Joint ACOG/SMF Statement on Maternity Health Levels

In a joint statement released last month entitled Obstetric Care Consensus: Levels of Maternity Care the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) called for the creation and adoption of a classification system for maternity care. The statement outlines five levels of care which increase in their ability to handle medical complications for pregnant and postpartum women: Birth Centers, Level 1 (Basic Care), Level II (Specialty Care), Level III (Subspecialty Care) and Level IV (Regional Perinatal Health Care Centers).

The statement goes on to describe each level of care center, the type of care providers available and examples of the patients appropriate for each. For example, birth centers are described as providing care for low risk women, those with uncomplicated, singleton pregnancies with a baby in the vertex position. The capabilities of a birth center include the ability to provide low-risk maternal care, transfers to a higher level facility should the need arise and medical consultation at all times. In this document, every patient at a birth center is to be attended by certified nurse midwives, certified professional midwives and other legally licensed midwives. Level III facilities, on the other hand, care for complex maternal, obstetric and fetal conditions and provide advanced imaging services such as ultrasound at all times, have medical and surgical intensive care units for pregnant patients, offer round the clock anesthesia services onsite, and have both maternal fetal medicine specialists and critical care providers onsite at all times. The overall idea is to match the patient with the right level of care for her needs so as to improve outcomes for maternity care. ACOG and SMFM propose that this system be coordinated regionally so that patients have access to varying levels of care.

consensus for maternity care

This idea of a tiered and integrated system of care based on specific capabilities is not at all new. In fact, in 1976, the March of Dimes issued a report (Toward Improving the Outcome of Pregnancy) that outlined a system to create designated levels of care for pregnant women and newborns based on their medical needs. In the nearly forty years since, a tiered system for neonatal care has been put in place based on the capabilities and staffing at hospitals and was last updated in 2012. Last month’s ACOG and SMFM statement notes that studies have shown that this system has improved outcomes for babies and calls for a similar system for maternity care. Currently, Arizona, Indiana and Maryland have guidelines which establish maternal care criteria but the three are operating independently and do not use the same designations or descriptions for each level. ACOG and SMFM suggest a nationally consistent system using agreed upon definitions and criteria.

At first glance, Obstetric Care Consensus: Levels of Maternity Care may appear to be of more interest to hospital administrators who want to obtain the appropriate designation for their facility than birthing families or the doulas who support them. However, this document has a great deal of educational value that doulas can reference. The descriptions for each facility level can help families better understand the differences between facilities and make more informed choices for a birthing location that best meets their medical needs as well as understand why they might be transferred to a higher level facility should complications arise. This joint statement also clearly supports midwifery care for uncomplicated pregnancies and birth centers as appropriate options for low risk mothers. This is very important in ensuring that families have a range of choices in care provider and facility for their births.

It is unclear how long it will take for such a system to be adopted nationwide. The report notes that many barriers will need to be overcome to implement such a system including determining if state or even national accreditation organizations need to be established and funded to oversee this system.

This is the second joint statement from ACOG and SMFM. Last year they jointly issue Safe Prevention of the Primary Cesarean Delivery, which directly referenced the value of doula support in lowering the cesarean birth rate. We can likely expect more collaboration between these two maternity care organizations in the future.

The Birth of a Hospital Doula Program

sujata_gamiEditor’s Note: Sujata Gami has been on staff with the Women’s Education Department at St. Francis Hospital in Greenville, SC as a childbirth educator since 2007. Her experience with the Alternative Birth Methods team she describes below has inspired her to become a certified birth doula, doula mentor and volunteer as the SPAR (State/Regional/Area Representative) for DONA International. Her story illustrates how we can impact not only families with our work but our entire community – even hospitals and providers – and be personally changed by that experience.
– Adrianne Gordon

In 2014, St. Francis Hospital in Greenville, SC formed an Alternative Birth Methods team, comprised of hospital administration, nurses, providers and educators. The objective of this interdisciplinary/collaborative team was to discuss and brainstorm growth strategies for hospital volume and promote communication among providers, nurses, the women’s education department and administrators using shared decision making and teamwork.

