My Doula Identity Crisis

For a number of reasons, I'm toying with not recertifying with DONA International next year. (The reasons are best left to a different post.) When considering my options for a new certifying organization, an interesting thought crossed my mind: why recertify at all?

Think about it. Doulas are not medical professionals; there is no such thing as "practicing labor support without a license." It doesn't take a sheet of paper and a nametag to offer holistic pregnancy and labor support. It takes training, knowledge, and most of all, a committment to your cause.

Your cause. And what is my cause? This whole inner dialogue, do I recertify or not, has driven me into a sort of Doula Identity Crisis.

Credentials or not, I am a Doula. I have always been one, and while I haven't always attended births (or, for that matter, attached that term to what I do), I have always played the Supporting Role in whatever challenge my friends and acquaintances are facing. Learning this about myself has given me the opportunity to playfully attach the term to many aspects of my life. Listening to a friend work through issues with her partner? Relationship Doula. Volunteering at Transformus' Sanctuary? Burn Doula. My partner mentioned his fire department's auxiliary. What I heard? Fire Doulas.

What we've come to forget - strangely enough - is that doulas have been attending births long before it was a paid profession. In fact we hear this history when we attend the trainings: women have been assisting women through childbirth for probably as long as childbirth has existed. Many mammals (i.e., elephants!) doula each other through labor. We know this, and yet we have allowed "those who are doulas" to be separated from "those who are not doulas" by a mess of paperwork, fees, and credentials. Even my local professional association of doulas separates certified doulas from non-certified doulas with the categories Certified Doulas and Trained Doulas Working Toward Certification.

Which leads me to ask again, What The Hell Are We Doing?

There must have been something in the air, because right as I started questioning this whole notion that "doulas are paid professionals with credentials," Miriam Perez penned an article on this very topic. She muses:

I think doula work is valuable and important, and I also don’t believe the essence of doula work—non-judgmental and unconditional support for pregnant and parenting people—needs to be locked away in a system that says only a certain amount of training, certificates, or other paperwork bestows upon someone the right to provide this support. We run the risk of replicating the model we’re trying to revolutionize. And I don’t think that is where real social change happens.

Let me pause for a moment and say that, had it not been for my training and push towards credentialing, I would not harbor the knowledge and skills I have today. I see the need for these trained and certified doulas that charge for their services, and I hope to remain one of them for a very long time. The work is invaluable, and charging for services rightfully reimburses us for the hours upon hours spent with someone's family (read: away from ours). It also helps to set a standard of practice so that families know what to expect - and not expect - from a prospective doula.

But as Perez rightly notes, we could be defeating our cause by over-stressing the importance of these things.

Last month, this piece sparked some heated discussion on my Facebook feed. On the one hand, I agree with the author that valuing our work and not selling ourselves short is important. On the other, her point completely ignores the vast number of families who should not be denied trained labor support simply because they cannot front a $500-$1000+ payment to someone who, let's face it, isn't exactly a mandatory part of the birthing process. This population, the under-served and often less educated, needs doula services the most. They are more likely to lack a constant support person throughout the process. They are more likely to be "rushed through the machine" of the hospital system. They are less likely to feel positive about their experiences. They need doulas, and anyone who says I'm "cheapening the profession" by volunteering my time to help someone have the birth they want needs to reassess the reasons they became a doula in the first place.

Fast forward to today. I have a client with one of the more medical physicians practices in this city. They've scheduled an induction for Monday, four days after her estimated due date, because "baby is measuring big." After venting about the obvious issues to a friend, I found myself thinking, "I just need to stop taking clients with this practice."

Woah woah woah woah. What am I saying?

Suppose for a moment I wasn't her doula simply because of who her doctor is. And say all other doulas felt the same way. This mama would still be induced on Monday, but I wouldn't be there to support her through it. No one would, and with a practice like this, it's these women that need my support most.

I'm envious of the doulas who "only attend home births" or "only work with patients of midwives." They are helping to support a certain portion of the population that deserves a doula as much as anyone, and I'm not saying their work as doulas is less important (far from it). However, if their goal is to only work with care providers that are already extra supportive of natural chlidbirth, then I can only imagine their mission differs from mine.

Thing is, I get it. I love working with the midwives, not worrying about contradicting a care provider's advice, not having to hide granola bars under hospital gowns, avoiding unnecessary interventions, etc. I'm excited to have two clients next month who are having water births.

But my mission is to help every person have a supported and satisfying birth. For everyone experiencing abortion or miscarriage to be validated and supported throughout the process. For all my friends and people I care about to have a non-judgmental ear, to have their backs rubbed when they need it, to be reminded to just simply take care of themselves. I'm not doing that if I'm limiting the population I'm willing to work with, and I'm certainly not doing that if I'm more concerned with my credentials and fee schedule than I am my ability to simply be there.

I have a lot to think about over the next year when my DONA certification expires. Do I want to certify with another organization? Let it go and work without cert? Does it even matter? I'm not entirely sure. What I am sure of is this: if I look at myself in the mirror and can say with confidence, "I am a Doula," I know I'm on the right track.