It’s Your Turn to Make Doula History

Apr 3, 2017 by

AmyConf1993

Amy Gilliland, Madison Area Birth Assistants booth, Oct 1993, Madison Women’s Expo

Lately I’ve thought a lot about what’s left after someone is gone – and who tells their story. It has made me really think about who is going to write the story of our movement. Traditionally history is written by people after events have happened, after the world has already changed. It’s written by people who have the power to write and disseminate information – which is why so many of our perceptions of history are distorted.

What about us? What about our history? Who will write the story of birth and postpartum doulas across North America and the rest of the world? Who will point out the indigenous women who never abandoned each other under the pressures of western medicine? Who will write about the women in the seventies and eighties who said, “I will go with you and I won’t leave you”? Who will write about how we took care of each other when our own families would not support us in breastfeeding or avoiding another cesarean?

The battleground of the doula revolution was not on a national stage. It was quiet, in every labor room across the planet, where one woman held another’s hand and said, “You can do this, I believe in you.” We made a stand for another person’s mental and emotional wellbeing in a system that had little room for it. We protected the space. We stood by her side when she said, “No.” We agitated the system with a smile on our faces. We kept doing it, over and over again, for years, until eventually those in power could no longer ignore us or their own research.

That’s the big story. But what about the little stories? What about the doulas in Pueblo, and Springfield, and West Bend? How did birth change there because of the presence of those early doulas? All of our communities have little stories. Each weaves a thread into the tapestry of our great big story of doulas changing birth in the world. Where are those stories?

Who came before you, person reading my blog? And what was birth like in your town? The time has come for you to seek out retired doulas and nurses and midwives and find out.

You see, if we don’t write our own stories, someone else will tell a tale that serves their own purposes. Or they will be forgotten, seen as not being important. Much of women’s daily lives has been unimportant to historians. But doula history is significant. If any one movement will be singled out as creating change in our system of birth, it is going to be birth doulas. Mostly we’ve been like dripping water, slowly eroding rock, getting the system to change. Lots of drips lead to pitting a foundation, causing it to change in response or else collapse. So while we may not be at most births, we don’t have to be. Our impact continues to grow. We aren’t done yet.

What is your community’s story of change?

Starting in the 1990’s I was the Archivist for Doulas of North America (DONA). Doulas sent me articles from their hometown newspapers. Back then it was a rare occurrence. While we might have wanted to change birth, what we really wanted to do was make sure women didn’t lose their power while having their babies. We couldn’t do that for everyone, so we just focused on the family in front of us. We hoped that over time the value of what we did would show.

Our strategy (if you can call it that) worked. Nowadays there are tens of thousands of trained doulas, and many cities have well established doula communities. ACOG recognizes the value of birth doulas. That means to me that it’s an excellent time to look backwards.

That sounds good to me, you say. But what are you suggesting I DO?

  1. Have fun! Talking about this history of birth in your town can be really fun. Most people like to reminisce and are excited that their memories are important.
  2. Investigate! If you don’t know who came before you, start asking. More experienced doulas may be able to remember a name or two. But don’t stop there. Ask the nursing unit director, the lactation consultant in her sixties, and your local midwives. Childbirth educators often last for decades and may be very knowledgeable about past trends. If everyone is young, ask who they’ve heard about being important in years past. Sometimes the only people who are remembered are the ones people didn’t like, but they don’t want to admit it! That’s fine. One name will lead to another. Look for old newspaper articles in the online archive. Most articles will reference older ones, sometimes going back ten years or more.
  3. If you can’t find a specific person, ask retired perinatal professionals about birth trends. Hospitals were remodeled, attitudes towards induction, breech birth, VBAC, episiotomy, cesarean birth, and having family members present have all changed dramatically in the course of my career.
  4. Interview alone or have a party! Sometimes a celebration is in order. In fact I think we need more parties in our lives that celebrate our accomplishments, especially when it comes to birth. Instead of interviewing one person, you could lead a group of people to reminisce. That might be more enjoyable for everyone.
  5. Ask questions that encourage explanations and depth about events. Here are some OralHistoryTips (pdf doc) I compiled to help you.
  6. Create a timeline of the order of events and include anything that might be relevant. This will likely lead to more interesting questions and observations. If you like mystery novels, this is your project! It’s a discovery of how your community moved from where things were in 1980 to where they are today.
  7. Record your interview and make sure your participant has a microphone near their face to avoid recording background noise. Many smartphones can do this well.  There are apps that can transcribe your interview into written form as long as there is no background noise. You may end up with a really interesting podcast, or a local historical society or oral history project may want your recordings for their files.