We discussed the major findings of the National Listening to Mother Survey III on attitudes, choice, control and decision making of childbearing families and its implications on perinatal care practice. Almost six in ten (59%) of the mothers in the survey agreed with the statement, ‘Giving birth is a process that should not be interfered with unless medically necessary.’ We discussed how the demographics of the population we served at St. Francis Women’s Hospital also had similar attitudes and wanted more choices and control in decision making.

In an open dialogue, our providers shared that their practices did offer choices and shared decision making to their patients; however, there were some areas where we as a team could focus our efforts to change perceptions related to meeting the non-medical, psychosocial needs of laboring women. We also discussed how our medical system is set up whereby the doctors and nurses are primarily responsible for the health and wellbeing of the mother and baby and that these priorities usually take precedence over the nonmedical, psychosocial needs of laboring women. The highly technical function of today’s clinical nurse and how it lessens her ability to give the type of continuous social support that can impact outcomes was also discussed. After exploring and talking about the role of a birth doula and the impact a trained, skilled labor support person can have to empower women, which can then lead to better birth outcomes and patient satisfaction, the team came to the consensus that a St. Francis Hospital Doula Program should be implemented.

Following the decision, my role was to understand the requirements of the DONA International birth doula certification process. I started the process of gathering information to chalk out the prerequisites of becoming a certified birth doula and, one step at a time, completed all of the requirements personally, including attending births as a doula in training. Throughout the process, I updated my manager in the Women’s Education department consistently about the doula’s Scope of Practice, details of documentation required, challenges I faced and feed-back from patients. My manager used the information to sketch out a plan to hire and train a cohort of doulas with the goal of having these newly hired birth doulas work as part of a team alongside our maternity-care providers and nurses at St. Francis Hospital.

Here is an outline of the milestones of conceptualizing, planning, implementing, hiring and training of the doula cohort:















By utilizing an integrated and collaborative interdisciplinary team approach, the Alternative Birth Methods initiative at St. Francis was successful in:

  • Demonstrating effective communication between hospital administrators, providers, nurses and educators.
  • Information sharing amongst the team regarding what worked and what could be done differently
  • Conceptualizing, planning and implementing a hospital doula program set-up for success
  • Planning and organizing an in-service training for labor and delivery nurses to ensure that they buy into the hospital doula program.
  • Planning and organizing an in-service training for the newly hired doula cohort to ensure they were adequately trained to practice within the DONA International birth doula scope of practice.
  • Working out scheduling details for best client doula match-ups so that laboring women’s needs are met and contracted doulas get adequate financially sustainable work.

Another significant outcome of the interdisciplinary team meetings was that it was decided to have a Lamaze Evidence Based Nursing training for our nurses. Like the DONA International birth doula training, this training is evidenced based and served to get everyone in the maternity care team on the same page to effectively meet the medical, emotional, physical and psychosocial needs of women in labor, which we expect will lead to both better birth outcomes and greater patient satisfaction.

— Sujata Gami, MS, LCCE, FACCE, CD(DONA)

Learn more about the St. Francis Doula Program.

Ballen, LE, Fulcher, AJ. (2006). Nurses and doulas: Complementary roles to provide optimal maternity care. JOGNN; 35(2): 304-311

Declercq, ER, Sakala, C, Corry, MP, Applebaum, S, Herrlich, A. (2013). Listening to Mothers SM III: New Mothers Speak Out. New York: Childbirth Connection, June.

Klaus, M.H., Kennell, J.H., & Klaus, P.H. (2012). The doula book: How a trained labor companion can help you have a shorter, easier, and healthier birth. Boston, MA: Merloyd Lawrence Books. ISBN: 0738215066/ISBN-13:9780738215068.

Simkin, P. (2013). The birth partner: A complete guide to childbirth for dads, doulas, and all other labor companions (4th ed.). Boston, MA: Harvard Common Press.

