Over a decade went by between the time that I first felt called to serve women and families during the birth process, and when I actually listened and started to work with clients as an independent birth attendant.  In retrospect, it would not have been possible for me to have been attending births in my twenties—I was a mess.  And while my life is far from perfect right now, I have learned a thing or two, including the following rules for anyone interested in becoming a birth-worker.  Not to say that I have each of these points entirely wrapped up, but I’m pretty clear on the importance of at least having an awareness of these essential parameters.

A Good Birth Worker Must:

1. Have Integrity.  Having integrity means that we are whole: our words and our intentions and our actions are in alignment.  Someone who has integrity takes 100% responsibility for his or her life, actions, reactions, choices and outcomes.  This means that in lieu of complaints, we look at where our agency has led us.  This means owning our mistakes, being on time, apologizing when we mess up, never making excuses.  This is important in all areas of life, but especially when it comes to birth work.  All the credentials in the world are meaningless if parents don’t feel that they can trust us to do what we say we will do.

2. Be Comfortable with Uncertainty.  We can never know the outcome of a birth.  No one knows what will take place tomorrow.  Life is a mystery, always.  Often, during the birth process, things proceed in unexpected ways.  No birth is like any other.  Get used to the possibility that this birth and every one after it will blow your expectations.  Get used to the possibility that this mother will be stronger than you ever thought possible.  Get used to the fact that people will surprise you, and that things are not always as they seem.

3. Look Professional.  I will never forget the first doula training course I did with Gloria Lemay 14 years ago.  I showed up in an outlandish shirt and the most hideous bright green pants imaginable, (which I had sewed myself by hand).  Gloria looked me up and down and then very sweetly asked the group to share some of our insights into the importance of clothing, grooming and physical appearance.  We were then asked to describe the physical attributes of our ideal birth attendant.  With painful sincerity, I remember suggesting that I would feel most comfortable with someone who wore a caftan and who had lots of dirt under her fingernails.  Sigh.  Apparently it only took a decade or so for me to get it. Things are different now.  Especially because I work independently, the way I present myself in public is extremely important.  I do make an effort to look clean, put-together, and somewhat conservative.  First impressions are important, and resonant, and I want my outward appearance  to inspire a sense of confidence, familiarity, and ease.  Wearing clean, plain, professional yet casual attire is a way for me to open myself up to the greatest number of potential clients, and to alienate as few of those potential clients as possible (that is, before I open my mouth, of course).

4. Be Clear & Impeccable about who you are and what you do.  Are you a registered midwife?  Tell your clients immediately that you work under the authority of a college, hospital or government, and share with them the full scope of what that means.  Are you a doula?  Be absolutely clear with your clients about your practice, and tell them whether or not your accreditation involves limitations or guidelines and recommendations that might affect your ability to support your clients’ birth choices, or your ability to guide them in those choices.  I am an independent birth consultant.  I am always totally clear and up-front with my clients about the fact that I am *not* a midwife, that I do not practice medicine, and that I have absolutely no formal midwifery or medical credentials.  This allows me to work entirely for my clients with no biases or conflicts of interest.  It is essential to always be open about your role.

5. Value Your Livelihood.  Whether or not you like money, are afraid of it, have issues with it, or attachments to it, money is how our culture expresses value.  If you want to be effective and powerful as a birth worker, you must charge a reasonable rate or you won’t last. Birth-work cannot be a volunteer gig: it is time-intensive, energy-intensive, and it eats families.  Birth-workers are often on-call for months at a time.  You need gas to get to the birth, food to feed your kids while you’re there, childcare too for those nights  you have to leave  your own children to welcome someone else’s. Money signifies commitment.  When a client pays you, they too are creating a commitment to themselves; a clarification that they truly want your presence, and that they trust you, and that when the birth-time comes, they will be invested in calling you and treating you with professional respect.  I have learned the hard way not to do births for free.  Just because this is an *amazing* job to have, doesn’t mean it isn’t a job.  I need to be able to take care of my children and myself in order to continue to serve other families effectively.

