In-Person Day 2 · 8:30 AM to 4:30 PM CST · YWCA Baton Rouge
Postpartum, Newborn Care
Mental Health & Professional Practice
You came back. Today you finish. By the time you leave this room, you will have everything you need to walk into your first birth as a doula.
Training Address
YWCA Empowerment Center
1690 North Blvd, Baton Rouge, LA 70802
By the End of Today, You Will Be Able To
- Identify normal postpartum physical changes and recognize red-flag warning signs that require escalation
- Describe the basics of breastfeeding physiology, support a latch without instructing, and refer appropriately to an IBCLC
- Explain normal newborn appearance and behavior in the first 48 hours, including hospital protocols and informed consent conversations
- Demonstrate diapering, paced bottle feeding, burping techniques, the rebath method, and newborn massage
- Differentiate between postpartum mood and anxiety disorders and describe the doula's language, limits, and escalation pathway
- Navigate difficult real-world conversations involving family dynamics, unexpected interventions, and competing voices in the birth room
- Define your professional ethics, boundaries, and burnout prevention strategies, and draft your personal mission and vision statement
- Outline the ICEA ICBD certification pathway and identify your personal next steps toward certification
Day at a Glance
| 8:30 AM | Welcome, Breakfast & Check-In | 30 min |
| 9:00 AM | Postpartum Changes in the Body: What's Normal, What's Not | 45 min |
| 9:45 AM | Breastfeeding Basics: Support, Not Instruction | 45 min |
| 10:30 AM | Break | 15 min |
| 10:45 AM | Early Newborn Care: What Every Doula Needs to Know | 45 min |
| 11:30 AM | Newborn Skills Lab | 45 min |
| 12:15 PM | Lunch | 45 min |
| 1:00 PM | Newborn Massage & Teaching Parents the Art of Touch | 30 min |
| 1:30 PM | Postpartum Mental Health: Screening, Support & Escalation | 60 min |
| 2:30 PM | Break | 15 min |
| 2:45 PM | Professionalism, Ethics, Boundaries & Handling Difficult Conversations | 75 min |
| 4:00 PM | ICEA Certification: Pathway Overview & Next Steps | 15 min |
| 4:15 PM | Coating Ceremony, Certificates & Closing | 15 min |
8:30 AM · 30 Minutes
Welcome, Breakfast & Check-In
Welcome back. Grab breakfast and settle in. We open with a check-in circle: one word to describe how you felt after Day 1. Your instructor will cover any housekeeping, take a quick pulse on lingering questions, and preview the day ahead. Bring your character and her birth plan. We will be building on them this afternoon.
9:00 AM · 45 Minutes
Postpartum Changes in the Body: What's Normal, What's Not
The postpartum period is often called the fourth trimester, and it deserves as much attention as the birth itself. A client who feels informed, prepared, and supported in those first weeks is far less likely to suffer alone through something that has a name, a cause, and a solution. Your job starts at the placenta and does not end until the postpartum visit is done.
Normal Postpartum Physical Changes
| Uterine Involution | The uterus shrinks back to pre-pregnancy size over 6 weeks. Fundal height drops roughly one finger-width per day. Afterpains, cramping during involution, are stronger in multips and breastfeeding moms because oxytocin surges during nursing accelerate the process. Lochia follows a predictable progression: rubra (bright red, days 1 to 4), serosa (pinkish-brown, days 4 to 10), and alba (yellow-white, days 10 and beyond). |
| Perineal Healing | Tears, episiotomies, and hemorrhoids are common and painful. Comfort measures include ice packs in the first 24 hours, then sitz baths, witch hazel pads, numbing spray, and stool softeners. Your doula role is comfort education and normalization, not wound assessment. |
| Breast Changes | Colostrum transitions to milk around days 3 to 5. Engorgement during this shift can be intense: full, firm, sometimes feverish-feeling breasts that are not mastitis. Warm compress before feeding and cold pack after help. Nipple soreness in the first days is expected; bleeding nipples and unresolved pain beyond the first week are referral signals. |
| Hormonal Shift | Estrogen and progesterone drop sharply after the placenta delivers. Days 3 to 5 often bring the "baby blues," weepiness, emotional lability, and mood swings that are hormone-driven and self-resolving. Night sweats and hair loss around weeks 3 to 6 are normal and should be mentioned proactively so clients are not alarmed. |
| Recovery Timeline | Six weeks is not a finish line; it is a checkpoint. Many clients receive clearance at their six-week visit and assume full recovery, when in reality healing, strength-rebuilding, and emotional processing can take months. Set realistic expectations early. "Cleared for exercise" is not the same as "fully recovered." |
Postpartum Red Flags: The Doula Must Know These
You are not a clinician, but you are often the person a postpartum client contacts first. Knowing these red flags can save a life.
