Babies are great, but what I love about birth is how that experiece will influence who the birthing parent is, how they view themselves as the caretaker of this new little person they have made, and how they view themselves as a person with a place in this world. I want everyone to feel at the very least competent, and birth in American seems revolve around making birthing people feel inadequate, dysfunctional, dependent. My vision as a birth educator is to change that.
When I dipped my toe into our local birth community in 2012, I was ready to join the ranks of other birth warriors, fighting for the rights of birthing people in my hometown and all of Monterey County.
Well... found fighting for sure...
Fighting doesn't scare me. I'm comfortable in debate, I'm not easily offended, I believe in confrontation and flushing things out into the light.
I'm also successful. Eric's work is unpredictable and some years my income keeps us from losing our house. I've started several successful businesses. I've never left an industry because I couldn't get my service to the people who need it and make enough money to live, save, and support my tattoo habit.
So if you have read Buzzfeed's recent ProDoula article, this is a response.
If a friend hadn't sent it to me, I may have never heard about it. I don't belong to many birth pro facebook groups. There is real, life changing and saving work to be done and I don't think it happens in those groups. I don't find them productive and everyone is usually rehashing the same arguments over and over. Meanwhile, we need to change legislation, hospital policies, and radically improve outcomes and experiences and I do not have time to do that and argue with yet another doula about fees. I give zero fucks what you charge when this motherfucker over here snapped yet another cord during an aggressive 3rd stage management.
But I read it, and read some interesting responses and there's many good points that can be made, but I was reminded of the practices that had deeply damaged our community, so I thought I'd share.
So, in 2012 I stepped into a community, specifically a birth network (not affiliated with BNN), where tensions were high and collapse was possibly imminent. I kept my opinions to myself and listened to warnings about competition and scarcity and backstabbing and cutthroat doulas who worked more for the doctors than the moms and unprofessional rogue doulas who fought with care providers, and who was safe and who wasn't and if you want to make it you have to be in with so and so or don't piss off blah blah blah.
Well, I've never "made it" because I was in with someone, so while that wasn't meaningful to me, I was sad for these people doing such important work, but hobbled by all this drama. I wanted to fix it, but I also needed to fix it because my students left Meet the Doula events saying many of the doulas were clearly trying to have the last word, very competitive, palpable dislike for one another, and they didn't want that at their birth. I went to see for myself and lo and behold that's exactly what I witnessed.
Yes, this community also had childbirth educators, midwives, OBs, nurses, massage therapists... but all of the tension came from the doula community. They were the problem child and at first leadership was a permissive parent, but I later discovered they were mostly exhausted and out of options, considering letting the birth network dissolve. When I joined the Board, I pushed us forward into gaining our nonprofit status, establish by-laws, a code of ethics, a grievance policy... and advocated for saving the Meet the Doula events, even though I am not a doula.
Then I picked up the end of the string at "scared, anxious community" and followed it to just a couple aggressive and insecure doulas holding a community hostage with threats, fear mongering, and divisive marketing approaches that centered around harming the reputations of their competition (or peers) to both parents and care providers. The local "rogue doulas," a myth. I've never found any evidence of a doula here working outside their scope or interfering with care, just a lot of vague rumors that drove business in one, clear direction... which I followed. I asked questions and listened to all sides and learned from the successful doulas how they aligned themselves with the desires of the nurses and providers, at the expense of their clients as they persuaded them to comply... cornering the market on some OB and hospital referrals. As a business model, this may be a ProDoula fairy tale, but I don't think it's what parents are expecting when they hire a doula.
In the end, the policies put in place to protect members and parents worked, without my involvement. Truthfully, I hoped by offering ethical marketing alternatives we would see aggression traded for confidence and collaboration. I was a little dumbfounded that it didn't play out that way, but now our birth network is a safe place. It has doubled in size, nearly all the local doulas, educators, midwives, and many complimentary practitioners and some wonderful OBs belong. I want that to be not because they are afraid not to, or because of cult like devotion, but because we help them reach more clients and give them valuable professional development resources. The number of families we connect with professionals has multiplied many times over.
