Doulas as Leaders


2012 Conference—

Cancun, Mexico


Quarterly publication of

Volume 20, Issue 3 | 2012

2 International Doula Volume 20, Issue 3

We’re going virtual in 2013!

19th Annual

DONA International


Live Broadcast:

July 19 & 20, 2013

Access the full recorded conference

after the live broadcast.

Every Doula, Everywhere





07 An Unrivaled Celebration of 20 Years of

Success During the 18th Annual Conference

08 A Heroine’s Birth Journey

16 Doulas as Leaders

20 2012 Conference—Cancun, Mexico

32 Labor Support—You Mean That’s

a Profession?


06 DVD Review—Guerrilla Midwife,

a Documentary

22 Tricks of the Trade—Mount Everest or

Mount Douglas?

31 Poem—The Sum of My Parts



26 Essay—Expectations, Acceptance and

Empathy: Journeying From Doula to Mother

Member News & Benefits

30 Postcard from Home



34 Network Communications –

Conference Audio Recordings 3

F or



International Members,

some of us the summer has come to an end and fall is in full swing.

The highlight of my summer was traveling to Cancun for the conference

and a vacation with my family. It was a perfect combination.

In case you have missed the announcement, your Board of Directors has been

working hard for a year to design your 2013 conference. DONA International has

always been known as a groundbreaking organization. As we enter our 21st year, we

are excited to announce the DONA International 2013 VIRTUAL conference.

We know that this is a break from tradition; but we also recognize that online

learning is the wave of the future, and this is a way for us to reach every doula,

everywhere. We want to make sure you know that we are not abandoning in-person

conferences, and we are already working on site selection for the 2014 in-person


Next year’s conference will debut as a two-day conference with a number of

keynote speakers, as well as concurrent sessions. After the initial release, the sessions

will be available on demand for viewing, or re-viewing, at your leisure. There will be

opportunities for our members to interact and ask questions of the speakers. We

are also working on ideas for members on the local level to come together during

the scheduled conference time for networking and fellowship. If you have any

suggestions for grassroots activities you would like to share please contact me at

Warm Regards,

Jennifer Rokeby-Mayeux, CD(DONA)


DONA International

4 International Doula Volume 20, Issue 3




President Elect




Director of Education


Director of Certification


Director of Publications


Director of Int’l Development


Director of Membership Support


Director of Public Relations


Multicultural Director



Northeastern US


Southeastern US


Midwestern US


Southwestern US


Western Pacific US


Eastern Canada


Western Canada









Director of Publications


Managing Editor




AURORA, CO 80014

Associate Editor


Please send all contributions

to the editor


Smart Business

Content Marketing



Dear DONA Members,


As a postpartum doula, I understand and appreciate the trust placed in me to enter a family’s home,

already functioning and full of history, and fill a small role as they adjust to the changes that a new baby


As a journalist, I understand and appreciate the trust placed in me to join this publication, with 20 years of

history, and fill a small role as DONA International stands on the dawn of its 21st year.

With respect for International Doula’s history and passion for DONA International’s mission, it is my honor and

privilege to step into the position of managing editor. I look forward to reading your submissions and engaging the

doula community at large.

As Marcie Macari, author of She Births: A Modern Woman’s Guidebook for an Ancient Rite of Passage, so

poignantly stated, “Birth is a rite of passage of women. Their journey should be honored, their rights should be

fiercely protected and their stories should be shared.”

That is my goal for this publication. Let’s honor birthing women. Let’s honor our roles in their journeys. And

let’s share stories.

With gratitude to the Board of Directors, Associate Editor Jessie Harrold, the designers and the contributors, it is

my pleasure to present this issue.

Please enjoy, 5


Review of Guerrilla Midwife,

a Documentary

By Rivkah Estrin


uerrilla Midwife (2011)

invites viewers to join Ibu

Robin Lim at her birth

center, Yayasan Bumi

Sehat, in Bali, Indonesia. Ibu Robin

Lim was named CNN’s 2011 Hero of

the Year, and once you view this artfully

crafted film, directed by Deja Bernhardt,

there will be no doubt that her prize

was well-deserved. Ibu Robin, as she

is affectionately called, is on a mission

to annihilate postpartum hemorrhage

resulting in maternal mortality. She

created the center to honor the culture of

the birthing families and offer options to

women that were previously unavailable.

The practice in Indonesia, where many

families can’t afford a hospital delivery,

is to hold the baby at the hospital until

payment is received. Parents are allowed

in for only 20 minutes twice a day to feed

and change their babies. At Bumi Sehat,

births are affordable, respectful and in

line with the parents’wishes.

In the film, we are also privileged to

join Ibu Robin as she brings her skills

and compassion to Aceh, a region in

need of medical assistance after being

devastated by the tsunami in 2004.

The viewer has the unique

opportunity to hear Ibu Robin’s musings

and poetry, while beautiful shadow art

captures the essence of the spoken

words. Images of the tsunami and the

stories of the affected families are so

touching and emotional, the heart

breaks for them. And yet the people

of Indonesia, who lived through this

unspeakable horror, tell their stories with

smiles and hopes for the future.

Interwoven with the images of Bali,

Aceh, Bumi Sehat and the village

where Ibu Robin resides are interviews

with Michel Odent, Marshall and

6 International Doula Volume 20, Issue 3

Phyllis Klaus, Ibu Robin’s daughters,

midwife Mary Jackson and other birth

professionals who assist at her clinic.

One cannot watch this documentary

without being moved to the core. What

a brilliant, clear way to get across

the message that gentle birth is so

important. It’s important to individual

families and, as the film convinces, it’s

vital to the future of humanity. From Ibu

Robin’s lips, she’s “healing the Earth one

baby at a time.”

Rivkah Estrin is a postpartum

doula (DONA), childbirth

educator (ALACE), writer,

blogger, wife and mother

of four living and working

in South Florida. She has

had a passion for all things

pregnancy and birth her entire

life and is living her dream

working with mothers and babies.










An Unrivaled Celebration

of 20 Years of Success During

the 18th Annual Conference

By Sunday Tortelli, CCE, CD(DONA), BDT(DONA), HBCE, LCCE, CLC

Spirits were high and

expectations even higher as we

gathered in the ballroom for our

opening general session, which

was a look back by our founders at 20 years

of successfully building a doula movement

and organization, while looking forward to

even greater success in the years to come.

Although disappointed that our beloved

Penny Simkin was experiencing a plane

delay and could not be part of the opening

session, Annie Kennedy and Phyllis Klaus

carried on brilliantly, presenting this session

with the assistance of Kathie Lindstrom

and Barbara Hotelling, past presidents of

DONA International.

This year, the conference was scheduled

a little differently so as to allow our

attendees some free time to enjoy the

tropical setting. We began with the opening

general session on Thursday evening

coinciding with our welcome reception.

Friday was a fully scheduled day consisting

of two general sessions and two blocks of

concurrent sessions. We held our annual

membership meeting during the extended

lunch hour on Friday at which attendees

shared their meal with other doulas from

their region and their regional directors. The

annual membership meeting was conducted

during lunch, and we also presented the

Penny Simkin Founder’s Award to Elena

Carrillo and Guadalupe Trueba, two very

well-deserving doula role models. We sang

“Happy Birthday” to DONA International

and enjoyed a wonderful slice of birthday

cake while recalling each of our own

memories of this impressive organization

and our doula careers.

On Saturday, one general session

and two blocks of concurrent sessions

brought us to the early afternoon; and

many conference attendees then headed

out to hit the beach, shop or visit some

local sites. Sunday morning, we reluctantly

concluded the conference with two

inspiring general sessions.

A very eclectic mix of stimulating

topics made it a challenge for attendees

to choose which concurrent sessions

they would attend when registering. The

general session speakers often brought

us to our feet, clapping wildly, shedding

a few joyful and prideful tears and even

singing at the top of our lungs. There were

so many wonderful comments made on

the conference evaluations about each of

the sessions. Everyone went home fulfilled.

It would be foolish of me to even try to

describe all of the offerings, but I will at least

acknowledge the general session speakers.

Penny Simkin spoke about traumatic birth

and the deleterious effects it can have on

women and families while giving us hope

that doulas can and do make a difference.

Teresa Pitman reminded us of the basic

tenets of assisting the breastfeeding dyad to

get off to a good start and helping to reduce

barriers to successful nursing relationships.

Elena Carrillo shared the incredibly

loving Mayan tradition of extended

postpartum support, which inspired us to

initiate this idea with our client families.

Cynthia Gabriel got us all fired up about

supporting natural childbirth in a hospital

with her practical strategies and ingenious

approach. Debra Pascali-Bonaro motivated

us to do better in all ways for mothers and

babies through grassroots support and

implementation of the 10 Steps of the

MotherBaby Childbirth Initiative.

This conference report would not be

complete without mentioning the utterly

divine and scrumptious food that we were

served throughout each day. Not only

was it a bounty of many exquisite taste

experiences, but it was fresh, healthy

and beautifully presented. The hotel’s

Feature Story

sous chef, Dominic, and pastry chef,

Valeria, were treated with a standing

ovation during our luncheon and became

somewhat like rock stars!

All in all, it was a completely satisfying

conference experience. We honored the last

20 years of DONA International and kicked

off the next 20 with enthusiasm and doula

spirit. In 2013, DONA International will do

something even more unprecedented—we

are offering the first virtual doula conference

ever! Why? So “Every doula, Everywhere”

can experience a DONA International

conference, that’s why!

Sunday Tortelli is president-elect

of DONA International, thrilled to

be serving the membership in

whatever capacity she can to

ensure they feel as confident

in their training and certifying

organization as she does. A

resident of Greater Cleveland,

Ohio, she teaches childbirth

classes and birth doula workshops and attends to her

doula clients. 7

Cover Story





8 International Doula Volume 20, Issue 3

Photos by doula Alissa Wehrman


By Penny Simkin

This series of articles provides a rare

opportunity to deeply explore one

woman’s extremely challenging birth

experience through the eyes of her

and her “village”—her support team

of her partner, her doula and her

psychotherapist. Claire and Dan had

attended my childbirth class. When Claire

sent me her story, I was very moved and

suggested she and her support team write

up their views of this uniquely instructive

birth story.