Hodnett ED. (2002). Pain and women’s satisfaction with the experience of childbirth: a systematic review. Am J Obstet Gynecol; 186(5): S16072.

Hodnett, ED, Gates, S, Hofmeyr, GJ, Sakala, C, Weston, J.(2011). Continuous support for women during childbirth. Cochrane Database Syst Rev. Feb 16; (2):CD003766.

Gilliland ,AL. (2002). Beyond holding hands: The modern role of the professional doula. JOGNN; 31(6): 762–769.

Peddicord, K. (2012). Quality Patient Care in Labor and Delivery: A Call to Action. JOGNN; 41(1): 151–153, January/February.

Getting the Most from Online Training Options

baby-84626_1280The Internet opens up a whole new world of possibility, including learning. While online classes and degrees have been around for some time, webinars and virtual conferences are now available to doulas, as well. With the recent launch of DONA International’s Every Doula Everywhere & Anytime Webinars, and this year’s virtual conference, it seemed like a good time to share some tips for getting the most out of an online learning experience. These tips apply more to short-term educational experiences like a webinar or conference, if you’re considering taking a longer online class or getting a degree online, be sure to check out the additional resources for success at the end of this post.

1. Check Your Tech. Before you register (and pay) for a webinar or virtual conference, find out the technical requirements and test your equipment. A headset makes for a much better listening experience and is less likely to disturb anyone around you. Some webinars require that you download an application to view the webinar. If that is the case, download it ahead of time and test it to make sure it’s working properly. Some live webinars also require that you phone in for audio. Have your cell phone charged and those earbuds handy.

2. Be Distraction Free. To get the most out of the experience, turn off your phone’s notifications and close any other browser windows. Choose a time and place where you won’t be interrupted. While you can pause and playback recorded webinars, like those that DONA International offers, the experience is better and more educational when uninterrupted – easier said than done for busy doulas, of course!

3. Check the details. Can you re-watch the webinar if you miss part of it or just want to absorb more a second time? Is there a quiz or other requirement in order to get credit for completing it? What do you need in order to be able to apply the webinar to any recertification requirements you may have? Do they automatically provide a certificate or email of completion, or do you have to request one?

4. Keep Records. Hold onto registration confirmations or receipts you receive via email. If a certificate of attendance is provided, be sure to save it. While this information can be retrieved later, it can be a hassle and some conferences charge fees for reissuing certificates.

These simple tips can help you get the most from online learning options like webinars and virtual conferences. Do you have tips to share? We’d love to hear about them in the comments.

— Adrianne Gordon, CD(DONA),MBA

Additional resources:

Submit Your Proposal to Present at the DONA International Annual Conference!

Presentation proposals are now being accepted for the 2015 annual conference, Building on Tradition, Embracing the Future. This will be DONA International’s 2nd virtual, conference allowing doulas, childbirth educators, lactation consultants and anyone interested in maternal-child health from around the globe to learn together without the cost or time associated with travel. The conference will premiere on August 7 and 8, 2015, with sessions available for on-demand viewing until November 7th. Speaker submissions are due no later than March 15, 2015.

We know many of you have a wealth of knowledge and experience in matters of interest to birth and postpartum doulas. We are eager to have you share your expertise!

You do not have to be a DONA International member to present. Submissions are being accepted for 60 or 90 minute concurrent sessions which will be remotely recorded. A complete packet of information, including submission requirements and forms, is available at:

The more we can share with one another, the more we can stay informed and inspired!

Important New Research on Postpartum Depression May Bring Changes to How the Disorder is Diagnosed

directory-466935_1280For all of the awareness that has been generated about postpartum depression, there is a great deal that is still unknown about the disorder. Is postpartum depression a unique type of depression where women experiencing it are biologically different than those experiencing a major depressive episode at another point in life? Or is postpartum depression a major depressive episode that occurs in a specific timeframe? What about depression that begins during pregnancy? Is it wholly and distinctly different than depression that sets in six weeks after birth? Believe it or not, even the diagnosis of postpartum depression is technically unofficial.

