The Downside of Doula-ing

The Downside of Doula-ing

Usually, I write about births, and I’m focused on parents preparing for birth. Today is a little different. Today, I have thoughts to share with the doulas and birth professionals, my sisters and brothers who share in the experience of caring for birthing women.

When I first felt called to become a doula, I imagined the joy of witnessing the happiest and most memorable day of a mother’s life again and again. I knew that it would be a blessing and an honor to hold the sacred space for the passage of a new life into the world. That was absolutely right, and remains true to this day, as hundreds of babies later, I am still moved to tears almost every time.

I hadn’t imagined this amazing work having a downside. It’s mothers and fathers and babies! It’s Happy Birthdays and awe and wonder! How can there be any shadow to that? I have learned, over the years, that most women who train to be doulas stay in the field for less than two years. There is an incredibly high burnout rate among labor support professionals. Having spent several years now working with my own mentors, and supporting newer doulas as they go along their own doula path, it seems there are a few bumps we all experience along the way.

If you are starting out as a birth professional, or are considering becoming one, I want you to know that these things happen. It’s healthy to be prepared for them,  and it’s important that we talk about them with one another as part of our Self Care. Holding in our tension, our grief,  our stress and our own processes is exactly where burnout comes from. In fourteen years and 400 births, I have learned that we’ve all experienced some of the same rough spots.


1) We’re human, and we’re superheroes.  A full-time doula’s schedule can be brutal. It’s intense.  Any day, any time, we are ready to lift right out of whatever we may be doing. When someone gives the “come now”, like Superman hearing a call for help,  we drop everything, make a quick change, and show up. Births can be long. We need rest and food – two things that aren’t always easily afforded when supporting a laboring woman. She is allowed to be grumpy and tired. You are not. She’s irritable and demanding. She’s due-any-day and a basket case. It is not acceptable for you to be so. You had a rough day? Trouble in paradise? Doesn’t matter. Hang your personal life on a hook outside the door when you walk in, and be fully present.

2) We get attached. The skill of non-attachment is required, and it’s not easy.  You will experience the “bump” and the resulting swirling feelings that happen the first time (or first several hundred times, depending on how much time your learning takes) that a mama doesn’t take your advice, or disagrees with something that may be important to you. You might feel frustrated, or feel rejected, or be tempted to take something personally. Your buttons are going to get pushed, sometimes very hard. You cannot decide what she will do – you may only decide what you will do. You may have to remind yourself repeatedly “This is not my birth. This is not my birth. This is NOT MY BIRTH.”  It really isn’t. It’s hers, completely, and it’s your responsibility to let her have her own experience. It’s our job to present the information as objectively as we can, and allow her to make her own best decision.  Regardless of her birth story or outcome, if she knows what choices she has available and understands that she has the power to speak up, we’ve done our job. The end.

3) Our mamas are human, too.  We get the honor of being present for one of a woman’s most raw and vulnerable life experiences. This is a privilege, no question. It is huge to be in that place of trust. Most of the time, this means that we get to play an integral role in someone’s most precious memories. Though birth is profoundly beautiful every time, the truth is, it’s not always pretty.  Women will show up for labor exactly as they show up in life. Every woman has an entire life story that has taken place prior to meeting you, and as her doula, you often won’t know more than the tip of the iceberg.  She has her own habits and her own core beliefs – about birth, about her own strength, about power and control –  that will play out during her birth time. One in four women has experienced abuse in her lifetime. Marriages aren’t always functional. Friends and relations present in the birth space aren’t always supportive. Sometimes, if it is part of how she lives, a mama will be looking for someone to resist or to blame, and doulas are easy targets. Sometimes, if it what she has learned to do,  a woman will surrender her power to other people,  even to her doula, and the expectation is there that the doula will tell her what to do.  There is sometimes a spoken or unspoken expectation that a doula will be able to control people, emotions, or events that she simply cannot.

