Whose Team? Whose Values?

I received a frustrated message from a BA reader. It detailed her inability to meet a certification requirement for her doula training that she has been working tirelessly on for the past 2 years.

The unattainable requirement?

A completed evaluation on the student doula by her client’s primary care providers (the physician or midwife). This student doula’s frustration was with the organization’s lack of flexibility and compassion with her situation. I sympathize with her, but the situation also raised much broader concerns.

Like….

When women are routinely coerced, condescended, and verbally and physically violated in the maternity care system, do we really expect a care provider within that system to be able to assess a doula’s value?

When the majority of physicians feel that medicating a woman for labor and birth is the best way for her to give birth, do we really value their determination of whether or not a doula’s techniques effectively provided physical support for the mother?

When a woman’s emotional state is not valued by her care providers, how are we to expect them to consider a question about the emotional relief that a doula’s techniques provide?

When a woman’s support people are generally ignored, how is the staff supposed to answer questions about whether or not a doula seemed helpful to those people?

What purpose does an evaluation on a doula serve…

  • from a profession who largely does not understand doulas,
  • who largely work adversarially with doulas,
  • and who function under a model of care that is contrary to woman-centered care?

When the standard of care in the present maternity care system is rife with abuse, disrespect, and non-evidence based care, I don’t know that I give a rat’s ass what that institution’s employee has to say about a student doula’s effectiveness.

We all hope for a day when doulas are considered a “valued team member,” but I must ask, whose team? Or more importantly, whose values?

Hospitals are, more and more, setting up barriers to women’s ability to access professional doulas. Hospitals craft doula agreements, for example, which range from a contract a doula must sign – agreeing, essentially, that they are on hospital “turf” – to the more aggressive models – (like one Florida hospital) that require doulas to operate as sort of independent contractors of the hospital – requiring TB tests, mandatory vaccines, background checks, and a HIPAA class.

When we present the dysfunctional institution with a paper that asks them to evaluate our care, we not only affirm their assumed authority in this hierarchical model, but we also infer that their model WORKS.

THIS, my sisters, is part of the problem.

* To read more about this reader’s account, please visit her facebook post, which details her experience.

Comments

  1. says

    I dropped my doula certification. I felt the same way. Something is very wrong when you get a “good” rating from a doctor who railroaded a woman into a c-section.

    Great post!

  2. says

    I agree. So far I have chosen not to certify with any of the well known doula organizations. The requirements and the time limit are very hard for rural women to meet. However, I am thankful for newer organizations that are just getting started like, Intuitive Childbirth who seem ready and willing to work alongside women of all incomes and living in all parts of the country. It has always bothered me that some organizations literally bar women because of the kind of birth they had, or because of the lack of options in their region from being able to train and certify with them. I’m grateful that Lamaze International was accessible for me and my childbirth educator certification. Thus far, I have used so much from my other certifications to serve my work as a doula, and I am looking forward to one day certifying with an organization who supports a new paradigm of birth.

  3. says

    The first client I had that I got completed evaluations from was induced from 0 cm, and after 12 hours was 9 cm, at which point she was told she needed a cesarean for “failure to progress.” Yeah…REALLY. First time mom. But anyway, I thought as I handed the form to the OB to fill out “this is crazy, he was barely in the room with us for more than 10 minutes over the course of the 12 hours. How can he evaluate my performance?”

    For the question “how was the doula’s support of the client during labor?” instead of circling one of the numbers, he wrote in “can’t evaluate, patient never labored.”

    I’m completely serious. Apparently going from 0 to 9 cm on Pitocin, up to 7 cm unmedicated, is not “laboring.” But this person was supposed to evaluate me?

    • Profile photo of Kathi Valeii says

      I just keep hearing these stories…. it is just so illogical and it makes me feel as though I will internally combust. By the time the cavalry rides in on their white horses, they’ve already missed the entire ordeal – you know, the part where, in your story, *nothing* was happening. They clearly have NO IDEA what the hell went on with the laboring woman, let alone between the woman and her doula.

  4. Sarah says

    Excellent post that raises good points about certification and the hoops required.

    One nit-picky item: it’s HIPAA, not HIPPA. :)

  5. CNM hopefully not too dysfunctional says

    My Dear Sister Ladies:
    Becoming a guider of birth, midwife, doula, md, is a life long pursuit. Not 2 births or 5 or 10. I contemplate a DNP as a midwife of 30 years experience because I might learn something of value to mothers, children and families. I did not want to go to nursing school, ugh no way. Yet I learned there what is crazy high BP and diabetes and I share with you so many mothers bring me their unhealthy bodies to birth safely. So I am grateful.
    And then an Ivy League CNM after getting trounced from Frontier for asking too many questions. It costs around 100k!!! And yet also of value. I learned some rock solid shit.
    Trust the process. Aurelia you are clearly a Christian. The Lord will provide you avenues of inquiry you can’t imagine, and streams of resource to pursue them. Think Maria in the Sound of Music: The Lord never closes a door but that he opens a window. It is the truth of adult life that anything worth doing is twice as hard as you imagined an costs twice as much.
    That doula passion has not died in me. It burns every day. I play the edge and I always have. I have dropped episode scissors. I have lost bulbs for suction. I have absentmindedly forgotten to cut cords so that thriving pink babies remained with their Mom.
    Embrace your frustration, pray for guidance, find your edge. What can you do or learn today that advances your passion?
    Gentle as doves Wiley as a coyote. That is the job description for a Christian a doula a midwife or a woman who is all of these at once.

  6. Janet says

    I am affirmed. Thanks for writing this Kathi. I have so much to say about this subject. Unfortunately I am sickened by the reality that many of us might be run out of town by some sort of national requirement where by we will have to be evaluated by medical professionals that sew up moms without medication, refuse to honor birth plans, pull babies out by their necks and at the very least pull out the death card if mom does not want to use pitocin after 10 hours of labor.

  7. says

    I love this. Love, love love love love. I’ve been trying to get people on this page, but end up with responses like: http://doulaingthedoula.com/what-if-acog-decided-to-certify-doulas/
    To which my response was :
    Yes they could try to take us down, but we should not underestimate the collective power of women. I wont willingly lose myself in some licensure that will end up all about money just so the system cant force me out of the way in order to take more power and control over women. To quote Benjamin Franklin, Those who would give up essential liberty to purchase a little temporary safety deserve neither liberty nor safety.

    Or “doulas that are not certified are uneducated”… to which my response is: are you f****** kidding me?

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