Then what?  If you complete your local project, I will publish it on a web site devoted to doula history that is available for everyone to read, including students of history to use in their papers.

This project is about more than you. It’s about those who came before but also for those who will come after. You may not know what they will look like or how they will interpret doulaing for their generation, but our history is important for them to know. And if you don’t record it, probably no one will.

 

Resources:

Christine Morton covers much of the big history of doulas in her book, Birth Ambassadors: Doulas and The Re-Emergence of Women Supported Birth in America. It’s our most extensive resource. Since I lived that history, what struck me the most was what wasn’t in there – including all of our small struggles in our own communities. It’s our responsibility to build on Dr. Morton’s achievement and share our stories to build a more comprehensive history.

Along with Mothering magazine, in the 1980’s and 1990’s many of us eagerly read The Compleat Mother, a quarterly newsprint periodical that espoused a radical wholistic philosophy of empowering women through childbirth.  It was more raw and less polished than Mothering. It did not shy away from exposing the patriarchal philosophy entrenched in the medical system and the feminist power available to us when we took charge of our bodies.  Famous Midwife Gloria LeMay wrote “Remembering Catherine Young”, founder of The Compleat MotherRemembering Catherine Young, 21 July 1952 – 11 September 2001

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Career Minded Participants in Birth Doula Trainings

Dec 29, 2016 by

 

career-minded-doula-training-participantsIts natural to assume everyone in your birth doula training was there to become a doula. Not so! Only about half the people are there because they want to do labor support as birth doulas. What else can my research can tell us about career minded attendees? In my Journal of Perinatal Education article, “What Motivates People To Take Doula Trainings?” (Summer 2016, Vol 25, No. 3, p. 174-183), “become a professional birth doula with my own practice” ranked as the fourth most popular answer out of eighteen possibilities. In the question where people were forced to choose only their favorite five reasons, 60% included “birth doula” but only 30% chose it as their number one reason.

Hospital Based Doulas: What about “working for a hospital program”? Only 4% chose it as their top reason, but 20% selected it as one of their top five. Some participants expected to work both independently and for a hospital, as 24% chose both options. Hmmm…there are only a handful of hospital programs that employ doulas or pay them as independent contractors in North America. So this percentage made me wonder if some trainings in my sample were being conducted specifically for a hospital based program. However, these responses were not associated with a specific training, location or doula trainer.

Midwifery and Nursing Students: Another significant presence in trainings was participants desiring to become midwives. “Want to become a midwife (or am considering it)” was the number one reason for 20%, and a top five reason for 43% of participants. For the most part, the midwifery and doula bound groups had little overlap. Only about a third of people who put “birth doula” in the top five also chose “midwife”. Midwifery bound attendees are different in other ways too. They tended to be younger, not have children, and only about half had attended a birth (not their own). Interest in midwifery was confined mostly to women in their twenties. It dropped off almost entirely in the 30-39 year olds, with resurgence in the 40-49 year old group (who had all had children and attended a birth). Another contributing factor may be that 64% of all nursing students (n=42) chose “midwifery” as one of their top five reasons, and nursing students in the study tended to be younger and childless. In my experience, midwifery students have always attended doula trainings. But only in the last eight years are many midwifery schools requiring that students take a doula training before being accepted. In this way, the training serves as a screening and preparation tool to ascertain whether people understand the importance of support skills.

