How to Build a Sustainable On-Call Schedule as a Birth Doula

By Birth & Baby University · Last updated: October 2026 · 3 min read

Being on call for a birth means that for several weeks your phone can end any plan, any night’s sleep and any school pick-up. Doulas often manage this alone, with no employer rota, and burnout is a recurring theme in doula research. Evidence on on-call work among doulas themselves is thin, so this article draws on systematic reviews of on-call work, studies of midwives who work on call, and the continuity and backup standards doulas are expected to meet.

Key takeaways

• A systematic review of eight studies found that working on-call from home appears to adversely affect sleep quantity and in most cases sleep quality, though studies did not separate nights with and without calls.
• A survey of 238 midwives in England found higher burnout than reference groups, with working hours positively associated with burnout and occupational autonomy and support for work-life balance protective.
• A study of extended wakefulness found that after about 19 hours awake participants rated their driving ability as poorer and their reaction performance declined; earlier studies with the same protocol found performance equivalent to a blood alcohol concentration of 0.05%.
• DONA’s standards say backup arrangements should be stated in the contract and Illinois’ code expects doulas and clients to identify backup doulas.

What the research and guidance say

Sleep and health

A 2017 systematic review of on-call work found eight studies of working on-call from home and sleep, which suggested adverse effects on sleep quantity and in most cases quality, and found data on stress physiology insufficient to draw conclusions. An earlier review of on-call work and health said the limited research suggests on-call scheduling can pose a risk to mental health, job stress, sleep and personal safety, with critical gaps in the literature. A study of 32 people kept awake for 40 hours found that self-rated safe driving fell as performance slowed, reaching poorer-than-neutral self-ratings after 19 hours of continuous wakefulness, and cited prior work equating that level of impairment with a blood alcohol concentration of 0.05%. A drive home after a long birth is therefore a real safety question. This study was in a laboratory, not doulas.

What midwives report

A survey of 238 midwives at one English hospital trust (128 responded) found significantly higher burnout than reference groups, with high occupational autonomy a protective factor, working hours positively associated with burnout and support for work-life balance protective. An interview study of 17 midwives in an Australian caseload model described strategies for managing flexible hours and on-call work, and found a period of adjustment was needed and that organizational, team and individual structures shaped how flexibility was managed. Midwives work in institutions with colleagues and pay, which most independent doulas lack, so the analogy is imperfect.

What standards expect

The DONA birth doula standards say the doula should make backup arrangements whenever possible, state them in the contract, and notify the client in writing if discontinuing service. The Illinois Medicaid-Certified Doula Guide says doulas are transparent about planned absences, identify backup doulas with clients and share necessary information with backups while protecting privacy.

What this means for doulas

• On-call is a health variable. Reviews suggest it can disturb sleep even when no call comes.
• Limit what you take on. Number of clients in a window and length of the on-call period shape the burden.
• Backups are part of the job. They make time off possible and meet professional standards.
• Plan the drive home. After a long labor, decide in advance how you will rest or get home safely.

Putting the evidence into practice

• Set a maximum number of clients due in any three-week window, and write it into your plan.
• Define your on-call window in the agreement, and your response expectations during it.
• Build a backup group of two or three doulas, agree how information is shared and test the system before it is needed.
• Protect recovery: plan a rest period after each birth, and arrange not to be on call for other clients immediately after a very long one when possible.
• Keep days off between windows, and mark them in advance on a calendar that clients can see.
• Review each season: hours worked, nights disturbed, how you feel, and adjust capacity.

The bottom line

On-call work can erode sleep and well-being, and professional standards expect doulas to plan backup. Sustainable practice means limiting client volume, defining on-call windows, building a backup network and protecting rest, with the caveat that research specific to doulas is lacking.

Related reading: How to Create Professional Doula Service Packages and Contracts; Understanding the True Cost of Running a Doula Business; Professional Boundaries and Emotional Labor: Protecting Your Well-Being as a Doula.

This article is for professional education. It is not medical, legal, financial or tax advice. Check the standards of your certifying organization and the rules where you work.

Sources and further reading

• Hall SJ, et al. The effect of working on-call on stress physiology and sleep: A systematic review. Sleep Medicine Reviews 2017. Read the source
• Nicol AM, et al. On-call work and health: a review. Environmental Health 2004. Read the source
• Jones CB, et al. Self-awareness of impairment and the decision to drive after an extended period of wakefulness. Chronobiology International 2006. Read the source
• Yoshida Y, et al. Occupational burnout and work factors in community and hospital midwives: a survey analysis. Midwifery 2013. Read the source
• Fereday J, et al. Managing a work-life balance: the experiences of midwives working in a group practice setting. Midwifery 2010. Read the source
• DONA International. Birth Doula: Standards of Practice (revised September 2025). Read the source
• SIU School of Medicine. Illinois Medicaid-Certified Doula Guide (posted December 2024). Read the source

Sustainable on-call practice depends on backup, boundaries and community. Birth & Baby University’s For Doulas page describes training, mentorship and agency-building resources that touch on building a practice you can sustain. Check your certifier’s standards on backup and continuity for your own agreements.

More for professionals: the Professionals Blog.