I pride myself on being a black, queer Jewish doula, but does that mean I'm the right doula for someone who, say, identifies as a white, heterosexual Christian? Yes, maybe.
According to an article about Black Midwives in the LA area, "Nationwide, black women are at the greatest risk of pregnancy-related death, have the highest rates of C-sectionsand, compared with whites, black infants are four times as likely to die of complications at birth and twice as likely to die before their first birthday."
This disparity in maternal care along racial lines is something that can't be ignored. When a woman of color in the hospital birthing system is possibly surrounded by doctors and nurses who don't look like her, having a black doula to help her advocate for herself can be the difference between a natural birth and an emergency c-section. I want to be clear that this isn't to say that a white doula couldn't provide a woman of color care that is just as comprehensive and caring, it's just different. A black doula shares a similar life experience as her black client, even if they come from two separate worlds.
So what about religion? Is it important that my doula matches my personal religion? Again, I can't say, though I've personally doulaed for couples who shared my religious background and those who did not. For some, the religious/spiritual aspect of birth is important. It can mark a new life cycle event that requires special prayers or affirmations be recited. Having a doula who is familiar with those rituals can be helpful. For others, birth is just a part of life that doesn't hold any specific religious significants, but has a spiritual element that a doula can help facilitate. Mother blessings, placenta burying, and similar are all rituals that a doula can help plan.
Lastly, what about sexual orientation. Would it be weird to have a lesbian doula at my birth if I'm not a lesbian myself? Again, I can't answer this question for anyone. However, I will say that all of my clients to date have been straight couples or single women and it hasn't been an issue. Like race and religion, having a doula who understands differing pronouns, gender presentation, language, and processes can be helpful for couples and singles in a hospital setting, where awareness and sensitivity may be limited.
So what does this all mean? Should I only accept clients who are like me? No, not at all. I love that my client base has been an incredibly diverse mix of single women, couples, friends and strangers. I love that I've been able to whisper tehillim (Psalms) while a woman labors and mimic "Thank you, Jesus" when an exhausted mother holds her baby for the first time. I always encourage clients that I meet for consultation to interview at least two (or more) doulas to find the one that "fits". And if the one that fits happens to be similar to you, great. If the doula does not, well, that's great too.
One of the things I often hear is that doulas cost a lot of money.
And I get it.
When you see a one-time, often up-front price ranging from hundreds to thousands of dollars, it can be intimidating. Add to that the fluctuation of prices from doula to doula, and the process can become overwhelming.
So why are we so expensive? Truthfully, we're not. I say that as a person who would gasp (okay, maybe faint) whilst forking over a thousand dollars (or more) for a doula when my time comes.
So where does your doula fee go?
Experience and Training
Most parents who are looking to hire a doula start with where she was trained as well as how much experience she has. Doulas who have been through multiple trainings and have attended a great deal of births tend to charge more for their experience. But, that's not to say that a doula who has only attended a few births doesn't also charge "market price" for her services. While most of the money we earn for births goes towards logistics (more on that later), a chunk of it (at least for me) goes towards advanced training. This ultimately makes for better doulas.
The average cost of doula training is about $600, though I have seen it higher for week-long retreat-style trainings. Postpartum training can also range between $600-900. If you want to become a Certified Lactation Consultant, trainings can be as much as $900, and if you'd like to take it further to become an Internationally Board Certified Lactation Consultant, testing costs money as well. Becoming certified in Placenta Encapsulation, Child Birth Education, and Essential Oils and Herbs are trainings that most doulas want to add to their business. We earn these certifications and attend trainings based on our income.
Most doulas go on 24/7 call at least two weeks, but sometimes as early as a month before the time of a client's Estimated Due Date. This means they are essentially "on the clock" 24 hours a day. If I divided my current doula fee* of $850 by two weeks, I would average about $2.52 an hour without counting the amount of time doulas spend with their clients during their birth. Like most doulas, when a client calls me for their birth, I stay by their side until 2 hours after the baby is born and the parents are settled. This also means that we are not taking new clients. We are usually not going on initial consultations or meetings because we could be called to a birth at any moment. We are committed to our clients.
Gas, Food, Etc.
Doulas pay for their own gas or fare for public transportation to all consultations and prenatal visits. We also make postnatal visits (up to 2, or 3 in some cases) without charging a "postpartum doula fee." While we don't get lunch breaks, we do pay for our food, water, and supplies that we bring to each birth. This can range from books we loan to clients to birthing balls, rebozos, etc.