4) Doctors, Midwives, and Nurses? Also human.   Some practitioners are bullies. Some practitioners have had negative experiences with other doulas, or with a laboring woman’s sisters or friends who call themselves “doulas”, and have negative feelings about doulas being present for their patients at all.  Some may not have great communication skills. They might be busy, or snarky, or having an off day. They get bumped and triggered, too.  As doulas, we’re the lowest folks on the totem pole in the birthing room. We have a responsibility for acting with politeness and respect toward every other professional in the room, regardless of our personal opinions, previous experiences, or  inner reactions. We don’t tell them what to do, or how to do it – NOT OUR JOB. We get good at biting our tongues, or better yet, we can be a model for taking a deep breath, letting it go, and providing compassionate support for our mamas. That’s what we’re there for.

5) Sometimes, things just go wrong.  We may want, with every fiber of our being, for every birth to go peacefully, happily, and well. We may do everything in our power to help this happen for every woman we can. Often, it does, and that joy is the best part of this doula gig. There are other times when the unthinkable happens. Medically necessary inductions aren’t always successful. A longed-for unmedicated birth becomes an unexpected cesarean birth.  Husbands are caught in affairs or leave the marriage with no reason and no warning, leaving the mama to birth on her own. Dire medical emergencies occur. We witness abuse in relationships between mothers and daughters, or husbands and wives. We witness birth rape.  Babies are diagnosed with conditions “not compatible with life”.  Births become a time of grieving.  We come prepared to support women through the physical pain of birth, but the tools we carry in our birth bags are useless for the breathtaking emotional pain that  happens. Sometimes, a doula’s most powerful skill is to simply be the one who witnesses that, yes,  something went very wrong.  We hold space for a lot of  pain and loss. This unanticipated aspect of the doula role is why many quit after the first undesired birth outcome.


In time, it becomes clear that when we give our YES to walking the doula path, we are giving a bigger YES than we expected to our own learning and growing more deeply than we may have ever thought possible.  These challenges hold the potential to become the valuable life lessons that doula work has to offer. “I could get called away any minute” can also become “Be fully present and enjoy this moment, right now.” As we learn to make observations instead of placing  judgments  we learn that our feelings and reactions have nothing to do with the mama who is in labor, or her partner, or her doctor.  Feelings belong to the person experiencing them, not the person who triggered them, and are indicators of what your lesson will be with this birth.  In being gentle with our mamas, we learn to be gentle with ourselves. Learning to accept ourselves as “good enough” in the face of the desire to defend ourselves  is our own work to do. The same is true for discovering our own core beliefs, recognizing where they differ from the stories of others, and allowing both to co-exist. We’ve been given an opportunity, in experiencing these bumps, these hard moments, and these feelings, to work on our own growth. That’s the gift that doula work gives us, again and again. These skills take time, sometimes a lot of it. It takes patience, and a willingness to work deeply with our inner selves.  Reach out to your own support people. Do your own self-care work in whatever healthy way you know how. You’ll begin to see where these lessons – honoring boundaries, taking nothing personally, owning our own experiences – pop up in other places in your life, too. Keep it up. It gets easier with practice. We learn to hold space with love and compassion for someone else’s process, without making it our own. We witness the breaking points, and we learn to stretch without becoming broken. We grow stronger and become the rock our mamas need to lean on and reach out to, without their needing to worry (as they may with friends and family) that seeing their fear, their struggle, their vulnerability, their grief and their anger will tear us down or push us away. We support them in the process of learning that they, too, can stretch without breaking.

Each downfall, each dark side, each shadow is yet another opportunity to look within ourselves and ask, “What’s my lesson in this?” These lessons are the reward we receive from our wholehearted willingness to honor the rite of passage that is birthing a child. We can let them tear us down and burn us up, or we can learn, and grow, and be grateful. The choice is ours.


What have been your bumps, and your learning? What have your biggest lessons been?  I’d love to hear you – please feel free to comment.

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44 Responses »

  1. This is a really excellent post! Thanks for summing it up so expertly. As a doula myself for 10 years, I relate to everything you wrote, and completely agree. Sharing!!

  2. All of this completely true. We are so blessed and sometimes so overwhelmed by being a doula. It is an amazing journey for sure.

  3. Thank you for sharing this, i am about to embark on this journey and have had many questions and you have answered many. What a privilege to become part of such a beautiful and honest community.