Nursing Students made up 9% (n=42) of total attendees and were more likely to attend to increase their birth knowledge (72%) and to explore midwifery (71%), as indicated in their top five choices. I found it very interesting that one quarter wanted to be in an atmosphere that “believed in women’s bodies and ability to birth naturally”. For the most part they were not interested in a doula career (only 7%) but many intended to volunteer their labor support services (36% of nursing students).

In comparison, “birth doula” bound attendees usually have birthed or adopted children, tend to be more evenly distributed across the age spectrum, with about the same number in their twenties and thirties. Participants in this study adopted children at twice the average rate in the United States (12% versus 6%). I don’t know what that signifies, but it’s worth mentioning! Slightly more than half have attended at least one birth (not their own) already.

Volunteering As A Doula: Birth doulas also displayed other altruistic motivations. Ten percent chose “volunteering as a doula on my own or as part of a program” as their number one (2.5%) or number two (7.5%) reason. A closer look revealed that 23% of all people in the study chose these three reasons as part of their top five: “professional birth doula with my own practice”, “volunteer as a doula”, and “make money in a profession I enjoy”. They felt that all of these things were possible as part of their doula career. In an open-ended question, participants said they intend to volunteer for specific programs for low income women, to go to foreign countries to serve, or for their own parish or mission work. Its also possible that they felt that volunteering was part of the path to gaining experience, had a lack of knowledge of how this could affect doula businesses, or thought this was an easy way to get started. Recall, these are neophytes to the doula world – these questions were asked before they had ever taken their training or likely joined a doula group on Facebook. They probably were unaware of the divisions over the “no free births” paradigm.

Making Money: What about “making money in a profession I enjoy”? Data was collected in late 2010 and again in 2013. While the two samples did not have any statistically significant differences with one another, the birth doula world itself was going through a large shift. In the early days of doula work, the idea of “making money” almost seemed exploitative, like it was breaking some kind of code of honor. How could you benefit from someone else’s labor and birth experience? It wasn’t unusual to think of doulaing as “a hobby that pays for itself”.

The next step in our professional evolution was a push to make birth doula work viable economically. It required a shift in how doula services were perceived by parents, perinatal professionals, as well as doulas themselves. I consider this period of time, from 2010 to 2015 to be a time of commodification[i] [ii] in the birth doula profession, most notably from the influence of ProDoula and their beliefs and paradigm. This shift in business professionalism has made “making money in a profession I enjoy” much more likely today. My point is that this was an emerging idea at the time of the first sample, and was much more established three years later at the time of the second sample. However there was no difference in the two time periods. Why?

First, these are not members of doula communities, but outsiders. It was fairly rare at the time to join a large doula group on Facebook before taking a training. Today, (by my own observation as a doula trainer) that is often the first place an interested person will visit. Two, commodification and the presence of doulas in the labor room are now assumed to be normal by non-doulas. Three, only DONA International trainings were sampled (2 countries; 19 states, 3 provinces; 38 trainers; 46 trainings; 467 participants; 85% response rate).  So these research findings likely only apply to trainings that also have an open focus (see “Take A Doula Training, Change The World” for more information on generalizability).

Now that I am a Research Fellow at the Center for Child and Family Well Being at the University of Wisconsin Madison, I am looking forward to interviewing a younger cohort and comparing the First Wave and Second Wave of birth doulas in future studies.

Perinatal Professionals: How about the childbirth educators? Only 14 out of 467 people identified as childbirth educators (CBE), but 63 people said they were taking the training “to enrich their childbirth education practice” as one of their top five reasons. Two things come to mind. First, people may consider the doula workshop to be part of the preparation to become an educator. Second, rather than focusing on becoming a CBE who teaches classes, their intention was to informally educate people about birth.

Ten participants were postpartum doulas and all of them wanted to become birth doulas. None were using the course to enrich their postpartum doula practice. But 14 people who were not PP doulas were taking it to enrich their future practice as postpartum doulas.