Walker Karraa, Ph.D., author of Transformed by Postpartum Depression: Women’s Stories of Trauma and Growth, explains how The Diagnostic and Statistical Manual of Mental Disorders (DSM), fifth edition and the International Statistical Classification of Diseases and Related Health Problems, tenth edition address, or rather do not address, postpartum depression, saying,

“Unfortunately there is not official diagnostic criteria for any perinatal mood or anxiety disorder in either the DSM5 or the ICD-10. With postpartum depression for example, the DSM categorizes it as an episode of Major Depressive Disorder that has an onset specifier of occurring within 4-6 weeks after childbirth.”

However, a new study published in the January edition of The Lancet Psychiatry provides important new insight on postpartum depression. Researchers at the University of North Carolina School of Medicine evaluated data on over 10,000 women diagnosed with postpartum depression in an attempt to answer some of the above questions.

The study focused on women who were diagnosed as having major depression within 12 weeks of giving birth to a single live fetus and were without history of schizophrenia, biopolar disorder or psychotic symptoms. The data reviewed was provided from researchers in seven countries through the Postpartum Depression: Action Towards Causes and Treatment (PACT), a psychiatry consortium created in 2010 to support research on the causes of postpartum depression.

The research team at the UNC School of Medicine did a statistical analysis of the data, including symptom ratings from the Edinburgh Postnatal Depression Scale or the Hamilton Depression Rating Scale (it varied depending on what scale had been administered to the patient), when symptoms began, pregnancy and obstetrical complications, previous history of depression or anxiety and suicidal ideation.

After analyzing this data, three specific classes of postpartum depression emerged based on severity of symptoms. Referred to simply as Class 1, 2 and 3 in the study, the creation of tiered classes could help bring greater clarity to the disorder and help providers assess and manage risk factors for their patients, leading to better treatment and outcomes.

When evaluating these three classes, researchers found some interesting commonalities among those who experienced the most severe levels of postpartum depression. Sixty-seven percent of women with the most severe symptoms (class 3 as identified in this study) reported that their symptoms began during pregnancy. This group was also more likely to have a history of mood disorders. The researchers conclude that for these women, it may be that postpartum depression is part of a larger pattern of depression or anxiety rather than a specific response to the hormonal changes associated with birth. Interestingly, women assigned to class 3 based on symptom severity were more likely to have experienced obstetrical complications. This may indicate that obstetrical complications may be a potential trigger for depression or anxiety, particularly in women with a prior history of these disorders. The DONA Doula Chronicles previously shared a study that evaluated the connection between pain during childbirth and increased risk of postpartum depression (Do Epidurals Reduce the Risk of Postpartum Depression?).

“What is so powerful about the PACT study is that they are asking women about the experience; having women inform science about the disorder is critical to clarifying current nosology.” — Walker Karaa, Ph.D.

More research, such as this most recent study from the University of North Carolina, is needed to determine whether there are certain types of depression and anxiety during pregnancy and postpartum. This determination could have significant impact on how women are evaluated for risk of developing a mood disorder in pregnancy or postpartum, the prevention of severe symptoms including suicidal thoughts and the best course of treatment for each woman.

‘Heterogeneity Of Postpartum Depression: A Latent Class Analysis’. The Lancet Psychiatry 2.1 (2015): 59-67. Web.

Additional information can be found about this study:

Show your clients a little love this Valentine’s Day


Want to build your doula practice in 2015? Staying in touch with past clients can be a great way to get referrals!

Originally posted on The DONA Doula Chronicles:

Valentine’s Day is usually connected with candlelit dinners, chocolate, flowers and jewelry (or so the TV commercials want us to think!). Because it’s seen as a time to celebrate romantic love, this probably isn’t a holiday that makes you think of connecting with past doula clients.  Valentine’s Day can be great inspiration to reach out to families you supported and let them know you are thinking of them.

