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Burnout in Birth Work: Exploring Integrative Approaches to Nurturing a Healthy Doula Workforce

Bintou Diarra, A.B Candidate | Medical Anthropology, Brown University | January 26, 2023

We cannot deny the integral role of doulas in supporting reproductive health. A recent report by the National Partnership for Women & Families emphasized community-based and community-led doula services as essential components of an effective maternity care system. 

While the growing recognition of our nation’s necessity for doulas calls for birth workers who stay for the long haul, the issue of burnout threatens to turn doulas away from their highly essential passion prematurely. Much like doulas take care of people during their most vulnerable times, our systems and structures must routinely nurture our doulas to lower the rates of burnout. The Mama Glow Foundation is spearheading this work by exploring the factors that contribute to birth worker burnout and proposing solutions for supporting a healthy doula workforce in their Birth Worker Burnout Report.

Understanding the unique roots and manifestations of burnout within birth work requires a working definition of the term. The Mama Glow Foundation frames their report around the World Health Organization’s (WHO) definition of burnout: “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed”. The symptoms are feelings of energy depletion or exhaustion; increased cynicism, negativism, and/or distance from one’s job; and reduced efficiency with regards to the work. Birth work is already a highly demanding profession—pregnancy, childbirth, and the postpartum period are marked by unpredictability and stress at many points. This means that we must be intentional about easing self-care for our birth workers and pouring into them.

Unfortunately, the United States currently falls short, and past grievances cast a long shadow. The report highlights the past conditions that create unfavorable circumstances for our nation’s birth workers.

The work of doulas is an ancestral practice—the push to increase the population of enslaved people meant that enslaved Black women would give birth in high numbers, and Black midwives and doulas took on the duty of caring for them in the process. With the growth of obstetrics and gynecology as a profession came the shrinking of birth work. Black birthing people were leaving their homes and putting their care in the hands of physicians within hospital settings. Simultaneously, the nascent emphasis on credentialing and medicalization of birth pushed some birth workers out of the workforce entirely. While Black women remain at the center of care work today, this work, which is communal in nature, occurs within institutions that do not always have their best interests.

The Mama Glow Foundation captures the institutional and interpersonal shortcomings contributing to burnout in the Practicing Doula Experiences Survey. According to the report, doulas attribute the high rates of burnout to six main factors: 1) the emphasis on Medicaid reimbursement and the associated administrative burdens, 2) the high level of need and demand among clients, 3) the compensation, which does not account for the demands of the job or the cost of living, 4) the lack of funding for community-based programs and services, 5) the unrealistic expectations outlined by institutions, and 6) negative experiences with discriminatory treatment and racism within institutions.

One major finding in the foundation’s research is the contribution of questioned autonomy, authority, and qualifications to the dissatisfaction of doulas. 77% of respondents reported feeling unwelcome and disrespected while practicing in hospital settings. One doula explains: “I attended a birth there and throughout my client’s pregnancy I was included in her birth plan and her doctor was aware. Once we arrived at the hospital for delivery I was told that I cannot operate as a doula but as a support person”. The Mama Glow foundation names the cultural divide between the field of obstetrics-gynecology and birth work as the source of these negative experiences. Some physicians do not fully understand the value of community-based doulas, and this manifests as experiences that undermine their work.

While this alone is enough to heighten the difficulty of the work, the inadequacy of the institutional treatment of doulas only starts there. In addition to the constant questioning of expertise, the Mama Glow Foundation’s research found that lack of communication, stemming from the erasure of doulas within institutional settings, and poor working conditions only increase work dissatisfaction for doulas.

Although there is growing knowledge on the value of doulas, a gradual increase in information alone cannot solve the issue of birth worker burnout. The Mama Glow Foundation’s research underscores the importance of intentionality in policymaking. The current medical framework marginalizes our doulas. Policymakers have a duty to incorporate doulas at every stage of the policymaking process so that written guidelines create conditions where they can thrive in their work.

The solutions are not easy, but there are valuable steps we can take to get there. The Mama Glow Foundation recommends educating practitioners on the role of doulas and fostering the relationship between medical providers and birth workers without compromising the patient-centered, intimate nature of the work. Additionally, the foundation suggests simplifying the strict Medicaid requirements and procedures that often bar doulas from practicing without administrative burden. Lastly, the foundation advises providing wages that allow doulas to flourish in their roles, rather than cause them to worry about survival during a pivotal time in their clients’ lives.

Access the Birth Worker Burnout Report here.

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