| Warning Sign | What It May Indicate | Doula Action |
|---|---|---|
| Soaking more than 1 pad per hour, passing large clots, feeling faint | Postpartum hemorrhage | Call 911. Do not wait. |
| Fever above 100.4 F, foul-smelling lochia, redness or warmth at incision site | Infection | Contact provider today. Do not wait for the next scheduled visit. |
| Severe headache, vision changes, swelling in hands or face | Postpartum hypertension or preeclampsia (can develop up to 6 weeks after birth) | Call 911 or go to the ER immediately. |
| Calf pain, leg swelling, shortness of breath, chest pain | DVT or pulmonary embolism (consistently underrecognized) | Call 911. This is a medical emergency. |
Doula Script: When a Client Describes Something Concerning
"I hear you and I want to make sure you are safe. What you're describing is something I want you to call your provider about right now. Call them and if I haven't heard back from you in 20 minutes I'm going to follow up with you. If you can't reach them or they don't call back, please go to the ER."
You are not diagnosing. You are not minimizing. You are making sure she gets care.
Breakout Discussion (10 min)
Your postpartum client texts you at 4am: "I'm bleeding way more than yesterday. Is this normal?" Walk through your response in pairs. What do you say? What do you NOT say? At what point do you tell her to call 911? Three pairs present their approach to the group.
9:45 AM · 45 Minutes
Breastfeeding Basics: Support, Not Instruction
The title of this section is the entire lesson. Your job is to support, not instruct. You are not an IBCLC. You are not a lactation consultant. You are the person who holds the space, offers encouragement, normalizes the struggle, and knows exactly when to say, "Let me help you get someone on the phone who can really help."
Breastfeeding Physiology: The Basics
| Colostrum | Present from the second trimester, colostrum is produced for the first 3 to 5 days. It is small in volume by design. A newborn's stomach is the size of a cherry on day one. Colostrum is concentrated immune protection, not a small quantity of real milk. Reassure parents that they are not "not making enough." |
| Milk Transition | Transitional milk comes in around days 3 to 5, often dramatically. Breasts become larger, firmer, and warmer. The supply-demand model governs production: the more milk is removed, the more is made. Infrequent feeding or supplementation without pump support can suppress supply. Normal frequency is 8 to 12 feeds in 24 hours, not a schedule. |
| Prolactin and Oxytocin | Prolactin drives milk production. Oxytocin triggers the let-down reflex, causing milk to release. Skin-to-skin contact powerfully boosts both hormones. Stress, pain, and anxiety can inhibit let-down. This is one more reason your presence and the birth environment matter even after baby arrives. |
Supporting a Latch Without Instructing
Signs of a good latch: wide-open mouth, lips flanged outward, chin touching the breast, and no nipple pain after the initial latch. What you are looking for as a doula is comfort, not technique. Knowing the positions helps you describe options to a parent without prescribing them.
