The Life of a Canadian Doula: Successes, Confusion, and Conflict

      This paper is only available as a PDF. To read, Please Download here.



      Despite evidence that doulas improve maternal and newborn outcomes, some maternity care professionals have had difficulty both in understanding the role of doulas and in accepting doulas as collaborators. We sought to examine the backgrounds, practices, and professional motivations of doulas and to understand their role and interactions with other maternity care providers.


      We conducted a postal survey of 212 Canadian doulas whose contact information was provided by DONA International. The main outcome measures of the survey were demographics, practices, motivations, perception of working environment, interactions with and acceptance by other maternity care providers, and overall work satisfaction.


      The most common reasons for becoming a doula were the desire to support women in childbirth, personal interest, and a wish to share their own positive birth experience with others. Only 21.7% described the doula role as a means of achieving personal financial support. Most respondents intended to continue doula work in the next five years. Doulas felt more accepted by midwives than other care providers. Most doulas reported no conflict with other maternity care providers, but on rare occasions, doulas had been excluded from attending birth by maternity care providers, hospital and/or administrative regulations, and rarely by a client. Almost all doulas (98.5%) rated their overall professional experience as good or excellent.


      Better recognition and respect from other providers significantly influenced doulas' satisfaction. This study helps clarify areas of possible conflict and obstacles that doulas may face in their work environment and in their interactions with other maternity care providers.



      Malgré l’existence de données indiquant que le recours aux services de doulas améliore les issues maternelles et néonatales, certains professionnels des soins de maternité ont eu de la difficulté à comprendre le rôle des doulas et à les accepter à titre de collaboratrices. Nous avons cherché à examiner les antécédents, pratiques et motivations professionnelles des doulas, ainsi qu’à comprendre leur rôle et leurs interactions avec les autres fournisseurs de soins de maternité.


      Nous avons mené un sondage postal auprès de 212 doulas canadiennes dont les coordonnées nous ont été fournies par DONA International. Les principaux critères d’évaluation de ce sondage étaient leurs caractéristiques démographiques, leurs pratiques, leurs motivations, leur perception du milieu de travail, leurs interactions avec les autres fournisseurs de soins de maternité et la mesure dans laquelle elles se sentent acceptées par ceux-ci, et leur satisfaction globale au niveau professionnel.


      Les raisons les plus courantes de devenir une doula étaient le souhait de soutenir les femmes pendant l’accouchement, les intérêts personnels et le souhait de partager sa propre expérience positive d’accouchement avec d’autres. Seules 21,7 % des répondantes ont décrit le rôle de doula comme étant un moyen de subvenir à ses besoins sur le plan financier. La plupart des répondantes prévoyait continuer de travailler à titre de doula au cours des cinq prochaines années. Les doulas se sentaient plus acceptées par les sages-femmes que par les autres fournisseurs de soins. La plupart des doulas n’ont signalé aucun conflit avec d’autres fournisseurs de soins de maternité; toutefois, à de rares occasions, les doulas ont été tenues à l’écart de la salle d’accouchement par des fournisseurs de soins de maternité, des règlements hospitaliers et/ou administratifs, et (rarement) des clientes. Pratiquement toutes les doulas (98,5 %) ont estimé que leur satisfaction globale au niveau professionnel était bonne ou excellente.