Greeting cards are widely available with “I’m thinking of you” messages. Add a quick note letting the family know you are thinking of them and hoping they are taking some time to celebrate their marriage or relationship on this special day. Mention some ways you noticed how they connected  with one another or sweet moments you observed between the parents while supporting them. If you are willing and your schedule allows, ask them to stay in touch or let you know if…

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What’s in store for 2015: Interview with DONA International President

Recently, Sunday Tortelli, President of the DONA International Board of Directors talked with The DONA Doula Chronicles about the organization’s plans for this year.
TDDC: The DONA Doula Chronicles,  ST: Sunday Tortelli

Sunday headshotTDDC: Thank you, Sunday, for making time to talk with me and provide a look into what’s coming for DONA International in 2015.

ST: I appreciate the invitation and enjoy the opportunity to connect with our membership!

TDDC: Let’s start with a quick summary of your role in DONA International. For our readers who aren’t familiar with either how non-profit boards of directors work or DONA’s own structure, could you give us a quick summary of your role as President of the Board of Directors?

ST: As the President of our board, I guess you could say that role is one of a “generalist” rather than a “specialist.” What I mean is that I have the privilege of working with everyone on pretty much everything. Each director on our board is a specialist overseeing the work of their committee.Our executive director and home office staff are also specialists focusing on very specific functions as they assist us with the management of such a large and active organization. It’s important that I have an overall working knowledge of the goals and challenges of our management and each committee, as we strive to uphold the mission and vision of DONA International in all that we do. For that reason, I am grateful to have spent many years as a “specialist” in my first role on the DONA International Board of Directors as Director of Publications. In that role, I was responsible for producing the International Doula and eDoula, and I also had the advantage of assisting in the production of all the documents, packets, brochures and published information from all the committees. That experience gave me a very deep understanding of all aspects of our organization and I draw from it every day in my current role.

TDDC: And you also serve as Interim Editor of the eDoula newsletters in your spare time!

ST: Yes, I am happy to fill in on a temporary basis, but that position is available if any of our readers are interested!

TDDC: I’ll be sure to include information so our readers can learn more if they are interested. With the start of a new year, I thought we might be able to talk about what’s in store for DONA International in 2015. If there were a theme for this year for DONA, what would it be?

ST: Hmmm…..I think it would have to be “connection” or “connecting” something along those lines. We are really looking to strengthen our connection to our members and their connection with the organization, better connect doulas to high quality, accessible, affordable and evidence-based continuing education and increase DONA’s connection to the larger community including families.

TDDC: DONA International has always been known for its commitment to education so let’s start there. What is happening in 2015 to connect DONA members to information and training to improve their knowledge and skill?

ST: Actually, we mean all doulas, not just DONA International members. We think that by offering quality educational offerings for doulas who are not yet members we will improve the knowledge and skills of all doulas. This also lets us highlight our strong commitment to continuing education, scope of practice and evidence-based resources to the larger birth community. We are now offering on-demand webinars so doulas can access DONA approved trainings anytime and from anywhere. Just like at our annual conference, we will address topics related to the doula’s role, research, business areas like marketing and where possible – doula practice skills. We are giving members one free webinar per calendar year.

TDDC: Since DONA is offering the webinars will they count toward recertification contact hours?

ST: Yes. Just like sessions attended via our virtual conference coming up in August, the webinars will count toward the continuing education requirement for recertification.

TDDC: Tell us about strengthening the connection between DONA International and its members.

ST: One of the things we recently reviewed is recertification. From time to time, it’s important for every organization to evaluate its processes to see how those processes can be improved to better serve our members. We know the recertification process can be stressful and confusing for members and it also takes considerable resources by DONA as well to answer questions, review packets, etc. We believe very strongly in recertification to maintain knowledge and skills, and also demonstrate legitimacy and credibility to care providers and the families doulas serve. Most professions have recertification requirements for the same reasons – accountants, lawyers, nurses, doctors, therapists, and childbirth educators to name a few. So, we’ve simplified the recertification process. Now there is only one designation and one fee. Rather than the previous “inactive” or “active” statuses, which were confusing to many members, a doula will simply become “recertified” upon earning and documenting the minimum number of contact hours, maintaining DONA International membership and paying the recertification application fee. There is no need to submit documentation of doula experiences. The recertified doula may then choose to be listed on the DONA website or not. This updated recertification information for birth and postpartum doulas is already available on the website. We are also making some minor modifications to the certification process, and the birth and postpartum certification packets are currently in revision.