  4. Well said, thank you so much for sharing this. I am in my 5th year as a doula and have found that processing with my doula network and self care are the main ways I have been able to avoid burn out. Such a great and crucial topic!

  5. Thank you! So well put, and I’m just beginning this journey. I started two years ago with an “unfortunate outcome” and I knew at that moment that this is exactly what I need to be doing. You are too right about, “this is NOT my birth”.

  6. You are so right! You write about this with empathy and compassion for everyone (including yourself and the rest of us doulas!) and I think that is the key. Of course there are wonderful moments, but there are also hard, hard moments in birth. There are hard moments for everyone in the room, for very different reasons. I have learned the most from what might be labeled the most “difficult” births. The birth I learned the MOST from was an all-natural hospital birth after which the nurses called Child Protective Services and the mom wasn’t allowed to be alone with her baby for 24 hours and had to fight for custody for many weeks after the birth. My practice as a doula changed dramatically after that birth. It made me angry, angry, angry, but it also led me to think deeply about how to reach hospital nurses and I think I do a much better job of that now. Thanks for a great post!

  7. Well articulated Jodi! I try and share with my doula students these “downsides” and also tools to help prevent some and to grow with some. You are right, these lessons take time and soul-searching and — like labor! — are of great value. A doula who quits or moves on should not feel badly as she has learned a great lesson about herself and her limits too. Life is Good.

  8. I became a doula in 2005. I attended my last client last year. I was on the CPM path and recently changed to the CNM path. I do not have the ability to do both so I hung up my hat as a doula to concentrate on these other plans. I stopped attending hospital births years ago. The client I attended last year was a home birth mother that transported and I could no longer stand by and watch a mother being abused because she transported it. I can make a bigger difference as a CNM, even in a hospital setting, providing mothers with better care.

  9. Thanks for putting this to paper! It is so nice to know that sometimes its ok to feel upset about choosing to be a Doula. I think the greatest lesson I learned was that it is not my birth and I do not have to feel like a personal failure after a birth that ended differently than expected. I learned to be greatful for how the MOM chose to allow me to help her through the process than get upset because MOM did not take my suggestions to reposition.

  10. The biggest and hardest lesson I have learned is you can not save someone from themselves and their choices. Wheither that be the care provider or if they get an intravention. Every woman has the right to make her choices, and we are simply there to support her choices. And I remind myself of that before I walk into a prenatal, a labor room, or a postpartum visit. And often multiple times when I’m there. And I pray for God to give me patience and the will to hold my tongue when I need to.

  11. God this is just what I needed today! Thank you, had my first no-call in 5 years of doula work. My ego hurts, but then I get to thinking, I did my preparation really well, they felt they could do it without me, and didn’t need me, this is positive not negative. I don’t know about the story yet of the birth, why they didn’t call, if they got the birth they wished so long for, but I just wish them all the love with their new baby in their arms. Thank goodness for doula sisters to share my feelings with, we take on so much, so much more than anyone realizes with all the emotional baggage it is so key to have excellent support around you to debrief with and gain support.

  12. Thank you for your brilliantly honest words Jodi! I am right behind you having attended almost 400 births in 12 years. Every word rang true.
    I am so grateful to the women I’ve served. I tell people every day, “Each birth teaches me something, yes me, the doula. Your baby, your birth, will teach the world, whoever will listen (grandparents, OB’s, nurses). Babies are our teachers. They are so smart! Ha! Just look at how much you’ve learned in the few months you’ve been pregnant!”

  13. Thank you for this! I just started out this year and Im hoping to stick with it, but it helps to know going in what Im in for!
    My first birth was traumatic for me to witness even as a birth photographer and I had to write it down and I think the world knew I needed time to bounce back as I had no births right after planned for a month. I was angry for the mom and wish I could have done more than stand there and witness it all unfold before my eyes. However, to my pleasant surprise, the mom 2 weeks later when I photographed her son was happy about her birth experience even though every outcome wasn’t as planned. Seeing her strength helped me overcome it and it also helped me realize every birth wasn’t going to be perfect. Not in my eyes and not mom’s eyes, but that is okay. I look forward to continuing on with this life lesson and keeping all the things you stated in mind as well as I learn more! Especially when I make the step towards becoming a doula in a few years as is my current plan.