We begin with Claire’s own account

of her long, complex labor and birth,

which was followed by sadness and selfdoubt

that increased with time after the

birth. Then we have Dan’s recollections

of his thoughts and feelings as a partner

and father-to-be during this marathon

labor. Alissa Wehrman, their doula,

shares her memories of the events (from

her extensive notes taken during the

labor), sprinkled with her inner thoughts

and some valuable “doula wisdom”

gained from 400 births. Finally, Leslie

Butterfield, a gifted clinical psychologist

who specializes in perinatal emotional

health and adjustment, tells us how she

and Claire worked together to discover

and remedy the circumstances that led

to Claire’s sadness. Their work helped

Claire to see her own role more clearly

and much more positively. As she says in

her essay, “Now, instead of looking back

at my labor in sadness, I look to it for


One lesson made clear from these

stories is that birth is not over when the

baby is born. It goes on in the hearts and

minds of those most intimately involved,

especially the mother. As you will see,

Claire’s perceptions of herself and her

role in her birth changed over time

because a woman remains vulnerable

to the words and actions of others after

birth, just as she was during birth.

Read, learn and be inspired!

Penny Simkin, PT, CCE, CD(DONA), BDT(DONA),

is one of DONA International’s founders, a birth

doula, birth doula trainer, childbirth educator,

counselor, author and producer of books,

articles and videos on birth-related subjects.

She is a member of the senior faculty at The

Simkin Center for Allied Birth Vocations at Bastyr

University, which was named in her honor.

continued on next page

Cover Story 9

Cover Story



y newborn infant lay

on my chest quietly

as we sang the song

we’d been singing

every night before bed throughout my last

trimester. “’Tis the gift to be simple, ’tis

the gift to be free.” He had been wailing

just before but the sound of us singing

that familiar song calmed him in his first

moments of life. Minutes later, he rooted

for my breast and soon began to nurse.

These joyful moments came after an

unplanned cesarean section three days

after my water broke. I had wanted a

natural birth at a birth center but needed

to transfer to the hospital when, after I

had dilated to nine centimeters, my labor

abruptly stopped (a situation my midwife

said she had seen only a handful of times

in 12 years of practice). I had a long labor.

My entire birth experience was calm and

relaxed, though. I felt listened to and able

to negotiate my needs.

After I got home, I was surprised by

the level of horror people expressed

when they heard how long I’d been in

labor and that I’d had to have a cesarean

section. “I am SO sorry,” they told me in

heartfelt tones. Many women have related

to me how devastated they were by their

cesarean sections, and I empathized with

each of them. For me, though, when it

had come time for the cesarean section,

I had been the one to tell the OB to get

ready. I knew we had tried absolutely

everything. I labored at home, I labored

at the birth center and I labored at the

hospital. I tried every position. This was

not the too-often repeated scenario in this

country in which a woman who wanted to

have a natural birth is rushed through to

10 International Doula Volume 20, Issue 3

an operation for the convenience of the

medical staff. I dilated all the way, and my

baby moved out of being in a cockeyed

position because of all the work and

positioning my doula, Alissa, did with me,

but he moved to being sunny-side up. I

pushed for four hours, but my baby did not

descend down the birth canal. I needed a

cesarean section. I really appreciated the

availability of technology but, a few days

later, I admitted to myself that I felt sad on

a bigger, cosmic level that for some reason

it just hadn’t worked out. My baby and I

couldn’t make it happen for him to come

out vaginally.

Not long after I admitted that, my milk

came in and the tears started to flow. I

began to have so many doubts. I cried that

Benjamin’s name would not be put up on

the board with all the other babies at the

birth center because he was born at the

hospital. My doula reassured me that his

name would be there. “A birth is a birth

is a birth,” she said. But I didn’t believe

her. When we went to the birth center,

the receptionist was waiting for us with

her pen hovering over the whiteboard

to record Benjamin’s birth weight. I

photographed the board with my baby’s

name there with all the others, so glad that

we still belonged.

Months after my baby was born, my

doubts and sadness about the birth only

increased. I shut it out of my mind and

focused on my baby. When my doula tried

to talk to me about it, I said it was pretty

much not relevant anymore. Months later,

Leslie, a wonderful therapist I was seeing,

convinced me to share my birth story

with her. “It’s weird,” I told her, “because

when I think about the cesarean section

By Claire Gilbert

in general, I feel bad. But when I actually

remember the labor, what it was like and

how it went, I remember feeling good.”

I told her how I had tried all the natural

methods to stimulate labor after my

water broke, finally drinking castor oil in

a chocolate milkshake while doing yoga

to stay relaxed. I explained how relaxed

I had been the first night at the birth

center, using the breathing and yoga I

had learned to stay calm and at ease as

I progressed to nine centimeters dilated.

I told her about the sense of acceptance

I felt when my midwives suggested I go

to the hospital for Pitocin after I stopped

having any contractions two full days after

my water broke. I explained how annoying

I found the midwife at the hospital and

the monitors and the equipment in my

hospital room, but how I’d been able

to advocate for myself and labor free of

machines and monitors for part of my

time there. I told her how my baby’s

head had been cocked to the side and

the many, many positions I labored in to

move him out of that position. I explained

how AFTER the midwife abruptly stopped

the Pitocin, I became fully dilated and

transitioned to pushing—one of the most

exciting and triumphant moments of my

life—with no Pitocin in my blood. My body

did it on its own! And I told her how at

first when I was pushing I could feel my

baby’s head engaging deep within the

muscles in my vaginal canal and a sense

of the very earth pushing down through

me and how for some reason, that feeling

went away even though I pushed for four

hours. So when the obstetrician came in

to see if my baby had descended, I told

him before he even checked that the baby

In your labor, you

too prepared as best

you could, but as

you continued on

your journey, you

faced challenge after

challenge, and you had

to draw on resources

within yourself to deal

with them.

had not moved, and I told everyone that I

was ready for a cesarean section. I told my

therapist how I had prepared for the birth

and the excitement my husband and I felt

that we would be meeting our baby in only

minutes. Even telling her the story, I felt

better. My therapist, a mother herself and

a wonderfully kind and empathetic person,

said, “Wow.” And then, “I had no idea that

your labor was so long and difficult.”

One of the strongest feelings I had

about my labor was a sense of failing to

have a natural birth. Though I felt good

about the labor itself, I was consistently

troubled that I had been unable to give

birth vaginally. I was further troubled by a

fear—real or imagined—that the natural-

birth community would somehow judge

me (or perhaps exclude me) because I’d

had a cesarean section.

Leslie said my story reminded her of

a myth in which the heroine sets out on

her journey prepared as best she can.

Inevitably, the heroine meets challenge

after challenge, and she must face each

one as it comes, sometimes using what

she brought in preparation but more

and more often drawing on resources

deep within her as each new challenge

occurred. “In your labor,” she said, “you

too prepared as best you could, but as

you continued on your journey, you faced

challenge after challenge, and you had to

draw on resources within yourself to deal

Cover Story

with them. “ She went on to say a natural

birth is an idea—a beautiful idea—but

an idea nonetheless. “You had to face

challenges in reality. You let go of the idea

and like a heroine—and a mother—made

decisions in reality.”

I felt so powerfully affirmed by what

she said, and I was able to look back and

see it was true, although I would have

wished for something different (images

of my baby coming into this world in a

warm birthing tub as relaxing music plays

are still in my mind to this day), I know I

navigated an arduous course with grace

and clarity and I held my baby in my arms

at the end of that journey. Now, instead

continued on next page 11

Cover Story

I knew we

had tried



I labored

at home, I

labored at the

birth center,

I labored at

the hospital.

I tried every


of looking back at my labor in sadness,

I look to it for strength. So many times

as a mother things have not gone as I

imagined or hoped. But I can remember

my labor and remember that as a mother,

I am a heroine who faces challenges in

reality, always navigating the best course

I can for my baby and my family in an

unpredictable world.

Benjamin is a hero, too. He was

healthy as can be when he was born, and

he showed every indication of having

strived mightily to get out. His head

was formed into a tall cone at birth, a

testament to all his efforts. He continues

to be a hard worker, climbing every

object that comes before him and moving

furniture around our house, grunting and

huffing as he goes.

Claire Gilbert has mostly been at home with her son

since his birth two years ago. She is learning all kinds

of things from the ups and downs of being a mother.

Claire has also worked as a union organizer with

low-wage immigrant workers and done research

for community organizations. She lives in Jamaica

Plain, MA, with her husband and son.

12 International Doula Volume 20, Issue 3


STORYBy Dan Nicolai

I couldn’t

really say what

I felt like when my son

was born. I’ll never

forget that moment

or the days leading up to it, but the

words I have seem inadequate. When

Claire was getting prepared for her

cesarean section, I stood in the hallway

outside the operating room where the

obstetrician was pacing and talking

on his cell phone about something

mundane—his schedule the rest of the

day, maybe. It was like so many other

times since we’d found out Claire was

pregnant: miraculous and extraordinary

events coexisting with repetitive,

quotidian everyday life in the same room

and even the same conversation.

When Benjamin came out (he wasn’t

Benjamin yet; we figured that out in the

next few days) he was angry, screaming

and had his fists clenched. He wore pretty

much the same expression he still gets

sometimes. I remember feeling amazed

by Claire and confused about what to

do next. The nurses were cleaning up

the baby on a little table and I asked our

doula, Alissa, if I could pick him up. She

said, “Yeah, he’s your baby.” We sang to

him and he calmed down.

Claire had been in labor for 60

hours, 80 after her bag of waters broke!

After the first day, when we realized

our birth-center plan would not work,

we got a sandwich and drove to the

hospital. Much later, I realized this was

the last time the two of us would be

alone together for months. From that

point on, Claire became incredibly

calm, determined, courageous and

sure of what to do. I was aware she

had those qualities, but this was a

bigger challenge than any we had been

through together.

Over the previous six months, our

reading, planning and conversations

with other parents had focused on a

natural labor and birth and avoiding

unnecessary medical interventions.

That preparation left me at peace

when we had to transfer to the

hospital and then deliver by cesarean

section because I knew we did

everything we could—yoga, castor oil,

calisthenics, sex, etc. When we ran

into a medical person who wasn’t

listening to us at the hospital on day

three, we’d had enough experience

with good care providers, and

knowledge of our own, to push back.

Alissa was great. When Claire

talked in the first trimester about

finding a doula, I had not heard the

word before and responded sort of

like I did to her requests for refried

beans or another wacky food craving.

Sure, whatever you want. I trusted

our midwife and was not sure why we

needed someone else in the room.

During the event, Alissa was with us

when we transferred and had to deal

with different care providers, and her

compassion and experience helped us

to make difficult decisions.

A lot of people told us we could

never completely prepare for seeing

our child born or for the impact he

would have on our lives. A lot of

people told us, too, that everyone was

going to tell us that. That aspect of

commonality, even cliché, is one of my

favorite things about being a parent:

We share this totally normal experience

with all kinds of people, which at the

same time is constantly amazing.

Dan Nicolai lives with Claire and Benjamin

in Jamaica Plain, MA, and works as an

organizer for a service workers’ union in


I ’ve

Cover Story


By Alissa Wehrman

attended many births

in the 11 years I’ve been

supporting families as a

doula. Moments and words

I felt welcomed, and my role was clear.