Nurses: Labor and delivery nurses made up 2% (n=10) of the sample, but nurses with no perinatal experience made up 4% (n=19) of the sample. Almost all of this latter group felt the workshop would make them more desirable candidates for labor and delivery positions, as indicated by choosing “add to my resume”. Seven chose “want to become a midwife” as their number one answer. A smaller number wanted to become birth doulas. Why weren’t there more nurses? As a doula trainer for twenty years, I can say that in the first seven years we had many OB nurses in trainings. But now nurses have other options to learn labor support skills at nursing conferences or workshops and earn CE credits. I also teach these workshops.

Non-birth professionals: Almost one fifth of participants (19%) taking trainings had no intention of becoming doulas, midwives, or labor and delivery nurses, as indicated by their top five reasons. Five percent chose “help women have better births not as a doula or birth professional” as their number one reason. Many had incidental contact with pregnant people and wanted to enrich their knowledge and support skills. They also wanted to be more informed listeners. In the open ended question, several listed their related occupation as social workers, home visitors, case managers, day care providers, or yoga instructors. This is a really important group. As I mentioned in my previous blog post [LINK], these are the outer rings of people who can pass along birth knowledge and listen attentively to birth stories. They extend our sphere of influence outward and change the conversations about childbirth to more meaningful ones, simply because they understand that support matters.

So far we’ve covered people who are in a training to advance their career aspirations, and those who want to increase their knowledge about birth and be inspired for change. In my next post I will cover a third group, who have a small but powerful influence over how a workshop actually unfolds. These are the people who are coming for healing from past births.

 

[i] Commodification is the transformation of goods, services, ideas, people, or other entities that were not previously considered goods for sale into a marketable and saleable item. It implies some standardization.

[ii] An interesting article on the commodification of women’s household labor, which has bearing on the internal and external struggles for legitimacy of the First Wave of Doulas (late 1980’s to mid 2000’s): http://digitalcommons.law.yale.edu/cgi/viewcontent.cgi?article=1126&context=yjlf

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What U.S. Birth Professionals Need to Understand About ICWA

Oct 13, 2016 by

icwa-alex-garland-photo-copyThe Indian Child Welfare Act – why is that relevant to my practice? The laws concerning children’s rights changed earlier this year. Although standards vary among the 544 tribal nations recognized by the United States government, some tribes consider a person with one drop of Native American blood as a member.  While only slightly over five million people have full or partial Native American heritage, the growth rate within the population is more than double that of other racial groups. At 26.7%, birth rates between 2000 and 2010 were almost triple that of the nation as a whole at 9.7% (U.S. Census, 2012). The average age of a Native American is 29 years old, compared to 37 years for all Americans (U.S. Census, 2012). This means most of the indigenous U.S. population is in their childbearing years – when they are most likely to be utilizing our health care services.

Why should we care? Recognition of tribal status is important to the individual, the family, and for the continuation of the tribe. The child may qualify for different social programs because of their heritage, but the most significant impact occurs if they enter a Child Protective Services (CPS) system.

Tribal status begins with correct information on the birth certificate. Even misspelling a name can interfere with identification. (The infamous Veronica case went all the way to the Supreme Court in 2013, which was caused in part by an error in spelling the absent father’s name on the birth registration form. Even though he was registered with his tribe, his misspelled name did not show up in a search. So the child was legally adopted by a White family until the father contested.) Since hospital staff are filling out the forms, it is important that parents and their support team ensure that correct names and demographic information appear on the birth certificate. In a recent briefing session, Oklahoma CPS social workers explained, “Even though we have a higher than average population of Native Americans in our state (Oklahoma), nurses still look at the baby to discern race and ethnicity. If the baby looks white or black, they check that off without ever asking the parents.”

Parents may also not realize why it is important to categorize their child’s heritage correctly from the very beginning. It is difficult, but not impossible, to get that changed at a later date – but it must be done with a court order by a judge.

Doulas can explain to families how ICWA affects their child’s rights, their ability to receive assistance or scholarships, and placement in the welfare system if those services are ever needed.