| Cradle Hold | Baby lies horizontally across the parent's front, cradled in the arm on the same side as the feeding breast. Baby's head rests in the crook of the elbow, body supported along the forearm. Good for babies with a strong latch and parents who are comfortable with breastfeeding. |
| Cross-Cradle Hold | Similar to cradle but the opposite arm supports the baby. If feeding from the right breast, the left arm holds the baby and the right hand can support or guide the breast. This gives the parent more control over the baby's head and is often recommended for newborns still learning to latch. |
| Football Hold | Baby is tucked under the parent's arm like a football, with legs extending behind the parent. Baby's head is at the breast and the parent's hand supports the baby's neck. Helpful after a cesarean birth to keep pressure off the incision, and often easier for parents with larger breasts or for premature babies. |
| Laid-Back / Biological Nurturing | Parent reclines at a comfortable angle, baby lies on the parent's chest and belly with gravity holding them in place. Baby's natural rooting reflexes are activated in this position, often making latching easier. Good for parents with a strong let-down or for babies who struggle with fast milk flow, and particularly useful in the first hours after birth. |
Language That Supports Without Taking Over
| Instead of this | Try this |
|---|---|
| "The latch is wrong." | "Can you try bringing baby a little closer to you?" |
| "You're not making enough milk." | "His feeding cues look good. Let's talk about what you're noticing." |
| "You need to see a lactation consultant." | "I want to connect you with someone who specializes in exactly this. Can I help you set that up?" |
Common Challenges and Doula Responses
| Engorgement | Warm compress before feeding to encourage flow; cold pack after to reduce swelling. Hand expression can relieve pressure without triggering additional supply. This is not mastitis unless there is fever, flu-like symptoms, and a localized warm red area. |
| Sore Nipples | Tender in the first days is normal. Bleeding, cracked, or severely painful beyond the first week warrants a latch assessment from an IBCLC. In the meantime: lanolin, air exposure, and reassurance. |
| Low Supply (Real vs. Perceived) | Most clients who believe they have low supply do not. Assess by feeding cues, not the clock. Wet diapers and weight gain are the real indicators. Perceived low supply is often driven by cluster feeding, which is normal growth-related behavior, not a supply problem. |
| Mastitis | Flu-like symptoms plus a localized, hot, red, painful area of the breast. Rest, warmth, frequent feeding or pumping, and medical evaluation are all needed if fever is present. Mastitis can progress to abscess. This is not a "wait and see" situation. |
Feeding Inclusion: All Valid, All Supported
Formula feeding, combination feeding, and exclusive pumping are all valid choices. Your job is to support the mother's goals, not a feeding ideology. A client who feels judged for how she feeds her baby will stop asking you for help. Protect the relationship. Ask: "What are your goals around feeding? How can I support you in that?"
Demo and Practice (10 min)
Using teaching dolls, practice positioning for cradle and football holds. Then practice latch coaching language with a partner: one plays the doula, one plays the new parent. Focus on guiding without directing. Debrief: where did you feel the urge to fix instead of support?
10:30 AM · 15 min
Break. Stretch, hydrate, use the restroom. We resume at 10:45.
10:45 AM · 45 Minutes
Early Newborn Care: What Every Doula Needs to Know
The Newborn in the First 48 Hours
New parents are watching every breath, every color change, every sound. They will look to you. Know what is normal so you can reassure with confidence, and know what is not normal so you can act without hesitation.
| Apgar Scoring | Assessed at 1 minute and 5 minutes after birth. Scores 7 to 10 are normal. Doulas do not interpret Apgar scores for parents, but we know what they are and what the care team is assessing. When parents ask, "What does that number mean?", redirect warmly: "The nurses are doing a quick check on baby right now. They'll let us know." |
| Normal Appearance | Vernix (white coating), milia (tiny white bumps on the nose), lanugo (fine body hair), and molding (cone-shaped head from vaginal birth) are all normal and resolve on their own. Caput succedaneum is soft scalp swelling that crosses suture lines and resolves in days. Cephalohematoma is firm, does not cross suture lines, and may take weeks to resolve. Acrocyanosis (blue hands and feet) is normal in the first hours when the core is pink and warm. |
| Weight and Jaundice | A loss of 7 to 10% of birth weight in the first week is normal, with regain expected by days 10 to 14. Physiologic jaundice begins on day 2 or 3, peaks around day 3 to 5, and resolves on its own with adequate feeding. Jaundice appearing within the first 24 hours is pathologic and requires immediate evaluation. |
| Newborn Reflexes | Rooting (turning toward touch on the cheek), the Moro or startle reflex (arms fling out with sudden sound or movement), and the palmar grasp (fingers curl around objects) are all present at birth. Observe for tongue-tie: limited tongue mobility, heart-shaped tongue tip, or clicking during nursing. |
Hospital Protocols and Informed Consent Conversations
Parents have the right to informed consent for every newborn procedure. Your role is to make sure they feel safe asking questions, not to advise them what to decide.