Standing, leaning, walking, hands and

knees, the toilet and the rebozo—we kept

busy. I had a feeling that maybe baby

hospital for Pitocin? Stay and take castor

oil? Rest before, or later, or never? We

stepped out to give them a break. It was a

grey area and not a rush, not one of those

from some of them stand out to me like a needed some jostling to find the right no-brainer situations where we go now and

Greatest Hits album, and Claire’s labor and position. “Move the mom = move the talk about it later.

birth was full of memorable tunes. Though baby.” Claire and Dan were on board. She It gets very cerebral at that point in a

for this story, I am grateful for the thorough was a pleasure to help and was engaged labor for me as a doula. For everyone,

notes I took while on their journey with with her labor, taking it one step at a time, I suppose. We had to think to make

them, because they now bring me back to although at this point she was anxious things happen. Claire’s labor was

the event even more clearly.

that progress would slow down again, and no longer a primal, physical event. I

It started like many others. Leaking fluid, she really wanted to avoid transferring remained connected to Claire and Dan’s

early labor signs and telephone support to the hospital. She stayed active and concerns and gut feelings by helping

through the next 24 hours as early labor things progressed at home. We called the them understand their choices and

came and went. I joined them at 8:45 a.m. midwives and went to the birth center, brainstorm their own solutions. Prenatally,

at home on the second day. They had which was just across the neighborhood. we had spent a lot of time talking about

formed a nest in the center of the living I remember snapping a photo of her on transferring to the hospital. Dan had

room. It was a familiar scene of only the her way to the car as she turned back to wanted to understand how to handle

essentials: mom, dad, ball and water. Upon remind Dan to bring the crackers. She the different reasons for transferring to

arrival, they told me that labor seemed to knew what she needed.

the hospital. They had spoken in detail

be spacing out. The sun was rising, and At the birth center, she melted into the with their midwives and had thought

Claire half-joked, “Why couldn’t I have slept tub. I think we all felt things were finally through their concerns and preferences

at night and labored during the day?” She moving along, and I feel Claire really sunk with each scenario. I was impressed with

was coming out of labor land and was in down into the work of it at that point, how they sought just enough information

good spirits. They planned to nap and then perhaps feeling safe in the place where to understand what they could control

take a walk together. I left and asked them she planned to have their baby. Her cervix and what they couldn’t. It paid off in

to check in later. As the day progressed, was opening nicely, but her midwife also this situation. I also credit the excellent

they checked in with me. Pressure to get said that it was unevenly thinning out. That relationship that they had developed with

contractions going was mounting since her told us that baby was cockeyed. So after their midwives, their class with Penny and

water was broken, and her midwives were some soaking, out she came to hang and their inherent self-reliance. They used all

suggesting things like castor oil and herbs. lunge. Still progressing, she was now eight of us to get information and ideas and

I stayed in contact over the phone as she to nine centimeters. Yay! Hydrate her, give ultimately took ownership of their choices.

had a chocolate milkshake with a shot of her calories, alternate resting with action. And their midwives trusted them to do so.

castor oil, and by 9:30 p.m., things were Same as most labors. Claire was strong and When we returned to the labor room,

rolling again, this time stronger than before. focused, asking, “What else can I do?” More Claire was not in labor land anymore.

I arrived at 10:30 p.m. and didn’t leave ideas, more time, more patience. “This is They had decided to transfer. I hadn’t

them until their baby boy was content at her the way babies are born,” her wonderful experienced this type of break before. It

breast 36 hours later.

midwife said. I’m sure this statement has was hard to remember she was in labor

When I joined them that night,

been repeated millions of times before from because contractions had totally stopped.

we formed an easy team, Dan and I woman to woman. A while later, Claire Staying focused on a family when this

following Claire’s needs. She was one of was still at nine centimeters, and labor was happens can be hard. Life outside starts

those clients with whom I had a natural slowing. We started to wonder what was to come back. I kept saying in my mind,

connection—willing to try anything and going on, and the birth-team strategizing “She’s nine centimeters!” It was a mental

free to say what didn’t work for her. So began. IV? Nipple stimulation? Go to the

continued on next page 13

Cover Story

pinch to shape up when I was losing

focus. Most other transfers for me had

happened more smoothly—continuing a

woman’s coping ritual with her in the car

while giving directions to her partner and

reviewing transfer plans stealthily between

contractions. In those labors, my role was

the one thing that hopefully didn’t change.

This was different—Claire’s break was really

like a fresh start.

The hospital was a new chapter. I work

at this hospital often and knew many of

the staff who greeted us. To me, it felt like

an eternity to get Claire and Dan fully

transitioned into the hands of their new

medical caregivers, including a new midwife.

We had to say good-bye to their birth-center

team because they didn’t have privileges

at the hospital. Claire seemed able to stay

on top of the situation, although she said

she was nervous about being out of labor

and going back into that intense place. Her

brain was turned on and she needed to get

into a zone again. I had a clear sense of how

she felt about the midwife on call that day.

“She was the most annoying person I’d ever

encountered,” as Claire later put it. That was

the card that was dealt. It almost seemed

to give her some spunk to have something

recognizable to be frustrated with. I did

my best to help everyone communicate

clearly. After an exam—Claire was now six

to seven centimeters —the midwife had said

that perhaps it was a “fit issue,” and Claire

seemed baffled, saying, “I don’t think my

hips are too small. I have childbearing hips.”

The difference in numbers must have been

discouraging as well. She and Dan seemed

to be getting the sense that it wasn’t just

Pitocin they were looking at.

At this point, it was getting dark again.

That’s February in Seattle—so much

14 International Doula Volume 20, Issue 3

darkness in one day. I remember trying to

recreate the cave-like environment from

the birth center for her and let the time of

day fall away from her focus. Pitocin on,

walking, new sounds, acupressure points,

some food for them, some food for me,

open-knee chest, dangling, marching,

resting, etc. She labored on, focused and

determined. Contractions came back. Baby

straightened out and her cervix opened

up—again. She was eight centimeters now,

hours after Pitocin was started. Claire was

inspiring; she was strong and focused. But

she was tired and started to struggle.

At this point, I didn’t think it was

transition. It makes sense in the big picture

that it could have been. But I was tired, too.

Doubts, indecision, over-stimulation—all the

hallmarks of transition—were happening for

her. The staff seemed to doubt her ability

because there was not a lot of progress, and

the midwife said she didn’t think baby could

fit. Transition is usually where a woman

needs stronger support: It’s working; keep

going. But I think the staff felt she needed

a break. The midwife recommended an

epidural, gave her a ton of info about

other possible interventions and turned

the Pitocin off. I am not really sure why

that was done. It seemed strange, and I

felt confused and frustrated. I focused my

waning energy on Claire. I didn’t want to

say something that seemed exasperated to

the staff; that wouldn’t help anything. I just

wanted to get her out of bed. She seemed

trapped there, as if she was tangled at the

edge of blackberry brambles and couldn’t

see the clear, grassy field three feet away.

But maybe that’s just hindsight, knowing

now what was to come. Still, I know I didn’t

want her to make any decisions in that

state. That’s the place where the “what ifs”

live. What if I had done something else?

What if I had kept going? My notes say,

“Not coping well, too much talking, not

good position.” I managed to create and

communicate a plan to her. “Let’s get you

in the tub and wait an hour to see if you

progress. If not, consider an epidural.”

Claire agreed to get back in the tub. I hoped

it would be a relief like before at the birth

center. I reminded her of what was working.

She was healthy; baby was healthy. But her

doubts continued. “I need to calm down!” I

remember looking to Dan for confirmation

that, because she didn’t have a code word,

he also felt she was truly at the end of

her rope. She hadn’t said she wanted an

epidural, but the idea was out there, and

this seemed like a situation where she

would be accepting of it. That’s the place I

want a woman like Claire to get to before

choosing one.

I was also really struggling to stay awake

at this point. Anticipating the rest that we’d

all get after an epidural was like standing

outside the bathroom waiting my turn

after a long car trip. So close! I considered

calling my backup. My head literally

nodded, as we were heading into the third

night with little sleep for any of us. But as

Dan and I spoke to her, contractions kept

coming, closer and closer. Four minutes

apart now. No Pitocin. What’s happening?

Is this transition? And then, a beautiful

moment where I felt totally in awe of the

process of birth and my ignorance of the


way it all goes: she’s moaning that she can’t

do it, then uncontrollably grunting. She’s


pushing. “Claire, are you pushing??!!”

My words don’t come close to capturing doula

it—the change in energy at that incredible by

moment, when she realized she was finally

pushing. It still makes me smile and brings Photos

tears to my eyes. Out of the tub, an amazed

midwife checks her and says she’s fully

dilated and baby is lower. She humbly says

she should go lie down to get some rest

before the birth. “Damn straight!” Claire

exclaimed as she pushed on the toilet free

of all monitors or tubes. I mentally let go of

calling my backup and said thank you to my

adrenal glands. It was 2 a.m.

The next few hours were spent all over

the room: squat bar, in the bed, out of the

bed, leaning, lunging and sitting on the toilet.

The hopeful high of the first hour started to

wane. Claire needed feedback. The midwife

said baby had moved but was still in “a funny

position.” The obstetrician tried to turn

him manually with resistance both ways.

Contractions stopped again, and Pitocin

was restarted. The obstetrician said it was

reasonable to push another hour and then

see. So we threw everything into it for Claire

while she pushed her brains out. We also

started to acknowledge that the little person

inside had his own role in this. I helped Dan

massage her hanging belly as he coaxed

his baby to turn. I have a note that says

“honestly believe if this doesn’t work, then

he won’t come.” I am fairly certain those are

Claire’s words. It was a good sign for me that

if a cesarean birth was the next step, she’d be

ready for it, and that’s something I reminded

her of after the birth. I don’t remember

being surprised that there was no change in

baby’s position when the obstetrician came

back just before 7 a.m. I guess I just read

Claire’s body language. She knew she was

done pushing. The decision for the cesarean

was made fairly quickly, and we realized the

end was in sight. A baby was on the horizon.

Excitement and lightness entered the room,

welcome characters in the drama we’d been

starring in for the last days. This would be a

sunrise birth.

I went back into the operating room

with them and took pictures. I love it

when I am welcomed into the birthing

room when it happens to be the OR, too.

I attend births however and wherever they

She seemed trapped

there, as if she was

tangled at the edge of

blackberry brambles

and couldn’t see the

clear, grassy field

three feet away.But

maybe that’s just

hindsight, knowing

now what was to come.

happen, and when the staff appreciates

and supports me being in the OR, I am

so grateful. A birth is a birth is a birth.