      Le fait d’être mieux reconnues et respectées par les autres fournisseurs de soins exerçait une influence significative sur la satisfaction des doulas. Cette étude aide à clarifier les domaines de conflit et les obstacles possibles auxquels les doulas peuvent avoir à faire face dans leur milieu de travail et dans leurs interactions avec d’autres fournisseurs de soins de maternité.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Obstetrics and Gynaecology Canada
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kayne M.A.
        • Gruelich M.B.
        • Albers L.L.
        Doulas: an alternative yet complementary addition to care during childbirth.
        Clin Obstet Gynecol. 2001; 44: 692-703
        • Goer H.
        The assault on normal birth: the OB disinformation campaign.
        Midwifery Today Int Midwife. 2002; 63: 10-14
        • Hook B.
        • Kiwi R.
        • Amini S.B.
        • Fanaroff A.
        • Hack M.
        Neonatal morbidity after elective repeat cesarean section and trial of labor.
        Pediatrics. 1997; 100: 348-353
        • Klein M.C.
        Quick fix culture: The cesarean-section-on-demand debate.
        Birth. 2004; 31: 161-164
        • Klein M.C.
        Obstetrician’s fear of childbirth: how did it happen?.
        Birth. 2005; 32: 207-209
        • Klein M.C.
        • Grzybowski S.
        • Harris S.
        • Liston R.
        • Spence A.
        • Le G.
        • et al.
        Epidural analgesia use as a marker for physician approach to birth: implications for maternal and newborn outcomes.
        Birth. 2001; 28: 243-248
        • Leeman L.
        Family physician and maternity care: high tech or high touch?.
        Birth. 1995; 22: 236
        • Leeman L.
        • Fontaine P.
        • King V.
        • Klein M.C.
        • Ratcliffe S.
        Management of labor pain: promoting patient choice.
        Am Fam Physician. 2003; 68: 1023
        • Leeman L.
        • Fontaine P.
        • King V.
        • Klein M.C.
        • Ratcliffe S.
        The nature and management of labor pain: part II. Pharmacologic pain relief.
        Am Fam Physician. 2003; 68: 1115-1120
        • Picard A.
        Natural birth no longer the norm in Canada.
        Globe and Mail. 2004; (Friday, Sept 10,): A1
        • Rosenblatt R.A.
        • Reinken J.
        • Shoemack P.
        Is obstetrics safe in small hospitals Evidence from New Zealand’s regionalised perinatal system.
        Lancet. 1985; 2: 429-432
        • Sachs B.P.
        • Kobelin C.
        • Castro M.A.
        • Frigoletto F.
        The risks of lowering the cesarean-delivery rate.
        N Engl J Med. 1999; 340: 54-57
        • Childbirth Connection
        2nd ed. What every pregnant woman needs to know about cesarean section. Childbirth Connection, New York2006 (December)
        • Canadian Institute for Health Information
        Giving birth in Canada: providers of maternity and infant care. Canadian Institute for Health Information, Ottawa2004
        • The Society of Obstetricians and Gynecologists of Canada
        Joint policy statement on normal childbirth.
        J Obstet Gynaecol Can. 2008; 30 (SOGC CPG No. 221,): 1163-1165
        • Maternity Care Working Party
        Making normal birth a reality. Consensus statement from the Maternity Care Working Party: our shared views about the need to recognise, facilitate and audit normal birth.
        (Accessed November 17, 2008. November 2007.)
        • Hodnett E.D.
        • Gates S.
        • Hofmeyr G.J.
        • Sakala C.
        Continuous support for women during childbirth.
        Cochrane Database Syst Rev. 2007; 3CD003766
        • Hofmeyr G.J.
        • Nikodem V.C.
        • Wolman W.L.
        • Chalmers B.E.
        • Kramer T.
        Companionship to modify the clinical birth environment: effects on progress and perceptions of labour, and breastfeeding.
        BJOG. 1991; 98: 756-764
        • Kennell J.
        • Klaus M.
        • McGrath S.
        • Robertson S.
        • Hinkley C.
        Continuous emotional support during labor in a US hospital. A randomized controlled trial.
        JAMA. 1991; 265: 2197-2201
        • Klaus M.H.
        • Kennell J.H.
        The doula: an essential ingredient of childbirth rediscovered.
        Acta Paediatr. 1997; 86: 1034-1036
        • McGrath S.K.
        • Kennell J.H.
        A randomized controlled trial of continuous labor support for middle-class couples: effect on cesarean delivery rates.
        Birth. 2008; 35: 92-97
        • Klein M.C.
        • Kaczorowski J.
        • Hall W.A.
        • Fraser W.
        • Liston R.M.
        • Eftekhary S.
        • et al.
        The attitudes of Canadian maternity care practitioners towards labour and birth: many differences but important similarities.
        J Obstet Gynaecol Can. 2009; 31: 827-840
        • DONA International
        Code of ethics for birth doulas. DONA International, Seattle (WA)2008
      1. DONA International. Standards of practice for birth doulas. Available at: Accessed July 7, 2009.

      2. P. Simkin, K. Way A DONA International position paper: the birth doula’s contribution to modern maternity care. DONA International Accessed April 4, 2010

        • Reime B.
        • Klein M.C.
        • Kelly A.
        • Duxbury N.
        • Saxell L.
        • Liston R.
        • et al.
        Do maternity care provider groups have different attitudes towards birth?.
        BJOG. 2004; 111: 1388-1393
        • Lantz P.M.
        • Low L.K.
        • Varkey S.
        • Watson R.L.
        Doulas as childbirth paraprofessionals: results from a national survey.
        Womens Health Issues. 2005; 15: 109-116
      3. Report of the Fourth World Conference on Women: Beijing, 4–15 September 1995. New York: United Nations;1996.