  14. I really enjoyed your article! Had never read anything about the downside of this work until this. My first birth client did not have the birth that had wished for. They were planning on a water birth at a birthing center and were very well prepared for it. Unfortunately, mom ended up with a 102 fever and a kidney infection and was admitted to the hospital and given pitocin and then asked for an epidural. I learned right from the start that you have to be able to go with the flow and change the plan at any given moment! Baby was fine by the way, and so was mom!

  15. Yes, very important info here. I have also learned that there is a doula for every family and a family for every doula. If your heart is telling you that you aren’t the right doula for them or they aren’t the right family for you…go with your gut. If you don’t, you might regret it like I did. That’s been a huge lesson for me. We want to assist everyone but you have to know when to back off an ask yourself the important questions.

  16. I also find that during the interview process I tell my potentials that it is like interviewing for a temporary best friend. Then after everything is over I definetly feel a void, my life is wrapped around them for a period of time and then SPLAT you’re left out to dry. Not really, but there is an empty void temporarily.

  17. So well said! Great reading while I wait for birth #496, which could happen tonight … or next week or the week after that. Who knows. I especially liked, ““I could get called away any minute” can also become “Be fully present and enjoy this moment, right now.”” Thanks for that 🙂

  18. After my first 2 births in the capacity of doula I realised I would not be able to do this. My own childhood memories and my extremely empathic and sensitive nature would simply not allow me to witness women and babies being hurt. Period. I am outwardly a strong and level-headed person, but on a sub-conscious level there is way too much going on. I suffered serious PTSD symptoms after being present for my first birth in hospital, insomnia, crying jags, crying in my sleep, nightmares that woke me screaming, I would occasionally have a total inability to hear what people were saying when they spoke to me…it was rough. I was debriefed by a trauma counselor and that helped tremendously, but the 10 births I attended after that I had to be very very careful not to bring any trauma of my own into the situation. I gave comfort, praise and practical help, and I focused strongly on equipping the husband or partner to support the laboring woman, I did my very best to frame each outcome in a positive way to preserve the woman’s self-esteem and bolster her self-image as a mother. But it was not a positive experience for me on a personal level. I thought perhaps that becoming a CPM through NARM would be a better course of action for me, I would very much like to be able to medically assist at home births and set the tone for the entire experience as one of gentleness, safety without bullying, humour, kindness, support, responsible care without unnecessary intervention, the highest regard for the formation of a tight family unit between mother, new baby and father, as well as the rest of the family. I am not sure as yet if I would be in a position to cope with hospital transfers, unavoidable unfavorable outcomes, or being vilified by the medical community. For now I have changed roles to be a Dunstan Baby Language educator, helping new parents learn how to interpret their babies different cries, which is an extremely gratifying and risk-free occupation, with a very positive effect on family life and society as a whole. I may consider becoming a post-partum doula as well, until I can work through my own issues and re-address my dream of becoming a CPM.

  19. I’m reading this post coming off a rather rough birth experience! I’ve been a doula for almost 5 years. I was moved during this particular birth to realize that often doula work is the lending of our hearts. We give our love, compassion, support and tenderness like a sister or a mother would – without being related. We offer information, physical touch, prayer, and tears along side the family and friends. We are a team player with the staff working to create unified and loving care. We are in essence a giant heart for whomever needs us at that moment. It isn’t about us, we put on the cloak of love and give it freely. It isn’t until we return home that our heart is ours again and we get to process the joy, hurt, confusion, adrenaline, elation that has pumped through us. My heart has grown with each birth allowing me to give more each time. In the same breath I realize we are to protect our hearts as they are gentle and will be broken at times in this line of work. Doula sisters like yourself, acknowledging our importance and the entirety of our work, allows us to persevere to continue. We know full well there will be dark days, but we also know there is a light on the other side of that darkness. Thank you for shedding light on what a doula really does. hugs

  20. These downsides can have a positive impact long term if the person can accept the growth and maturity that comes from it. I know that I’ve grown so much since starting this work. I’m now able to really be there for people without my own ideals getting in the way. As far as the being on call, being present, and accepting that nature hands us curve balls…I’m a much more adaptable person as a result all three! I’ve also grown much more compassionate in the way I view care providers. Whereas before I judged them harshly.