I witnessed Claire and Dan welcoming

their perfect cone-headed boy, and their

joy and relief was evident in the way they

sang to him. She couldn’t see my smile

under the mask, but I felt truly joyful, too.

I was grateful and satisfied that everyone

was safe and healthy, both physically and

emotionally—for the moment at least. I

feel that in most cases birth isn’t truly over

until a baby reaches the breast and settles

in. Or until a mother takes in her baby

and my own heart heaves a sigh of relief.

Both of these events happened quickly

and easily once we returned to their labor

room for recovery.

At our first follow-up visit a few days later,

we probably didn’t discuss the birth much. I

don’t usually bring it up unless my families

talk about it or have questions. The internal

story for a mother is so new and fragile. I

remind them I have my own notes and we

took pictures. Both of those things will be

here forever. The way a woman remembers

her own journey is incredibly susceptible to

others’ opinions at this point. I try to follow

a mother’s lead and answer questions with

mostly facts, if asked, and offer only seeds

of accomplishment, if possible. With Claire

that was very possible. I thought she was a

warrior! I was in awe of her. Honestly, I don’t

always feel that way about a new mother

after a birth, even though I know I should.

We were in touch often during the next

Cover Story

few weeks as they adjusted to life with a

newborn. I remember Claire pushing me

away at a certain point from wanting to

talk about the birth. At our final visit weeks

later, I vaguely remember her dismissing

my suggestion of going through my notes

step by step. We did talk it through, but

afterward, I recall Claire being “done.” Now

as I hear her thoughts from that time, I can

imagine sharing her story wouldn’t have

been a cathartic, empowering experience

for her yet. The power and confidence that

can be generated from birth often can’t be

sustained. Postpartum life is often drudgery,

and with fatigue, recovery, blood, sweat and

tears comes doubt as well. But as I started

to say good-bye to Claire, I did feel the skills

that had gotten her through her heroic

journey were still inside her. She wasn’t the

type to withdraw and isolate for too long.

Dan was a great support and would stay

connected with her. He had asked upfront

about how to know if she was depressed

postpartum. And I often privately asked him

how he felt she was doing. She felt positive

about therapy and had connections. She

was meeting other new mothers in the

neighborhood. These things let me say

good-bye to her as her birth doula about

a month or so later. Her willingness to

engage in the process of recovery by

discussing her transition to motherhood

had disappeared for now, but I left the door

open if she wanted to connect with me in

the future. Obviously, she did.

I feel Claire’s labor and postpartum

adjustment were both as long as they

needed to be. “This is the way mothers are

born.” And she stuck with both journeys

as long as was necessary. Just as any

heroine would.

Alissa Wehrman has worn many hats during the last

decade in the Seattle birth community, but none fits

better than birth doula. She also enjoys gardening,

singing and walking her dogs. She is grateful for her

wonderful partner, 12-year-old son and the amazing

support of her fellow birth professionals. Learn more

about her at

this series continued on page 19 15

Feature Story

Doulas as Leaders


“Leadership is important, not just in your

career and within your organization,

but in every sector, in every community

and in every country. We need more

exemplary leaders.”

– Kouzes and Posner,

The Leadership Challenge

What is leadership and why

does it matter to doulas?

Perhaps you’re thinking,

“We don’t lead a mother

or her family; we follow their lead.” And

that’s true—but look deeper. Doulas are

leaders in the birthing room, in a client’s

home, in our businesses and in our

community. Doulas need leadership skills.

We all have leadership roles in some

form in our lives as parents, employers,

as a class parent or PTA president, in our

place of worship or coaching our child’s

sports team. Not everyone is an exemplary

leader, but you can learn and improve

your leadership skills; you can be a leader

in small or grand ways. We all have our

own styles as doulas, parents and leaders.

If you don’t yet see yourself as a leader,

start here to take your first steps.

I am using the concepts of leadership

developed by Jim Kouzes and Barry

Posner in The Leadership Challenge 1 .

Based on their research, they define

five practices of exemplary leadership:

1. Model the way, 2. Inspire a shared

vision, 3. Challenge the process, 4.

Enable others to act and 5. Encourage

the heart. Let’s look at each of these

from the perspective of a doula.

Doulas Model the Way

To lead effectively, you must first find

your voice and clarify your personal

values. In our DONA International doula

trainings, we take time to examine, define

and explore our individual beliefs. This

is a continual process of self-reflection

16 International Doula Volume 20, Issue 3

and the core of who we are as humans,

doulas and leaders.

We also need to characterize the values

of whomever we are working with—a

client, an organization or club. Leaders set

the example by aligning their actions with

the shared values of the client or group. In

other words, leaders “walk the talk.”

With clients, we don’t have to agree

with them or how they choose to birth

or parent, but we do need to connect

ourselves with their wishes and model

for everyone in the room—grandparents,

fathers, partners, nurses, staff—how to

support a birthing mother or new parent.

Doulas set the tone for respecting

a mother and her choices; we model

validation, how to touch a mother or hold

a baby, even where to stand in a birthing

space or how to soothe an infant. We are,

in fact, leading them to where they want

to go, and guiding them to achieve what

they expressed as their ideals.

Our shared value is in giving a family

the best possible, confident, secure start.

We believe in the gift and importance

of labor and postpartum support, which

is the foundation for nonjudgmental

doula care.

Key traits of strong leaders are

integrity and authenticity. It will feel

wrong if you are not living in line with

your ideals. You feel it in your gut when

you’re not being true to yourself and

your core beliefs. When you recognize it,

return to your center and move forward

grounded in your morals.

Doulas Inspire a

Shared Vision

The job of a leader is to lift the fog so

participants are clear about the direction

in which they are headed.

How do you help a client envision the

undisturbed birth she desires? How do

you lead a client when her birth wishes

and her chosen provider and/or birth

place are not compatible? How do you

build a new mother’s confidence in

breastfeeding or a new father’s self-image

as capable of soothing his baby?

As doulas, we can empower a

mother to own her birth. We can

protect her space and the everlasting

memory of her birth. We can provide

resources and encourage families

to research the evidence to make

informed decisions.

We can inspire a mother to imagine

the birth she wants through reading birth

stories, drawing her ideal birth, dancing,

visualizing, singing to her baby (Penny

Simkin is passionately promoting and

advancing this practice) and in numerous

other unique ways. In our gentle and

inclusive doula way, we also work to enlist

others in the birth setting to share the

vision of the family.

Sometimes we need to inspire the

mother and father/partner in the labor

room to buy into their pre-labor vision

of their birth. Leading her toward her

original goal without being disrespectful

of changes in her feelings is a nuanced

skill for birth doulas, and sometimes

redoubling our cheerleading efforts helps

a mother buy back into her desire for a

drug-free birth.

Through the words we speak and the

interactions with everyone in a hospital or

birth center room, we indirectly appeal to a

family’s birth team to share in the family’s

birthing aspirations. We fill the mother’s

labor space with her birth vision and

endeavor to make it the common vision.

Cynthia Gabriel, author of Natural

Hospital Birth: The Best of Both

Worlds, advises parents who want no

interventions in a hospital setting to

become a broken record and keep

repeating, “I want a natural birth. We

want a natural birth. We really want

to have a natural birth.” As doulas we

wouldn’t say that to a nurse or doctor,

but we can prenatally recommend

Gabriel’s book and encourage parents

to repeatedly state their vision for

their birth.

Postpartum doulas support and uplift

clients as they build the family they have

imagined. Pointing out to a new mother

that her baby is satisfied and happy after

nursing allows her to see the mother

she is becoming. Teaching guideposts in

development and normalizing a baby’s

behavior reassures a new parent. When a

postpartum doula tactfully validates a new

mother’s way of doing things and includes

Grandma, she is helping to unite the

players in a shared dream. All of these are

actions of a leader.

As a community leader or birth activist,

can you articulate and paint the picture of

a future ideal? Can you express a detailed,

unique vision with a shared sense of

destiny and a call to action?

Doulas Challenge

the Process

Certainly at a birth, doulas are not

challenging anything. (But put on your birthwarrior

hat outside of the birthing room

and go for it!) As doulas, we can support a

mother if she feels she must challenge the

process. Ideally, we guide couples prenatally

to evidence-based resources so they can

make informed choices, and we can

encourage clients to trust their intuition in

birthing and parenting.

Many practices can be discussed and

negotiated pre-labor with a provider, but

a mother may not know she has options.

Discussing the usual process of labor in

a particular facility and reviewing the

birth “plan” together can help clients

understand where Mom and Dad/partner

may need to advocate for themselves in

advance of and during labor. As a doula

leader, we can give a mother permission

to change providers if she is struggling

to reconcile her views with those of her

doctor or midwife.

Postpartum doulas may support new

parents as they challenge a cultural

tradition that they disagree with or as

they resist an old way of thinking. For

example, a doula may support a Jewish

family who decides against circumcision

in conflict with the grandparents or a

mother who holds her baby all day at

odds with a father who believes you

should not give in and pick up a crying

baby for fear of spoiling. Doulas provide

Feature Story

Has a member of

your DONA doula

community recently

passed away?

Please let us know

so that we may

remember them

during the DONA

International Annual


An acknowledgment will also

be made in the first issue of

International Doula each year.

Send information to

Amy L. Gilliland, M.S., CD(DONA)




Help track




Complete a Survey for

every insurance

reimbursement claim

submitted by your clients.

Find the Survey in the

free Third Party

Reimbursement Packet

and on-line at 17

Feature Story

support to these individuals as they

challenge a process.

It’s important for leaders to seek

opportunities to effect change and find

innovative ways to take action. Is there

something in your community or birth

place that you want to alter? Switch from

your doula role into your activist role:

What bold step can you take to find a

better way of doing something? How can

you engage hospital officials to reexamine

a policy that contradicts the evidence?

Doulas Enable Others

to Act

Strong leaders give power away and build

trust through cooperation. That defines

a doula’s role. We nonjudgmentally

empower mothers and families to birth

and to parent in their own way.

Doulas give authority to parents

through encouragement, research,

resources, demonstration, active listening,

touch and holding their space. Families

who feel secure and educated are

empowered to act on their own behalf

toward their goals.

As doulas and leaders, we work to

galvanize the families we serve to build

a birth and/or postpartum team that is

working for them. They should expect an

honest and respectful relationship with

their provider, their doula and anyone in

their circle. Doulas lead by being trusting

and trustworthy, cultivating collaboration

and promoting cooperative relationships

as well as by listening, being open to

advice and feedback and fostering

interaction between all parties.

We also enable others to act by

strengthening and invigorating them so

they feel in control of their lives. In many

ways, it’s what we do as doulas. We build

confidence and a sense of competency in

parents and cultivate their ownership of their

birth experience or their parenting abilities.