When a doula goes on call, she/he does so with the knowledge that at any time we could be called for a birth. This means we miss family time, vacations and trips, or nice dinners with our significant others. And when the time comes for baby to be born, we leave our full time jobs (if we work outside of doula-ing), family, and children for an undefined amount of time.
Is it Worth it?
I can't say that for anyone (typical doula answer). The evidence shows that having a doula-attended birth results in less intervention, fewer cases of unplanned c-section, better management of labor pains, shorter labors, and healthier breastfeeding relationships.
Like most doulas, I'm not in it for the money. I do what I do because I'm passionate about it. I love helping people become parents. There is still nothing more awe-inspiring than watching a baby be born. I get a rush from the sheer power and determination of women in labor and nothing beats the smell of amniotic fluid clinging to your clothes. The oxytocin that baby and new parent emit is intoxicating and contagious. I always tell parents that I interview with that they should pick a doula not by how much she costs, or her experience, but by how you feel when you are in her presence. And to my mind, that presence is priceless.
There's a stereotype that only one kind of person hires a doula. The image is usually of a woman who is white, in a higher socio-economic bracket. She is, perhaps, a professional with a hippy edge. She is educated and informed about her birth. And it's true. Women like the one I have described may opt for a doula to attend their birth or hire a postpartum doula. But other people hire doulas as well:
Trans people hire doulas.
Black and Latino (and Asian, and, and and) hire doulas.
Jewish women hire doulas.
Muslim women hire doulas.
Stay at home parents hire doulas.
And yes, folks who are "poor" hire doulas.
One of the reasons that I decided to become a doula and to train with Ancient Song Doula is because ASDS is an organization started by a woman of color and an organization focused on training women of color as doulas. ASDS spends time in the community it aims to serve, educating people about birth.
Doulas aren't just for the rich, they're not only for white folks, or for straight people. It's my philosophy that ANY PERSON giving birth not only needs, but deserves to have a doula by their side. And ANY PERSON who has given birth not only needs, but deserves the support of a postpartum doula in the weeks following birth.
Less than one hundred years ago, people birthed surrounded by their mothers, grandmothers, aunties, cousins and friends. We birthed in Red Tents, in Birthing Huts, in low-lit rooms of homes. We roared our babies earthed from our bodies without fear, because we'd seen birth. A doula's job is to help provide that tribe we've lost. And while we're only one person, rather than the mother, grandmothers, and aunties of the past, we stay by your side. Reminding you of your strength, telling you that you're beautiful, and holding space for you to birth your baby in the way that's best for YOU.
My sister was an addict, so the word "junkie" has always had negative connotations for me. It indicates that someone is powerless to a substance; whether it be drugs, food, alcohol, or anything else that is harmful or does harm.
So, to put "junkie" behind birth? It's just not for me.
I love birth. I remember my first birth like it was yesterday. I was with the mama for almost 48 hours, it was a long induction followed by a long labor followed by quick pushing. Her little one needed to be placed in the NICU for observation so I stayed with her even longer and visited her baby boy.
When I finally got home I was exhausted but alive. I even mentioned to my partner that I smelled like birth. It was then, that I knew I was hooked.
Hooked. There's another possible triggering word, a word with some negative connotations as well, and I used it.
I do have a strong desire to get back into birth work. The move to the Pacific Northwest has been a transitional one and while I have a full time job that is fulfilling me financially, it's not fulfilling me as a person. Only birth work has done that for me.
So am I addicted to birth work? Am I hooked on it? Am I "birth junkie"? I think not, I'm just a woman who wants to live to help other women experience the blissful pleasure that is birth.
Head over to Maiden to Mother to read an article by another doula and the term "birth junkie"
One of my favorite births was a dear friend of mine. She had a hard labor that totally veered off of our Birth Vision. Low fluids followed by an induction and a strong reaction to Cervidil followed by epidural and Pitocin and a lovely, healthy baby boy. Through the hard times and the bliss that an epidural can sometimes bring, I felt like I was a witness to the birth, rather than a participant. Which sounds strange as a doula.
What I mean is that this mother and her husband were so connected, so in sync, so in their own world that much of my role was to support them.
A doula doesn't replace the role of husband or partner or birth partner, our role is to enhance and support. And yes, sometimes to stand watch while the partner takes a nap.
What About The Father’s Role When Using A Doula?
