Why Are Birth Doulas So Darn Picky?

It is my understanding that by being choosy about clients and committing to those who demonstrate the highest level of commitment to physiological and unmedicated childbirth, who are also most likely to choose a like-minded caregiver, doulas try to protect themselves- their souls and their hearts.

During the holiday season, I attended a local birth community gathering in San Jose.  Our lovely host, a DONA trained and seasoned birth doula, invited us to introduce ourselves saying: “Tell us how you practice; what is unique about your practice, so we know which birth clients to refer to you.” The first doula to go shared that she is mainly practicing in one particular hospital, because everyone knows and respects her there,  and she only supports birth clients who are strongly committed to a natural and unmedicated childbirth, and state that they are open to medical solutions if these are needed. Her introduction set the tone for our community freely share their preferences, and the trend became very clear: Doulas are picky about the clients they take on- and it has nothing to do with specializing.  

I began practicing 19 years ago as a pioneer doula in my country. At that time, I was struggling to convince expectant parents of the value of hiring a birth doula. Needless to say, I did not have the privilege of being picky about my clients. Did I enjoy supporting certain types of birth clients more than others? Of course! But it never occurred to me to choose clients in accordance with the OB practice or the hospital, nor with their level of commitment to avoid pain medications or other medical interventions. I was passionate, and still am, about supporting every potential client in hopes of leading them toward a healthy and satisfying birth experience. While I can’t say when the trend of filtering through clients began,  I have some ideas about the reasons that brought it to the surface.

The practice of a birth doula is a hard one due to a vast array of aspects, including practical or logistical, physical, emotional, social and financial aspects. Being a change agent, or an activist promoting natural childbirth, you already stand out in every social gathering outside of the birth workers community.  Your close friends are mostly birth workers who speak your language and share your passion and are the only ones who, like you, live their lives constantly on-call, practicing flexibility and willingness to change plans in a blink of an eye, with no hard feelings. Your family and friends are always secondary to your devotion to attend your clients’ unpredictable births. As for your own mental state, commitment to as little as one birth a month means that you are not making big plans like birthday parties, or a romantic getaway, without stressing out about this one client.

Now let’s look at the emotional and physical hardship of being a doula. While modern society is committed to alleviating pain –  physical or emotional pain, doulas are the only caregivers on Earth to accept pain, embrace it, and work through it.  Supporting our clients throughout labor contractions by containing their pains, doubts, fears and moments of crisis and despair takes its emotional toll. In addition, providing massages and physically supporting our clients’  bodies as they change positions, for an average of eight hours, is physically exhausting. On top of it all, we often deal with these challenges during night time, or at the end of an active day. And when medical complications arise, we coach our clients towards making an informed and mindful decision, empowering them to demand patient-centered care and not give up on their birth vision too fast.  

It is my understanding that by being choosy about clients and committing to those who demonstrate the highest level of commitment to physiological and unmedicated childbirth, who are also most likely to choose a like-minded caregiver, doulas try to protect themselves- their souls and their hearts. Doulas want to guarantee their clients are committed to unmedicated physiological childbirth as much as they are committed to supporting and leading them throughout this kind of experience. They, therefore, refuse to support clients who say “I am attempting natural childbirth, but I’m open to the option of taking epidural”. Doulas try to avoid the draining scenario of medicalized childbirth and being a witness to the frustrating cascade effect of medical interventions. By supporting only clients of caregivers we trust and with whom we are compatible, doulas avoid witnessing abuse in Labor and Delivery. Overall, this trend of carefully choosing one’s clients serves doulas’ need to decrease the hardship of their practice and get a sense of control over the birth experience they take part in.

As a seasoned birth doula and a doula trainer, I get it, I really do! And at the same time,  I still find myself being drawn to those clients who “try for a natural birth but are open to…epidural”. Perhaps it’s because I’m a dinosaur in the doula community, but for me, there is a special reward, a triumph, in leading that birthing client, who wants the natural childbirth because she sees the value in it, but is being honest about her doubt in her strength and abilities to be with pain. Leading this mother all the way to an unmedicated and healthy birth, looking into her wide-open eyes and her joyous expression when she says: ”I DID IT!”  is so rewarding for me. It empowers me as a woman, a doula, and a doula trainer.  


In order to increase my chances to avoid the draining scenarios of medicalized births and to make sure my clients demonstrate a high level of commitment to their healthy and vaginal birth experience – I practice prenatal coaching. Prenatal coaching is my leading technique, and it is how I make sure my clients and I are aligned in our belief system about birth, clear about their goals and what it takes to lead them towards achieving their desired birth experience, and we’re equally accountable to what it takes to get there. While I understand doulas motivation to decrease the hardship of our practice, I see prenatal coaching as the pathway to achieving this goal, rather than filtering clients.  Serving only those who are mentally and emotionally prepared for a physiological birth means that we gave up on one of the most important ambitions for doulas’ emergence – facilitating a cultural change in maternal care.  

To healthy births on Earth!

Neri Life-Choma

I am the founder of Birth Coach Method and am celebrating 20 years of leadership in the field of childbirth support. Throughout my career, I have been honored to provide doula support and teach childbirth ed. classes to hundreds of expectant couples, as well as to direct two birth resource centers. I am also a doula leader in my community in the South Bay area of Silicon Valley in California.
Neri Life-Choma

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