Doulas must empower parents to

take responsibility and action on their

own behalf; they cannot hire a doula

and subcontract out their birth or early

18 International Doula Volume 20, Issue 3

parenting. Through our leadership,

we need to mobilize clients to educate

themselves, to know their options

and buttress them to be able to trust

themselves to accept or reject advice,

whether from a book or friend. Leaders

coach, encourage, cheerlead, guide and

boost others to have faith in themselves.

That’s what doulas do, too.

Doulas Encourage

the Heart

In your doula practice, how do you let

others know they matter? Making your

client feel she matters is basic and obvious,

but what about the father or partner?

What about the grandmother that is at

the birth or in the home when the family

comes home? How do you make the

hospital staff, nurses, doctors or midwives

feel they are important?

As leaders, recognizing others in a

sincere way that is meaningful to them is

vital. Can you think of a way to thank or

recognize a nurse who went out of her way

to support a mom’s birth vision? How could

you acknowledge a mother-in-law’s efforts

in caring for her new grandbaby or point

out how a couple worked in sync together?

Consider sending a handwritten note

to a provider or labor and delivery nurse

from your point of view. Not on behalf of

your clients but from you. Write a note to

postpartum clients recognizing specific

things that reflect their parenting skills,

and include details of tenacity and honor

in a birth story. Celebrate others in any

way you can dream up!

As doula leaders, we should expect

the best from clients, staff and those

around us. People rise, or sink, to the

expectations of them. We see the power

of this when we tell a mom in transition,

“You are doing this! You can do it!”

Much of what we say in a birth by way of

encouragement is exactly this quality of

leadership, but can we extend this beyond

praise for the mother?

Leaders bring out the best in others,

just as doulas enter relationships with

clients believing that all parents want to be

good parents. We encourage their hearts

so they go forth grounded in confidence

and self-assurance.

In Conclusion

Practice these five qualities of an

exceptional leader, whether as a

doula or as leader of a billion-dollar

organization. Kouzes and Posner assert

that “leadership is everyone’s business.”

Leaders demonstrate authenticity and

integrity; they set an example and light a

path. Leaders enrich and fortify others;

they reflect, trust and continue to learn in

an ongoing process of self-development.

Doulas are leaders and, like all leaders, we

must begin by leading ourselves first.

“There’s an ethical dimension to

leadership that neither leaders nor

constituents should take lightly. This

is why we began our discussion of

leadership practices with a focus on

clarifying your values—on finding your

authentic voice in a set of principles

and ideals. ... Attending to moral values

will always direct your eyes to higher

purposes. As you work to become all

you can be, you can start to let go of

petty self-interests. ... As each of us takes

individual responsibility for creating

the world of our dreams, we can all

participate in leading.”

– Kouzes and Posner,

The Leadership Challenge,

4th ed., pg. 346.

Leah DeCesare is a DONA

certified birth and postpartum

doula, as well as a childbirth

educator and certified lactation

counselor, serving families in

Rhode Island. Leah is a blogger

(, writing

about perspectives on parenting

from pregnancy to teens. Leah

is currently conducting the Mother’s Circle Young

Women’s Birth Survey, which is open to 18- to

26-year- olds. She is a past DONA International

Northeastern US Regional Director and is cofounder

and co-president of Doulas of Rhode Island.


1 Kouzes, James M. and Barry Z. Posner.

The Leadership Challenge, 4th ed. San Francisco:

Jossey-Bass, 2007.

continued from page 15


PERSPECTIVE By Leslie Butterfield

I met

Claire when her baby,

Benjamin, was six weeks

old. She’d been referred by

her midwife after scoring a

little bit high on a postpartum depression

questionnaire. Many of the issues

common to the postpartum period were

present for Claire—sleep disturbance,

trying to blend her old self with her

new mother self and processing all the

psychological layers of being both a

mother and a daughter. But Claire had a

deeper sense of grief and sadness about

her birth experience and a sense of having

lost her connection to Benjamin. When

people came to care for her and the baby

during her recuperation from the cesarean

section, some of them spent a lot more

time with Benjamin, and Claire began to

feel less and less necessary and then less

and less capable. Her maternity leave was

half over, and she didn’t even feel like a

real mother yet. No wonder she felt sad!

Our initial time together focused on

helping Claire find her voice again—a voice

that would protect her time with the baby

and reconnect her to her husband. We

invited Dan to the therapy, and the two of

them created some significant agreements

about how to deepen and maintain their

marital relationship while simultaneously

forging a family in accordance with their

core values. Claire challenged herself

to assess the level and value of some

relationships and explore the possibility of

leaving her beloved career in order to be

with Benjamin. I have to say her integrity

was impeccable. She was a wonderful role

model to me about facing emotions and

problems honestly.

About six weeks into our therapy,

Claire shared her birth story in detail.

Two things immediately stood out to me.

First, I was amazed at her tale of power

and perseverance as she described an

80-hour labor with numerous difficulties

and decision points. It was like listening to

one of those fairy tales in which the hero

embarks on a quest only to find himself

beleaguered by challenges and difficulties

at every turn. It was astonishing to hear

all that she had endured, and how her

perseverance and courage were tested

repeatedly—right up to and including the

cesarean section.

But the second thing amazed me

even more. While Claire was sharing her

“disappointing” birth experience, she

became transformed. Her eyes sparkled,

her voice grew strong and a sense of vitality

radiated from her physical being. This was

a woman experiencing power and the

exhilaration of knowing her own strength.

It was remarkable. And then she described

how happy and proud she had been

immediately postpartum, knowing that she

had exhibited stamina, flexibility and good

judgment. She knew she had lived up to her

own standards. Here, I thought, was our

ticket to joy and recovery.

I asked Claire to audiotape herself

telling her own story and listen to this

at least once a day for the next week

or so, focusing on the strength and

perseverance that were the real truth of

her experience. Then, she and I set out

to discover what on earth had separated

her from her original sense of triumph

and brought her to doubt her own

courage and capability. How did her

birth go from that of a mature woman,

struggling through repeated difficulties

with grace and intelligence, to a birth and

a mother that somehow didn’t measure

up? As always, there were multiple

contributing factors, but two of them

seemed predominant. The first was that

some of the people who came to help

care for Claire in the postpartum period

relieved her of childcare. Thus, this lioness

was left without her cub to fiercely protect

and remind her of her stature. In their

desire to be helpful, they inadvertently

took away from Claire the very meaning

of all that hard birth work, and the birth

Cover Story

itself began to lose its original value. Little

by little Claire lost her sense of heroism

and the belief that she was the central

figure in Benjamin’s life. Second, she was

inundated with comments from people

who assumed the cesarean section was

disappointing and Claire must regard

herself as disappointed and as having

failed to have the birth she had prepared

for. The insidiousness of this negativity

did its work, and soon the birth came to

be regarded as a source of sadness, rather

than as the celebration it had started out

being. We humans are such a socially

oriented species—it is hard for us to mourn

or celebrate without a community that

accompanies us and shares our reality.

Claire was drawn into the prevailing

social belief that her birth experience was

something to be mourned.

I’m really happy to say that once

Claire did reconnect with her own story

of Benjamin’s birth, she was able to

remember who she really was. She could

recall and, thus, re-experience in her

daily life her own courage and flexibility.

Once again, as it had been at the very

beginning, the birth became an emblem

of Claire’s soul, her emotional honesty

and great capacity for love—even in the

face of fear. She embraced her old self and

returned to life as a mother with renewed

pleasure. I feel so lucky to have had Claire

as a client. Some of what she shared with

me has stayed with me over time, helping

me to live my life with a bit more courage

and determination.

Leslie Butterfield, PhD, is a clinical psychologist

specializing in perinatal emotional health and

adjustment. For more than 20 years, she has

provided therapy to pregnant and postpartum

women and their families, as well as consulting for

agencies that care for families in the childbearing

years. She is currently the chairperson for

Postpartum Support International of Washington

State and an adjunct professor at Bastyr

University’s Department of Midwifery. She is

struggling to adjust to the fact that her babies

are now young men. She can be reached at 19

2012 Conference

Cancun, Mexico

above: Happy

birthday DONA


20 International Doula Volume 20, Issue 3

left: Western Pacific U.S. region doulas

below: Founders and Penny Simkin Founder's Award winners

above: DONA in the sand

left: Luncheon

elow: Tweeting #DONA12

right: Snorkeling doulas!

below: Lunch buffet

above left: Mexico region doulas

above right: Traditional Mayan midwives

left: Spanish interpreters during a general session

below left: Canadian smiles

2012 Conference

2012 21


Mount Everest or Mount Douglas?

By Eva Bild, MA, CD(DONA), LCCE


t’s 2 a.m. Monday morning.

My client* has been in

labour since 11 p.m.

Saturday. She didn’t get a

leisurely and pleasant early labour spent

watching movies, making cookies and

taking long walks. Instead, her labour

started right in with contractions 30

seconds long and three minutes apart.

So strong she couldn’t sleep. I went over

to her house around 2 a.m. Sunday and

helped her in and out of the shower, on

and off the bed and round and round

her living room. When her midwife came

to check on her Sunday afternoon, my

client’s cervix was only three centimeters

dilated. And the poor mother-to-be was

exhausted and suffering terrible back

pain. It was time to go to the hospital.

We spend several more hours at the

hospital labouring in the shower and on

the birth ball walking the halls and up

and down the stairs. Her partner and I

take turns massaging her back, applying

counterpressure and the double-hip

squeeze. My client does everything we

suggest. She is so strong, brave and

determined. But after several more hours,

my client decides to have an epidural.

“It’s not the contractions,” she says. “It’s

the back pain. It’s there all the time. I

never get a moment without pain.”

So we get on that merry-go-round—

the one that lines up one-to-one nursing

and gets the anaesthetist into the room.

That takes another two hours. Then it

takes another half an hour to put the

epidural into her back, followed by

immediate relief. “Phew,” I think. “She’s

finally going to catch a break.”

Relief Is Not to Be Had

But no. Within half an hour, the epidural

stops working. Pain returns on one

side of her body. Then in her back. The

22 International Doula Volume 20, Issue 3

anaesthetist comes back several times.

First, he just tops off the medication.

Then he takes out the epidural catheter

and puts in another one.

Through all this, the partner and I stay

very close, holding the mother’s hand,

keeping eye contact, talking her through

every contraction and every procedure.

Finally it works. The epidural is in the

right spot and the pain goes away. It’s

now 25 hours after she first started

having contractions, and her cervix is five

centimeters dilated. She may still have

hours of labour ahead of her.