| Erythromycin Eye Ointment | Prevents eye infection from bacteria in the birth canal. Required by law in most states. If parents have questions, direct them to their provider. |
| Vitamin K Injection | Prevents Vitamin K Deficiency Bleeding (VKDB), a rare but life-threatening condition. Newborns are born with very low Vitamin K levels. Some families decline. Know the evidence. Support their right to decide. Do not tell them what to do. |
| Newborn Metabolic Screen | The heel stick (PKU screen) screens for up to 60+ conditions including PKU, congenital hypothyroidism, and sickle cell disease. Timing is usually 24 to 48 hours after birth. Prepare parents for the brief cry. |
| Newborn Hearing Screen | A painless test done while the baby is quiet or sleeping, typically before discharge. A small probe is placed in the ear and measures the ear's response to soft sounds. Passing does not mean perfect hearing; a refer result means a follow-up test is needed, not that the baby has hearing loss. Reassure parents that a refer result is common and not cause for alarm. |
| Baby-Friendly Hospital Initiative | The BFHI is a WHO and UNICEF program that promotes breastfeeding-supportive practices including immediate skin-to-skin, rooming-in, and avoiding formula supplementation without medical indication. Doulas support BFHI-designated hospitals by reinforcing these practices with families. |
Newborn Red Flags: Notify the Nurse Immediately
- Respiratory distress: grunting, nasal flaring, chest retracting, breathing faster than 60 breaths per minute
- Extreme or early jaundice: yellow tint appearing within 24 hours, or yellowing that reaches the belly or legs
- Poor feeding: not waking to feed, no wet diapers by 24 hours, inconsolable or lethargic
- Temperature instability: feeling cold to touch, or fever above 100.4 F in a newborn is always urgent
Discussion: The Vitamin K Conversation
A parent declines the Vitamin K injection and then turns to you and asks: "You think we made the right choice, right?" How do you respond without steering and without abandoning them? Discuss in pairs, then share with the group. This is one of the hardest moments in scope of practice, and it happens more often than you would think.
11:30 AM · 45 Minutes
Newborn Skills Lab: Diapering, Bottle Feeding, Burping & Bathing
Four stations, approximately 10 minutes each. Your instructor will demo at each station before rotation begins. Laminated instruction cards are at every station. Sign off each technique on your skills checklist as you complete it.
| Station 1: Diapering | Proper lift technique (hand under buttocks, not ankles, to protect hip joints). Umbilical cord care: keep dry, fold diaper below the stump. Non-judgmental language for circumcised and uncircumcised care. Diaper rash prevention: air time and barrier creams. |
| Station 2: Paced Bottle Feeding | Semi-upright position, horizontal bottle, frequent pauses, baby-led pacing. Paced feeding honors hunger cues, reduces overfeeding, and supports the breastfeeding transition by preventing bottle preference. Practice with dolls and water. |
| Station 3: Burping Techniques | Three positions: over the shoulder, seated forward lean with chin supported, and face-down across the lap. How long to try, how often, and what to do when no burp comes. Signs of reflux and when to suggest a pediatric conversation. |
| Station 4: Rebirth / Rebath Method | Gentle newborn bathing that mimics the womb environment. Warm water, fetal position support, baby fully submerged except the face, slow movements. Benefits include reduced stress hormones, improved sleep, and bonding. Use after cord falls off, or the warm swaddle version before cord separation. Demo with waterproof doll in basin. |
12:15 PM · 45 min
Lunch. Rest, connect, and come back ready for the afternoon. We resume at 1:00 PM.
