Me First – Part 1: Burnout in the Birth Workers

We work in spaces that hold both the best of times and the worst of times. We are given the extraordinary honor of an invitation to enter our clients’ lives in the most joyous and intimate of situations. Yet as beautiful as this work is, it is also stressful. We train to learn how best to meet their every need. We pour ourselves out in service to preparing families for labor, birth and newborns, to the bringing of new life, and in support of new families. It is wondrous, it is fulfilling, and it is a joy. Yet all the while, many of us are slowly (or quickly) burning ourselves out.

We have specific burnout data for midwives. Thumm et al report that 40%, or two in five, certified nurse midwives and certified midwives in clinical practice in the United States are experiencing burnout. [1] We do not know exact numbers for doulas, but we know that the factors contributing to burnout are similar. [2] The demand for doulas is increasing as the data continues to speak to the importance of our work. Reducing burnout and increasing work satisfaction for maternal support workers can only be a good thing.

The work we do is costly for both ourselves and our families. The cost is physical, emotional, and psychological. Working at night has been shown to affect circadian rhythms and is also linked to several other health issues including metabolic disorders (obesity, diabetes) [3] and even cancer. [4] When we are serving families, we may place our needs secondary to theirs. Birth is not typically scheduled and being called away from family events or missing special occasions is costly, again, to ourselves and our families. It is costly to step out of our lives, on a moment’s notice, and to step into the lives of the families who contract our services.  We know that maternity support workers experience higher levels of burnout when they experience high levels of work/family conflict. [2] Labor doulas face the additional stress and vicarious suffering that come with bearing witness to obstetric violence, defined as “… the appropriation of a woman’s body and reproductive processes by health personnel, in the form of dehumanizing treatment, abusive medicalization and pathologization of natural processes, involving a woman’s loss of autonomy and of the capacity to freely make her own decisions about her body and her sexuality, which has negative consequences for a woman’s quality of life.”[5] To witness these events again and again increases the risk of burnout for maternal support workers. [2]

Our families pay the cost when have to leave events and occasions. They pay the cost when we walk out the door, not knowing how long it will be before we return. They may worry when we leave in the middle of the night, rain or shine, to attend a family and I imagine it must be disturbing to go to bed with your parent there, then wake to find they have left and you do not know when they will be home again. Our significant others may be called upon to shoulder a larger share of the burden of family life, all in service to the work we do for others. The work we do is costly. When we become intentional about caring for ourselves, we reduce that cost to ourselves and our families, without compromising the service we provide to our clients.


  1. Thumm EB, Smith DC, Squires AP, Breedlove G, Meek PM. Burnout of the US midwifery workforce and the role of practice environment. Health Serv Res. 2021;1-13. doi:10.1111/1475-6773.13922
  2. Naiman-Sessions, Miriam & Henley, Megan & Roth, Louise. (2017). Bearing the Burden of Care: Emotional Burnout Among Maternity Support Workers. 10.1108/S0275-495920170000035006.
  3. Skene DJ, Skornyakov E, Chowdhury NR, Gajula RP, Middleton B, Satterfield BC, Porter KI, Van Dongen HPA, Gaddameedhi S. Separation of circadian- and behavior-driven metabolite rhythms in humans provides a window on peripheral oscillators and metabolism. Proc Natl Acad Sci U S A. 2018 Jul 24;115(30):7825-7830. doi: 10.1073/pnas.1801183115. Epub 2018 Jul 10. Erratum in: Proc Natl Acad Sci U S A. 2021 Sep 7;118(36): PMID: 29991600; PMCID: PMC6065025.
  4. NTP Cancer Hazard Assessment Report on Night Shift Work and Light at Night (April 2021):
  5. Second Hemispheric Report on the Implementation of the Belém do Pará Convention – Follow-up Mechanism to the Belém do Pará Convention (MESECVI) (April 2012):

About the Author

Debbie Hull began learning about birth in 1996 after the birth of her first baby and has been serving Houston area families since 1999. She is certified with CAPPA as a new parent educator, labor doula, and childbirth educator and is honored to be on CAPPA faculty for both labor doula and childbirth educator. Debbie has been privileged to attend several hundred births in homes, birth centers, hospitals and, on one memorable occasion, a grocery store parking lot! She believes that it is the most precious and sacred of honors to be invited to care for a family during their childbearing season and is very proud to have the opportunity to speak into the work of the next generation of birth professionals. Her work has taken her places she never expected to go, including becoming a talk-radio guest-host (listen at She also portrayed Jillian in all the Houston productions of Karen Brody’s play, Birth, but only with the fingerprints of her beloved midwife/friend all over her back. They say the birth sounds she made there, on a stage in front of hundreds of people, sounded real. She profoundly hopes so. Debbie designed and developed the curriculum for an innovative, interactive childbirth class and began offering classes that even dads report enjoying! Her minor in training and development and experience as an American Sign Language interpreting mentorship program manager perfectly prepared her for mentoring doulas and childbirth educators. She believes that we learn best when we are laughing, so her training is designed to be enjoyable and memorable. It should be noted that there have also been tears in training, when groups dive deep into the emotional side of birth work. Debbie is most proud to be the mother of two amazing formerly breastfed and homeschooled young adults, the youngest of whom has been on a 21 year nursing strike. When she is not working on her feelings about that, Debbie enjoys movies, reading, and game nights, even when she loses.

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