The midwife and I encourage the

mother-to-be and her partner to go to

sleep. The partner passes out on the

easy chair. I sit by my client’s bed and

try to help her relax and wind down. But

after all that work, she can’t sleep.

We talk quietly, intimately, in the dark

room. I get her to talk about the baby.

About the grandparents-to-be. About

baby names. And then she asks, “What

were your labours like, Eva?” I am silent.

I don’t know what to say. Can I tell her

about my three straightforward births—

two of them home births? How would

that help her? How will it help to make

her feel she is doing her very best, that

she is coping as well as she can and

making her own best choices?

I say something non-committal. “Oh,

that was long, long ago, in a galaxy far,

far away ...” Luckily the nurse comes in

to check on the IV and the fetal monitor,

and the topic passes.


Later, when I am debriefing the birth

with my doula partner (the mom had the

baby vaginally with the help of a vacuum

extractor at 4 p.m. Monday after three

hours of pushing), I say, “Comparing

her birth to mine is like comparing

climbing up Mount Everest to climbing

up Mount Douglas.”

Mount Douglas is a large hill (213

meters or 640 feet) in Victoria, British

Columbia. There is a paved path all the

way up and, although I huff and puff

when I climb up, it’s just a pleasant

afternoon walk. I would pack a granola

bar, some water and a jacket in case the

coastal weather turned suddenly.

Mount Everest takes a whole other

set of skills and equipment to scale. It

requires training, hundreds of thousands

of dollars, guides, helicopters, oxygen

tanks, a base camp and who knows

what else. It can be lethal. (According to

a study in The British Medical Journal,

Volume 337, December 2008, by PG

Firth and colleagues, the death rate

among people climbing Mount Everest is

1.34 percent. I know this is MUCH more

dangerous than giving birth. Please

don’t take my analogy too literally.)

Why do some women get Mount

Douglas labours while others get Mount










DONA certified birth

and postpartum doulas,

fluent in English and

Spanish, volunteer to

serve on the certification






Valuable information

is gleaned from every

doula experience!






for each and every

experience YOU

attend as a

DONA doula and

mail or fax it to

the DONA

home office:

2851 South Parker Road, Suite 560

Aurora, CO 80014

FAX: (303) 755-7363

24 International Doula Volume 20, Issue 3

Everest ones? Well, I know some labours

that could have been Mount Douglas get

turned into Mount Everest because of

the misuse of technology. If I were afraid

of Mount Douglas and spent a whole lot

of money setting up a base camp and

renting a helicopter, I could make it very

difficult to get to the top in an afternoon.

But some women are not afraid and

are not led to misuse technology by

their care providers. They just have bad

luck. Their labours are long, exhausting

and complicated. Their babies try to

come out in an inconvenient position,

their placentas are in the wrong spot or

their blood pressure goes up and down.

None of these things are anyone’s fault.

They just happen sometimes. The Fates

assign some women a Mount Everest

labour. And in those situations, we are

so very glad the technology exists to

be able to help women out of those

labours safely.


Some women who get a Mount Douglas

labour find it very, very difficult. (I find

Mount Douglas much harder to climb

than my trim, fit friend, Jude.) Some

women experience Mount Everest

labours as huge triumphs and feel proud

and strong afterward.

I find it is useful to some of my

clients, after the fact, to hear their

labour was a Mount Everest. To a client

who is telling me how difficult she found

her labour, I might say, “You know,

compared to other births I’ve seen, that

one was really long and really tough.” I

usually see relief on her face, “Oh, good!

It wasn’t just me. It’s not just that I’m

a wuss!” Part of our job as doulas is to

provide perspective, to help our clients

make sense of their labour stories.

On the other hand, I don’t think

it’s useful to tell a woman who is

complaining about a Mount Douglas

labour that her labour was no big deal.

If it was a big deal in her head, that is all

that matters. I feel quite accomplished

when I get to the top of Mount Douglas,

even though Jude can run up and down

twice in an afternoon!

The height of the mountain is not the

only factor in how women feel about

their experience. If a woman just has

to climb up a little hill but it is dark and

cold and there is a mean gym teacher

shouting at her that she’s lazy, that little

hill might as well be Mount Everest! We

can’t determine the kind of mountain

our client is going to have to climb. But

we can make sure that as she trudges

along the trail she has an arm to lean

on, a friendly voice encouraging her

and her favorite kind of granola bar for

the rest stop. We can make sure she

knows the way and what her options are

at each fork in the road. We can make

sure when she gets to the summit, she is

treated like she’s on top of the world! A


Eva Bild has been working

with childbearing families for

almost 20 years. She is a birth

doula, childbirth educator and

breastfeeding educator in

Victoria, British Columbia. She has

three grown children and felt like

a hero after every one of those

Mount Douglas births!

*Author’s note: The mother

whose story I tell here is not a

real client but rather an imaginary

woman whose story is made up of

many births and experiences.




The DONA International

Founders’ Awards were

established to honor the work

of the men and women whose

vision was the beginning of

DONA International. Each

year, the Founders’ Awards

committee seeks nominations.

Awards are given when we

have outstanding nominees

who represent the spirit of the

founders. The founders do

not participate in the selection

process but are pleased

to present their namesake

awards to the deserving

recipients each year at our

annual conference.

Virtual Bliss –

Have you ever been disappointed

that you were unable to attend a

DONA International conference? Perhaps

the distance to travel deterred you. Or the

total cost seemed like more than you could

justify. Or perhaps your doula calendar

was so full that you could not find the

time to get away. DONA International

recognizes these issues are prevalent. Over

the years, the conference committee has

done its best to keep the costs as low as

possible and schedule the location of our

conferences in various regions striving

to be near to as many of our members

as possible over time. Even so, we know

many of you have yet to experience a

DONA International conference.


Doula Spirit and Mentoring. This

prestigious award was presented

to Guadalupe Trueba and Elena

Carrillo of Mexico.

Lupe and Elena have been tireless

ambassadors for birthing women and

new families in Mexico and Latin


Lupe has been a doula for more

than 38 years, and Elena has been

a doula for 40 years. Between them,

they have supported almost 4,000

women during their births.

We found the solution! We will bring

the conference to YOU! Our 2013 virtual

conference will have all of the same features

as our in-person conferences, except

the warm hugs. Yet we will still provide

the opportunity for you to connect with

other doulas via chat rooms, during live


sessions and in the

exhibit hall. The best part

of a virtual conference,

besides its affordability

and accessibility, is that

if you are unavailable

during all or part of the

live broadcast, you will

be able to access it in its

Lupe honored the traditional

midwives of Mexico by incorporating

the rebozo into doula practices,

which many of us now think of as an

essential item in our doula bags.

Elena served on the DONA

International Board of Directors for

numerous years. She is responsible

for bringing DONA International to

Mexico. Elena has spread DONA

International’s Mission and Vision

throughout Latin America.

Between the two of them they have

taught many workshops in Mexico,

Argentina, Uruguay, Chile, Puerto

Rico, Northern Ireland and England.

They have also been on the faculty of

The Anahuac University’s Especialidad

en Educacion Perinatal Program,

a post-graduate course in perinatal

education, for the last 18 years.

A Conference for Every Doula, Everywhere


entirety for some time afterward! And, if

you wish to listen to a session again, it will

be available for you.

The conference committee is so

excited to be developing this new way

of bringing continuing education to you

and connecting you with the DONA

International doula

community across the

globe. We will share all the

details as they unfold. In

the meantime, mark your

calendar for July 19 and

20, 2013, which is when it

will be broadcast live, and

plan to be a part of this

innovative experience! 25


Expectations, Acceptance and Empathy:

Journeying From Doula to Mother

By Jessie Harrold, CD(DONA)

From Doula to Mother

I have been a birth doula for four years

and have had the honor of supporting

women through long, quiet nights of

steady contractions and intense, breathtakingly

rapid labor. I have held hands

and stroked wisps of hair away from eyes

that stared upward at the operating-room

ceiling and down into the comfort of a

warm tub. When I lay in bed with my

husband, heart hammering as I moved

my hand away from the digital display

on the pregnancy test I had just taken, I

realized that the birth experiences I had

shared with others had both everything

and nothing to do with the journey I was

about to take.

When I gazed at that simple little word

—pregnant—I already had a wealth of

information and support at my fingertips.

I knew what my intentions were for my

birth. I had seen the inside of the birth

unit and the operating room many times;

I knew a lot of the hospital staff. My doula

helped me find a family physician that

was supportive of my preferences, and my

26 International Doula Volume 20, Issue 3

husband had already perfected the doublehip

squeeze. As the births of previous

clients began to circle in my head,

however, I wondered if perhaps ignorance

was bliss. Though I had witnessed beautiful

births during which my clients’ wishes

were respected and their intentions seen

through, I had also seen instances where

potentially unnecessary interventions

contributed to feelings of confusion and

disempowerment. Sometimes I could

call upon those positive experiences as

inspiration for my own birth, but I also

began to fear the worst as I remembered

some of the challenges I had seen other

women face.

Feeling the Pressure

Fast forward a couple trimesters. I am

perched on a ball in the birth unit of my

local hospital across from my husband,

my doula and a nurse with whom I’ve

spent many an hour supporting laboring

women. My water has been broken for a

very long time, and my uterus hasn’t yet

gotten the memo. After much research,

soul-searching and, finally, acceptance, I

have chosen to start a Pitocin induction.

“It must be a lot of pressure, isn’t it,”

the nurse asks, “as a birthing woman

who is also a doula? Having to have an

intervention must be really difficult.”

It’s the understatement of the

year. Throughout my pregnancy, my

doula brain reminded me that birth is

unpredictable and though I may set

intentions for my birth experience,

ultimately I had to be prepared for

anything to happen. At the same time,

there was a part of me that held onto

this romanticized birth. You know what

it looks like: I’m in the tub, breathing

through each contraction, integrating the

pain beautifully because I’m so open, so

prepared, so relaxed. I peacefully push

my baby into the world with a smile on

my face, and then I breastfeed like I’ve

been doing it all my life. I created this

scenario in my mind despite knowing that

it might be unrealistic. I even felt like my

friends, family and clients expected that I

would have this idealized experience, as

though being a doula would enable me to

somehow control my birth process in a

way other women could not.

When I shared this with two of my

doula friends who had supported other

women through their births before

becoming mothers themselves, they could

relate: “I put a lot of pressure on myself,

as a doula, to have a certain birth,” one

friend shared over a cup of tea. “I wanted

to look like the model-birthing woman

or something, like I had it all together. I

wanted to set an example of how natural

birth could work.”

It seemed as though we each had

created a double standard whereby we

supported our clients through their births

without judgment or expectation, and yet

we were unable to support ourselves with

the same loving, gentle doula spirit.