1:00 PM · 30 Minutes
Newborn Massage & Teaching Parents the Art of Touch
Infant massage is one of the most evidence-supported tools you can teach a postpartum family. It improves weight gain in preterm babies, reduces colic symptoms, promotes bonding, and supports sleep regulation. More importantly, it gives parents something powerful to do with their hands when they feel helpless.
| When to Massage | Awake and alert state, not right after a feed. Let the baby lead consent by watching for engagement cues, eye contact, open hands, and relaxed body, versus avoidance cues, turning away, arching, or fussing. Stop when baby signals stop. |
| Oil Choices | Unscented coconut oil, sunflower oil, or no oil at all. Avoid mineral oil, which blocks skin absorption, and avoid nut-based oils with allergic families. Check with the pediatrician for premature or skin-sensitive infants. |
| Basic Sequence | Legs and feet: milking strokes from thigh to ankle, sole circles. Belly: I Love You strokes for gas and colic, I down the left side (descending colon), L across the top and down (transverse), U up the right, across, and down the left (ascending). Chest: open book strokes outward from the sternum, butterfly strokes. Back: long strokes from shoulders to hips, small circles along the spine. |
Your Teaching Role
"I'm going to show you on the doll first, then you try it with your baby, and then your partner can try it too."
That sequence matters. Seeing it on the doll removes pressure before hands touch the baby. When the parent tries it, you coach from nearby. When the partner tries it, both gain confidence together and the touch becomes part of their relationship with their baby, not just yours with the client. Normalize fumbling. Parents do not need to be perfect. They need to be present.
Practice (15 min)
Partners take turns: one plays the doula demonstrating on the doll, then coaching the other as they practice on the doll as if they were the client with their baby. Switch and repeat. Then try teaching the sequence to your partner as if they were the birth partner learning alongside a new parent. Use the sequence card. Instructor floats and coaches throughout. The goal is not mastery of the strokes. It is practicing the teaching voice: calm, encouraging, and never critical.
1:30 PM · 60 Minutes
Postpartum Mental Health: Screening, Support & Escalation
Postpartum mood and anxiety disorders affect up to 1 in 5 mothers. They are the most common complication of childbirth. They are also among the most underreported, because clients are ashamed, afraid, and often don't know what they are experiencing has a name. You may be the first person they tell. What happens in that conversation matters enormously.
Understanding PMADs: The Full Spectrum
| Condition | What to Know |
|---|---|
| Baby Blues | Days 3 to 14, hormone-driven and self-resolving. Crying, mood swings, feeling overwhelmed. Does not require treatment. Does require reassurance, presence, and monitoring. If symptoms persist past 2 weeks, they are no longer blues. |
| Postpartum Depression | 1 in 5 mothers. Onset can be within weeks or up to a year after birth. Persistent sadness, difficulty bonding, loss of interest, hopelessness, exhaustion beyond normal sleep deprivation. Treatable with therapy, medication, or both. |
| Postpartum Anxiety | Often more common than PPD and consistently underdiagnosed. Racing thoughts, constant worry, inability to rest, physical symptoms like rapid heart rate and shortness of breath. A mother who cannot stop catastrophizing about her baby's safety may be experiencing PPA, not just "new parent nerves." |
| Postpartum OCD | Intrusive, unwanted thoughts about harm coming to the baby. Parents are horrified by these thoughts and terrified to disclose them. These thoughts are ego-dystonic, meaning the parent does not want to act on them and finds them deeply distressing. This is not a danger signal; it is a mental health condition that needs professional support. |
| Postpartum PTSD | Triggered by a traumatic birth experience or by previous trauma resurfacing during birth. Flashbacks, nightmares, hypervigilance, and avoidance. Clients may need support processing the birth before they can fully bond. |
| Postpartum Psychosis | Rare (1 to 2 per 1,000 births) but a medical emergency. Rapid onset within days of birth. Hallucinations, delusions, confusion, and disorganized behavior. This is not PPD. Do not wait. Do not leave the client alone. Call 911. |
Screening Tools: Doula Awareness
The Edinburgh Postnatal Depression Scale (EPDS)
A 10-item screening tool, the most widely used in postpartum care. Doulas do not administer the EPDS. But we know what it is, what the scores mean, and how to encourage a client to answer honestly when her provider asks. A powerful thing to say: "I want you to really answer these questions. Your provider can't help you if they don't know what's actually happening."
