Nine years ago, our beloved babysitter delivered the devastating (to us) news that she was veering away from childcare to train as a doula. My German partner looked confused. Despite his fluent English, “doula” was, to him, just two syllables stuck together, signifying nothing. I had heard of doulas, but I was also confused. Doulas, as I understood it back then, were a purely American phenomenon: providers of non-medical support to women who were giving birth.
Back rubs, I thought, offers of tea and hand-holding, all things I could see being of value during the bewildering rollercoaster ride that is childbirth, but also things well-catered to – and more importantly, paid for – by the German healthcare system. Cut to 2025, and doulas are an established and valued part of many Berliners’ birth stories. While the exact number of doulas working in Berlin is hard to come by (there is no licensing body), a simple Google search threw up dozens of Berlin-based English-language doulas.
We’re doula-ing each other for free, and we’re burning out.
The doulas I spoke to had more requests from potential clients than they had time to offer; one was about to run a third English-language Berlin-based doula training, with each intake consisting of 10-15 trainees. What’s more, the support offered by doulas has expanded far beyond my understanding of the role nine years ago. In Berlin, it is now possible to be accompanied by a doula when going through a multitude of life-changing events, including abortion, miscarriage, stillbirth and death.
As of 2020, it is even possible to hire an English-speaking, Berlin-based doula who will support you during a gender transition – a service only offered by a handful of doulas worldwide. In other words, despite doula packages costing anywhere from €500 to €2,500 out of pocket, doulas are flourishing in Berlin – a city where almost all healthcare expenses are paid for by insurers. What gives?
To find out, I called up the doula whose website appears at the top of all my web searches: our former babysitter, Jes Walsh. When she started her business in 2017, Walsh was one of the first doulas in Berlin. Now, having assisted “somewhere between 70 and 100” clients, she’s one of Berlin’s most sought-after English-language doulas. She acknowledges that the early days were tough. “Very rarely did anyone know what a doula was,” she recalls. “What helped grow my business was that the general population of Berlin shifted. A lot more start-ups and bigger companies moved to Berlin, which meant many more international people moving to Berlin from the US, the UK and Australia – all places where doulas were much more common.”
Although women have been helping each other during birth for as long as women have been doing it, the professional doula was born out of the natural birth movement in the US in the 1960s. The name was coined in 1969 by American medical anthropologist Dana Raphael, who, somewhat mystifyingly, drew on an ancient Greek word for “female slave” (it could have been worse: the word “gossip” was used in Renaissance England to describe the way friends attend a birth).
While birth doulas do indeed rub backs, the suite of services they offer runs the gamut from the emotional to the practical: offering a listening ear, a postnatal massage and an address book full of contacts; rehearsing what may come up in labour; sticking to you like glue in the delivery room; advocating. Initially dismissed by the medical establishment, studies have long since demonstrated that doula-assisted births can result in a reduction of interventions such as Caesarian sections and in a higher Apgar score, which measures newborn health at birth. One early advocate for the work of doulas, Dr John Kennell, observed that “if a doula were a drug, it would be unethical not to use it”.
Given the very different medical landscapes of America and Germany – not least the fact that parents in Berlin are already entitled to one-on-one midwife care before and after a birth – the explosion of doulas working in the city in the last 10 years is noteworthy. In fact, since 2015, massively increased liability insurance premiums have driven many freelance midwives out of the delivery room. A Germany-wide shortage of Hebammen means that hospital midwives are often covering several births simultaneously.
Beleghebammen, like the one I worked with, are increasingly hard to find: a weary joke among pregnant families is that it’s necessary to start the search at the moment of conception. The particular demographics of a city such as Berlin, with its population of young, international residents, plays a role in the rising number of doulas. While the specifics may vary, the work of the doula is often an act of translation, not just between German and English but also between highly divergent health care systems and expectations.
Midwives began enjoying when a doula was there because if the clients didn’t speak German, there was a language barrier. “They were just happy someone could translate,” says Walsh. “Navigating the system here, if you’re not German-speaking, is quite a barrier,” observes Frances Witherspoon, an American who “grew up all over” and has been a Berlin resident since 2017 and a doula since 2022. “It’s helpful to have someone who first understands the language, and then also understands how the system works and how to navigate it.”
Like most doulas I spoke to, Witherspoon describes themself as a “full-spectrum doula”, which means they also offer doula services for those going through an abortion or miscarriage. What this looks like varies from client to client; it could mean offering support during a decision-making process, being at someone’s home during a medical abortion (which involves taking pills outside of a clinical environment), or processing the emotional impact of an abortion, miscarriage or stillbirth. Walsh has had the experience of supporting a client with a devastating late-stage abortion for medical reasons and then, a few years later, helping her give birth.
We give people, post-birth, all this grace and space. We also deserve that for ourselves post-abortion, or post-loss.
