No we don’t. We don’t need doulas that lack integrity, who interfere with a mother getting an epidural or a cesarean, or who say nasty things to their clients about hospitals, doctors, nurses, or midwives. In my experience these doulas may leave damage behind but they don’t usually last very long. We hope.
What we have is a huge variety of doulas. Doulaing is so important and integral to the process of supporting women in their birth experiences that it is finding its way everywhere. There are doulas who work only in their own religious or ethnic communities. There are some who only attend births for free because it is their way of giving back to the world. There are doulas who can’t imagine getting paid for work of their heart and spirit. There are doulas who have no problem putting a price on their caregiving skills and need to support their families. If we’re going to have a social revolution to rehumanize birth we need all the doulas. Friend doulas, hobby doulas, grandma doulas, and professional doulas who work for programs, hospitals, and have independent practices. We need inclusivity to change birth.
There are doulas who live in a neighborhood and are known as the “woman who knows about birth”. There are doulas who move to foreign countries and hold the hands of mothers whose language they don’t understand. There are doulas who are angry about how women are treated in labor. There are doulas who cry about the lack of recognition that the baby is a conscious being. There are doulas who can’t imagine attending a woman they’ve never met before and don’t know intimately. There are doulas who do that on a weekly basis. There are doulas who receive additional training and use other skills such as acupressure, homeopathy, Reiki, or aromatherapy. If we want all women to have doulas available, that means we need to accept all different kinds of doulas.
The dilemma is this: If we need all kinds of doulas to humanize and change birth, we also pay the price in delaying our claim to legitimacy for our profession. There is a difference between a professional doula and other doulas. No other birth profession has this dilemma where the stakes are so high. There aren’t any hobby doctors, hobby nurses, or even hobby childbirth educators. It’s no wonder there is confusion and conflict among doulas and medical staff. Friends acting as a mom’s doula have no allegiance to advancing our profession and no idea that their actions reflect on all doulas. When doctors and nurses interact with a doula they have no idea whether she is a novice, a professional or somebody’s buddy. We can look alike from the outside and seem like we’re doing the same thing.
Legitimacy is like the right of way in driving a car. The right of way is not something you automatically receive, it is something the other driver gives you. We can claim the space for legitimacy but it is up to other forces to recognize us as having it. Those key forces are parents, physicians, midwives, nurses, educators, third party payers, and the general public. We need to have professional standards and educate about the differences to doctors, nurses, midwives who will work with all the doulas. We need to tell them that their expectations can and should be different of professionals. We need to show them there is a difference.
There are some doulas who feel that a goal of professionalism is missing the point. Their vision is for every community or neighborhood to have their own doulas. They would be the go-to person for pregnancy questions, education, and support during labor. In this vision it is all about connection and creating a knowledgeable empowered female community. This happens when people have pre-existing relationships that continue as the child grows. While I can appreciate that vision, many of the mothers we serve don’t live in that world. Our connections occur most often with the assistance of technology not around the back porch. Some women feel most comfortable with intense intimacy when they purchase it – they retain control.
The doula revolution was born through social forces and will continue to form itself around existing systems. In other words there will be all kinds of doulas everywhere – including those that break rules others hold dear. We are fighting for two separate things – to improve birth where a mother can have the support she needs from the person she wants to serve as her doula. We are also massing to shift the perception of us as professionals and to communicate there is a separate set of standards. Sometimes the accomplishment of the former conflicts with the latter: when a non-professional doula acts in a way that a professional would not. This is messy and confusing for all of us, including nurses and medical care providers. While we may not need all kinds of doulas (see first paragraph), all kinds of doulas exist and we need to live in that world.