Support for doulas is critical to developing an effective and empowered doula work force.

The doula survey, in-depth interviews with 23 key informants, and the lively exchange shared at the convening confirmed three essential periods in the life cycle of doula work where support is critical to developing an effective and empowered doula work force. Providing supports to doulas as they pursue training, move from learning to practice, and seek to sustain that practice will help to recruit and retain doulas in the state.

Tewa Women United shared this Research-to-Policy Brief, which highlights key recommendations for funders and policy makers, with partners at the opening of the state legislative session.

Getting started

Doulas need accessible, affordable, values-aligned training to prepare to enter the field.

Aspiring doulas, particularly those from New Mexico’s BIPOC communities, enter the field driven by a passion to support others through the transformative processes surrounding reproduction. While medical care is beyond their scope, doulas nurture, creatively and collaboratively problem-solve, gather resources, and in myriad ways attend to and advocate for their clients.

To prepare to do this well, they need customized, responsive training opportunities tailored to regional and community-specific needs. Doulas seek entry training that connects ancestral wisdom and contemporary medical knowledge within an inclusive, anti-racist, reproductive justice framework and an approach that is open to and respectful of all traditions and lifeways.

Of the 80 survey respondents (of 87 total) who have trained as a doula in a recognized program, 60% attended programs held in New Mexico.

Doulas emphasized the following influences when choosing a training program.

Accessibility and affordability.

Some selected online and/or self-paced programs because of their family responsibilities; others chose local programs for the convenience. Cost significantly limited access for many. Unreliable transportation was named as a persistent challenge by those living in rural areas and tribal communities currently underserved by reproductive health practitioners and facilities. Still, all-online programs were no panacea; inadequate internet access in areas of the state, the unique advantages of hands-on training, and the connections formed while meeting in real life were all reasons we heard in support of in-person or hybrid programs.

Aligned values and approach.

Many sought programs taught by Indigenous or Black women and highlighting those traditions. Quite a few mentioned gravitating initially to national programs (e.g. DONA, CAPPA) for their prestige and availability, and then augmenting with a local and/or BIPOC program for the aligned values and approach. Among survey respondents, satisfaction was highest among those who attended BIPOC-led and/or local training programs.

Recommendations from trusted mentors or peers.

Formal and informal networks of doulas offer tremendous value to those considering entering the field.

Our extensive conversations with practicing doulas have clarified several essential points. We’ve learned why BIPOC-led trainings are essential, both because of who (the identities, skills, and qualities of trainers that allow them to connect with a broad spectrum of NM potential doulas) and what (anti-racist, anti-oppressive framework and reproductive justice lens) they offer.

Research revealed the cost to host a full-spectrum doula training, including administrative and venue costs and especially during start-up, can exceed $100,000 for a cohort of 20-30 participants. While our map of doula training offerings shows a small handful of BIPOC-led trainings, most of these rely on sponsorship by a local organization and are offered sporadically. Through 2021, Tewa Women United was the only BIPOC-led, community-based organization in the state to offer regularly-scheduled, onsite doula trainings through their Yiya Vi Kagingdi Doula Training Program. Other community-based start-ups elsewhere in the state offer promise, but these, like TWU’s YVK, will require sustained funding.

Transition from learning to practice

Mentorship, business training, and other key supports are helpful to newly-trained doulas entering the field.

Of the 88 survey respondents, 12 had trained but never practiced professionally. Among the supports needed at this critical transition were formal mentorship, peer support, business training, and facilitated connection to birthing families for their first few clients. The role of community-based doula programs, like the Dine’ Doula Collective and TWU’s Yiya Vi Kagingdi Doula Project, is essential in helping newly trained doulas find clients, navigate the medical environment, and access ongoing training. Funding and policy making decisions to promote a successful transition from learning to practice should be guided by the doula-serving community-based organizations, which are alert to regionally- and culturally-specific concerns and solutions that may not be evident otherwise.

When asked, After your training, did you feel like you had everything that you needed to serve clients by yourself? 60% felt like they had everything that they needed to serve clients by themselves. Of the 30 (40%) who did not, they would have found the following supports helpful:

  • mentorship;
  • business support;
  • support network of other doulas;
  • help finding clients;
  • more knowledge of birthing process;
  • more experience;
  • more hands-on training.

Creative exchange within the convening yielded various suggestions to increase effective mentorship.

  • Develop funded positions for experienced doulas to regularly be on-call to listen to new doulas’ concerns and reflections, and to offer advice, support and education.
  • Create a funding mechanism to allow experienced doulas to “co-doula” with those still early in their career, offering hands-on training experience while sharing the burden of continuous attendance at lengthy births.
  • Foster doula network development that provides for peer support as well as structured and unstructured learning opportunities for early career doulas.

Sustaining a practice

Without reliable childcare options and other meaningful supports, many trained doulas find themselves unable to sustain a practice.

Perhaps most of all, the research revealed how absolutely essential it is that BIPOC doulas, especially those who serve Indigenous, Black, or other communities of color, be able to access the support that will allow them to center their doula work while maintaining a positive, sustainable work/life balance.

The survey showed fewer than 1 in 7 doulas are currently able to make a living through their work.

Our survey results show that few doula respondents are able to make a living as a doula – and yet the irregular and unpredictable hours the work requires, and the intensely engaged nature of that work, make it challenging to split time with other employment. Without reliable childcare options and other meaningful supports, many trained doulas find themselves unable to sustain a practice.

Doulas who practice outside the metro areas face challenges that can contribute to isolation and burnout. Rural doulas, particularly those working in Indigenous communities, are often called to travel long distances to serve birthing families. They need reliable transportation as well as steady internet and phone access – advantages that may not be available to all.

Those who have practiced for years identified the supports that allow them to contribute.

When asked, What supports help (or have helped) you integrate your doula work with the rest of your life?, doulas emphasized the following:

  • Doulas rely heavily on spouses/partners/family members to be able to do the work. Families help with childcare and with home responsibilities, and quite a few are supported financially by working spouses.
  • A supportive doula community is also essential, both for mentorship and for sharing experiences, and the opportunity to learn more about the field.
  • Self care, including somatic practices, time management practices, keeping a reasonable caseload, taking breaks, and similar.
  • The financial support of community doula organizations
  • Co-doula arrangements to share the load
  • Ongoing professional development, skill-building circles for doulas, online resources, and similar

Doulas who stopped practicing, along with those struggling to get started or to continue despite the challenges, named supports that could be helpful:

  • Childcare
  • More peer support – emotional, educational, etc.
  • Work properly compensated
  • More co-doula arrangements
  • Mentorship and apprenticeship
  • Care options like sabbatical stipends, self care stipends, debriefing services, counseling services (care for mental health)

To equitably serve birthing families in New Mexico, it’s important to ensure practicing doulas are able to thrive through adequate compensation, organized regional resource hubs, and increased recognition of doulas’ value in both medical settings and among the birthing population.