Tuesday, December 15, 2015

Talk To The Hand: Agencies - Doula Services Are Not Free


Denise Bolds MSW, CD(DONA)
December 15, 2015

The question above of doula services remains a heated debate and is a chronic occurrence… The scenario: low income women who are also without resources are pregnant… Agencies repeatedly and mistakenly request the intervention of a doula for ‘free’.

This request is a blatant hypocrisy in reducing maternal health disparities involving low-income women; mainly women of color/culture. In the USA there are evidence-based models verifying the benefits of birth doula intervention during labor and birth. Many believe doula support is a luxury; this is possible in some cases. For low-income women of color/culture the support of a doula can be a matter of life and death.

Black women and their black babies have the highest rate of infant mortality, fetal demise, low birth weight, maternal death, and poor breastfeeding rates than any other ethnicity/race. The majority of grievances about 'free' doula services are from white women. Many who gripe have no concept or education of the history of the chronic decimation of women of color/culture when it comes to maternal health outcomes. People are certainly entitled to their opinion. However, it's a matter of life and death when agencies knowingly request ‘student’, free or volunteer doulas when evidence shows the benefits of having a certified professional doula support a birth.

Low-income women of color/culture have higher incidences of birth trauma, experience epigenetic inheritance as well as medical care disparities. Period.

Agencies requesting student, free or volunteer doulas repeatedly commit acts of exploitation: to call upon uncompensated, unsalaried services of doulas when the solution is as evident as the evidence agencies utilize to obtain funding to operate is a form of prostitution. Agencies have the capability to request funding, the doula and the mother do not. Physicians, nurses and midwives are not approached in this manor; why are doulas? Doulas are certified, follow a professional model and many possess advanced college degrees. Doulas are on call 24 hours, 7 days a week for their clients, they use gas in their transportation, they invest in education that is not free, they pay for liability insurance; in a nutshell – doula support is not free. There was and is a sacrifice either monetarily or otherwise made by a doula to support a woman in childbirth. It maybe a surprise to many, but doulas pay mortgages/rent, utility bills, car payments, gas, food, childcare and more.

Agencies possess grant writers, as well as designations that can result in the allocation of budgets offering compensation, salaries and adequate stipends to doula providers. Continuing to request ‘free’, volunteer, student doula services devalues the doula profession. By offering the pregnant woman (client) ‘free’ student, volunteer doula services results in the client being further stigmatized and reluctant to engage in this empowering service. It also breeds suspicion and mistrust as well as perpetuates the stigma of learned helplessness. Many of these agencies are directed or managed by white women who have had supported births themselves. The knowledge is present; the congruence is not.

The intervention of a birth doula with a low-income woman of color/culture is a life saving action: advocacy, education, support and awareness supports both mother and baby to bond, for mother to be able to feed her baby and to heal from birth; to alleviate oppression that can result in life threatening depression. Imagine how many lives can be saved if mother and baby did not give up in the medical system that can be maternally hostile.

One solution is very simple: agencies, put in an adequate budget for professional doulas. Evidence shows how invaluable this service is. The outcomes are diversely positive across all spectrums of maternal health. Until the education of maternal health disparity is universally and correctly disseminated, until agencies incorporate appropriate funding that adequately compensates doula services; the mis-education, mis-direction, and mis-allocation of services will redundantly continue with women and babies dying in the United States of America.

Agencies know better, it’s time to do better. In order for negative statistics to decrease such as high cesarean section rates, poor breastfeeding rates and stronger families; funders must include proper allocation of doula services to agencies requesting funds.  Talk to the hand agencies. Let the revolution begin.

As for the term ‘student’ doula, I don’t know what the hell that is. Once a doula receives proper training, she can support births and be compensated accordingly. Is this done with ‘student’ lawyers, doctors and nurses? I don’t think so.