Towards an Apprenticeship Model of Doula Training

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by

mentorchar
in

Since the 1990s, the industry standard model for doula training has been this: You take a weekend (roughly 15-20 hours) training in which you are taught about the basics of labor, what the role of a doula is, and skills to support families. You are then let loose on the world with the mandate to “get certified” by some doula organization. Said certification usually entails having to market yourself as a doula, finding 3-5 clients, and then have those clients and their care providers or support staff write up evaluations. 

This has lead to some serious, ongoing problems for new doulas:

  • They are often expected to work pro bono or low cost in order to get their “certifying births”, creating a sustainability problem right out of the gate. 
  • They are expected to engage in networking, marketing and establishing relationships with their peers; all while trying to establish a client base in competition with those peers.
  • Past their weekend training, all their skills are developed on the job, with little to no peer feedback. Errors and missteps for new doulas can have lasting career consequences. 
  • Because of the heavy expectations on new doulas, the burnout and turnover rate is high. The ‘learning curve’ to “Actively working doula with a regular client load” is steep. 

It also creates issues for the doula profession as a whole:

  • The industry expectation of “one doula, continuously, for hours on end” causes physical and emotional harm, and excludes doulas with physical limitations from practice. It also creates challenges for doulas without easy access to 24/7 child care.  
  • Doula training & employment is primarily accessible to white, married, financially stable women.
  • Those who have not been trained in the “usual” manner are often excluded from doula certification; this issue disproportionately impacts Black, Indigenous and People of Colour doulas. 
  • Doulas have to rely on expensive workshops for continuing education, skill building and training; making ongoing development out of reach of many. 
  • There is very little in the system that allows experienced doulas to share their knowledge or skills with others, instead most rely on social media.

One possible solution to these issues is to model doula trainings more on the midwifery model of care, where an in-training or new midwife is matched for a period of time as an intern or assistant. 

A Pilot Apprenticeship Program

My fantasy Apprenticeship Program pilot would be a 3 year “direct entry” doula training program, the purpose of which would be to:

  • Normalize apprenticeship as a valid birth doula training path
  • Normalize the presence of two doulas at birth, helping to prevent doula burnout
  • Emphasize ongoing experiential learning
  • Shift away from the “Weekend training and then go solo!” industry paradigm
  • Create strong partnerships and networking between doulas at the start.

The Program:

  • Matches experienced doulas with apprentices
  • Oversees the apprenticeship process
  • Provides yearly skills-building workshops & hands-on skills training
  • Maintains a professional standard of practice and code of ethics. 
  • Facilitates matching Preceptors & their Apprentices with clients.
  • Develops and administers online study modules on subjects like (but not limited to): budgeting, marketing, active listening, understanding hospital protocols, etc.   

The Apprentice:

  • Over the age of 18 (youth 16-17 may be accepted with parental permission into a “pre-apprenticeship” program) 
  • Excited about learning about birth, and working with an experienced doula
  • Prior doula/birth skill training is not required
  • Attends an in-person interview
  • Willing to commit to 3 years of the program

The Preceptor:

  • Has ideally attended over 100 births in a “primary doula” capacity
  • Is willing to commit to having an apprentice at their prenatal visits, births and postnatal visits
  • Will teach both hands-on skills and ‘soft’ skills to their apprentice
  • Will represent to their clients that they have an apprentice who will be attending births
  • Does screening interview

YEAR 1:

Apprentice Orientation in March, where new apprentices will get a program overview, learn what their rights and responsibilities are, be given program materials, and meet their Preceptor. 

  • Online study modules & at least one in person, hands on skill development class
  • Serve no less than 5 clients (prenatals, birth & postnatals) with the Apprentice in an assistant role
  • Required reading list and evaluations of those materials. 
  • At least 3 Birth Self Evaluation Forms
  • At least 3 Birth Evaluation Forms by the Preceptor
  • End of Year review with AP Board and Preceptors

YEAR 2:

Apprentice Review in March, touching bases on how things are going, expectations for the year, and any changes.

  • Online study modules & at least one in person, hands on skill development class
  • Serve no less than 5 clients with the Apprentice in an active role
  • Required reading & evaluations
  • At least 3 Birth Self Evaluation Forms
  • At least 3 Birth Evaluation Forms by the Preceptor
  • End of Year review

YEAR 3:

Apprentice Review in March, touching bases on how things are going, expectations for the year, any changes.

  • Online study modules & at least one in person, hands on skill development class
  • Serve no less than 5 clients with the Apprentice as primary doula
  • Required reading & evaluations
  • At least 3 Birth Self Evaluation Forms
  • At least 3 Birth Evaluation Forms by the Preceptor
  • End of Year review

Following the In-Person interview, the Apprentice will participate in a Program Review:

  • Submit packet of Evaluations
  • Personal Statement Essay
  • Program evaluation
  • In-Person interview

Upon completion of the three year program, the Apprentice can either “go solo”, pair up with another graduate, find another partner elsewhere, or continue working in a professional capacity with their Preceptor. These arrangements would be outside the program, and the details up to the individuals involved.

CERTIFICATION:

Upon completion, Apprentices will receive documentation of their participation in the program. Certification itself is a fraught subject in the doula profession, with clear pros and cons to both sides. If this program were to include a formal “certification” element, it would need to be mindful of all of the concerns involved.

COSTS:

The tuition for the program would need to cover yearly operating expenses, and preceptor fees, while still maintaining accessibility.  Tuition could be paid in full, in installments, or through a scholarship or sponsorship and would include:

  • Matching with a Preceptor
  • Access to online courses and discussions
  • One free hands on skill workshop yearly
  • All course materials
  • Yearly meetings and reviews
  • Certification evaluation

Preceptors will be paid a flat fee per Apprentice, and they be limited to 2 Apprentices per year. They would be responsible for billing their clients at their usual rate- we would suggest a 5-10% stipend to the Apprentice.  

CHALLENGES:

Apprenticeship is, by no means, the one-size fits all solution to problems facing the doula profession. For one, we are still often fighting an uphill battle to have a single doula recognized as an integral and valued member of the birth team by hospitals, let alone having two doulas. It also doesn’t address the significant racial inequality and barriers that exist in the doula industry- especially when a sustainable apprenticeship program would need to be financially viable.

Another challenge is finding willing Preceptors. Because many doulas are not financially flush from their work, the idea of bringing someone else along without major compensation for their time and energy will not be feasible. There is also the consideration that, because doula work is a deeply emotional and personal job, matching people who are compatible together will have it’s bumps.

We also need to look at the cultural expectation of “One doula and a backup”. Clients are accepting one person into their birth space where they are vulnerable, but may not be willing to consider two people. I believe that perception would change over time with the increased normalization of an apprentice doula. Clients have few troubles accepting birth assistants or intern midwives at births, the same should be true for doulas.

Overall, however, I believe that moving from one-shot weekend trainings and tossing new doulas into the deep end, and recognizing the many pathways people come to birth work and gain experience in birth work is vital for the doula profession as a whole.