About a year ago, DTI reached out to a powerful trio of women who we noticed were doing amazing work. We were drawn to their vision, their business model as a collective, and their strong advocacy voice. We called up one of the co-directors and truly hit it off from the first conversation. We talked at length about the challenges that doulas face in today’s culture of birth. We shared deeply about our work and our ideas for transforming how doulas are trained and mentored in the field. We talked about dreaming together and finding ways to collaborate as doulas who are ready to jump out of the comfort zone and into a space where change may feel uncomfortable, but necessary. Our field is relatively small and it’s built on supporting each other and lifting one another up. DTI is committed to re-imagining our role as doulas and dismantling the many forms of competition that keep us apart rather than united. Doulas supporting doulas is the very heart of DTI.
When we saw the article by Anemona Hartocollis about Carriage House Birth in the New York Times, we cheered our doulas sisters on! We cheered for us all. But then, we read the article and the familiar feeling of misrepresentation and lack of content sunk in. CHB is doing amazing work. They are a passionate, dedicated doula collective offering doula services and a wide variety of classes from childbirth education to breastfeeding support to understanding post traumatic stress disorder in labor and birth. We’re thrilled to be collaborating with them and CHB has become our Brooklyn home for our DTI2 trainings. We love their vision and several of our DTI doulas are part of their collective as well. But, no matter how much we support our sister-doulas and celebrate their acknowledgement (and we do!), we need to separate that from the damaging misinformation that was published in yesterday’s New York Times article. From what we can tell, there was a lot of it.
Now that we’re clear that this is not about undercutting women we admire, let’s take a closer look…
To start, there have been two versions of the article published yesterday. The first version was worse than the second one. In the original piece, it stated, “But privately, some doctors say having a doula in the room adds one more wild card to be managed within the already unpredictable environment of birth. Even Dr. Moritz, who has given courses to doulas, says “they have to know their place,” and he is not happy if the doula contradicts his medical judgment in front of the patient.”
Later in the day that quote was omitted and the new edited version read, “Some doctors say they understand how doulas fill a need in an impersonal hospital setting, and at the very least, feel obliged to honor their presence because they are what the patients want.”
Doulas as a wild card to be managed? We know from years of working intimately with couples that the majority of our clients experience being over-managed in birth, but this puts a new and honest light on a stereotype that many doulas already negotiate. There is a deep lack of respect for the power and positive outcomes of our work. We are expected to stay in line, “know our place” as good girls should, and not rock the boat. Instead of just managing, condescending, or at the very least feeling obliged to acknowledge our presence, how about working with us? What would birth look like if doulas were recognized as the missing link offering compassionate woman-centered care in our maternal health system? Language plays a huge role in keeping doulas at bay, keeping us quiet and well behaved. This article does a great job at demonstrating that. When we talk about re-imagining the doula’s role at DTI we’re not talking about creating more antagonism with doctors or staff. In fact, we’re talking about bridge building through effective communication and respect for every role in the room. We created the Slow Doula Method ™ to teach our doulas in our trainings communication and rapport skills so that they can use their voice as advocates providing unconditional support and education for their clients. Our program teaches action steps for doulas to professionally negotiate the power dynamics that often assume our role to be a passive bystander. In order to transform that we must be willing to re-imagine our role no longer as a passive supporter, but as an active one. When doulas step into their role of unconditional support of a woman’s birth process and function with the intention of honoring human rights in childbirth, there’s a shift in how they approach the systems that they are working in. Although individual accountability is extremely important, we’re addressing how to deconstruct and operate in the systemic violence that many of us experience in our work. Doctors should not feel obliged to honor our presence because it’s what the patient wants. It’s the opposite, really. Doctors, we hope, have the intention of recognizing the great and immense value that doulas have on better birth outcomes for women. In fact, we have a doula report (there are many) with evidence-based research to back that up.
While the article mentions Carriage House Birth and the incredible work of Mary Powel-Thomas and the doulas from By My Side Birth Support Project, it does little to focus on the breadth of research of the doula report that was recently published by Choices in Childbirth-a report that directly addresses the gaps and disparities in health that disproportionately affect low income women and women of color, as well as how doulas improve overall birth outcomes. “Doula Care in New York City: Advancing the Goals of the Affordable Care Act” examines doula care within the “triple aim” framework to demonstrate how doula care can help to improve outcomes, reduce spending and improve the patient experience of care. The report also considers the powerful role that doulas can play in fostering greater patient engagement in health care decision-making and reducing disparities in health outcomes, additional goals outlined in the ACA.”
This article also undermines the role of the partner and doula as a unit working in the best interest of the mother. The particular partnership mentioned depicts a disconnected partner more interested in technology, cars and sushi then the transformation taking place before him. Without knowing the details, our sense is that this too was embellished by the reporter. This article paints the picture of women being left to labor with only their doula. Here, the realm of birth is not about the personal transformation partners experience in birth, but rather one that excuses them from the process. Hired help takes the place of one’s partnership where partners sit on the sidelines. Doulas know this is simply not our role. Rather, we work with couples, often months in advance, building trust, normalizing birth, and getting to know their partnership so that we can best support them on the day their baby is born. Doulas support the birth mother and her partner to create an environment where the two can focus on each other. Of course, there are times when doulas support single mothers or the partner is a friend or family member. In those cases too we find ways for connection of a family to be strengthened, not dissolved. As doulas, we are moved time and time again, by the intimate and emotional rites of passage we are privileged to witness. We hold the space for couples to be together–not to keep them apart.
Is all press good press? Maybe but maybe not. What is great is that a new conversation is evolving from this article. It’s a conversation that is necessary if we want to change the current crisis in maternity care. As doulas, let’s not be satisfied with morsels. Our role differs greatly from a doorman, a waitress, or Amazon Prime. We are not a fad. In fact, many of us are career doulas that have attended hundreds of births. This isn’t trendy for us, it’s not a side-gig and we’re certainly not living in a birth climate where the over-medicalization of birth is a perception.
It is time to pull the veil off, tell the truth about birth and celebrate the transformative power of our work as doulas.
In support, DTI
Aimee Brill, Tara Brooke, and Gina Giordano