“[An abortion] is a very personal experience,” Witherspoon notes. “Some people might be very clear on the decision they’re making, but it still stirs something up on an emotional level.” As a queer person of colour, they are also acutely aware that an already complex emotional situation can be intensified by the specifics of identity. “Something that is maybe acknowledged but not talked about so much is that a lot of medical racism does happen. When you’re navigating an abortion, or any type of physical health issue, it becomes even more difficult if you have to navigate racism to advocate for yourself. It just makes it a more painful, more difficult experience. The same can be said for queer people. There’s just extra layers.”
Technically, abortion is still illegal in Germany, though doctors can approve the procedure under certain circumstances, and violations are very rarely prosecuted. (A recent attempt to make abortions legal failed just before the February election.) Until three years ago, it wasn’t even legal for a clinic to advertise it. Abortion is not covered by health insurance and costs anywhere between €350 and €600; it must be carried out before the 12th week (with some exceptions) and you must prove that you have undergone a state-approved consultation at least three days prior. That can all amount to what Cristina Leoni-Osion, another Berlin-based full-spectrum doula, calls “a huge logistical barrier”. They came to doula work after experiencing a dearth of support in the aftermath of an abortion in their home state of Virginia in 2012.
Alongside paid abortion doula care (“Sometimes I just meet people in a park and we eat ice cream and they talk about it”), Leoni Orison holds a free abortion storytelling circle in Kreuzberg’s Frauenzentrum Schokofabrik each month, during which participants process their experiences of abortion. “We give people, post-birth, all this grace and space. We also deserve that for ourselves post-abortion, or post-loss,” they say.
Perhaps it’s no surprise that in a city with a large English-speaking population living away from family and old friend groups, there is a need for a support system, whether that’s provided professionally or through a structure like Leoni Orison’s storytelling circle. Add to that the difficulties of finding an English-language therapist in Berlin, and the rise of the doula becomes even less surprising.
Wisconsin-born doula Gem Kocher has been practicing for several years, and has put together their own Berlin-based training programme for aspiring doulas, Rainbow Doula Coaching. In 2020, after observing how their peers in the non-binary and trans communities struggled to secure gender-affirming care, they decided to add a gender doula offering to their roster. “There was a gap, and I saw that it was needed, plain and simple. In the trans and non-binary community, we have Google Docs full of resources and referrals and contacts. We’re doula-ing each other for free, and we’re burning out,” they say.
For their trans clients, Kocher provides a mix of practical and emotional support, depending on where they are on their transition journey: researching doctors, confirming appointments, translating and attending them. One client asked them to be in the recovery room when they came out of surgery. “Combining the emotional load with the logistical load of doing all that research and reaching dead-ends is a lot,” they say. “I’ve seen as a doula that there can be a benefit to receiving professional support.”
All of the doulas I spoke to offer their services on a sliding scale, to make it more affordable to those on a lower income. Kocher slots a couple of free gender doula sessions into their calendar each year. Newer doulas may offer a reduced-cost or even free service. Still, if doulas are picking up the slack in a city with a shortage of therapists, midwives and support services for queer and trans people, it is hard not to wonder if individuals are being obliged to pay for the failings of a healthcare system, and whether such failings could be dealt with at a political level.
The other problematic element of the rise of doulas in Berlin is that the profession is unregulated. Each of the doulas I spoke to was trained and certified, but there is no international certification body and no license required: essentially anybody can call themselves a doula. While many doulas recognise the pitfalls of this situation for clients who have little to go on other than Bauchgefühl, or gut feeling, and testimonies of previous clients, many are cautious about what a licensing system would look like.
“Doulas are providing non-medical support during birth and postpartum, so from that perspective, I don’t see that there’s a benefit or need for regulation,” says Kocher. “People confide in us, they trust us. The fact we’re not part of the medical team is the strength of our profession, and we stay the strongest when we maintain that clarity around our role.”
“It’s a complicated topic,” Walsh says carefully. “What I would say is that a lot of skills from life carry over into doula’s work that you can’t learn in a training: having compassion, being a good listener, understanding systems and having a good relationship with the people you work with.”
Some 15 years before my Berlin births, I had a London abortion. Although I had to travel to England because abortion was, until 2018, illegal in my home country of Ireland, I was one of the lucky ones. My then-boyfriend came with me, and paid for half of it. I never regretted it. But the night before I was due to go to some anonymous clinic in a London suburb, my soon-to-be-ex boyfriend and I had a stupid fight about something. I had to walk past protestors outside the clinic. I woke up from the procedure with excruciating cramps. When I think of my twentysomething self in that cubicle and imagine a doula at my side, holding my hand and telling me I’d be okay – I would want that for anyone.
- Profamilia provides non-judgemental advice and information on pregnancy choices and abortion in Berlin, details.
