The Professionalization of Perinatal Support: “Doula” Work in a Canadian Context

Over the past three decades, women in North America and elsewhere have increasingly turned to “doulas” for non-medical support in the perinatal period, particularly during childbirth. Correspondingly, more and more women are training and certifying as doulas in order to offer this type of care. Doulas offer women and their partners prenatal childbirth preparation, non-medical techniques for relaxation and pain reduction during labour, and attentive support throughout the entirely of labour and the immediate postpartum period. Their services are provided for a fee – paid for privately by individual clients – that fluctuates according to the doula’s level of experience and certification status. While it is difficult to pinpoint the impetus for growing interest in doula care, at least two factors have likely played a role: the medicalization of childbirth and the lack of necessary support for women during labour and delivery in the context of neoliberal restructuring and reductions to the nursing work force. For doulas, this work represents an alternative entry point to the maternity care field that is more accessible than the highly competitive and time consuming training required to become a registered midwife. Existing literature relative to doula work has thus far considered women’s experiences of doula care and doulas’ perspectives on the value of their model of care for their clients. However, little attention has been paid to the experiences of doulas as workers who hold a liminal and precarious position within established health care systems and the professionalization strategies they use to legitimize their role in the field of maternity care. Drawing on qualitative interviews with doulas working in Toronto, this paper explores how doulas navigate their liminality within the state-funded maternity care system, including strategies aimed at making space for their own knowledge and skills within that field.