Self Care for the Birth Worker

Doula work is a high risk profession. As doulas, we do not ultimately take on responsibility for the outcome of a birth, but we, often more than anyone except the birth giver’s partner, have a deep personal relationship with people’s birthing journeys. Often, their hopes become our hopes, and their disappointments become our disappointments. Sometimes, their exultation becomes ours; sometimes, we are also receptors of violence done to them. Much of this will be out of our control, because birth exists in a realm beyond human control. We are subject to it, not it to us, no matter how hard we try sometimes to deny this. But what is within our control as doulas is our skillfulness in self care. And this can make all the difference. One of the most profoundly important things a mentor ever said to me about birth work was, “it’s your life, too.” Dear doula, this is your life, too.

Here are some ideas which have helped me practice self care as a birth keeper:

Everyone Needs 2 Layers of Support
I learned this from a workshop with Birthing Beyond the Binary. Anyone who is depended on needs to have two layers of support behind them. For instance, my clients lean on me sometimes, while I in turn lean on my therapist, and my spiritual mentor. I can go to either of them when I need, to process without guilt, knowing what I say is confidential and that there is a well-cultivated garden of understanding between us, whose plants we can eat of. Someone leaning on a person who has two layers of support experiences a truer feeling of safety. Like all self care, this benefits both you and your clients.

Know Your Triggers
This phrase was repeated many times at my Brooklyn DTI training, as a mantra of accountability, and of self care. Awareness of the self precedes skillfulness of action and loving relationship. An example of this in my life is that I have a difficult relationship with authority. (Doulas are laughing right now imagining my inner post-birth dialogues with doctors, and you’re right.) But knowing that I am distressed by unfairly wielded authority was just step one. Once I realized this, I began to find the parts of my own mind which are unfairly or meanly authoritative towards myself. Which in turn allowed me to cultivate a kinder attitude towards myself, which has alleviated some of the harsh feelings I have about doctors, and made me a more present and skillful doula.

Compassionate Boundaries
You’ve just got to have them. They make this work so much more bearable for you and your clients. There is a wonderful essay about this in Doulas and Intimate Labour: Boundaries, Bodies, and Birth, which says more than I can here.

Sometimes we push past personal boundaries because it will benefit ourselves or our clients in the short-term. But this is a sort of traditional deal with the devil, because we will always have to pay up at some point, and the price we ultimately pay will be much greater than if we had respected our boundaries initially. It’s sort of like emotionally, physically, or spiritually buying on credit.

On a deeper level, when you are serving a client and you have passed a boundary, this truth will be present in you and them and the feeling they receive from your care. To be honest, it was becoming a doula that forced me to learn how to create and maintain boundaries in relationships. What a worthwhile practice. Now if a client (or a friend, or a partner) looks at me worried and says, “have you slept?” or “have you eaten?” I look into their eyes with loving calm and say with a sense of easeful security, “I am taking good care of myself. You don’t have worry about me,” and see their concern evaporate. Being boundaried is a gift to your loved ones; it is practicing authenticity of self. People want to experience you. And (have you felt this one yet today?) you are enough.

Know Your Ideal Client
I learned an extremely important lesson when I took on a client in need who had already reached their due date (no time to establish a rapport, get to know their wishes, or prepare together.) They planned to give birth in a big hospital with a highly authoritative inner structure and high rate of interventions. Now, some doulas are nodding along here, thinking, “bring it on! I know just how I would help that client! I am a fierce wolf and I would be that birth giver’s armour! I was born to do this work.” Other doulas, who are more like me, are quivering in their tummies thinking, “oh no this is gonna be scary.”

The birth was quite traumatic for me, and as I spent a week crying, sleeping, and taking salt baths to recover, I met with my mentor. She pointed out some very important things that day which changed my life. First: my healing process required a lot of energy, which was being taken away from other things I love and am good at, even from other clients I was supporting at the time. Second: my more unique doula skills were not welcome in that birth setting, which means I was not being the most helpful to that client, or to anyone.

