Some of the most heartbreaking news that doulas received along with the outbreak of COVID-19 was that we are banned from hospitals. Many of us were already committed to couples and families that we have come to love and care for, and with the increased level of uncertainty and fear, we knew that our clients needed us even more. As the numbers of COVID-19 cases continue to increase, it becomes clear that this crisis might last as long as a year or even more, raising a growing concern about doulas’ source of income. As upsetting and tormenting as this ban might be, the current crisis bears an opportunity; an opportunity to achieve work-life balance.
I have been practicing as a doula for almost three years. I’ve also certified in the Birth Coach Method as a birth support coach and am extremely grateful for the training I received under Neri Choma. I love this role of supporting families. My main goal is for them to feel supported and loved as they welcome their baby to the world. I was a teacher for over ten years prior to launching my doula career, so planning and organizing was a big part of what I did. I like structure. As a doula, I try to structure my prenatal sessions. It helps me get to know the needs and goals of my clients in a systematic way and to understand how to support them and meet them where they are at. As part of my service, I also fill in any educational gaps as needed. I want to help them understand their options.
But what happens when I have a client who is a doula? How do I inform her? Do I just offer labor support and skip all my sessions with her? I usually offer each client three to four sessions. This client didn’t need to practice the tools of labor support with me since she is a trained doula and prenatal yoga instructor. She also had taken a childbirth class with her partner. So I felt like the bulk of what I usually offer my clients was off the table.
I needed to go beyond informing and all the way to coaching.
Twenty years ago, when I was nearing the end of the yearlong doula training program in Jerusalem, my trainer advised us all not to quit our jobs in favor of establishing a doula practice. Regardless of the fact that we enrolled in a yearlong program with a commitment to give 100 hours in hospital shifts, Shoshannah guided us to view the doula role in terms of community service rather than a career path.
This perspective is reflected in the well-known saying “A doula for every woman”, a motto I trust was carved with noble intentions but prioritizes the welfare and empowerment of only one woman – the birthing woman, at the cost of disempowering another woman – the doula. It should be noted that the topic of doulas’ monetary compensation, just like the other two dilemmas I addressed before it, has also caused some turbulences within the doula community. This can be read in Penny Simkins’ Real Talk from Penny Simkin, in which she responded to the disagreement with this motto as expressed by a ProDoula member.
This is the second blog in a series of three that I began writing in November. I am very passionate about the doula profession. That’s why I feel called to write this series before it is too late. And by “too late” I mean that I think our profession is in danger. Being a doula trainer and at the same time an approved continuing education provider for obstetric nurses, allows me to be connected and empathetic to both sides of the conflict – doula and medical caregivers. On top of listening to nurses’ pain points in their relationships with doulas, I recently have been invited to speak at a few OBGYN and midwives’ practices and heard that they are on the verge of banning doulas
Additionally, recent events confirm what I have been fearing – the current practice of doulas’ who share evidence-based information that supports better obstetric practice (while not being medically trained and bearing no liability for their clients’ health) is going to hurt us.
Since the seventies, those who provide education and support to birthing individuals have all been called ‘Labor Coaches’. In that group are childbirth educators who teach about childbirth and deliver a body of knowledge, usually in a group setting. Also in that group are doulas who are trained to provide emotional, physical and informational continuous support throughout the birth. We all got used to thinking about childbirth as an event in which our role is to help the birth giver cope with labor strains while providing information, reassurance, and applying comfort measures.
On the other hand, coaching, a growing industry generating $11 billion in the USA, is an entirely different practice that stands by itself. It is the practice of leading competent and healthy individuals to optimally perform in order to achieve their goals.
Transformational Birth support coaches that are trained here at the Birth Coach Method, likewise, are also trained to coach expectant individuals towards achieving their desired birth experience.
After a decade of practicing as a doula and childbirth educator, I was about to quit. I was burnt-out. The rising rate of medical interventions led me to doubt my ability to fulfill my role and facilitate healthy and positive birth experiences. Additionally, the growing gap between doulas’ approach to childbirth and the approach held by the medical caregivers that our clients trust for their journey, triggered a lot of tension in me. These circumstances, in addition to the given hardship of the doula practice, made me reconsider my career path.
Ten years have passed since I felt under-resourced and I still enjoy practicing as a doula and training doulas. How did this happen? I discovered coaching!
In the last couple of years, I have come to learn that I am not the only one to have gone through this professional struggle. In spite of ACOG’s recognition of doulas’ benefits and some big headlines reporting the many celebrities who hire doulas for their birth, doulas experience a few major dilemmas that cause great hardship.
This uneasiness reflects in social media and doulas’ blog posts, and I can sense the confusion, frustration, and disputes that percolate within the doula community. Being passionate about doulas and our valuable stewardship position, I’d like to share my personal path that helped me resolve the three major dilemmas doulas face:
The advocacy dilemma in the field of childbirth support is a tough one to crack. The dilemma lies in the tension between certain components of birth support practice, such as serving and supporting, and other components such as being a change agent in our society and a birth activist. By relying on coaching principles and strategies, I suggest that you can be sure to practice within your scope of practice and to refrain from projecting or engaging any ‘activists agenda’ in your relationships with your birth clients. Coaching is the pathway to client-centered relationships and care.
Does an ‘Expert Position’ serve professionals in the field of birth support?
Do you consider yourself an expert in ‘how to give birth’? If you are a childbirth educator, a birth doula, a midwife or a labor and delivery medical staff member, I’m almost certain that there is a confident voice inside your head saying, “Yes, I know all about giving birth, it’s my profession and what I do for a living”. I believe that since the seventies, with the beginning of birth activism, birth givers have been torn between two types of “experts” – “medical experts” and “natural birth experts.”
Maybe it’s time to rethink our position: Can anyone be an expert and say how another person should give birth?
A couple of days ago I had a beautiful mentoring session with two local doulas; we will call them Iris and Lily. We were going over some challenging cases they experienced recently and exploring how the Birth Coach Method’s strategies and tools help. Pretty early in our discussion, I learned that their ‘typical birth clients’ represent some degree of polarity: Iris works only with clients who are strongly committed to an unmedicated birth. She feels that potential clients who are “willing to try [birthing] with no epidural but leave themselves open to the option of taking it” are not a good match for her. Lily said that her clients are hiring her in order to “Check the box” of doula services; meaning that they read the statistics showing doulas reduce cesarean rates and they are hiring her to avoid a cesarean.