The PHQ-2: Two Questions Worth Knowing
The PHQ-2 is a two-question screen for depression used widely in primary care. Doulas do not administer it clinically, but knowing these questions helps you listen more deliberately during postpartum check-ins. If a client's answers to either question give you pause, that is information worth noting and following up on.
| 1 | "Over the past two weeks, how often have you been bothered by feeling down, depressed, or hopeless?" |
| 2 | "Over the past two weeks, how often have you been bothered by little interest or pleasure in doing things?" |
Responses are: Not at all / Several days / More than half the days / Nearly every day. A score of 3 or higher on the combined scale suggests further evaluation is needed. If she scores high, your job is not to diagnose. It is to help her get to someone who can.
The Birth Story: First Step in Every Postpartum Visit
Before any screening, before any checklist, before anything else at your postpartum visit, ask your client to tell you her birth story. Even if you were there. Even if you know everything that happened medically. What you were present for is the clinical record. What you are asking for now is her experience of it, from the inside, in her own words.
This matters for everyone in the room. Invite the partner to share too. Invite anyone who was present to offer their perspective. The birth story sounds different from every chair in that room, and hearing how each person experienced it builds understanding, surfaces unspoken grief or fear, and opens the door for connection that might not happen any other way.
Make It Part of Your Practice, Every Time
- Open with: "Tell me about your birth. Take me through it from your perspective."
- Then turn to the partner: "And what was it like for you?"
- Listen without fixing. Validate what you hear. Do not rush to the silver lining.
- What surfaces in the birth story, grief, confusion, gratitude, trauma, pride, often tells you everything you need to know about what kind of support she needs next.
The birth story is not small talk. It is the first step of every mental health intervention in the postpartum period. Telling the story out loud, to someone who was there and who cares, is itself healing.
Doula Language and Approach
| Say this | Not this |
|---|---|
| "What you are describing is really common and it has a name. You are not alone and you are not a bad mother." | "Everyone feels that way after a baby. It'll get better." |
| "Have you been having any scary thoughts you feel like you can't tell anyone about?" | "You seem fine. You're doing great." |
| "I want to help you make an appointment today. Call them and if I haven't heard back from you in 20 minutes I'll check in." | "You should talk to someone." (and leave it there) |
Escalation Pathway
| Mild Concern | Normalize and name what you are observing. Encourage the client to be honest with her provider at the next scheduled visit. Follow up at your next contact. |
| Moderate Concern | Actively help schedule an appointment. Do not leave her with a number; help her make the call. With her consent, loop in a partner or family member for additional support. Make a plan together for who she contacts if things worsen before the appointment. |
| Postpartum Psychosis | Call 911. Do not leave the client alone. Do not wait for her to agree. This is not a wait-and-see situation. Postpartum psychosis has a narrow treatment window and a high risk of harm when untreated. |
Resources to Know by Heart
- PSI Warmline: 1-800-944-4773. Peer support, available in multiple languages, not a crisis line.
- PSI Provider Directory: postpartum.net. Helps clients find a PMAD-specialized therapist or psychiatrist.
- National Alliance for Eating Disorders: for clients where disordered eating co-occurs with postpartum distress.
Role Play Practice (15 min)
Work in pairs. One person plays the doula, one plays the client. After 3 minutes, pause and debrief: What worked? What veered into therapy? Where did you want to fix her feelings instead of hold them? Then switch roles and try the next scenario. Your instructor will call which scenario to practice.
Scenario A
At her 3-week check-in your client says: "I love her, but I just cry all day. I thought I would feel happy by now. Is something wrong with me?"
Scenario B
At your 72-hour check-in your client's partner pulls you aside and says: "She won't put the baby down. She hasn't slept. She keeps checking if the baby is breathing every few minutes. She snapped at me when I tried to take the baby so she could rest. Is this normal?"
Scenario C
Your client is telling you her birth story. It was a long labor that ended in an emergency cesarean. When she gets to the part where she was wheeled to the OR she stops and says: "I keep seeing it. The ceiling lights going by. I felt like I was dying. I still feel like that happened to someone else. Is that weird?"
Scenario D
Five weeks postpartum your client laughs nervously and says: "Don't tell anyone I said this, but sometimes I have these thoughts, like what if something happened to her. Not that I would do anything. But these thoughts just pop into my head and I can't make them stop and I feel like a monster."
2:30 PM · 15 min
Break. Last one. We come back for the home stretch at 2:45.
