Mentors in Health: An Interview with a Doula

In this interview, Karla Salinero shares her journey to becoming a doula. As a passionate women’s healthcare advocate, registered labor and delivery nurse, lactation consultant, and DONA International-certified birth doula, she enthusiastically encourages anyone who’s interested in community-oriented birth work to pursue a career as a certified doula.

What inspired you to become a doula?

“My long-term goal is to become a nurse midwife and earn my doctorate of nursing practice, and while I’m working my way up the ranks, I decided one of the best things I could do is get doula certification,” says Ms. Salinero.

“Nurse midwives typically work at hospitals and birthing centers and have education and training as nurse practitioners. I’ve been in women’s health for six years, involved with labor and delivery nursing for two years, and I’m all about serving new mamas and their families through my work. I work with all types of patients from the ‘crunchy granola unmedicated mamas who want midwife deliveries in the birthing center’ to complicated high-risk deliveries in the operating room, and everything in between.”

You’re a labor and delivery nurse, lactation educator, and a doula. How do these different healthcare tracks complement each other?

“The real joy is when I get to combine the holistic and the medical parts of my practice together,” Ms. Salinero reports. “As a labor and delivery nurse, I use all three specializations every day and I’m lucky to work at a hospital where these three skill sets are supported.”

In speaking of her lactation and doula credentials, Ms. Salinero says these extra specializations bolster her abilities as a nurse: “Nurses who have backgrounds in lactation and doula work are a little more sensitive to the needs of laboring mothers. They are able to better meet the needs of their patients because of their specialized training. Being a doula is about being an advocate for the mother, but more importantly guiding her in advocating for herself so that together we can achieve a birth experience that she sought.”

What does a typical birth experience look like?

“There’s no such thing as a typical birth experience!” Ms. Salinero remarks. “Sometimes you can see general trends in labor and delivery which can help you predict or give a little foresight as to how things are progressing. But no matter how much labor and delivery experience you have and no matter how many births you’ve attended, you never really know what’s going to happen. In childbirth, there’s the rule and there’s the exception to the rule. A good doula, labor nurse, or midwife is prepared for the rule and the exception and will work to guide the mother through it.”

“In a perfect world, a birth doula has a chance to meet with the mother first before delivery, so the doula can best support her through her birth experience,” Ms. Salinero says. “The doula will typically ask about the birth plan, whether the mother prefers a medicated or unmedicated birth, and whether or not she would like the doula to advocate for her during her birth experience. Primarily, a doula provides emotional support and pain management techniques for the mother,” Ms. Salinero says. “The birth doula may join the mother at her home while she is still in the early stages of labor, prior to going to the hospital. Early labor may take a few hours or a few days.”

Supporting the needs of the expectant mother also requires that a doula be aware of who the mother wants with her in the birthing environment. “Being aware of how the mother wants to integrate her family members and other support people is essential. Who they do and don’t want in the room during labor is ideally discussed in the first client meeting in the third trimester. Working together as a community is the best part of this work and making sure that the mother’s wishes are met is an important aspect of the spirit of community-oriented birth work.”

Although some doulas are self-employed, others meet clients for the first time as hospital employees. “Some hospitals have doulas that are paid on staff,” Ms. Salinero says. “Other hospitals have volunteer doula programs for doulas who are gaining experience through mentoring”.

Do you have any unique specializations you like to integrate into your work as a doula?

“A good doula comes with a whole bag of tricks to support mothers during birth. These include pain management and breathing techniques. A doula needs to have multiple strategies because what may have worked well for the previous 15 minutes might stop working. Some doulas implement the use of TENS (Transcutaneous Electronic Nerve Stimulation) units or essential oils to manage labor pains. I love to use breathwork. Practicing yoga has given me an appreciation for mindfulness skills I can incorporate during birth work,” says Ms. Salinero.

What are the most rewarding aspects or best parts of being a doula?

“It’s a privilege! Being able to work as a team with other labor and delivery professionals to help a mom and her family is great. Childbirth is one of those major life events that people don’t forget. I’ve heard stories about families who look back and remember specifics about their lives and memories of bringing children into the world are experiences that people can vividly recall,” Ms. Salinero said.

What are the most challenging aspects of being a doula?

“The hardest thing is balancing a labor and delivery career with the needs of my own family,” Ms. Salinero says. “Labor and delivery schedules are unpredictable and in some ways, it’s easier to be a doula when children are older. A big part of career success as a doula is having a supportive life and professional partner. Most doulas have reciprocal agreements with other doulas to be an alternate for one another. They closely coordinate client due dates and if one doula cannot show up for a client’s birth, the alternate doula will take her place. When I meet with clients, I let them know about the alternate doula plan in case I cannot attend their births, and most clients are fine with this arrangement”.

When considering doula training programs, what were the important factors you looked for?

“I did some research and DONA-accreditation was important to me. There’s no licensure for doulas, but having accreditation is helpful in that it helps to legitimize the profession and protect families. A lot of hospitals require DONA certification for doula employment. And hospitals will also allow non-certified doulas as well as mentoring doulas into the labor and delivery rooms as part of a family’s chosen birth team,” says Ms. Salinero.

What advice do you have for aspiring doulas?

“Doulas all love working with mamas in the labor process, and to support our personal and professional needs, creating our own professional and personal support team is essential,” says Ms. Salinero. “Start looking around for doula partners right away to build your professional network. And always remember: a supportive community is best for the mamas, babies, and the doula profession”.

What are some simple things that people can do to have a positive birthing experience?

“For expectant parents: have an open mind. Having a plan is fantastic, but at the same time, things don’t usually go to plan,” Ms. Salinero recommends. “Keeping an open mind and being flexible is the best thing you can do. Otherwise you may be setting yourself up for disappointment. At the end of the day, the goal is to have a healthy mom and baby. Ask questions before and during the birthing process. It’s empowering to know what’s happening and if you don’t know, ask someone.”

“For doulas: remember that birth work is a team sport: nurses, the families, doulas, doctors, and midwives—we’re all in this for a common goal to keep mamas and babies healthy. When we keep that shared goal in mind, great things can happen”.

Is there anything else you’d like people to know about doulas?

“I highly recommend them. From my own personal experience when I had my son, I thought I could apply my own doula skills to my birth experience, but in hindsight, I should have used a doula,” Ms. Salinero says.

“For people who think that doulas are only for hippies, research from ACOG and other leading women’s healthcare resources supports the efficacy of improved birth outcomes when a doula is present during childbirth. From both holistic and medical perspectives, research supports that having a doula present makes birthing go more smoothly,” Ms. Salinero says.