Ultimately, if you know your ideal client, you can feel free to take on clients who are very different, but with an awareness that you are doing so, which may mean the way you practice changes. That is the key.

It’s Not Your Birth
I have used this mantra at most births I’ve accompanied, and I plan to keep using it anytime I need. Softly, lovingly to myself in my head, this is not my birth. This is not my birth. This is my wonderful client’s birth. This is not my birth.

When You Witness Violence
This article is very helpful in defining birth violence, the language we use to to describe it, and the doula’s role as it relates to this phenomenon: Birth Rape and the Doula. Violence is rampant in maternity care worldwide, so the first important thing may be to feel valid in recognizing that fact, and to give that truth space to breathe and exist in you.

One thing I’ve noticed (and many colleagues have also observed) about birth violence is that my client and I experience it in very different ways. Sometimes a client will reflect on their birth in very positive terms, and never even mention a moment which I may have trauma-induced flashbacks to for weeks (or even months) later. When you witness violence, use the language that feels real and correct to you for the experience. Lean on your two layers of support. If you witnessed violence outside the birth room, in the rest of the world, where violence (depending on the context, perpetrators and victims) is largely considered abhorrent, you would likely seek out care, therapy, and conversation after the incident. Violence is widely and shockingly still accepted in the birth setting, but this does not mean that you should not find it equally abhorrent and seek out similar care after witnessing it.

Only Tell People Your Story Who Have Earned It
This is a Breneé Brown concept. She uses it slightly differently, but I feel it applies here. When I first became a doula, I couldn’t stop talking every person I met’s ear off about the crisis in maternity care and birth is an enormous human rights issue and have you ever heard of prophylactic episiotomy??!!

Oops. On a smaller scale, this was not using my energy mindfully. On a larger scale, it’s deeply important to protect your story, and only bring it out to share with people who have truly earned the honor of hearing it. Your work is exactly as important and revolutionary as you think. Anyone who really loves you should recognize that. So…be patient with finding those people. It will be very good when you know the right person and the right time, and you share a piece of your soul and your work with them, and feel them hold it in awe, and know it to be safe. The energy will not leak then; it will swell.

Trauma 101
Some of the things which define traumatic experiences at a neurobiological level and cellular level reflect the experience of it happening, and it is good to be aware of these things. One defining marker of trauma is when there is no time taken to process in the moment: when things cannot or do not slow down or pause. They speed by with no break or recognition. Another defining marker is that the traumatized person feels compelled to be in a passive role and does not know which actions they can take to defend themselves or change the outcome. (See Birth Rape and the Doula article for suggestions on changing from a passive to an active doula in traumatic situations.) Another marker of trauma is silence, or someone feeling they cannot speak about (or during) the incident. It is helpful to be aware of these things and to bring this awareness into one’s practice.

Self Care Beyond Births
Our birth bags are packed with snacks, a change of clothes, a pillow, a sleeping mat even, essential oils to give us energy or soothe us, special stones, a favorite sweater…we treat ourselves well at births. We have to. The hours go by and we need to make sure we eat, brush our teeth, nap, hydrate. How often do we do all these things when we aren’t at births? Try to keep up your self care practice. You deserve it. Just being you is good work.

Birth As Teacher
People who give birth and people who are engaging in a meaningful way with birth know that birth is the ultimate teacher. Learn from it the art of letting go. Learn from it that contraction brings expansion. Learn from it that love is the source and motivator. Learn from it that we can and will. Learn from it that something much bigger moves us. Learn from it that life will come. Learn from it that there is movement. Learn from it that this movement is a spiral, never static. Learn from it that when we are fully open, we push. Learn from it that vulnerability is power. Learn from it that to be human and experience the feminine will bring pain, and joy. Learn from it that no one is the same. Learn from it the value of life, so hard won. Learn and learn and be grateful, and you will thrive, and you deserve love from yourself and others through this work. I believe (in) you.

 Annie Kocher, C.D. (DTI) is a queer doula, musician and writer practicing in Berlin, Germany. They are motivated by soulful intersectional perspectives on the creative process. You can find them at . 

Back to blog