Fourteen randomized trials have demonstrated that continuous caregiver support during childbirth can lead to shorter labors and decrease the need for intervention. In response, there has been a significant increase in the number and use of doulas as paraprofessionals who provide social and emotional support to women during labor/birth for a fee. We conducted a mailed survey of a nationally representative sample of certified and certification-in-process doulas in the United States (n = 626, 64.4% response rate) to gather some descriptive information on their sociodemographic backgrounds, practice characteristics, and beliefs/attitudes on a number of salient issues. The survey results suggest that, in 2003, doulas were primarily white, well-educated married women with children. The majority of certified doulas worked in solo practice and provided childbirth support services on average to nine clients per year. Very few doulas were earning more than $5,000 per year from this work, and only 10% of certified doulas reported receiving third-party reimbursement for their services. Thus, while almost all doulas found their work emotionally satisfying, only one in three saw their work as financially rewarding. Doulas also reported challenges in getting support/respect from clinicians and in balancing doula work and family life. In addition, one in four doulas reported that they were preparing for a career in midwifery. Doulas can play an important and unique role in the childbirth process and reap many personal rewards engaging in this type of work. However, a number of financial, personal, and professional challenges present significant obstacles to the growth of doulas as childbirth paraprofessionals in the United States.
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Paula M. Lantz, Associate Professor of Health Management and Policy at the University of Michigan School of Public Health, conducts policy-focused research on women’s health services and social inequalities in health.
Lisa Kane Low, Assistant Research Scientist in the School of Nursing and lecturer in Women’s Studies at the University of Michigan, is interested in women and adolescent’s experiences of childbirth and their association with processes of care during labor.
Sanjani Varkey, MPH, is interested in epidemiological perspectives on women’s health issues and global health.
Robyn L. Watson, is a doctoral student in Health Services Organization and Policy, University of Michigan, and is interested in research on the health care experiences of low-income minority women.
Accepted: January 3, 2005
Received in revised form: December 6, 2004
Received: July 28, 2004
© 2005 Jacobs Institute of Women’s Health. Published by Elsevier Inc. All rights reserved.