Recently I wrote about how we needed to increase the value of doula care in the minds of consumers, caregivers, and third party payers. If we are to create a social revolution regarding the value of professional caregiving, doulas can do it. Many of us are white, well educated, and have other sources of income besides doula work (Lantz et al. 2005). Groups with these characteristics have greater influence. For many years the majority of professional caregivers in America have been immigrants or have brown skin. They had little social power in our country and it was better for them as individuals to be silent. Historically and now, professional carers are our nannies, home health nursing assistants for the elderly, and aides for the developmentally disabled.
Our movement as professional doulas is tied to these other jobs, whether we like it or not. All involve caring for others and improving their experience of living in this world. Being young, old, or disabled are not illnesses. But they are times of vulnerability where the family seeks trained outside help. Nannies, CNA’s (certified nursing assistants), and aides all offer emotional, physical, and informational support. They must get along with the medical care providers and responsible adults guiding the individuals they support. Most importantly, their outcomes are mostly soft. Soft outcomes consist of good memories, satisfaction, improved relationships and the ability to communicate with others. They also put a price on their caregiving skills and must maintain standards if they are certified.
So when we are asking for our doula skills to be valued, we are asking for social change. We are making a statement that caregiving is a skill; it is not something innate to all women (or people). It is learned and cultivated and takes years of experience to be consistently effective. Caregiving skills have value. Receiving good caregiving makes a positive difference in one’s health, personal growth, life satisfaction, and social interactions with others. In obstetric outcomes, effective caregiving by professional doulas leads to fewer interventions, less pain, increased birth satisfaction, fewer operative deliveries and cesarean surgeries. We have quantified the influence of the human factor in labor and delivery. We have “known” statistically for 15 years. But still few are willing to make the change.
Using Robbie Davis-Floyd’s terminology, the technocratic model* does not value caregiving as a reliable skill in influencing the machine like movements of the body. It cannot be used on every person and get the same outcome. Not every person offering doula care is a good match for someone who wants to receive it. There are human factors involved.
Inviting doulas onto the maternity team in a way that shows they are valued, means that there are influences that someone who has comparatively little training or education can have on the patient. The doula may make a bigger difference on birth outcomes than someone with 12 years of expensive education and training. That can be bitter to accept. (Of course the physician needs to have a low management style with few vaginal exams and little intervention to begin with.) Physicians may also feel that not doing anything (no continuous monitoring, no amniotomy, allowing food and drink, etc.) is the same as doing nothing. It isn’t. It is allowing the social-emotional-hormonal interactions of labor to bring forth the baby when it is possible.
Lastly, it is because we do not value what we do. We do not entirely one hundred percent believe that caregiving is a quantifiable skill that makes the vulnerable experiences in life better. We need to change. Our caregiving is not very different from the Filipino home health aide who is gently wiping the drool off your grandfather’s chin. It is not that different from the African American mother of ten who is soothing and changing your dying mother’s diaper. When your Down’s syndrome son is going into a rage in the group home, it may be the twenty-year-old community college student who knows how to talk him down.
We might like to think we are better than they are because our care is specialized, because it deals with mothers and babies, because we feel it is a calling and not a job. Because we value what we do but not what they do: “Anyone can wipe an old guy’s mouth.” Guess what? No one else thinks we’re that darn special either. As the mother of a child with a disability, as someone who has changed my dying mother’s diaper, and who has sat with many a drooling elderly man as he told me a story, it is not that different. They are all caring activities and involve many of the same birth doula skills – just applied differently.
Some of you are sitting there fuming – angry with me. Why? Is it because you feel I have devalued your skills? Is it because you would not want to do those other jobs but feel compelled to help mothers and babies? It is these feelings that I am directly addressing. We have an internalized prejudice against caregiving and we don’t value it. Until we do we are stuck exactly where we are.
If you start arguing with me about how different birth and postpartum doulaing is from these other jobs, you’ve missed the point. Yes, there are subtle differences and specialized skills involved with each professional niche. But they are all caregiving professions. In our society few of them are valued as important, even though every one of them is essential. We need to value all of them so that every caregiving profession is seen as important and worthy of a good wage.
Lantz, P.M., Low, L.K., Varkey, S. & Watson, R.L. (2005) Doulas as childbirth paraprofessionals: Results from a national survey. Womens Health Issues, 15(3), 109-116.
*Here is a simple chart of the Technocratic and Holistic Models with an exercise to use with your clients: ModelsofBirth13
* One of Robbie Davis-Floyd’s articles on the Technocratic Model of Birth.