The Next Step In The Doula Revolution
One of the most urgent issues facing birth doulas today is our future. Very few doulas seem to realize this because they are focused on their own businesses. In many ways the social revolution of birth doula support has succeeded. According to the Listening To Mothers III survey, 6% of women had birth doula care. ACOG recently recognized birth doula support as an effective method to lower cesarean rates. Decades of research has shown no negative effects with the presence of a trained birth doula. Capitalizing on the growing demand for trained labor support, many small organizations are cropping up to instruct doulas. These groups are of varying quality, but so are individual instructors within a larger organization.
When I look back on 27 years of doulaing and 17 years of being a trainer, I feel a sense of accomplishment. My mission was to educate women about the importance of birth in our lives and to ensure that mothers and their partners have supported, caring birth experiences. Usually that means a doula. Generations of people needed to “get it” in order to create cultural change and to listen compassionately to the women sitting next to them tell their birth stories. Both missions are incredibly important if we are going to turn the tides.
From my readings on social movements, especially those similar to doula support, the next step is for doulas to become part of the established system. Yup. It has started in several ways – hospital based doula care, community based doulas, and doulas who work for physicians, midwives, or birth centers. For the most part these programs are very tenuous. They are based on the champion of one person who keeps the program continuing. When they leave or funding dries up, the program also folds. It is most likely to last when hospitals are competing for market share and the doula program attracts mothers to their facility.
For many years being a successful birth doula implied a willingness to work independently and to create a new path. It necessitated some personal sacrifice to promote the cause of labor support. Newer doulas are less likely to want to do this. They have matured in a culture that promotes mentorship and the idea that there is an established map for success. Younger women today act as if doulas were always around! I don’t think this difference is entirely generational but a part of the success of birth doulas. Many older doulas feel their hold is more tenuous because they had to break ground. So there is a turnover in attitudes because of our success, and the personality traits needed now are different.
Another change that I see coming is the institutionalization of doulas. Almost any social movement that has become established in our society has been absorbed by the institution it desired to change. It developed as an alternative. Then once the concept was recognized as being a significant and positive thing, it was brought into the fold of the institution. You can see this with home schooling. Once an outside alternative movement that had to fight for recognition, it is now an established method of educating one’s children. You can even purchase established curriculums from public school districts.
When I wrote about this issue last fall, several people brought up the argument that having national certification didn’t help midwifery. Instead it brought about divisiveness. However, midwifery and doula work have very different histories. In addition, we don’t have the institutionalized power struggles that occurred with nurse midwives and professional midwives. We don’t compete for market share with any other profession like physicians and midwives do. Does that mean that we don’t have struggles? No. But our growing pains are not their growing pains.
What brought this to a head for me is the realization that even though ACOG wrote about doulas in February, we are still not taken very seriously. There are several public health issues where birth and postpartum doulas could easily be part of the solution. But we aren’t even mentioned. Doulas can have a key role in recognizing the symptoms of perinatal anxiety disorders and postpartum depression, yet any training we get is haphazard. If a mother spends 10 minutes actually interacting with a physician or the nursing staff at a clinic visit, and we spend 90-120 minutes at our visits, who has the better chance of viewing any symptomology?
One of the first questions we need to ask ourselves is do we want to be a part of that system? Do we want to provide a stronger, organized social support component? Do we want our prenatal role to be taken more seriously by other members of the health care team?
Of course there are pluses and minuses to each, which I’ll be exploring in future posts. With less organization, doulas can continue to practice independently incorporating whatever points of view they wish into their practice. This allows for a somewhat uneven delivery of services and an atmosphere of “let the buyer beware”. We can vouch for ourselves but not for our doula sisters – unless we know them personally. With a stand alone certification organization, we could allow for different types of training and practice styles while maintaining high standards for ethics. As I have stated before, I am quite concerned that if we don’t do it ourselves, physician, nursing, or public health organizations will do it for us. Some hospitals already have rules allowing only doulas who agree to them to accompany mothers.
Legitimization and set standards for birth doula care IS going to happen. It’s a matter of whether we’re going to be in charge of it or not. What do we want that to look like?
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Posts In This Series:
1. This Post: Social movements