How does a person become recognized as a tribal member? Heritage is not established by clicking a box; the person must be recognized by the tribe. Each tribe has their own standards and they are not the same. After applying, the first step will be genealogical research on the child’s relative, who may or may not be a recognized tribal member. Most tribes keep complex family trees. Some records are online and easily searched, while others have paper records kept in file folders. If the relative is already recognized, establishing heritage may be fairly easy.

Why does this status change how a child is treated in protective services?  Native Americans are dual citizens, and each tribe has the right to be self-governing as a sovereign nation over its own lands and properties. That means that most large nations have their own child welfare services. They work cooperatively with the state or county CPS agency. Anytime a child needs to be removed from the home and a biological relative cannot be found, the child needs an emergency placement. This could happen if there was an auto accident that hospitalized the parents and it took time to notify relatives, or when abuse or neglect is suspected.

It is considered ideal for a Native American (NA) child to be placed with a NA family rather than a non-NA family, preferably within the tribe. The majority of families who take in emergency placements or foster children in the U.S are White. ICWA is designed so that children will be preferentially placed in a qualifying NA home when a biological relative is unavailable – even if that placement is farther away, even hundreds of miles away, from the child’s school or home community. This is the controversy of ICWA: it states that the child’s status as a tribal member is more important to nurture than the child’s emotional or developmental ties with an existing family or community.

Here is how it gets problematic: Let’s say five year old Melinda needs a temporary foster family. She is not listed as having tribal blood on her birth certificate. As her relatives are contacted, one of her paternal aunts mentions that she is a tribal member so her niece is too. Rather than getting the best possible placement from the start, Melinda would be put in a temporary home while her records are investigated. Since placements with a tribal family are harder to come by, she would likely be placed initially with White or Black foster parents. It may take several weeks or months – if all records are in order – before Melinda’s initial placement is confirmed or she is moved to a new tribal foster family. If she is confirmed as a tribal member, she will be moved, with no exceptions. So, what most of us are wondering is, “Why aren’t they thinking about Melinda and putting her needs first?”

In their own way, they are.

So, the individual child’s welfare is considered secondary to the cultural preservation of the tribe? Yes, that is one way to look at it. But the goal is for both to be important. If records are properly kept from the very beginning, many of the heartaches shown in the popular news can be avoided. The world is seen differently by many tribal peoples and this influences their definitions of health, harmony, and balance. The more we can step back and understand the world from that point of view, the more ICWA’s policies make sense from that perspective. In this informative essay, Clark explains that most western European or American thought is linear, and Native peoples tend to think in relational terms. “In the linear view, the person owns or is the problem. In the relational view, the problem is circumstantial and resides in the relationship between factors. The person is not said to have a problem but to be out of harmony. Once harmony is restored, the problem is gone. In the linear model, we are taught to treat the person, and in the relational model, we are taught to treat the balance.” So ICWA helps to bring their world back into balance.

How is this affected by past racist policies to assimilate Native people into White culture? Between 1790 and 1920, it was considered good domestic policy by the U.S. government to bring as many Native peoples as possible into White culture. By 1890, that meant separating children into residential schools where they would not learn their tribal language or beliefs or participate in events and ceremonies. Children would be effectively cut them off from their past and their people. Adoption became a negative thing because it was used as a method to separate NA children from their culture and families of origin. The goal was not to place the child back in their home, but to find whatever possible reason to keep them from returning. This went on for over fifty years, leading to multiple generations of tribal peoples feeling angry, lost and without a sense of belonging. Many of the social problems that Native peoples face today have their roots in U.S. government policies of assimilation. So part of what is happening with ICWA in 2016 is a response to the damage done by assimilation policies of the past – and to bring indigenous peoples back together and into harmony.

