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.

Balance By Denise Bolds MSW, CD (DONA) November 4, 2015

“It’s always a black and white thing with you!” Randy Patterson of Pro Doula.

I get this a lot. Goddess Randy said this to me in a parking lot in Kansas earlier this year. In her New York accent and with tons of love, we fell over each other laughing freely. I’m a NYC, I immediately understood where Randy was coming from. I knew it was said in love and she was merely busting my balls. She get's it.

Fast-forward a few months…

As my time in this profession as a black birth doula evolves, I’m noticing a pattern of rhetoric around my blackness; my being a doula and my freedom of speech.  I have several venues of writing on social media: my professional, Bold Doula and my personal: The Audacious Black Woman.

As black woman in a predominately white world of maternal health, I am constantly faced with hyper-scrutiny that comes along with being who I am in the place I am in. Maternal health is homogenous in white domination of doulas, teachers, midwives and the like. Education in the maternal health arena is often white driven, the leaders are mostly white and the beliefs reflect whiteness overall.

In the deluge of trainings, I’m often told that I must forsake and renounce my master’s level education and ‘just be a doula.’ Hmmmmm. No, sorry. I cannot do that. After almost 20 years as a MSW social worker, there’s no way I could possibly undo the education, the ability to assess and the level of professionalism I hold myself to as demanded by my clients and peers as well as many who have barely completed high school let alone obtained a college degree. My master’s degree has opened some cracks for me to slip through. My clients benefit from my education; in no way am I crossing the boundaries of a doula and that of a clinician.

I am also told not to be an advocate in maternal health justice. My being an advocate is seen as a ‘threat to medical professionals.’ Really?  I’ve also been told: “You post too must stuff about blacks on your social media.”

Well I’ll be damned.

I am many things; first and foremost, I am black, I am a woman. Sojourner Truth begged the question “Ain’t I A Woman” hundreds of years ago; today I do as well. I simply cannot and will not forsake black woman and childbirth. I have birthed while being black; there are some huge disparities.  I’m not the only one. My fellow doula peer and goddess Ebony Milkah Jackson just faced this very same thing on her Facebook page recently. Many are not aware of the maternal disparities when it comes to the black woman. I still experience it now as a doula. When I post black themed posts on my social media, I get ‘you post too much about blacks, why not post about all the races?’ 

Here’s the teachable moment.

Imagine if I were to keep you (white woman) happy by not posting about blacks, I would be denying the essence of who I am.  Many are simply not aware of the contributions made by black female slaves to gynecological and obstetrical medicine in the United States. All of the advancements made within these two areas of medicine, down to the basic speculum are the result of research and experimentation upon the black female slave without anesthesia. Let’s also not forget how the United States was built for free from the uteruses of the black female slave who birthed babies who were immediately placed into slavery. Every inch of this country was touched, built and developed by blacks. Washington D.C was built by black slaves. Period. Every single OB/GYN advancement and instrument used today is the result of a black female slave being experimented upon for ‘medical advancement.’

Black women lead in statistics for poor maternal outcomes of stillbirth, prematurity, c-sections, low weight babies, fetal demise and poor breastfeeding. Why are these stats so dismal and remain so in the 20 years I’ve been in the health field? Know history of the black woman, know maternal justice discrimination and know economic discrimination; you have your answer, if you dare to face the truth.

Still don’t get it?

The black woman is not at the table of birth justice and maternal resources. Many white birth workers do not reach out to black women as potential clients. I’ve had a director of a local agency in Pougkeepsie, NY gleefully inform me: “doula services are the best kept secret in the Hudson Valley.” I’ve lived here for over 20 years and as a black woman, I never knew this resource existed. She wanted me to work as a doula in her agency for free; meanwhile she gets a salary.

I had birth workers tell me to my face: “Black women don’t feel pain. They were built to birth. They don’t need the support.” There’s another fugly discrimination in maternal health: economics.

Economic discrimination dominates in the birth world. Many white women have spouses who earn substantial salaries so these women can afford not to work full time and they can afford the trainings/certifications this field demands. Black women on average earn less than white and Latino males. Many black women simply cannot afford the thousands of dollars charged to obtain trainings to evolve their doula practices. For example: Birth Arts Institute charges $2,500 to train you to be a trainer, Nick Olow charges $5,949 to attend his 12-month training in accu-pressure certification and Our Baby Class Teacher training costs $3,000… there’s many more, the list goes on. I get tons of invitations to trainings and every time I ask these trainers if they offer any kind of scholarship to a woman of color to participate – very few do. If they do, it’s rarely publicized. 

So, my counter-questions to all those who ask why do I post so much about about blacks: do you realize I’m black? Ask this same question of your Latina and Asian friends. Where’s the awareness of the huge disparities that exists in black maternal health and what is being done to close them? Until that Grand Canyon wide disparity is closed, I will be posting as the educated, professional black woman that I am.