TDDC: What other ways is DONA International looking to foster a stronger connection with members?

ST: We are continuously looking to improve our communication avenues with our members so that we are providing them with timely and pertinent information whether that’s through the eDoula e-newsletters that are specific to each member’s region, the International Doula magazine, the blog or our social media accounts. In order to be more responsive to news items or research and continuously share practice tips and resources, we’re expanding our blog and social media presence this year. Last fall, we sent out our first Annual Update to help provide a summary of DONA’s activities and achievements, and we will look to repeat that and improve it this year. On a more direct level, we’d really like to see more of our SPAR – State/Provincial/Area/Representative – positions filled. These members are important first points of contact to new members in particular. SPARs are a great local resource for members and can help connect members to the right person within DONA – whether that’s someone at the Home Office or a Board Member to address their need. SPARs often host area gatherings or virtual meet-ups of DONA members, which helps to connect members to one another for support and to share resources. This role is a great way for members to support DONA and other doulas.

TDDC: You also mentioned connection with the public and expectant families. What are the plans there?

ST: We revitalized our Advisory Council this year to serve as a resource for the organization. They will provide us with outside advice on our operations, marketing and member services. We announced their appointment in the most recent issue of the International Doula and will be introducing the members of the Advisory Council to DONA International members more fully in the spring issue of the magazine. We will then share more on the Advisory Council and its members with the larger community. It’s important that our members hear of developments like this first. It’s their organization after all and we wouldn’t exist without our members.

TDDC: I appreciate you giving us a peak into what’s coming this year for DONA International and taking the time to talk with me today.

ST: You are quite welcome. Thank you for sharing what’s happening with The DONA Doula Chronicles readers.


Note: For those interested in the role of eDoula editor, please contact Director of Publications Tracy Good at If you would like to be a State/Province/Area Representative please contact the Regional Director for your area. The full list of Regional Directors and open SPAR positions is available here.

— Adrianne Gordon, MBA, CD(DONA)

Does Vitamin D Deficiency Increase Labor Pain?

Vitamin D is often called “the sunshine vitamin” since it can be absorbed through the skin from the sun. Deficiencies in vitamin D have long been associated with brittle bones and some research has found connections with cancer, autoimmune diseases, high blood pressure, asthma, and depression. Recently, a connection between low vitamin D levels and increased pain during labor and childbirth has been explored.

A study presented at the ANESTHESIOLOGY ™ 2014 annual meeting found an association between low vitamin D levels and increased requests for pain medication. The study evaluated the vitamin D levels in 93 pregnant women and then the amount of pain medication consumed during labor. The findings showed a correlation, but how or why vitamin D levels may impact labor pain is not known.

The sample size for the study is quite small and only patients who requested and received an epidural were included. This raises some interesting questions. Do expectant mothers who desire a natural childbirth produce or consume more vitamin D? Is this related to their level of information and education about pregnancy and childbirth? We know that childbirth education and the intention of a natural birth are correlated. Could it be that as part of their learning process, this population of mothers-to-be also research nutrition, diet and supplements?

Additional research on the connection between vitamin D levels and the amount of pain medication consumed during labor is definitely needed. In the meantime, it may be useful for doulas to provide information to clients on what is known about vitamin D in terms of general health benefits during pregnancy. The World Health Organization (WHO) notes that vitamin D deficiency is associated with increased chances of pre-eclampsia, gestational diabetes and pre-term birth. WHO provides information on vitamin D supplementation, including their guidelines and evidence on the topic, here.