 

For more information about the Indian Child Welfare Act:

http://www.adoptuskids.org/adoption-and-foster-care/overview/who-can-adopt-foster/families-for-native-children

http://www.nicwa.org/what_we_do/documents/NICWA%20FAQ.pdf

https://www.childwelfare.gov/topics/systemwide/diverse-populations/americanindian/icwa/

Photo ©Alex Garland This photo has been altered to highlight the mother and child. https://www.flickr.com/photos/backbone_campaign/27186540216

 

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Doulas Are Paraprofessionals

May 31, 2016 by

2DoulasAreParaprofessionals (2) copyEncouraging professional behavior by doulas is one of the purposes of this blog, but it needs to be clear that the doula occupation is a paraprofession, not a profession. Community based, hospital employed, and independent practice birth doulas clearly fit dictionary and research interpretations and even the U.S. Department of Labor classification. However postpartum doula work is not such a neat fit. One of the definitions for paraprofessional is that they work alongside of or under the supervision of professionals. While they may work and make decisions independently, there is something about the nature of their work that is connected to the stronger influence of a professional.

Profession vs. Paraprofession

A profession is any type of work that needs specialized and prolonged training, a particular skill, or a high level of education; often a formal qualification or licensure is required. A defining characteristic of paraprofessional occupations is that training can be achieved with only a high school degree or its equivalent. While some programs may offer an associate’s (two year) degree, this is often done for financial aid reasons, not because it is essential for training purposes. Because there are no impediments to offering services (some people don’t even take a doula training before doing the work), we cannot define doula work as a profession.

However, that does not mean that doulaing does not require a high level of specialized skills to perform well, nor does it mean that there are lower standards for professional behavior. In fact, several papers discuss the need for paraprofessionals in the family support services field to develop a professional identity as helpers of families, and to transform who they are and how they serve others as part of a successful training process (Behnke and Hans; Hans and Korfmacher).

“Paraprofessionals frequently associate significant personal growth with their training and work experiences. They connect their training to higher self-esteem, greater personal and professional aspirations, and the ability to engage in more effective interpersonal relationships (p.10)…An emerging identity as someone who plays a valuable and valued role helping other individuals seemed to be a central experience of doula training for the women who successfully became doulas.” The women who did not complete this transformation [or become doulas] felt they gained “mostly technical knowledge” but did not feel personally changed by the experience. In fact they expressed “a resistance to change” and seeing themselves in a helping role.” –Behnke and Hans (2002)

It also does not mean that the professionals we work alongside of can effectively do our job. This is not to say that the professional person can perform the paraprofessional’s duties.   The paraprofessional has specific skills and attributes that make it possible for the professional to accomplish more complex tasks and responsibilities.

Several sources discuss that when paraprofessionals fulfill their role, they boost the effectiveness and relationship between the client and the professional. They are able do their job better because we do ours. I think this is true in the perinatal context for doulas because our core values are good communication, maternal involvement in decision making and maximizing positive memories. Even though the labor and delivery professionals we work with may not have the same values, our presence often contributes to meeting their medical goal of “healthy mom, healthy baby”.

Doula Research

The defining of doulas as paraprofessionals comes initially from research articles published in the Zero to Three journal from 2000 through 2005. Researchers at the University of Chicago were invited to participate in a community based doula program called the Chicago Doula Project (now part of Health Connect One). Examples of other paraprofessionals: paralegals who work in attorney offices; paraeducators working in school classrooms; library assistants; nursing assistants; paramedics; veterinary assistants working alongside veterinary technicians (associate’s degree) and veterinarians (doctorate degree).

Another aspect of the paraprofessional is that the person is considered a good fit based on personality characteristics and social skills they already possess. Paraprofessionals often work with the people part of a situation; they need solid interpersonal skills and to be good communicators. These skills are strengthened during the training and early supervision process. This concept is clearly defined and repeated in the articles about community based doula programs and their staff selection process.

In the only national representative survey of doulas (so far!) published in a peer reviewed journal in 2005, the title is, “Doulas As Childbirth Paraprofessionals: Results From A National Survey”. Lantz, Low and their team state “doulas have become a new type of “paraprofessional” (or someone with a lower level of training and /or credentials who works in tandem with another professional) with a specialized role and an interest in finding clients who will hire them for their services. As such, doulas (who are also called labor assistants) represent a new addition to today’s maternity care team.”