The role of the doula is never to take the place of husbands or partnersin labor, but to compliment and enhance their experience. Today, more husbandsare an active role in the birth process. However, some partners prefer toenjoy the delivery without having to stand in as the labor coach. By havinga doula as a part of the birth team, a father is free to do whatever hechooses. Doulas can encourage the father to use comfort measures and canstep in if he wants a break. Having a doula allows the father to support his partner emotionally during labor and birth and to also enjoy the experience without the added pressure of trying to remember everything he learned in child birth class!
Read the rest of this article outlining the benefits of having a doula.
So what is the evidence for doulas?
In 2012, Hodnett et al. published an updated Cochrane review on the use of continuous support for women during childbirth. They pooled the results of 22 trials that included more than 15,000 women. These women were randomized to either receive continuous, one-on-one support during labor or “usual care.” The quality of the studies was good.Continuous support was provided either by a member of the hospital staff, such as a midwife or nurse (9 studies), women who were not part of the woman’s social network and not part of hospital staff (doula 5 studies; childbirth educators 1 study, retired nurses 1 study), or a companion of the woman’s social network such as a female relative or the woman’s partner (6 studies). In 11 studies, the husband/partner was not allowed to be present at birth, and so continuous support was compared to no support at all. In all the other studies, the husband or partner was allowed to be present in addition to the person providing continuous labor support.
Overall, women who received continuous support were more likely to have spontaneous vaginal births and less likely to have any pain medication, epidurals, negative feelings about childbirth, vacuum or forceps-assisted births, and C-sections. In addition, their labors were shorter by about 40 minutes and their babies were less likely to have low Apgar scores at birth.
What does this mean?
It means that if you have continuous labor support (that is, someone who never leaves your side), you are statistically more likely to have better outcomes and your baby is more likely to have better outcomes! How did doulas compare to the other types of continuous support?
The researchers also looked to see if the type of support made a difference. They wanted to know—does it matter who you choose for your continuous support? Does it matter if you choose a midwife, doula, or partner for your continuous support? They were able to look at this question for 6 outcomes: use of any pain medication, use of Pitocin during labor, spontaneous vaginal birth, C-section, admission to special care nursery after birth, and negative ratings of birth experience.
For most of these outcomes,* the best results occurred when woman had continuous labor support from a doula– someone who was NOT a staff member at the hospital and who was NOT part of the woman’s social network. When continuous labor support was provided by a doula, women experienced a:
Why are doulas so effective?
A doula can act as a buffer in a harsh environment.
There are 3 main reasons why we think doulas are so effective. The first reason is the “harsh environment” theory. In most developed countries, ever since birth moved out of the home and into the hospital, women have been giving birth in conditions that can often be described as harsh. In the hospital, laboring women are frequently submitted to institutional routines, high intervention rates, personnel who are strangers, lack of privacy, bright lighting, and needles. Most of us would have a hard time dealing with these conditions when we’re feeling our best. But women in labor to deal with these harsh conditions when they are in their most vulnerable state. These harsh conditions may slow down a woman’s labor and decrease the woman’s self-confidence. It is thought that a doula “buffers” this harsh environment by providing continuous support and companionship which promotes the mother’s self-esteem (Hofmeyr, Nikodem et al. 1991).
A dad says: “My experience has shown me that, whether you’re giving birth in the hospital, birth center, or at home, your impact and ability to connect and support your wife during the birth process is both supported and maximized by having a doula there on your team.” Credit: www.yourbirthjourney.net and Seattle Birth Photography
The third reason that doulas are effective is becausedoulas are a form of pain relief (Hofmeyr, 1991). With continuous support, women are less likely to request epidurals or pain medication (Hodnett, 2011). Why are women with doulas less likely to request pain medications? Well, women are less likely to request pain medications when they have a doula because they just don’t need an epidural as much! Women who have a doula are statistically more likely to feel less pain when a doula is present.Furthermore, by avoiding epidural anesthesia, women may avoid many medical interventions that often go along with an epidural, including Pitocin augmentation and continuous electronic fetal monitoring (Caton, Corry et al. 2002).
Read the entire article here.
02/5/14 by Crystal Azul
I grew up hearing stories about births and deaths from my mom, who was raised in a poor, evangelical home in Mexico. My mom would tell me the story of her nephew Esteban’s birth. It happened during the middle of a hurricane, the water had risen a foot into the tiny house, and my mom’s cousin was in active labor. Baby Esteban, nearly having a water birth, came out of his squatting mother like a slippery fish, caught by my mom’s capable hands.