2:45 PM · 75 Minutes
Professionalism, Ethics, Boundaries & Handling Difficult Conversations
You cannot do this work well if you do not take care of yourself while doing it. Professionalism is not just how you present to clients. It is the structure you build to protect your longevity in this field. The doulas who burn out do not lack compassion. They lack boundaries.
Ethics and Professionalism
| Neutrality | You are not the decision-maker. You are the informed companion. This distinction protects your client, protects your liability, and protects your ability to be in the room. A doula who makes decisions loses the trust of both clients and clinical staff. |
| Scope of Practice | The temptation to cross scope most often comes from love, from wanting to protect your client. Naming that impulse openly is how you prevent it from becoming action. Ask yourself: "Am I doing this for her, or am I doing this because I can't tolerate the uncertainty?" |
| Confidentiality | What your client shares with you stays with you. What you witness in her home, her hospital room, and her postpartum visits is not yours to share. This includes sharing with family members, other doulas, or on social media, even without identifying details. |
| Dual Relationships | Friends, family members, and colleagues who become clients present ethical complexity. When the relationship exists before the doula contract, personal history can cloud professional judgment. It is not a prohibition, but it requires clear, upfront conversations about which role is primary when they conflict. |
Boundaries in Practice
| Phone and Text Availability | Set clear response time expectations in your contract and repeat them verbally at your first prenatal visit. "I respond to non-emergency texts within 4 hours during waking hours" is a boundary, not a failure to serve. |
| The On-Call Period | Define it in writing. What does being on-call include and what does it not include? How does the client reach you? What happens after the birth? The on-call period should have a clear end, not a drift into unlimited availability. |
| Backup Doula System | Not optional. Every doula needs a backup. Introduce your backup to your client prenatally. A birth doula who has no backup is a liability to her client. Identify your backup network before you take your first client. |
| Ending a Client Relationship | Sometimes the right thing to do is to end a client relationship. Abusive behavior, safety concerns, or an irreparable breakdown in trust are all grounds. Do it with dignity: clear communication, documentation, a warm referral to another doula, and no abandonment close to the due date without coverage in place. |
Burnout Prevention
Stress vs. Burnout: Know the Difference
Stress is temporary and context-specific. Burnout is chronic and identity-level. Stressed doulas feel overwhelmed by a particular birth or a difficult client. Burned-out doulas feel detached from the work itself, cynical about clients, and physically depleted in ways that rest does not fix. Knowing the difference matters because the responses are different.
- Debrief after hard births: peer debriefs, journaling, supervision, or therapy. Do not carry difficult births alone.
- Self-care as a professional obligation: not a luxury you earn by surviving a hard month. It is part of the job description.
- Build your doula community: peer support groups, mentorship, and continuing education. Isolation is a burnout accelerant.
Activity 1: Boundary Setting Exercise (20 min)
Your instructor will hand out the scenario cards. Work in groups of three. Each group receives three scenarios drawn from real doula situations across pre-birth, labor, and postpartum. Read each one aloud together and talk through it as a group. Each group shares one key takeaway with the room to close.
For each scenario, work through these five questions as a group:
- Does this cross a boundary? Is it a fair ask, or is it too much emotionally, professionally, or personally?
- How would you respond? What is your gut reaction, and is that the right call?
- What feelings does this bring up for you? Guilt, frustration, sympathy, or something else?
- What could happen if you say yes? Could it set a pattern that is hard to undo?
- What could happen if you say no? What might she need instead of what she is asking for?
Activity 2: Difficult Conversations (30 min)
Your instructor will hand out the scenario cards. These ten situations are drawn from the full arc of the doula-client relationship: pre-birth, the labor room, and postpartum. Your instructor will call a scenario and read it aloud. Someone responds in the moment. The group builds on it together. Not every scenario will be called. Come ready to respond to any of them.
For every scenario, come back to these three questions:
- What would you do?
- What specifically would you say or do?
- How do you keep the birthing person centered?
There is no graded answer here. The most useful thing you can say is "I don't actually know what I would do," because that is where the real learning starts.
