There is growing third party reimbursement for labor support. Grant funding is often available, and some Medicaid-funded health agencies have contracts with doula organizations to support women in poverty and women with special needs. At present, however, most doula care is paid for directly by the client. Training and Certification of Doulas Doula training focuses on the emotional needs of women in labor, and non- medical physical and emotional comfort measures. Generally, training programs require some prior knowledge of childbirth, and consist of an intensive two or three day seminar, including hands-on practice of such skills as relaxation, breathing, positioning and movements to reduce pain and enhance labor progress, massage, and other comfort measures.
Certification is offered by several local, national, and international organizations.
Positive evaluations from clients, doctors or midwives and nurses are also required. In summary, the doula is emerging as a positive contribution to the care of women in labor. By attending to the women's emotional needs, some obstetric outcomes are improved. Just as importantly, early mother-infant relationships and breastfeeding are enhanced. Women's satisfaction with their birth experiences and even their self-esteem appears to improve when a doula has assisted them through childbirth.