a doula, and the referral process; and/or
• business cards or postcards (see Doula Resources on FNHA website for a sample) to hand out to potential clients and community organizations and at networking events.
b) Promotional Activities
Below is a list of suggested activities that a doula can do to increase awareness of doula services:
• Present at band meetings, hub meetings, and community meetings.
• Distribute flyers in friendship centres and band offices.
• Place ads in band newsletters.
• Submit articles in newsletters of First Nations/Aboriginal organizations.
• Host an information session/table at prenatal classes and parenting sessions.
• Host an information table at health or career fairs.
• Submit articles in local newspaper, do interviews with radio/TV.
• Attend Pow Wows, Potlatches, and other culture events.
• Present at Elders Gathering and Elders lunches.
• Time promotion work around Aboriginal Mother's Day.
• Present at school parent/teacher association meetings.
• Put posters up in nursing stations, public health clinics, health centres, hospitals, child and family service centres, local churches, stores, and other retail outlets if available.
• Connect with local health care providers (community workers, nurses, midwives, and physicians).
• Connect with a local First Nations/Aboriginal navigator or liaison if there is one in the area.
• Host events with early childhood development, child care, and maternal health programs.
• Provide business cards to professionals providing home/family support to women and families, such as home support workers, health nurses, Aboriginal Infant Development consultants as they may know of women that could benefit from these services.
• Help host or involve yourself in community activities (Welcoming Babies or Naming Ceremonies).
c) Engage the Community
The more individuals a doula can connect with, the more support and referrals a doula is likely to receive. Organizations such as friendship centres, band offices, hubs, local health centres, and schools are essential for raising awareness and gaining support for doulas and doula services. Friendship centres, health centres, child and family centres, early childhood development programs, and child care programs can spread the word about doula services and act as safe locations for doulas to meet with clients.
Involve community groups and local businesses when organizing awareness events—ask them to sponsor or co-host events. Invite Elders to be involved by providing opening and closing prayers, reflections, guidance, encouragement and sharing knowledge and stories about maternity care practice.
Some important community partners a doula should work with include:
• Maternal and child health services
• Community health and social services
• Public health units, community health nurses, and home support workers
• Local midwives, physicians, and maternity nurses
• Friendship centres
• Elders
• Medical students
See the appendix for a list of suggested organizations.
d) Collaborate with Health Care Providers
It is important for a doula to establish credibility with local health care providers, so they can understand, appreciate, and work collaboratively with doulas to improve outcomes for mothers and babies. Health care providers can also talk to women about whether a doula is right for them and help refer them to a doula for support. A doula can set up meetings with partners at community health centres, public health units, and acute care facilities to establish these relationships.
Final Note
In summary, the work of a doula can be very rewarding profession because it has a direct impact on the health and wellness of expectant mothers and their families. As described above, there are a number of factors to consider when thinking about pursing training and practice as a doula. With many of the above supports in place, a doula can pursue excellence in their role as a valued professional supporting women and their families.
The information in this document is based on the evaluation of the Tripartite Aboriginal Doula Initiative, a pilot project which was conducted in the Vancouver Island and Interior regions and involved Aboriginal women learners in the area.
Recruiting and Retaining a Doula
A doula provides emotional, physical, and spiritual support for expectant mothers and their families during pregnancy, labour, and the postpartum period. Building on the role of the traditional Aunty, Aboriginal doulas can assist in honouring traditional and spiritual practices and beliefs associated with maternity care and support the language and cultural needs of the woman and her family.
The following are important considerations for communities and health organizations that would like to recruit and retain a doula as a part of their local health program. Please also refer to the accompanying document What to Consider Before Becoming a Doula.
1. Funding Considerations
Doula services in BC are not covered as a part of the Medical Services Plan (BC Services Card/Care Card) or First Nations Health Benefits. Doulas are self-employed and work independently or as a part of a team. The cost for doula services varies. As an estimate, for three to four visits, doulas on average can charge between $500 to $800 for their care. Families often pay for these services themselves. The BC Association of Aboriginal Friendship Centres offers the opportunity to apply for funding for expectant Aboriginal families, so they can access doula services. Some prenatal programs include the support of a doula at no cost.
Adequate funding is needed for the recruitment and retention of a doula as part of community health services, including: training registration fees and textbooks; travel, transportation, parking, and telephone communication; doula awareness and promotion materials and events; and office space and supplies when appropriate. Some of these are ongoing costs.
Organizations considering hiring a doula will also need to determine their approach to compensating the doula for their work. For example, an organization can employ a doula hourly or as a salaried staff member who may have additional roles and responsibilities beyond being a doula (e.g. early childhood development, childcare, or family programming). Or an organization can pay a doula on a case-by-case basis when a family has requested doula services. Some organizations and doulas may agree to compensation in the form of an honorarium; others may prefer to process payment based on invoices from the doula.
2. Work Environment and Infrastructure Considerations
a) Time Commitment and Flexibility
It takes commitment and flexibility to be a doula and to support a doula through training and ongoing practice. An organization and its doula candidate both should become familiar with the training and certification requirements (including study time, practical experience, and administrative paperwork) to ensure that both parties are willing and able to fully participate. Certification is not mandatory to practice as a doula, but having certification from DONA (Doulas of North America) shows that the doula has met a high international standard, which helps ensure expectant parents, their families, and their health care providers that the doula will adhere to the highest standards of conduct and ethics. Having DONA certification may sometimes be preferred by women and their families or organizations. It is also increasingly recognized within the health care system. Visit the Doula Training and Certification list on the FNHA website for more information, contact the training and certification organizations to find out exactly what their requirements are, and talk to other trained doulas who have already completed the process to get a sense of what the time commitment, expectations, and limitations are.
