Six months ago, if you had asked me what I thought a Doula was I would have painted you a caricature of a hippie woman who is hired to help upper-class white women through their pregnancies by giving them crystals to set intentions with and “sage-ing” rooms before the birth. I’ll happily admit that I was uninformed — and straight-up wrong. Since then, I have had the privilege to learn from and be educated by doulas on this incredible profession (and it didn’t take much to help reframe my idea of doulas once I came to know more about them). While the activities mentioned above may occur depending on the kind of doula you are looking for and what speaks to you personally, this doesn’t even begin to scratch the surface of what doulas can do to help pregnant people.
By working with an incredible coalition of doulas for the past five months, I have learned so much about what doulas are, the services that they provide, and the incredible impact of those services on pregnancy outcomes. I found out that doulas, and especially community-based doulas, do so much more than society gives them credit for, and a lot of this is due to the erasure of Black doulas and Midwives as a part of gynecology’s racist history. In the early 1900s, gynecologists pushed midwives out of the field in an effort to increase their own profits and create “progress toward ideal obstetrics,” calling midwifery barbaric and advocating to ban the practice across the US.[i] This monopolization of pregnant bodies for physicians and the disenfranchisement of Black and Indigenous persons in the birthing space has severely impacted BIPOC pregnancy outcomes to this day, as we see that Black and Indigenous women are 2–6 times more likely to die from pregnancy complications than white women.[ii], [iii]
The removal of doula and midwifery services from common obstetric vernacular and standard of care has left many pregnant people feeling afraid, uninformed, and incapable of giving birth. This is where doulas shine. They help give birthing people back their power wherever they decide to give birth. They provide “non-clinical emotional, physical, and informational support before, during, and after labor and birth.”[iv] These services have been shown to decrease the rate of cesarean section, reduce the use of pain medications, reduce the use of synthetic oxytocin (Pitocin) to increase the speed of labor, increase the likelihood of having a spontaneous vaginal birth, and reduce “negative birth experiences” reported by the pregnant person.[v] Further, community-based doulas work within their communities to help link their clients with social support services in their area (helping clients sign up for Medicaid and WIC) or giving referrals to free or low-cost services (like car seats and diaper banks).
After working with doulas to help advocate for increased access to doula care across the state of Maryland, I decided that in order to be a better advocate for these and other maternal health issues, I would take a doula class myself. I wanted to have a better understanding of what the training process looks like to become a doula and I wanted to learn more about the birthing process simply to satisfy my own curiosity. I took a four-day course offered virtually by an educator for one of the largest doula training organizations nationally (this is just what happened to be most accessible for me at the time) and jumped right in.
Over the course of a long weekend, I, and 30 other curious folks, embarked on an emotionally, physically, and mentally long journey. The class covered a myriad of birth-related topics from a doula’s role and scope of practice, pregnancy anatomy and the stages of labor, common labor interventions and support measures, and the business of being a doula and providing services to clients. We discussed (as much as you can in four days) how to be prepared for birth to best support your client. We role-played empowering clients to advocate for themselves by asking for more time and information in the labor room. We practiced comfort measures on loved ones, doing double hip squeeze and learning how to use a traditional Mexican “rebozo” on whoever happened to be around. We also learned what a doula is not and how to separate our own birth stories (which in many cases may have inspired the career choice) from our client’s stories, to ensure their wishes are the focus of our care.
Something that I didn’t know would come from this experience was the overwhelming emotional connection that developed between myself and the other participants. We discussed a lot of deeply emotional issues, like birth and labor trauma, survivor support, and the impacts of systemic racism in the US health care system. And even though this training was virtual, the engagement and emotion of each participant really came through in a way that I previously didn’t think was possible to do online. We admitted thoughts and experiences to one another that had previously not been voiced in other spaces or to other people, and we were heard and given space and comfort by one another’s presence and accompaniment.
We covered all these topics and more, and I still left every day feeling as if there was so much more to be learned. Completing this training clarified the vast amount of continuing self-education doulas are responsible for completing. And additionally, it showed how many subsequent certificates doulas accumulate to provide services such as post-partum and sibling care, abortion care, or even bereavement and death services, each of which comes with added costs of time and money. I gained an immense appreciation for doulas that have been supporting laboring people for years and the amount of dedication and commitment it takes to meet your client’s needs fully. All this said, taking this course solidified my belief (even more than before) that every birthing person deserves a doula and that expanding doula access across the state should be a priority for all who value maternal health.
[v] Childbirth Connection, Choices in Childbirth, National Partnership for Women & Families. (2016).