Dictionary and Wikipedia Definitions

As an English prefix, the word “para” is used “in the naming of occupational roles considered ancillary or subsidiary to roles requiring more training, or of a higher status, on such models as paramedical, and paraprofessional: paralegal, paralibrarian, parapolice.” (Dictionary.com) “A person to whom a particular aspect of a professional task is delegated but who is not licensed to practice as a fully qualified professional.” (Oxford Dictionary.com) Wikipedia, which represents the generally understood meaning of a concept, states that “paraprofessional is a job title given to persons in various occupational fields such as education, healthcare, engineering and law, who are trained to assist professionals but do not themselves have professional licensure [note – in the U.S. this is administered by state]. The paraprofessional is able to perform tasks requiring significant knowledge in the field, and may even function independently of direct professional supervision, but lacks the official authority of the professional.”

Are All Doulas Paraprofessionals?

While the definition of paraprofessional is grounded in the early literature on community based doula programs, the nature of a doula’s labor and her support behaviors do not vary substantially for independent practice and hospital based doulas. While each may have their own niche and specialty skills, the actions of support during the prenatal, labor, birth and the postpartum periods are the same. In teaching how to support emotionally and physically; offer information as needed; and prompting clients to advocate for themselves, the skills do not change. The setting changes, and the background knowledge to effectively complete the task, but the behaviors of support are transferable. For example, an independently hired postpartum doula comforting a new mother about her birth will use the same skills as a community based birth doula. Building confidence in one’s ability to birth is similar to building confidence in one’s ability to breastfeed.

One of the conflicts inherent in these definitions is that the paraprofessional works for or under a professional. We can make the case that a birth doula would not be engaged for their services if the person was not pregnant and is almost always seeing a physician or midwife for prenatal and labor care. But what about postpartum doulas? While a postpartum person may also engage a lactation consultant or be seeing a doctor for checkups, there is no connecting relationship between them and their doula.

Is Being A Doula A Vocation?

Doula work may or may not be a vocation, which is a strong feeling of suitability for a particular career or occupation. In my files, there are plenty of interviews from women who state they could not imagine not being a doula – it fulfills their purpose in life. I’ve previously written about it being a calling. However, not all doulas feel that way nor is it a requirement for effectiveness. Therefore, it is not a vocation.

United States Department Of Labor Classification

In December of 2010, the Bureau of Labor Statistics Standard Occupational Classification Policy Committee (SOCPC) added “Doula” to category 39-9099 Personal Care and Service Workers, All Other. They declared that no formal schooling was needed although most in this category had a high school diploma or equivalent. I don’t think we can disagree with that. Those of us who have advanced degrees find them helpful but they are not required to perform the tasks of doula work effectively. Other occupations in this category are Butler, House Sitter, Shoe Shiner, Valet, and Magnetic Healer. While being lumped with shoe shiners may feel frustrating or upsetting to doula readers, from the SOCPC standpoint, median wages for doula work are not high and there isn’t an educational requirement, nor are there many doulas. But also consider butlers. The Guild of Professional Butlers has 10,000 active members (35% in the U.S.) who earn $50,000 to $150,000 a year. I’d also like to point out that each of these jobs require a high level of interpersonal skill to provide good service and personal care.

DoulaDeptofLabor

 

Abramson, R., Altfeld, S. & Teibloom-Mishkin, J. (2000) The community-based doula: an emerging role in family support. Zero to Three, Oct/Nov, 11-16.

Behnke, E.F. & Hans, S. (2002) Becoming a doula. Zero to three, (November), 9-13.

Hans, S. & Korfmacher, J. (2002) The professional development of paraprofessionals. Zero to three, (November), 4-8.

Lantz, P.M., Low, L.K., Varkey, S. & Watson, R.L. (2005) Doulas as childbirth paraprofessionals: Results from a national survey. Womens Health Issues, 15(3), 109-116.