I believe in service, and donating thousands of hours to this community and seeing the culture of birth in our hospitals shift, access to midwives improve, and more people meet their babies in a supportive, respectful environment is very fulfilling, but it's not all selfless. It's worth noting that friendships are not without worth, and sure, you can't feed your family with good feels after a networking event, but it's possible to be successful, and liked. With a flourishing network, my business has grown, and I'm encouraging more people to offer high quality, comprehensive childbirth education to meet the demand. When yelp calls, I tell them I have no room for growth, my classes are full. I still have big aspirations and something new is always in the works, but I don't feel like I have to hustle so much, and I certainly haven't spent tens of thousands to get here. There is a comfortable and enjoyable rhythm to my marketing, and it's accessible to all of my colleagues who share my vision.
If you think the only options are to be cutthroat and successful, or a softhearted failure, I'm truly sorry for your narrow understanding of success. If you can't make it using ethical marketing, maybe you just aren't good at this work. I don't know Randy, she has cool hair and I'd have a beer with her like I would anyone else... but "elevating the doula profession" is not marketing the doulas whose success you will personally benefit pyramid scheme style, from while harming and excluding doulas outside of your organization. As long as that mentality continues, there will be hurt, and drama, and quality ProDoula doulas everywhere will carry that stigma.
When asked about my role in the birth community, I identify myself as a birth activist and educator. A common follow up question is whether I'm going to become a doula or a midwife.
Like I'm a caterpillar...
So I'm finding myself saying, "no I'm just an educator," and I feel myself reinforcing a birth worker hierarchy that I'm totally opposed to... a food-chain that would look something like educators as grass, then doulas, OOH (out of hospital) midwives, nurses, hospital midwives, OBs... right? And we need to be nice to whoever is above us so they don't eat us.
My experience leads me to believe many OBs feel they can do everything a nurse, OOH midwife, doula, or educator can do; that a nurse believes they can do everything a OOH midwife, doula, or educator can do, that a midwife believes they can do everything a doula or educator can do, and that a doula believes they can do everything an educator can do. Maybe you perceive this all differently, but I'd like to talk about it.
We are not nesting dolls, these are all unique professions, we aren't just leveling up.
Local physicians have told my students that they will be their doula, and my own OB told me there is nothing a midwife does that he doesn't do (long story short, not true). I've been told by midwives that they are their clients childbirth educators and doula. I've sat in rooms full of doulas, as the only non-doula, and had all these beautiful women whom I totally admire tell me they don't refer clients to childbirth educators, because they are their clients' educators.
I know parents are participating too. I sit on several panels a year and I watch parents hold the opinion of the physician higher than the doula's, when at times, the MD may have little or no expertise in the subject being discussed and the doula may have a tremendous amount. Parents have shared they have hired a doula because she is in midwifery school, which I see the logic there, but there are doulas who are in midwifery school who are much less experienced than doulas who are... "just" doulas.
This is deeply irritating not because... I'm the grass, or the littlest doll... but because I know how this negatively impacts parents, and I want us all to do better by being honest about our expertise, our roles, and referring our clients to the appropriate people to fill the other necessary roles on their team.
In addition to this, many of the roles actually prevent practitioners from truly taking on the responsibilities of the other profession, or their responsibilities interfere with their ability to take on this outside role.
Let's look at doulas and educators.
I want all my students to hire a doula. I have volunteered at least a thousand hours (pulled out a calculator, or the calculator app, to confirm) to the promotion of doulas in my community for no reason other than the fact I know a quality doula helps people have a better birth. Some of my closest friends are doulas, and I will have a doula at any of my future births.
This doesn't mean I will support the idea that a doula is a childbirth educator just because education is one way in which they support (along with emotional and physical support). I'm fresh out of several courses designed with doulas in mind, and I hope doulas are considering how their role as a support person can interfere with their ability to also be a truly comprehensive educator. Also keep in mind, if your certifying organization offers both doula and cbe certs, this topic may not come up because they want to sell you more of their product. Education is such a critical part of a birthing person's prenatal preparation. How much can you really cover in two prenatals, along with everything else you should cover as their support person? What about when the information might put you at odds with their care provider, whose referrals you may want or you will soon be working alongside in the birthing room? How does that impact your client's education from you?