When my friends started having babies, I became actively interested in birth justice work, especially after hearing their stories of unnecessary interventions, lack of communication from hospital staff about procedures, and the feelings of being too overwhelmed to make an informed decision during labor. As a feminist, womanist, and queer POC, I understood all too well the importance of advocacy during times of medical vulnerability. In 2011, I finally trained as a doula in Arcata (Humboldt County) and had my first client – a 17 year old woman who found me on a volunteer doula list through the Family Practice Nurses who worked with mothers on WIC. After this first experience of working for my client and representing her wishes, I knew that would never want to work for a hospital or similar institution and began searching for ways to be a doula in community.
Last August, I attended SQUATfest, a conference for people working in birth/reproductive justice and held at the Women’s Building in SF. As can be expected, the conference was predominantly white and cis, though some effort had been made to offer scholarships for low-income/POC birth workers. For many (qt)poc folks, accessibility with regards to affordability is one of the biggest obstacles to becoming a doula or hiring a doula. (There is a movement to include doula services through Medi-Cal, and there are volunteer doula programs in select hospitals that provide doulas for those who qualify as low-income.) During SQUATfest, I spent time in the Doulas & Midwives of color circle. There were many conversations about working in mostly white and privileged spaces, bringing services and support to communities of color, and burn-out being a major issue for (qt) POC birth workers. Some of the newer birthworkers discussed finding it challenging to “connect with birthworkers of color for mentorship because they are too done, tired and are moving on, have too much risk/responsibility already on their plate, or are homophobic/transphobic.” I had the privilege of hearing the wisdom of such birth justice workers as Midwives Makeda Kamara, Claudia Booker, and our local Certified Professional Midwife Laura Perez from Sacred Birth Place in Oakland.
By JOSIE PICKENS WriterAs far as I’m concerned, there is always country for Erykah Badu, whether she’s blowing us away with her genre- and spirit-shifting music, keeping it real by admitting what we all know about the state of hip-hop, or reminding us that reading is fundamental by clapping back at disrespectful detractors on social media. My favorite side of the entertainer, however, is when she speaks about doulas and natural birth. In an interview last year with Origin magazine, Badu opened up about why she became a doula:
“I kind of felt like, I like being the welcoming committee. I just continued to be present at different people’s births, and I started studying on my own, different techniques, and the variables of what being a doula is about. I learned to originally be like water, in the place that I was, so that I could be a container for whatever they need. I love being of service in that way. I’m an official doula, and I am working to get my midwifery license right now.”
I’m particularly attached to the natural birth narrative because I have “baby catchers” in both my maternal and paternal familial lines. I know that home births and midwifery aren’t for everyone. But I do believe the work of doulas is exceptionally important, a mostly forgotten aspect of the healthy pregnancy and birth story—a part that many Black women have forgotten are a significant part of our history.
So what is a doula, exactly? According to DONA International:
“The word ‘doula’ comes from the ancient Greek, meaning ‘a woman who serves,’ and is now used to refer to a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period.”
Doulas are essentially “team mommy” personnel. Their only responsibility is to assist mothers with being comfortable, safe and aware during the birthing process. Also, because doulas have birthing experience and training, they ensure that mothers-to-be are well informed about all that happens before, during and after giving birth. (Trust me, as a mother who had a very difficult pregnancy, there is a lot to know. It’s overwhelming how much.)
Giving birth can be a difficult, frightening experience, especially for first-time mothers and mothers who experience complicated births. A lack of knowledge, and the nervousness and stress that comes during labor and delivery, can make giving birth extremely tedious and complicated.
An extremely interesting aspect of doulas and Black women is the perception that it’s a ‘White granola’ thing to do. At one point, most of the midwives in the U.S. were Black.
Having a doula hold a mother’s hand, interact with medical staff on her behalf, and help her breathe and push—all while providing patience, information and instruction—can definitely make the birthing process less difficult, briefer and safer. Less difficult births mean healthier babies and mommies, and that is the power doulas offer the world.
I thoroughly enjoy reading tweets from @thepbg (a.k.a. Cashawn Thompson) as she chronicles her life of caring for young children. Thompson is also a practicing doula. When I asked her why she chose to take up the practice, she said, “We are living in a time where a lot of pregnant women find themselves alone and without a partner during pregnancy and birth, for any number of reasons and personal choices. That doesn’t mean they don’t need support. Doulas provide educational and emotional support during pregnancy and birth, which is empowering and absolutely necessary. It sets the tone for how one sees herself in the role of a parent, how effective she can be and how she will eventually parent her child.”
Some may ask, if being a doula is such a benefit, why have Black women shied away from the practice?