4:00 PM · 15 Minutes
Your Path Forward: MHN Volunteer Network & Certification
This training is the foundation, not the finish line. From here your path has two tracks running side by side: joining the MHN Volunteer Doula Network to begin serving families, and pursuing credentialing once you have the birth experience to back it up.
Step 1: Join the MHN Volunteer Doula Network
| 1 | Complete all Canvas module exams if not yet done. All modules must be passed before you are active in the network. |
| 2 | Sign your MHN Volunteer Service Agreement. This formalizes your commitment to the program and outlines your responsibilities as a volunteer doula. |
| 3 | Log in to the Doula Portal at maryshandsnetwork.org and submit your availability form. This tells the volunteer coordinator when you are available to be matched and what regions you can serve. |
| 4 | Get matched. The volunteer coordinator reviews your availability and assigns you a doula teammate and a client based on due date, location, and client needs. Both teammates confirm the match before it is finalized and you are introduced to each other and your client. |
| 5 | Begin serving, following your Field Guide. You reviewed the Field Guide in your prework. That document is your practical companion through every stage of the client relationship, from the virtual pre-birth visit through archiving the client after the postpartum period ends. |
Step 2: After Your First Three Birth Experiences
Once you have completed three birth experiences of at least six hours each and documented them through the MHN Doula Portal, two credentialing pathways open up to you simultaneously.
Louisiana Doula Registry
After three documented birth experiences you are eligible to apply for the Louisiana Doula Registry, the state-level credential required for Medicaid reimbursement and insurance billing in Louisiana. This is a significant milestone: it means your clients can potentially access your services at no cost to them, and it positions you as a recognized doula in the state's healthcare ecosystem. Your volunteer coordinator can guide you through the application process.
ICEA Birth Doula Certification (ICBD)
You are also eligible to enroll in the ICEA Birth Doula Pathway, submit your program documentation, and apply to sit for the certification exam. When you pass, you become a credentialed ICEA Certified Birth Doula. The credential is nationally recognized and demonstrates that your practice meets a rigorous professional standard.
For full details on the ICEA pathway, requirements, and exam application, visit icea.org. Your instructor can answer questions about the documentation process and what you need to submit.
Take home tonight: the MHN Volunteer Service Agreement to sign and return, and your Field Guide if you do not already have it saved. Log in to the Doula Portal and submit your availability form within 48 hours while today is fresh. The sooner your availability is in, the sooner you get matched.
4:15 PM · 15 Minutes
Coating Ceremony, Certificates & Closing
This is how we close. Not with paperwork. Not with a slide. With ceremony, because what you have done over these four sessions deserves to be marked.
Certificate of Completion
Every graduate receives a Certificate of Completion for the MHN ICEA-Approved Birth Doula Training Program. This document recognizes that you have completed all required coursework and in-person training and are now prepared to serve as a birth doula. Keep it. Frame it. It is the beginning of your record.
The Coating Ceremony
For those joining the MHN Volunteer Doula Network, this moment is yours. An active MHN volunteer doula will place your MHN purple jacket on your shoulders and welcome you into this network, this family, and this community of people who have chosen to give of themselves to the families in their community.
That jacket is not a uniform. It is a symbol of what you have committed to: showing up for strangers at the most vulnerable moments of their lives, pressing your hands into their backs at 3 in the morning, staying when things get hard, holding space when words are not enough. The doula who places it on you knows what that means. She has lived it. She is welcoming you into something real.
Your Next Steps
If you received a scholarship and are joining the MHN Volunteer Doula Network:
- Your Volunteer Service Agreement was signed digitally as part of your scholarship acceptance. You are already on record.
- Log in to the Doula Portal at maryshandsnetwork.org and submit your availability form before the end of this week. The sooner your availability is in, the sooner we can start building your team.
If you are joining the network as a paying trainee:
- Sign your Volunteer Service Agreement tonight and return it to MHN.
- Submit your availability form through the Doula Portal before the end of this week so we can begin building your team.
Everyone:
- Complete any remaining Canvas module exams if not yet done.
- Join the MHN Doula Cohort group community.
You were made for this work.
Welcome to the network. Welcome to the family. Welcome to Mary's Hands.
Mary's Hands Network · ICEA Certified Birth Doula Hybrid Training Program
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