Life Circle Birth International

A little history and the first question:

The doula profession was born in the 1970’s, an offshoot of the natural childbirth movement in America. Women were reclaiming rights to their bodies that had been systematically stripped away from them by men who thought they were the inferior sex, by companies that wanted their labor, and by hospitals that were turned into companies and run by men who had shockingly little regard for how their female patients wanted to be cared for. It was “discovered” (a great aha! moment for those researchers, I’m sure) that birth outcomes improved and satisfaction increased when the birthing person was accompanied by another woman. And so, a term was coined and “doulas” were allowed into delivery wards. Question #1: do women need some researcher’s stamp of approval to do what they already know needs to be done?

Capitalism and the second question:

Now the doula profession has grown into a movement in it’s own right. There are agencies big and small, certification boards aplenty, a push to be covered by insurance, questions about whether to be considered part of the medical team or not, discussions about gatekeeping and cultural appropriation and more. New doulas entering this scene can feel underqualified and overwhelmed, seeking to compensate by looking for boxes to check and certificates to prove their legitimacy. In an increasingly competitive field they must learn marketing, build a website, have a portfolio of supplementary services they can offer, be prompt, professional, and worth the extra cost to their clients. Many doulas are women who need work with flexibility. Many have given birth themselves and want to make a difference in other women’s birth experiences. Some began working towards midwifery but chose to become doulas instead because they wanted to support the birthing process without the added responsibility of ensuring the safe delivery of the baby. They are full of compassion, guided by ancient intuition that calls them to the side of their sister in her hour of need. Question #2: how do you value something that can’t be quantified?

Equity and the third question:

Meanwhile, women, BIPOC, the LGBTQIA+ community, and poor people are still grasping for those stripped away rights to the healthcare they deserve. But healthcare industrialization has continued apace with hospitals and insurance companies still more worried about their bottom lines than the people they care for. Healthcare workers from nurses and midwives to doctors and specialists often get disillusioned and bogged down by insurance, corporate logistics, and policies, forced to swim against the current to give their patients the levels of care that made them go into medical work in the first place. And it would be all too easy for doulas – seeking legitimacy in the eyes of regulating bodies and insurance policy writers – to get swept up into that conglomeration. Question #3: is change possible?

Ask anyone what a doula is and you might get any number of answers from, “Oh, only rich people can afford that,” to the blank stare of the person you are talking to wondering what language you are speaking. Maybe you have been told that doula is a Greek word meaning “woman’s servant.”

The doula profession was born in the 1970’s, an offshoot of the natural childbirth movement in America, but it has grown into a movement in it’s own right. Now there are certification boards aplenty, a push to be covered by insurance, questions about whether to be considered part of the medical team or not, discussions about gatekeeping and cultural appropriation and more. New doulas entering this scene can feel underqualified and overwhelmed, seeking to compensate by looking for checklists and certificates to make them feel like they deserve their pay. But no matter how many doulas you ask what they think a doula’s role is and what direction the profession as a whole should take, you are unlikely to get two answers that match. That’s because doulas exist outside the medical establishment. They are independent, unique, individual. What they offer child-bearing families can’t be certified, can’t be numerated on a checklist. And isn’t that their greatest strength? No matter how many trainings a doula takes, no matter how many certification boxes she checks, she should always be answerable first and foremost to herself and the family she works with. And that should be protected.

In the the modern healthcare industry, people struggle to be seen as human individuals which is why the doula role was created. Healthcare workers from nurses and midwives to doctors and specialists can often get bogged down by insurance, corporate logistics, and policies, forcing them to swim upstream to give their patients the levels of care that made them go into medical work in the first place. And it would be all too easy for doulas – seeking legitimacy in the eyes of regulating bodies and insurance policy writers – to get swept up into that conglomeration.

What if, instead, doulas dug in their heals and sunk their roots deeper into the space that gave rise to the demand for them in the first place? What if they broke down the gates that are often kept by those with too narrow a vision of what care for families looks like? What if they stood firm and spoke up against discrimination and harmful policies that hurt patients and healthcare workers alike? What if they broke free of the servile position that can put them at the bottom of the medical pecking order, doing everyone’s dirty work, quietly standing by with no say in how their clients are treated.

I think it’s fair to say that no one goes into healthcare work to cause harm, but so far all the oaths, policies, procedures designed to avoid lawsuits, and research haven’t found a cure for racial disparities in maternal and infant mortality. Science marches on, but so does lack of adequate healthcare in communities of color. Quality healthcare remains accessible only to those who can pay for the privilege of receiving it, to say nothing of equity in types and availability of mental health care.

And what is a doula to do about all this? How can she best help families caught in this giant tangle of intersecting problems? Must she hide behind “scope of practice” to avoid responsibility for any of it? Should she get a fatter insurance policy? Carefully toe all the lines to avoid getting on the wrong side of doctors and hospitals and their legal teams? Become an expert at speaking only to her client and not for them using language like, “Do you want to take a minute to discuss your options before allowing this procedure to go ahead?”