I recently completed a course in communication for doulas (that was wonderful, I'd recommend it to every doula) that was teaching doulas to communicate with, and educate their clients. However, they shared recommendations that completely undermined the doula's ability to educate in a comprehensive way, though did strengthen the bond between doula and client. This bond is essential, but is it smart to achieve it at the expense of the parent's education just so one professional can fill two roles?
I appreciate and frequently think about this passage from "Three Things Your Doula Can’t Tell You" by Cristen Pascucci of Birth Monopoly:
"My own doula and I have had more than one conversation about why she didn’t warn me about my own provider—someone who I now know has a reputation for not following through on promises to patients. 'But I asked you!' I’ve said to her. 'Why didn’t you tell me?'
I completely understand why a doula needs to choose the information they share carefully. Birth is an intimate event, it's important parents feel completely at ease with their doula. Same is true with OOH midwives. If a doula share's clear opposing or favoring evidence regarding an intervention, or a controversial newborn procedure like circumcision or vaccines, then the parents may take that as the doula being biased. The doula may fear the parents will feel unsupported in their decision that might be contrary to evidence, and that parents may hear "these studies show midwifery care has better outcomes than OB care," as "You made the wrong decision by choosing an OB." I've personally watched great doulas backpedal true but uncomfortable statements to comfort their clients. I don't completely disagree with this, I understand it, it's one reason I am not a doula. I present the evidence, I share stories, techniques, answer questions candidly (yes, even "what do you think of my provider") in a friendly and I hope engaging way, but will not also soften what may be a harsh truth or say positive things regarding decisions that I know work against the parent's desired outcome... I feel this role is important, and has a place, uncompromised by other roles. My experience is that parents want someone to plainly "tell them what they're up against" at some point in their prenatal care, and there needs to be a role carved our for that to happen.
There is nothing that I respect more in the birth community than a practitioner that frequently refers clients out to other complimentary practitioners. Have pride in your area of expertise, every one of these roles is absolutely indispensable.
If you are an OB and your patient wants a doula or a midwife, you will not fill that role, you will just have a less satisfied patient, maybe not the day of the birth, but someday when they have more information or experience. What you do is important, but different.
Midwives... you know I love you... half of my students who begin with OBs switch to midwives... but when you are being a midwife, you are not also being a doula. I've had a fair number of local families share they regretted not hiring a doula for their home birth, and often times they were told they did not need one. Doulas are not there to defend families against unnecessary procedures, home or hospital. The doula is there to provide continuous support in any setting while you chart, observe, rest... or so the partner can eat, use the bathroom, have a moment to collect themselves.
Doulas... I'm so grateful for you. I am lucky that in my community, doulas have embraced the need for comprehensive education for their clients. I'm concerned about burnout rates and the expectation that a doula should do it all, doula, cbe, placentas, photography, lactation... and how much of this is because of organizations trying to sell more certifications? I want to see doulas have long fulfilling careers doing what they love.
Educators... we provide the foundation. We present all the options and the evidence so that parents can make the important decisions that only they should be making. We help clients understand how a doula can support them, why a midwife might be an appropriate choice for them, or how to find an OB that is supportive of the care they want. Don't let anyone undervalue what you do.
Please network, connect with different practitioners in an authentic way! Midwives, sit in on your local CBE classes and Meet the Doula events and see how they can be of value to your clients. Doulas, keep the ass kissing to a minimum, you do noble work, expect respect for what you do. Doctors and nurses, come out and have a drink with us once in a while, come to birth network events, and hear our perspective and we will hear yours. We all make a great team if we'd all just let it happen.
In friendship and optimism,
Happy New Year
UPDATE: I am offering doula care periodically, only for families who have received the foundation of a quality, comprehensive childbirth class.
Natural Birth Series
Sept 28 – Nov 15
Infant Sleep for Expecting & New Parents
6:30pm - 9:00pm
Gentle Cesarean: Planning & Recovery
Toro Park, 3-6:30pm
Natural Birth Refresher
Salinas, 1– 4pm
Preconception & Early Pregnancy Class
Salinas, 1– 4pm
Sibling Prep for Parents & Kids
November 4th & 5th
Toro Park, 2:-4pm
Fall Home & Birth Center Birth Series
Nov 7 – Dec 12
Natural Birth Series
Nov 29th – Jan 17th