Vitamin D deficiency: and


— Adrianne Gordon, MBA, CD(DONA)

In Case You Missed It: Homebirths Encouraged for British Mums

Last month, Britain’s National Institute for Health and Care Excellence released new guidelines encouraging women with uncomplicated pregnancies – roughly 45% of all pregnancies in their estimation – to have their babies at home or in a birth center instead of a hospital. This new advice marks a significant shift in the NIH’s position on birth location, which as recently as 2007, advised caution about home birth. The change came, in part, from the findings from a 2011 Oxford University study that found that low risk mums-to-be birthing in a hospital had a higher risk of cesarean delivery, infection, and episiotomies. The study also noted that hospital-based births are more likely to include epidural anesthesia, which was found to increase the risk of protracted birth and the use of forceps. The overall risk of serious complications and death for infants was found to be the same across hospital, birth center, and home births for multipara mothers. First-time mothers birthing at home have a slightly increased risk for such complications.

home-479629_640Going forward, pregnant women in the UK expecting their first baby will be encouraged to seek care from a midwife-led delivery unit either based in a hospital or out-of-hospital. Those having their second or subsequent baby and considered low-risk will receive even greater encouragement to delivery at home. The guidelines recommend informing multipara mothers that a home birth would be just as safe for their baby and an even safer option for them than delivering at a hospital. NIH’s announcement about the new guidelines says, “Healthcare professionals should inform women of the options available to them and advise that they have the freedom to choose where they give birth.”

Read the full announcement from NIH here.

Additional coverage of the guidelines can be found at The New York Times and The Guardian.

Make S.M.A.R.T. Plans for 2015

new-year-586148_640A new year is upon us and with it comes planning for the months ahead. While some may resolve to start or expand a doula practice (pun intended!), it’s no secret that the right kind of goals can make all the difference in what you will achieve in 2015.

It is commonly known that writing down goals increases your chances of achieving them. But did you know that how you set those goals also impacts the chances they will be achieved? S.M.A.R.T. is an acronym that is both easy to remember and also provides very helpful tips in creating goals that are more likely to be achieved. It stands for:

Specific, Measurable, Achievable, Relevant and Time-bound

Specific – This means that the goal isn’t overly general such as “Become a doula.” What kind of doula – birth or postpartum? Does this mean attend a training? Complete certification? With what organization?

Measurable – There is a quantifiable aspect of the goal such as “Complete the remaining requirements for my birth doula certification.”

Achievable – This helps prevent the goal from being too large or complicated. For example, “Attend five births as a certified doula” might be too big of a goal for someone who hasn’t yet attended a training or reviewed the requirements to be certified – it simply may be too much to accomplish in the time available.

Relevant – While this generally applies more when someone like a supervisor is setting a goal for you, it is important to make sure that the goal is worthwhile and matches up with other goals and plans. For someone expecting a baby, finding a doula may be more relevant to where she is in life than becoming one! Of course for others, pregnancy may be the perfect time to lay the foundation for a flexible career that she can manage from home; it’s a matter of considering the whole picture.

Time-bound – Setting a specific deadline can make a big difference in whether a goal is achieved or not. This is particularly true when you have several steps which together achieve a larger, overall goal. For someone embarking on a doula career, setting deadlines to choose a training and certifying organization, completing the training, and supporting her first client will go far to help achieve the larger goal of becoming a doula. For someone who wants to finish up her certification and then expand her practice as a certified doula, her S.M.A.R.T. goals might look like this:

  • Find certification packet and review outstanding requirements by January 15th.
  • Complete reading requirements by March 31st.
  • Write essay by April 15th (sometimes shorter time frames can help stave off procrastination!).
  • Create resource list by May 15th.
  • Collect Client Confidentiality Release Forms, birth record sheets and client evaluations from all clients in 2015.
  • Request evaluations from care providers at every birth attended in 2015.
  • Submit completed certification packet by June 30th!

Remember that writing goals down can help make them a reality. Sharing your goals with family or a close friend who can help keep you accountable can also help keep you on track as well. Here’s to S.M.A.R.T. plans for 2015!


— Adrianne Gordon, MBA, CD(DONA)