As for my clients, they hire me because of my intelligence and my professionalism. They hire me because of my loyalty. They hire me because when its time to push; when that baby is crowning, they want Bold Doula right beside them. So, I can laugh with goddess Randy, because I accept the work that is before me.

Jump

Denise Bolds, MSW, CD(DONA) October 13, 2105

26 years ago I was at Cross County Mall, Yonkers NY calling my mom on a payphone. I told her my virus was the pregnancy kind. My marriage of less than a year was over; here I was, black, suddenly single and pregnant. I was having an out-of-body experience.

My mother went into empowerment mode; she told me I could do this, I would be a great mom and I could raise this baby; she and my father would be with me every step of the way. My marriage was over before it began; the man I gave my egg to and took a vow with was weak and unaccountable. I wanted a marriage like my parents. Now this?

I spent the next few months walking through a nightmare of dissolving my marriage, securing healthcare and keeping my head above water all through morning sickness and early pregnancy. It wasn't until I went into pre-term labor at 5 months when my midwife, Paula Duran sat me down and said: “Either you want this baby or your marriage; you are under tremendous stress, you can’t do both.”

I chose my baby.

After being discharged from the hospital after another pre-term scare, I prayed one night before sleeping.  Holding my big belly in my hands, I prayed to God for my son to be born healthy and mine. God answered me as I slept; we had an amazing conversation: I was in a high, bright place that was warm and peaceful all around me. God’s voice surrounded me and went through me every time he spoke: Me: “God, I want this baby, please don’t take him from me, I lost my marriage. I don’t want to loose him too.” God responded: “If I give you this life, it will forever change your life. You will no longer be the same as you are now.” I agreed to God’s intervention.  It took me along time to keep my word, but God always kept His.

After two days of back labor, I gave birth naturally to my son on September 13^th. My birth was traumatic and riddled with medical discrimination.  My mother and dear friend Maureen were my labor coaches. I was lucky to have my midwife assist in my birth; I was a Medicaid PCAP pregnancy and OB’s only wanted private insurances.

It was love at first sight when I laid eyes on my son as he was being born. I breastfed and cloth diapered him; I also suffered from post-partum depression that went undiagnosed for months after I gave birth. Another one of the results of medical discrimination. It was the only time in motherhood I was actually afraid.

The next 25 years were some of the most challenging, amazing tumultuous, growth times of my life. I grew up along with my baby, we grew super close. As I grew as a mother I also grew as a woman, I also grew spiritually. My father passed away when Jordan was three (a huge adjustment). I earned three college degrees, survived domestic abuse, miscarried a few more babies, owned a home, married again, divorced again, lost my home, filed bankruptcy, had my car repossessed and worked my ass off with my higher learning. My leap of faith I took into motherhood resulted in my growth as a person in spirit not just in this world, but this universe.  I failed well and repeatedly; my son was always there, cheering me on; playing with his toys in the back of the classroom as I sat in my college classes. My son sacrificed for me as I did for him.

Jordan is an amazing man. As a child he was highly intelligent, creative and very funny in his own sensitive, Virgo way. Jordan is an old soul, as a baby I would sing to him. Now I only sing for God.  Jordan also has his master’s degree, he is unique in both character and creativity; he taught himself how to surf (in Australia) and take photographs (since age 8). He loves music first and photography second. I introduced him to rock music and Michael Jackson. My son is very popular and he loves to travel. Apple does not fall far from the tree, Jordan is also fearless.

I am indeed grateful to this son of mine who has changed my life. I am grateful to my ex-husband for his biological contribution. I pray I never loose sweet memories of Jordan and I doing the coolest things while he was growing up. I love being his mom.

It was only fitting that Jordan and I go skydiving this year, 2015: I am now 51 and having fun. Jordan is a black man 25; and is still alive. We dived on a beautiful sunny day without a single cloud in the sky. I made Jordan go before me. I was the last one to leave the plane.

Watching my son fall from the plane attached to his tandem diver, my internal maternal gut reaction clenched for a moment, then my faith took over. I know Jordan would be all right without me. I have given him a strong foundation to be a good human being, a man and someday a father. Jordan didn't just jump – he dove! Just like he is doing with his life.  My son theVirgo did a perfect dive.

I was the last to jump out of that plane; it was a dozy.  Not only did I jump but being the Leo I am, I also did a summersault mid air! I came full circle. I did look back as the picture shows.

Looking back, I was saying good-bye to the old me; to all the sadness, disappointments, hardship and failures. I jumped into my faith, my strength. I jumped with my wisdom, bravery and fearlessness that I learned in 26 years. The jump initially took my breath away, just like 25 years ago when I first laid eyes on my baby boy as I pushed him out into this world.

My landing was one of grace and giggles. My son, was there to greet me. We both made it; breathless and exhilarated. I wouldn't have it any other way. I was meant to be Jordan’s mom. I took a jump 26 years ago, my God catches me every time without a parachute!

Here is the link to video of my jump:

https://www.youtube.com/watch?v=pdamILNs4Hc