6. Be Sober.  It is simply not possible to be a reliable, effective birth worker, if you have any substance issues.  Dependencies, habits or even preferences for any substance that might possibly hamper judgement, or clarity, simply won’t work. This is not a personal judgement of anyone’s habits, this is just reality.  The birth worker who smokes pot is compromising her effectiveness, her credibility, her reputation and her ability to make safe and sound decisions.  Being a birth worker means not being able to have a second glass of wine during the holidays, and it also means having to regulate sleep and other activities to make sure that these won’t interfere with being on call, or an upcoming birth.  Coffee is an exception…

7. Be Gracious and Generous.  We are in this together, as birth-workers, and it is imperative that we acknowledge our interconnectedness, and our sisterhood.  Do not compete with other birth attendants.  Do not slander, complain or gossip about other birth attendants.  Whether you see your calling as one that involves a spiritual element or not,  attending women and families during birth is life-altering and sacred and will change and shape humanity for the better.  Working against other birth-workers works against a vision for a better world. Remember also that you represent your profession wherever you go.  One person’s encounter with you will colour their vision of what it is to be a doula or a midwife.  When I go out in the world and describe myself as a “traditional birth attendant”, my behaviour is helping to create in others’ minds, what the term “birth attendant” means, and my behaviour stands for my profession, and affects how my colleagues will be received, also.

8. Get Over Yourself.  Birth-work is not about me, or you.  It’s about mothers, babies, fathers and families.  I attended a birth recently, and my experience of it was that it was a beautiful, powerful, and very challenging (and somewhat harrowing) birth.  When I heard the mother tell the story, I was gearing myself up to hear about all the craziness as I had experienced it.  Instead, the mother simply said “It was amazing!  So easy!  Next time we’re not even going to have birth attendants, they didn’t even do anything!”  At first I was surprised, then I was thrilled. The biggest compliment is when a family tells me that they really didn’t need me at all.  If you hear a birth story being told and *you don’t even get a mention*…pat yourself on the back.  Good work.

9. Deal With Your Anger.  One of the reasons why it was a good thing for me to postpone my entry into working with clients, is because a lot of the passion I had for birth came also from anger: anger over the way I and other women have been treated, anger towards the system, anger towards how babies are misunderstood and mistreated.  Feeling anger about these issues isn’t necessarily a bad thing.  Anger can be very galvanizing and inspiring.  Anger can also burn and do damage.  It was really important for me to deal with my own anger and my trauma, before I was able to work effectively with mothers and families.  My anger isn’t gone, but it has softened considerably, and I am able to channel it into writing and advocacy work.   I am also able to listen clearly to my clients, and to offer unbiased responses when they express their own emotions around birth.

10. Fix Your Relationship.  Again—my marriage is far from perfect.  But Lee and I are generally ok,, and when it comes to my birth-work, we have an excellent understanding.  I am very aware of the fact that if Lee were not supportive both emotionally and practically, that I would not be able to do this work.  As it is, he is really wonderful, and never complains or has issues when I have to go to a birth at all hours (Christmas morning!).  Being on-call can be stressful and tiring and hard on partners and kids.  Try to work things out so that everyone in the family gets what they need, or at least that everyone in the family is acknowledged and that they know they will get what they need *soon*.  Compromises, always.

11. Trust Mothers.  I work for mothers and families, and I am personally dedicated to the philosophy that mothers own birth.  It is the mother who is more invested in that baby than any other individual on the planet, and it is the mother who will be giving birth to that child.  When I was pregnant with my first baby 14 years ago, I believed my birth attendant when she told me that she would do *anything* I wanted her to do during my birth process, even if that meant climbing the tree in my driveway and howling at the moon.  When I say the same thing to my own clients now, I mean it.  I want the mothers I work with to know that I will be totally honest with them about my ideas, opinions, experiences and convictions about pregnancy and birth, but that I am only there as a consultant, to serve them, and that they have full authority over the entire process.

12. Support Human Rights.  It is my conviction that women possess an inalienable right to choose how, where and with whom they give birth.  Any legislation that interferes with this fundamental human right, is not legislation that I can support.  As a mother, I would not, in good conscience, be able to hire someone to support me, who worked under a regulatory body that criminalizes independent birth workers.  I would hope that other birth workers are clear and open with where they stand vis a vis unassisted birth, and other choices that fall outside of childbirth norms in our culture. I also believe that every individual has a right to bodily integrity, which is why I can not support the cosmetic modification of children’s bodies. I am up-front with all of my clients about where I stand on these issues.