In addition, doulas will need to work flexible hours, including daytime hours, evenings, and weekends as necessary, and be available on call 24/7 to support women and their families. Strong consideration should be made to having backup doula support to allow for continuous care in case a regularly employed doula is unavailable.
b) Communication
Ensuring a doula has reliable means of communication, including good cell phone coverage and an adequate number of minutes, is important to ensure timely and quality care for families. For expectant women and their families who do not have a cell phone, a doula or host organization could consider providing them with a temporary one while they receive doula services.
c) Travel
Ensuring a doula is able to travel to help women and their families in other communities is also important. A doula should have a driver's licence and access to a reliable vehicle or adequate public transportation to be able to meet clients when and where it is convenient for them.
3. Doula Awareness
It is important for an organization's leadership to be invested and committed to supporting doula efforts. An organization and its doula will need to build and maintain meaningful relationships within and across communities in order to increase awareness about doula services and reach potential clients. This is not a one-time activity but rather an ongoing aspect of doula work—an organization and a doula both need to be willing and prepared to do this promotional work. Ideas for how to build awareness about the role and benefits of a doula within a community or organization are suggested below.
a) Information Materials
An organization and doula should have promotional material on hand, including:
• a flyer or handout (see Doula Resources on FNHA website for a sample) describing what a doula is, the benefits women and families will experience when they have a doula, and the referral process; and/or
• business cards or postcards (see Doula Resources on FNHA website for a sample) to hand out to potential clients and community organizations.
b) Promotional Activities
Below is a list of suggested activities that an organization or doula could do to increase awareness of doula services:
• Present at band meetings, hub meetings, and community meetings.
• Distribute flyers in friendship centres and band offices.
• Place ads in band newsletters.
• Submit articles in newsletters of First Nations/Aboriginal organizations.
• Host an information session/table at prenatal classes and parenting sessions.
• Host an information table at health or career fairs.
• Submit articles in local newspaper, do interviews with radio/TV.
• Attend Pow Wows, Potlatches, and other culture events.
• Present at Elders Gathering and Elders lunches.
• Time promotion work around Aboriginal Mother's Day.
• Present at school parent/teacher association meetings.
• Put posters up in nursing stations, public health clinics, health centres, hospitals, child and family service centres, local churches, stores, and other retail outlets if available.
• Connect with local health care providers, such as community workers, nurses, midwives, and physicians.
• Connect with a local First Nations/Aboriginal navigator or liaison if there is one in the area.
• Host events with early childhood development, child care, and maternal health programs.
• Provide business cards to professionals providing home/family support to women and families, such as home support workers, health nurses, Aboriginal Infant Development consultants as they may know of women that could benefit from these services.
• Help host or involve yourself in community activities such as Welcoming Babies Ceremonies or Naming Ceremonies.
c) Engage the Community
The more individuals an organization can connect a doula with, the more support and referrals a doula is likely to receive. Organizations such as friendship centres, band offices, hubs, local health centres, and schools are essential for raising awareness and gaining support for doulas and doula services. Friendship centres, health centres, child and family centres, early childhood development programs, and child care programs can spread the word about doula services and act as safe locations for doulas to meet with clients.
Involve community groups and local businesses when organizing awareness events—ask them to sponsor or co-host events. Invite Elders to be involved by providing opening and closing prayers, reflections, guidance, encouragement and sharing knowledge and stories about maternity care practice.
Some important community partners a doula should work with include:
• Maternal and child health services
• Community health and social services
• Public health units, community health nurses, and home support workers
• Local midwives, physicians, and maternity nurses
• Friendship centres
• Elders
• Medical students
d) Collaborate with Health Care Providers
It is important for a doula to establish credibility with local health care providers, so they can understand, appreciate, and work collaboratively with doulas to improve outcomes for mothers and babies. Health care providers can also talk to women about whether a doula is right for them and help refer them to a doula for support. An organization can help their doula set up meetings with partners at community health centres, public health units, and acute care facilities to establish these relationships.
4. Evaluation
Evaluation is an important component of supporting quality doula service provision. It can help ensure services are useful and relevant to expectant women and their families. Evaluation also provides the opportunity to identify successes and lessons learned to improve care and share helpful learning with partners.
Ongoing evaluation of doula services is helpful throughout development and delivery. Evaluation results can capture steps taken and challenges faced during service provision. An organization can assist a doula in implementing a feedback mechanism with women and their families receiving services (e.g. a short questionnaire with five questions).
A doula should also track and monitor specific data, such as:
• number of women and their families who received doula services
• number of births attended
• number of women who initiated breastfeeding
• number of women who continued breastfeeding beyond six weeks, six months, and one year
A more comprehensive evaluation can include broad stakeholders (e.g. doulas, healthcare providers, Elders, community partners, etc.) through surveys, verbal check-ins, or formal focus groups as examples. Sharing the results with everyone who participated is an important way to maintain engagement and increase ownership for doula services.
Final Note
In summary, a community-based organization can play a significant role in supporting the recruitment and integration of a doula within existing maternal and child health services. Funding, infrastructure, awareness building, and evaluation considerations are all essential in ensuring that a doula is able to practice in a sustainable way that best meets the needs of women and their families.
These considerations are based on evaluation results from the Tripartite Aboriginal Doula Initiative, a pilot project which was conducted in the Vancouver Island and Interior regions and involved Aboriginal women learners in the area.
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