Doula-ing the Doula

I wasn’t the only one holding onto

expectations about how my birth would

unfold. Early in my pregnancy, a physician

wrote on my file “is a doula.” That file

went everywhere with me and, with it,

assumptions about my preferences for

my birth. One of my doula friends had a

similar experience and described how the

healthcare providers she encountered during

her birth treated her as a doula and naturalbirth

advocate who happened to also be

birthing and not the other way around. “It

was as if my role as a doula was somehow

tied to my choices as a birthing woman.”

Along with assumptions about

my preferences for my birth came

assumptions about my need for support

and information. More than once I heard,

“You’re a doula, so you probably know all

this already.” In fact, my inability to rely

on the knowledge I held in my doula brain

during labor and as I learned to breastfeed

caught me a little off-guard. I was bursting

with fierce instinct and sometimes

overwhelming self-doubt and had not a

practical, reasoned, objective thought in

my head. My friend shared this feeling: “I

was surprised because I thought I would

be this super self-advocate, but instead I

wasn’t ... I wanted people to tell me what

to do.” The thing is, no matter how many

books I had read, what I believed about

medical interventions and how many births

I had attended, my birth experience was

totally unique, completely unpredictable

and entirely out of my control. I needed

reassurance from my doula, my husband,

my nurses and my doctor that I was doing

a good job, that I would be fine and that

no matter what happened during my birth,

I was a strong, amazing woman sharing

the ultimate human experience, like the

generations and generations of women

who have gone before me.

Deeper Empathy

As a doula before becoming a mother, I

brought into my birth the experiences—

both positive and negative—of the women

I’d supported, tremendous internal pressure

to have an intervention-free birth

and others’ expectations and assumptions

of me. Now my husband and I lay

in bed with our incredible baby daughter.

On the night of her birth, I faced my fear

that my induction would end up in the

operating room like other clients’ had.

I accepted that I wasn’t going to have

the “natural” birth I thought I would. I

left behind everything I thought I knew

or wanted and allowed the events of the

night to unfold one contraction at a time.

As a woman and mother, overcoming

and even thriving amidst these challenges

was the most empowering experience

of my life. As a doula, I can more deeply

empathize with the women I support

because I really understand how it feels

to let go and let birth happen. Because

of this, my birth, though different than I

imagined, was absolutely perfect.

Jessie Harrold, MA, CD(DONA),

works in the field of health

promotion and moonlights

as a doula. She is the director

of education for the Nova

Scotia Doula Association and

is working on her lactation

educator certification. She

shares her life’s adventures with

her amazing husband, beautiful

daughter and goofy dog.


Are you a



Join the DONA



as an

International Doula

Associate Editor

Various editorial positions in

English, Spanish and French

are available for you to consider!

For more details, contact 27


All the Way From Greece:

One Doula’s Conference Experience

By Maria Andreoulaki, CD(DONA)


n July 2012, I had the honor of

representing Greek doulas at

the 20th birthday celebration

of DONA International at the

annual conference in Cancun, Mexico. My

trip was made possible due to practical,

moral and financial help and support by

the Greek Doula Association, the French

Association La Culture Pour Vivre and

DONA International through their Doula

Spirit Fund. I thank the people behind each

organization for making this happen.

I would like to share some main

points presented at the conference

sessions I attended that I found especially

meaningful and important for Greece

with the hope that we can be inspired

and motivated toward positive changes.

As DONA International celebrated 20

years from its first official meeting, three

of the Founders were present to honor

this event: Phyllis Klaus, Penny Simkin

and Annie Kennedy. It was impressive

how these women, veterans in perinatal

care, had traveled so far. How their

presence and presentations were still full

of inspiration, vitality and passion, just like

20 years ago when the doula movement

started in the United States.

28 International Doula Volume 20, Issue 3

The conference was attended by

doulas, doctors, mothers, activists, babies,

nurses, childbirth educators, psychologists,

therapists and exhibitors with products

relating to the perinatal period.

Four main points were made during

the conference that I found personally and

professionally relevant and important to

explore, discuss and hopefully implement

in Greece, with the hope they will be

implemented all over the world.

Traumatic Birth

DONA International Founders Penny

Simkin and Phyllis Klaus both talked in detail

about post-traumatic stress effects and posttraumatic

stress disorder. Their discussions

centered on how common they are, how

to identify symptoms in a woman, how to

prevent its occurrence and how to facilitate

healing. Penny Simkin began her work in

the perinatal field in 1968, and since then

she has worked extensively to define the

factors that influence a woman’s satisfaction

with her birth experience. Phyllis Klaus has

devoted her career to understanding and

supporting the emotional needs of pregnant,

birthing and postpartum women.

I cannot forget to mention the gift of the conference,

the gigantic Mexican sea turtles coming to the beach

every night to lay their eggs—a magical experience!







Postpartum Care

Mexican childbirth educator Elena

Carrillo presented the traditional Mayan

practice of La Cuarentena during the

40 days after birth, which is offered

to all Latina women regardless of

social, economic or family status. She

shared many customs and practices

of the Mayan traditional healthcare

providers. We must take the opportunity

to remember and revitalize our local

traditional postpartum-care practices

so all women can enjoy the benefits of

a supported postpartum period, which

is ultimately beneficial to the mother,

her baby and all other members of her

immediate and extended family.

International MotherBaby

Childbirth Initiative – IMBCI

An inspiring presentation was given by

Debra Pascali-Bonaro (with the assistance

of Rae Davies, both founding and

board members of the IMBCO), on the

history and actions of the International

MotherBaby Childbirth Organization 1 and

the initiative as it is practiced globally.

Debra urged us to explore and study

the work of important people who have

contributed to the promotion of optimal

care and health of the MotherBaby

unit: the work of the late midwife Mary

Kroeger, the book and movement Half

the Sky 2 on the oppression of women

worldwide, the White Ribbon Alliance for

Safe Motherhood 3 and the Inter-Agency

Group for Safe Motherhood, 4 which

states prevention of women’s mortality at

birth is a human-rights issue.

We were mesmerized by the excellent

video, Break the Silence: Respectful

Maternity Care. 5 Debra also presented

the eight demo sites worldwide where

the 10 Steps to Optimal MotherBaby

Maternity Services are being

implemented and talked about the

MotherBaby Networks (MBnets), an

easier step toward the understanding

and implementation of the 10 Steps in

all countries.

The Actions

of Doulas Internationally

I also attended a very uplifting and

hopeful concurrent session presented by

Debra Pascali-Bonaro and Ana Paula

Markel on the existence and actions

of doulas worldwide. The speakers

shared information about groups and

initiatives from doulas all over the

world—Europe, Asia, Middle East,

Latin America, North America, Africa,

Australia and New Zealand. Many of

these initiatives are offering amazing

support to birthing women and families,

including community programs, and in

some areas doula services are covered

by the national health insurance. Certain

areas have fully integrated doula services

in the healthcare maternity systems

through hospital-based doula trainings

and programs providing doula services to

birthing women in their facilities. Finally,

the speakers reminded us of how the

implementation of the 10 Steps of IMBCI

include the care and services of a doula

for the optimal care of MotherBaby,

something we can strive for in countries

where maternity care is not so optimal

(including in my country, Greece).

Last but not least, I cannot forget to

mention the gift of the conference, the

gigantic Mexican sea turtles coming to

the beach every night to lay their eggs—a

magical experience!

Maria Andreoulaki is a DONA certified

birth doula and is currently working

toward her birth doula trainer

approval. She serves as the Greek

SPAR for DONA International and is

the official Country Representative

for several international organizations,

including ENCA (European Network

of Childbirth Associations), EDN

(European Doula Network) and IMBCI (International

MotherBaby Childbirth Initiative). She is the co-founder

and/or supporter of many national organizations

dealing with perinatal care in Greece, including Eutokia,

BirthVoice, ENCA Hellas, Greek Doula Association

and LLL Greece. She is based in Athens, Greece, with

her two adolescent children, and offers her time, on a

volunteer and professional basis, teaching/facilitating

groups, researching, translating articles, networking

on a national and international level, organizing and

participating in national and international conferences,

seminars, events, training programs, social activism

and working as a reflexologist and a doula.


1 International MotherBaby Childbirth Organization


2 Kristof, Nicholas D. and Sheryl WuDunn. Half

the Sky: Turning Oppression Into Opportunity for

Women Worldwide. New York: Vintage Books,


3 The White Ribbon Alliance for Safe Motherhood.

4 Women Deliver.

5 The White Ribbon Alliance. Break the Silence:

Respectful Maternity Care.



International Doula is a

quarterly publication of

DONA International, a

nonprofit organization

registered in the state

of Indiana. All rights

to the content of

this publication are

reserved. © DONA

International 2012.

Articles published in

International Doula

do not necessarily

represent the

opinions of DONA International.

Authors are responsible for the accuracy of all

content. The names of people mentioned in

International Doula are fictitious or appear with

permission. Nonmembers may receive the

International Doula for $20 (U.S.) donation. In the

interest of education and the dissemination of

current and correct information, reproduction,

in part or in whole, of individual articles within

this publication, is encouraged unless otherwise

indicated. Reproduced articles must have

proper accreditation and must not be sold. This

permission to reproduce is limited to numbers

less than 100 unless prior permission is obtained.

Including any portion of the International Doula

on web sites or social media sites is prohibited

unless prior permission is obtained.

Moving? The post office will not forward the

International Doula magazine. Send your address

changes to DONA International, 2851 South

Parker Road, Suite 560, Denver, Colorado 80014,

or e-mail

Author inquiries should be addressed to the Editor

at or mailed to 2851 South

Parker Road, Suite 560, Denver, Colorado 80014.

Unsolicited manuscripts are welcome but will not

be returned.

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at the Farm Midwifery Center

with Ina May Gaskin and partners

Midwife Assistant Workshops

6-day Midwifery Assistant Workshops

March, April, June, July, August and

September of 2013

Neonatal Resuscitation

2-day classes to be held in Spring, Summer and Fall

Advanced Workshops

• Common Sense and Tradition:

Workshop for Midwives

May 19-23, 2013

• Advanced Midwifery Workshop

August 25-31, 2013

CEUs awarded for all advanced workshops

Herb Workshop

May 16-18, 2013 ACNM CEUs applied for

For more information and curriculum, write:

The Farm Midwifery Workshops

P.O. Box 217

Summertown, TN 38483

e-mail: 29


Postcard from Home

Dear DONA Members,

As a doula, certain information is required to maintain your certification. Here are a couple of tips to

help clarify specific information and make it easier to know what may need your attention and when.

Each doula’s membership with DONA International may be purchased any day of the month. When it

is purchased, the home office enters the date of purchase and the expiration, which is the first day of

the next month, plus the length of purchase. For example, if your membership was purchased August

12, 2012, your renewal would be due on September 1, 2013. As a certified doula, these dates do not

change because of the requirement of continuous membership.