Meyer, H., Kirwan, A. & Dealy, K. (2005) Expanding the Doula Model: An Illinois Replication Story. Zero to Three, 25(5), 35-42.

 

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A World Where We Didn’t Need Doulas

Aug 3, 2014 by

A World Where We Didn’t Need Doulas

Maybe it comes from being weaned on Star Trek reruns but I’ve often contemplated alternate universes.  The kind where if a different decision had been made the whole future course of humanity would be altered.  Recently I’ve contemplated what if we had a birth culture today where professional doulas weren’t necessary?  Going back in time, the critical point seems to be a little over one hundred years ago with women deciding to give birth in hospitals.

Like most cultural changes the reasons were multifaceted.  Pain relief was possible in a hospital setting.  At that time relief from labor pain was considered a feminist issue.  Rich women also wanted to set themselves apart from women in the lower classes so paying to go to a hospital accomplished that.  There is also the drive for modernism, to do what is new and improved which was hospital birth.  Once the wealthy had established a new norm and the physician profession benefited financially, a social movement for “safe and healthy” births in the hospital was quickly established.  Within a generation, our birth norms had altered the trajectory of our society. **

But what if something else happened instead?  What if wealthy women demanded that physicians come to their homes?  What if they asked to be attended by a midwife as well as a physician?  What if women surrounded each other with their closest friends and family members instead of strangers?  What if women retained their power by being in their own homes instead of transferring it to someone else in an unfamiliar location?  If physicians could bring their pain relieving medicines into the home or trained midwives to use them, we would have enough caregivers to provide for many laboring mothers.  Women and men would grow up with labor and birth, understanding its meaning and its risks.

As in all things there are probably some women and men who would be more drawn to helping during birth.  But they would have the opportunity to be part of a helping team from a young age and many more people would see birth as normal.  They would understand the caring skills that are necessary to see others through difficult times.  Instead of the unique skills set that doulas have now, these skills would be learned at an early age.  We would all learn to doula one another.

The paradigm of needing assistance during difficult transitions would be widespread.  Simply by growing up in a family or village group, we would learn how to care for one another.  Labor and birth would be our teachers.  Midwives, rather than being derided by physicians and seen as competitors for birth business, would be a necessary part of the paradigm.  Hospital birth would be the exception, not the norm.  With plenty of assistance from loved ones and reassurance from being in their own homes, fewer women might have needed pain relief to cope.  We would have an uninterrupted cycle of support, caring, and knowledge that spanned generations.  There would be no need for doulas because we would all be doulas.  In addition to whatever else we did in the world, doulaing would be second nature.

All the other events in the world – multiple wars, the Depression, the Atomic Age, all would have unfolded differently because we were together and cared about one another.  Touching someone’s brow when they are in pain and connecting with them on a heart level changes a person.  We see the inner power of connection and caring.  I do not think those lessons would be confined to the birth room but would be spread across the world.  Our whole social history would be different if we all learned the value and skills of caring.

So I guess I’m saying that doulaing has the power to change the world.  It shouldn’t have been confined to a select few but something all people should have experienced themselves and learned to do.  However we live in a world that has compartmentalized caring and who does and does not do it.  It has demanded that we professionalize caring in order to exist as a group in the current medical systems.  Sigh.  I think I’ll go watch another Star Trek rerun.

 

*This paragraph is a painfully brief summary.  Two good books written by historians are “Reclaiming Birth: History and Heroines of American Childbirth Reform” by Margot Edwards and Mary Waldorf (1984) and “Brought To Bed: A History of Childbearing in America” (1999) by Judith Walzer Leavitt.  There is also “Birth: The Surprising History of How We Are Born” by Tina Cassidy, a reporter.

** We know today that births in the hospital were not safer nor healthier for mother and baby.  However that was not the public perception of the time.  The propaganda circulating derided midwifery and home birth as “dirty”.   The American Medical Association was originally founded to push midwives from the market of delivering babies.

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