Freya Morani—doula, breast-feeding educator and creator of rootmama.org—believes Black women have disconnected from their ancestral attachment to midwifery and doulaing. “An extremely interesting aspect of doulas and Black women is the perception that it’s a ‘White granola’ thing to do,” she says. “Black women don’t know their legacy of midwifery and birth assistance. At one point, most of the midwives in the U.S. were Black. We’re far removed.”
As a doula, Morani says she’s dedicated to serving Black families, particularly Black mothers, who are up to four times more likely than White mothers to die from complications during child birth.
Looking back, I wish I’d have enlisted the services of a doula during my pregnancy and birth. It might have alleviated some of the stress I experienced as a first-time mom. If I decide to give birth again, I’ll surely have a doula by my side.
Read more at EBONY http://www.ebony.com/life/doulas-and-black-motherhood-888#ixzz2rtzBTTMy
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by Jess Helle-Morrissey, MA, MSW, LGSW, LCCE, CLEC
Doulas serve a multi-faceted role in a birthing family’s life: supporter, encourager, normalizer, educator, guide. We rub backs, we squeeze hands, we stroke hair, we breathe, we hold space. We press cool cloths to a birthing woman’s head as she brings her baby (or babies) forth from the warm, wet womb to the bright spinning world.
One role that is often overlooked, but is perhaps most sacred to my own doula heart, is that of witness. As doulas, we witness over and over again that unique and unparalleled moment in a woman’s life when she becomes a mother. Whether it’s a first birth, or a seventh, a mother is born each time she births a baby.
When a woman has a transformative birth experience (and really, what birth isn’t transformative?), she deserves to be fully seen. And that role is often uniquely the doula’s. Partners are witnessing, but they are most often deservedly caught up in their own personal experience of the moment. Midwives, doctors, and nurses are present, but they have medical tasks to attend to. Doulas are able to attend wholeheartedly to that moment.
We witness the joy of birth. We witness mamas finding their true selves for the first time in their lives as they birth their babies. We see the look on a mama’s face when her baby is five minutes old as she tells us, “Everyone said I couldn’t do it, but I knew I could.” We witness the hilarity of birth – I’ll never forget one mama who turned to me after birthing her twins and exclaimed, “That was f*cking AWESOME!” We get to see the way a partner looks at the birthing woman in complete awe as she makes her way through contraction after contraction. We get to see him or her wipe a tear away as this new little person makes that first yawling cry.
We witness the disappointments, too. And when things don’t go as planned, we can remind her that she is strong because we have seen it with our own two eyes, and we have felt it in our own doula souls. And we remember in a way that she might not.
So as witnesses to those moments, we begin to help her reframe: Last summer, one of my doula mamas had a surgical birth after a long and difficult labor. In a case like this, it is easy to go to a place of dwelling in what went wrong. I go to my postpartum visit. We talk about all that happened, and I validate the disappointment. I sit with the pain. But I also tell her, because I need her to hear, “I have never seen anyone work so hard for so long. I have never seen anyone fight so hard for what she wanted. You. Are. Amazing.” And she begins to feel it is true because I have seen it and I know it to be true. She knows I was there. She knows I saw her fully. And as I write this, I remember her fierce birthing spirit as if her baby was born yesterday, and I feel the hair on the back of my neck stand up a bit. Because I will never forget her strength, and the gift she gave me by allowing me in.
Above all, it is that sheer strength of birthing women – no matter how they give birth – that we doulas are witness to. The strength to carry on when it feels like all the reserves have been depleted. The strength to make a choice to go a different direction than we’d dreamed. The strength to joyfully claim a place in the history and lineage of birthing women.
And the repercussions of that witnessing can last a lifetime. I spent a good part of my own life feeling like I was not a very strong person. When I gave birth to my twin boys, I found strength I never even dared to imagine I had in me. Today, more than two years later, each time I see one of my two wonderful doulas, I still stand a little taller and feel that swell in my heart – “SHE has seen my strength! She knows the amazing things I am capable of!” A bit dramatic? Perhaps. But life-changingly, soul-stirringly profound for this mama? Most definitely.
So when you invite a doula into your life for some portion of the nine months of your pregnancy (and a couple months after), know that the benefits don’t end there. We not only witness, but we also remember. I tell my mamas, “If you ever need to be reminded of how incredible you are, call me and I will tell you as many times as you need to hear it to believe it.” So on behalf of all doulas, thank you to birthing families everywhere who invite us to witness your incredible journey. Thank you for giving us the best job in the world.
Hi there! I'm Erika Davis and I'm a doula working in the Seattle and South Puget Sound area.