~Melanie Griffey, Owner of Heritage Birth Works
Chattanooga, TN

Have you considered becoming a Doula or other birth worker? If you have, you’ve likely seen that there is no governing body to regulate. There is no certification or registration required before you start serving clients as a birth doula, postpartum doula, placenta encapsulator, etc. So, why spend the money to become certified if it isn’t a requirement? Does it really make a difference?

The following is true. Only the names and identifying information have been altered in the interest of privacy.

Marie wanted to be a doula. The thought of helping moms bring life into the world thrilled her to her core. She had done some reading and even invested in a certifying course. The course was short and basically, common sense. She breezed through the lessons, not learning much, but getting the coveted Certification. She was ready to find clients!

The first clients Marie obtained were a sweet couple who already had several children. They didn’t have family in town and wanted a doula to support them throughout pregnancy and birth. They met at a coffee shop and immediately hit it off. Rebecca hired Marie on the spot.

Soon, it was time for Rebecca to give birth. Rebecca’s husband, Jimmy, called Marie and let her know that the contractions were close together and Rebecca was having difficulty walking and talking through them. It was time to go to the hospital!

When Marie arrived, Rebecca and Jimmy were slow dancing to their pre-planned music. All Rebecca needed was a wet washcloth to wipe her brow and for Marie to press her fist into her lower back during contractions. Within an hour of arriving at the hospital, Rebecca said that she felt it was time to push. She went to the bed, propped her feet up in the stirrups, pushed 3 times and out came the baby!

Marie thought, “This is a piece of cake! I can TOTALLY do this!”


Marie had a client who developed pre-eclampsia. This was Geneva’s first pregnancy and she had no desire to attempt a natural birth. She was perfectly fine with the status quo and planned to get an epidural as soon as she was allowed. After talking to Marie and doing a little research, she decided that she would really like to try and see how far she could get on her own. She was not willing to give up her ability to get up and down as she wanted. Nor was she willing to be so out-of-control that she couldn’t do anything for herself with numb legs.

One afternoon, late in her pregnancy, her blood pressure spiked despite being on bed rest for over a month. It was time to go to the hospital.

Marie was there for the placement of the Cervadil and to tuck in the excited couple. The plan was for Marie to be back at 5am – in time to be situated before they started the Pitocin drip. Unfortunately, plans changed. Marie went home and was awakened a few hours later by the voice of Geneva’s husband on the phone in a panicked voice. “She’s crying. She wants you. And she’s asking for an epidural.” Marie told him to tell her to hang on and I would be there in a few minutes. “Too late, I think she’s already getting one.”

When Marie arrived – within ½ a n hour of the call – Geneva was sleeping. She had her epidural and was dilated to 5cm.

Sometime during the period when Marie had gone home, Geneva was offered “something for nausea.” Geneva thought it would be Zofran or something like it, but instead, it was Phenergan. This particular drug is one that Geneva absolutely did not want. She didn’t like the out of control, loopy feeling it gave her. When the medicine started to wear off, she woke up to extremely strong contractions induced by the Cervadil. She hadn’t had the opportunity to build up to these strong waves. Her doula wasn’t there. She was overwhelmed, loopy, scared and in pain. Boy, did Marie feel like she let down Geneva.

Labor progressed quickly and before long, the doctor said it was time to push. There were no less than a dozen people in the room including Geneva’s husband and Marie. The doctor sat in a rocking chair at the foot of the bed while nurses and students yelled, “push” and counted to 10. Baby was OP – “sunny side up” and nobody knew it. He was not coming out on his own, so the doctor told Geneva that he was going to try forceps to avoid a cesarean.

Marie watched as the student put the forceps inside the birth canal while Geneva screamed. The epidural had worn off and she was told they wouldn’t give her more so she could feel to push. The details of this part are disturbing and traumatic. They will not be shared, here. Suffice it to say that nothing that happened from forceps forward was gentle.

Beautiful little Carson was born and he was perfect – with the exception of the black-eye he had from the forceps and the cone-shaped head from being in the birth canal for so long.

Geneva did not fare so well. She had 3rd degree tears and spent about 2 hours having stitches put in to repair the damage.

Marie was dumbfounded. She had read that outcomes for moms with doulas were so much better. She didn’t understand how this had become a traumatic event instead of the beautiful birth she had experienced with her previous client.

Marie decided after this birth that she needed more information. She really needed to learn all about anatomy and physiology of birth. She needed to know why this traumatic birth happened and how to avoid them in the future.


After months of researching the various certifying agencies, talking to other doulas, posting in Facebook groups, Marie found the agency that seemed the perfect fit. Madriella has a membership format which allows students the opportunity to certify in as many or as few programs as they choose. The curriculum is first rate and its benefits could be touted for days, however, this is not a Madriella commercial.

Marie took this training which was much more in depth, had required readings, essays, and vocabulary. The information she was missing in the previous births was explained and she was able to see how the birth may have gone differently if only she had had more education. If only she could have served her client better…

Given the opportunity to go back, these things would be DIFFERENT.

First, Marie would not leave a client once in the hospital.

Second, Marie would remind Geneva to ask what kind of medication they were giving her for nausea. Geneva would have had the opportunity to decline the drug she didn’t like.

Third, Marie would be there for Geneva during the contractions (waves) as they were building instead of having her wake up with strong, overwhelming contractions therefore possibly eliminating the need for an epidural.

Fourth, Geneva would have had the opportunity to labor on her own terms, moving as she needed.

Fifth, having a nurse/midwife palpate the abdomen would have given them the knowledge that baby was OP. Geneva could have labored and even delivered on hands and knees. This would allow baby to move down the birth canal and not be impeded by the coccyx. This would also eliminate the need for a forceps delivery. This delivery and the 3rd degree tearing that happened as a result caused Geneva to require pelvic floor therapy.

Sixth, Marie would be able to talk to Geneva about her wishes and help her find a provider whose ideals and philosophy aligned with hers.

Sixth, Geneva would know that she had options. She had options about who was in the room, what medications she took, how she labored, how she delivered, etc.

How do I know that Marie and Geneva would have done things differently with more education? Because Geneva had BABY #2 with Marie by her side. But that’s a story for another blog.

So, back to the original thought. Does education really matter when deciding to become a Doula?