    So for me, I feel I’ve been richly rewarded for the stretching I’ve gone through as a doula. I’m thankful for it! I do see what you are saying though. This journey has not been an easy one, and has forced me to seriously reflect within and confront some not so pretty things that were hidden in the shadows. I can see how it might burn out people not ready for that ride.

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  23. Brilliantly put, Jodi. Doula work encompasses so many challenges. I really do feel like I’m stuck between a rock and a hard place at times. But to see the utter joy on a woman’s face when she births her baby HER way – it makes every heartache worthwhile.

    I think being a good Doula is about sharing a journey and accepting you are just a passenger. x

  24. Thank you so much for sharing this. While still in my first year I have attended my first 5 births. I have not yet come across any serious problems but I just wanted to say your post is inspiring & supporting & will be something I will definitely return to time after time. Many thanks again. Julie xx

  25. Thank you for this post. I’ve been doula-ing since 2005 and have been on call at the time of weddings, funerals, graduation parties, etc. Never have I had to leave one of these for a birth, but this week my doula work crashed into my personal life with incredible force.
    On Monday evening my husband found his father, passed away at his home. We had been his primary caregivers for the past 5+ years. We were getting ready to meet with the funeral director on Tuesday afternoon when my phone rang…my 35 weeks gestation, VBAC, repeat client was in premature labor. I assured her that I would try to get to the hospital as soon as possible, but had to be with my husband to support him. I attempted to contact my backup, but assumed she must be at work or with her own client when I couldn’t reach her. So, I dressed in my doula clothes, drove separately from my husband to the funeral home and put all my efforts toward supporting my husband.
    When we had finished with the paperwork, I left my husband and drove straight to the hospital just after she was admitted where my client successfully pushed her daughter out after just 9 hrs of labor. The birth of this beautiful, healthy baby girl by her incredibly strong mama who fought her own fears to get her VBAC was an unexpected blessing that helped balance the loss I had pushed deep inside when I got there.
    Yes, as doulas we may miss important family events, lose unknown hours of sleep, go without sufficient food for hours or days, or even have to feel split between our families and our clients who both need us…but, we also have the blessing of being witnesses to the amazing, awe-inspiring, glorious moment when a new life emerges. Certainly life-changing for the women we support…and, at times, for us as well.
    I am grateful for this post which reaffirms both my calling to doula and my love for my family.

  26. You article The Downside of Doula-ing is amazing <3
    It was shared by a friend of mine who's also a Doula.
    I don't have children, hope to have some one day, and stay educated through the things that my friend post.

    You write so thruthfully and beautifully. I made many parallels in my mind with the work I used to do as a counselor in a homeless shelter. I now have a more artistic career into which I try my best to share and encourage these kinds of values.

    Thank You!

  27. This was an insightful article. I have found all of these things to be true in my brief doula career and I am so grateful for all the personal growth each birth offers me…I look forward to all of it…even the sandpaper-to-my-soul type of experiences, which are the most painful yet yield the greatest gifts. Thank you for sharing your doula journey with the sisterhood of doulas.

  28. Oh yeah, doula work is rough. My first was a no-call, my second was a planned natural birth turned horrible fiasco. I didn’t do another birth for a while after that. A few good births later, I was happy with doula work again… but there is that void when they leave your life! You invest so much in them, and then they’re gone and you are happy and sad all at once.

  29. Thank you for this post Jodi, I’m a new doula and have just come across your blog, it’s great to hear your wisdom and experience about the reality of being there with women.

  30. This is an incredible piece that you’ve written. Ive doula-d for 15 years, and yes, sadly, i’ve seen many births that have not gone as expected…some even traumatic. What you have written here hits every thought i’ve ever had. Your words are so well written and expressed.

    I was wondering, i’m hosting a doula sharing circle in the next month or so. several of our local doulas have recently had some traumatic births. I was wondering if it would be ok to share some of your wise words at our sharing circle? Please let me know <3

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