When it comes to certification, your date of approval may be any day of the month as well, but your

recertification date will be entered into the system as the last day of that same month, three years later.

For example, if you were certified on August 12, 2012, your recertification would be due August 30, 2015.

The key to remembering these two important dates is to recall that membership will always be due the

first of the month and recertification will be due the last day of the month.

The application/affidavit for recertification requires your original certification date, certification

identification number and the date of certification expiration. In order to track this information, keep

the approval notice you received from the reviewer; it has the original date of your certification and is

usually emailed to you. It is recommended that you print this document for reference. You can find your

certification number on your identification card and your certificate; your certification expiration, or

recertification renewal date, is also on your ID

card and certificate. Your ID card and certificate

are updated every three years so make sure to

refer to the most current document.

We hope these tips about your membership

and/or certification dates and numbers help.

Should you have any questions, do not hesitate to

contact the home office at (888) 788-DONA.


–Your Home Office Team

30 International Doula Volume 20, Issue 3


The Sum of My Parts

By Elizabeth Mangum-Sarach, LCSW, CD(DONA), LCCE, BDT(DONA)

I am.

I am a doula trainer.

I am ready,





I am the sum of my parts.

I have my own story to share.

I am.

I am a doula trainer.

I am knowledgeable,




Elizabeth Mangum-Sarach is the executive director of BirthFocus, a doula practice serving families

in New York City and Austin, Texas. As a licensed clinical social worker, Elizabeth worked for close to

a decade in the NYC foster care system primarily focusing on women’s issues, adolescent girls and

family and couples work. She is a DONA certified birth doula who has attended 125+ births of all varieties

and a DONA approved birth doula trainer. Elizabeth is also a Lamaze certified childbirth educator and

is trained in Rock Your Birth and HypnoBirthing. Elizabeth serves on the advisory board of Village Birth

International, an organization dedicated to providing trainings for midwives and doulas in Uganda. When

not attending births, you might find Elizabeth walking her chocolate lab, Franny, practicing yoga or on a

motorcycle/camping trip with her husband in Austin, Texas.





I am the sum of my parts.

I have my own story to share.

I am.

I am a doula trainer.

I am fearful of failure,





I am the sum of my parts.

I have my own story to share.

I am.

"Faith is taking the first step even when you don't see

the whole staircase."

- Martin Luther King, Jr.

"A tree is known by its fruit; a man by his deeds. A

good deed is never lost; he who sows courtesy reaps

friendship, and he who plants kindness gathers love."

- Saint Basil

"To practice five things under all circumstances

constitutes perfect virtue; these five are gravity,

generosity of soul, sincerity, earnestness, and kindness."

- Confucius




A Third Party

Reimbursement Packet is

available to members only. It

provides best strategies for

US doulas and their clients

to request and receive

insurance reimbursement.

Order yours

in the DONA

Boutique today!













Feature Story

Labor Support –

You Mean That’s a Profession?

By Amy L. Gilliland, Ph.D., BDT(DONA)


n my 25 years of

offering labor support

professionally, there is

one persistent challenge

that our profession still faces: that of

legitimacy. While people may be more

knowledgeable about what the term

doula means, they are still befuddled

by what we actually do. If you asked

someone who already knew what a

doula was to describe what a doula

actually did, they would be hard-pressed

to describe it accurately. Most people

think (even those we think should know

better) that doulas pat laboring mothers

on the back and tell them everything

will be fine. Our clients have learned

through direct experience that birth

32 International Doula Volume 20, Issue 3

doula support is skilled caregiving. But

even their descriptions are limited by

their own birth experiences.

Doula care requires a large skill set.

It requires being able to accurately

perceive the needs of people you do

not know well and sensitively and

contingently respond to those needs

in a timely manner. Doulas need to

have many physical and emotional

support skills at their disposal in order

to effectively apply the correct strategy.

Effective communication skills with a

wide variety of people are necessary

for a doula to excel. Birth doulas also

know how to navigate the complicated

obstetrical health-care system in their

area. One of the main purposes of








my research has been to illustrate the

sophisticated nature of doula skills

(Gilliland, 2011). Caregiving is a skilled

profession, and doula support is

professional caregiving.

However, most people do not

recognize doula care as a skill. Even if

they do, that does not mean that our

caregiving has value. There is a long

history of disregarding professional

caregiving in the United States. Many

of the other caregiving jobs are not

well paid and are often held by people

not native to the United States. Most

Americans do not want these kinds of

service jobs—they feel they are beneath

them. The fact that most doulas are

white and from middle and upper

classes (Lantz, 2005) has not made us

immune to the struggle of recognizing

the value of giving care.

Then there is the idea that all

women are natural caregivers. Besides

being sexist, it is not true! Many of

us can think of women who have few

caregiving skills and men who seem to

possess them innately. But perhaps the

most insidious part of this idea is that if

doula support is something “all women”

could do if they wanted or needed to,

it makes it easy to devalue. The more

common a skill is, the less it is valued.

In addition, this is a career pursued

almost entirely by women, which also

gives it less status.

If we bring all of these ideas

together, it is easy to see why the majority

of the public doesn’t value doula work.

All women could do it if they wanted; it’s

a job few people want, has little status

and does not require any special skills.

While women pregnant for the second

time may have a better understanding of

what a doula has to offer, they may have

paid a high price for that knowledge.

If we want to be recognized by medical

caregivers, insurance companies and

first-time parents as a necessary service,

we need to increase respect for our skills.

The first 20 years has been about getting

the word out—now we need to make

certain people know what that word


Amy L. Gilliland, Ph.D.,

BDT(DONA), is a doula

researcher, doula and trainer

in Madison, Wisconsin. She

is also an AASECT certified

sexuality educator and on the

faculty of Madison College.

She travels frequently to

present at conferences and

do advanced labor support trainings. For more,

go to


Gilliland (2011), After Praise and

Encouragement: Emotional Support Strategies

Utilized by Birth Doulas in the United States and

Canada, Midwifery, Volume 27 (4) p. 525-531

Lantz, P., Kane Low, L., Varkey, S., Watson,

R. (2005), Doulas as paraprofessionals:

Results of a National Survey. Women’s Health


Feature Story

Volunteer on the



Multiple positions are open.

Please consider applying for

a position of leadership.

Find requirements and

application procedures

for all open positions at


for detailed information

You could be a





Submit your feature articles,

research, poems, book

or video reviews, doula

doings, questions for Penny,

letters to the editor and

photos or artwork.

Contributor’s Guidelines and

specifications available on request.

E-mail your submissions to 33

Network Communications Proudly Presents Audio Recordings of the

2012 DONA International Annual Conference

July 19-22, 2012 Cancun, Mexico

Audio CDs $10.00! DVDs of General Sessions $16.00!

Qty. Order# Description Cost

DN-W00D Full Set of Audio CDs in CD Storage Holders (Includes a 20% Discount) $192.00

DN-W00V DVDs of all General Sessions (PPT & Audio Synced) $76.00

DN-W00U USB Drive Containing All Recorded Sessions in the MP3 Format $159.00

DN-W00L DONA Audio Download Library! (All Files are in the MP3 Format!) (We will send you a link once payment is processed!) $129.00

34 International Doula Volume 20, Issue 3

Audio CDs $10.00 Each! – Buy 6 CDs and the 7th CD is Free!

MP3 Files MP3 Download Files $9.00 EACH! Check this box and then select the sessions you want from the list below. After we

process your charge, we will email you a web address that will allow you to download the session you have ordered!

General Sessions: Available on Audio CDs or DVDs (DVDs are PowerPoint & Audio Synched!)

DN-W01 General Session: Looking Back 20 Years to the Future of DONA International and Doulas – Barbara Hotelling, Annie

Kennedy, Penny Simkin, Phyllis Klaus

$10.00 CD

$16.00 DVD

DN-W02 General Session: Traumatic Birth, PTSD and the Doula – Penny Simkin $10.00 CD

$16.00 DVD

DN-W03 General Session: Breastfeeding and the Doula: How to be a Part of the Breastfeeding Team – Teresa Pitman $10.00 CD

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$16.00 DVD

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DONA Conference Concurrent Sessions – Available in Audio CD Only!

$10.00 CD

$16.00 DVD

DN-W07 101 The Mayan Midwife: Rescuing Traditions for the New Millennium, Part 1 – Elena Carrillo, Guadalupe Trueba $10.00

DN-W08 102 Balancing Your Energy Bank Account – Sändra Marie Smith $10.00

DN-W10 104 Being a Doula for Women Living in Conditions of Risk: Understanding Solidarity and Boundaries – Eva Bild, Jacquelin Green $10.00

DN-W11 105 Sleepless Nights: What’s All the Fuss About Sleep Training? – Teresa Pitman $10.00

DN-W12 201 The Mayan Midwife: Rescuing Traditions for the New Millennium, Part 2 – Elena Carrillo, Guadalupe Trueba $10.00

DN-W13 202 Traumatic Birth: A Therapist’s Perspective – Phyllis Klaus $10.00

DN-W14 203 Pregnancy, Babies and Birth, OH MY! Working With Anxious Clients – Pattie Treubert $10.00

DN-W15 204 Birth Class on a Yoga Mat: Doulas in the New Birth Frontier – Sarah Longacre, Gail Tully $10.00

DN-W16 205 Ways Doulas Can Help Dads to be Powerful Birth Partners – Joe Valley $10.00

DN-W17 301 Developing Empathy for the Careproviders – Cynthia Gabriel $10.00

DN-W18 302 The Paperless Doula: Virtual Paperwork Tips and Tricks – Sharon Muza $10.00

DN-W19 303 Effects of Postnatal Human and Maternal Placentophagy: Mothers’ Experiences with Placentophagy – Jodi Selander $10.00

DN-W20 304 Overcoming White Coat Syndrome: Helping Women Find Their Voices – Giuditta Tornetta $10.00

DN-W22 401 Third and Fourth Stages of Labor: Current Management Practices under Heavy Criticism – Penny Simkin $10.00

DN-W23 402 Supporting LGBTQ Families: Cultural Competencies for Doulas – Joy MacTavish $10.00

DN-W24 403 The Sneetches: Models of Collaboration – Barbara Hotelling $10.00

DN-W25 404 The Hero’s Journey: Using Storytelling to Empower Pregnant Mothers – Karen Brody $10.00

DN-W26 405 Global Models of Care – Debra Pascali-Bonaro, Ana Paula Markel $10.00

SHIPPING: U.S. Orders: $2.00 Per CD up to a max charge of $10.00. All Other Countries $3.00 Per CD

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