Disparities in the Doula Model of Care

After the Community Health Worker training that ended today, I'm faced with the reality of how many gaps there are in not just health care, but doula care.  Health disparities are everywhere, and there are amazing organizations and agencies out there gathering funding to provide free preventative health care to the under- and uninsured.  When it comes to doula care, however, access is limited to those who can pay out-of-pocket.  Painfully ironic is the fact that those who can afford it are in need of it the least.  

That's not to say that the privileged pregnancies that are on the receiving end of a doula do not deserve it.  But populations, particularly teens and women of color, who see the most health disparity and the worst maternal and infant health outcomes, are the most underserved by doulas.  How do we, as doulas, approach this?  Many of us offer our services for much less than what we should be making even for our full-paying clients.  If we have a particular interest in working to solve health disparities and applying social justice to our work, we work for next to nothing.  I've done many births where, in the end, I was getting paid a shocking hourly wage for expert advise, 24 hour on-call availability for weeks on end, and physically strenuous overnight hours- much less than minimum wage in the end.  This is not rare.  Ask the doula next to you if this is the case and you will likely get an emphatic "YES".  

What is the root of this?  My belief is that it stems from doula care existing in a for-profit model (as much of health care is, but that's another blog post).  That doulas have settled on charging their clients directly undercuts the potential of doula care- applying the benefits of doula care on populations that see the worst outcomes in order to make the most amount of change.  Taking a new approach is critical in improving outcomes.  But it will require doulas rejecting the for-profit model that so much of us have accepted.  We need to explore new options in receiving funding for our work, to generate public and private interest in doula care from stakeholders in maternal and infant health, and to work together, and not in competition like so much of the for-profit model encourages, to make our work sustainable for not only our clients but ourselves.

We know the benefits of our work.  It's time for doulas to get out of our comfort zones, advocate for those benefits, and start creating change.  We are at the forefront of improving outcomes with our unique advantage to spend time educating and empowering patients.  A public health approach to doula care is desperately needed if we actually want to see our work make a difference.

(If you know of a fabulous community doula project, or have seen doulas used by public health agencies, please leave some information in the comments!!)

Getting It Done

Wow!!  Inspired today by so much awesomeness.  Women rule.

I'm starting to see myself as an instrument of change.  The good news is that I don't have to play the whole band at once!  Activist birth work is becoming more reachable in my mind- the training I'm at now is empowering me with lots of tools to use to keep me focused, connected, and effective.

The training is through an extension of HHS's (Health and Human Services) Office of Women's Health called the Women's Health Leadership Institute (hell yea), and I got here because I'm a doula.  It's part of an initiative to introduce more Community Health Workers (CHWs) to the health field.  We get to directly interface with the community around us and have an impact on health disparities based on gender, socioeconomic status, and race.  The training group is about one third cornfed Midwestern ladies like myself, one third African American (a couple of ladies in maternal health in Omaha), and the rest are Latina.  There's a young mama who's an educator at Planned Parenthood, lots of women older than my mother, and the trainers are both cute and funny.  At the end of Thursday, I'm not going to want it to end.  We're all bringing so much to the table and learning so much at the same time.  I already have ideas churning on what my project will be (we all have to carry out and document some community health project once we're finished with the training).  What a blessing it's been so far (even if the internet at the hotel ain't free).

This kind of sisterhood can't happen enough.  This is how this shit's gonna get done.

This Self-Assuredly Strange Life

(In this post, I'm including pictures from a dreamy photo shoot I did with some lovely Denver ladies back in March outside of Red Rocks, as promised.  Enjoy.)

The lifestyle I've always dreamed of is finally, and strangely, taking shape.  A nomadic path bridging city and country life, uprooted in order to respond to any breeze or need.  I've been sleeping in a cozy four-person tent, bought cheap from Walmart, in my dear friend Amy's backyard.  Picture her city lot full of fruit trees, elderberry bushes, volunteer vegetable plants and perennial herbs surrounding a fire pit, just before entering the back half of wooded territory, which I have made my little grotto.  I've hung my hammock, although it's much too humid to avoid the mosquitoes.  I have a basket for linens, a crate of clothing, a drum, a book, and a rain fly.  My cooking tools and supplies are up by the house and my bulk herbs are in the garage.  The rest of my necessities are packed down in my Chevy Venture.  

Things as a medical professional are exploding.  I was just accepted to the Office of Women's Health and Women's Health Leadership Institute's Community Health Worker (CHW) training, which admittedly changes everything.  It impacts my doula work in a huge way, as CHWs are essentially public health "doulas" in a more broad sense in that they provide education and advocacy for a variety of different health conditions and populations (not just pregnancy and birth).  This means that I will be able to widen my services to include many aspects of reproductive health.  CHWs also have an interesting and critical role as their work places a heavy emphasis on culturally competent care- that is, providing it themselves as well as enforcing it from medical care providers.  Part of this particular training is getting set up with a supervisor who helps the trainee execute a community project in their home community.  So Sycamore Center will be heavily impacted by this, and it may even prove to give shape to the organization completely.  

I've also started my volunteerism with the American Red Cross.  I have distant dreams of being deployed in the face of natural disaster to set up mobile birth units, and I figure that climbing their ladder and getting trained in mass food distribution as well as shelter management is the best free way to do it (no degree!!  woo!!).

 

And I've also met the man of my dreams.  There's no other way to put that, really.  He feeds my vision of escaping the troubles of the world to high atop a Black Hill-side, feeding my goats and staring up at the clouds with nothing but the wind to hear.  Waiting patiently for the next mother to go into labor as I cultivate my herb garden, smoke out a hive of bees, or help him haul in the next project.  He calls me his goddess, Nefer, and perhaps someday I will be his queen, yelling at kids from the porch he built.  Through all of the hard work I'm doing these days, I'm walking on Cloud 99.

But tonight, with all of this spiraling around me (and not out of control, mind you, but part of the ever-changing cycle of my life which right now is busy, busy, busy), I am trying to stay mindful of the simple things.  Sage infusing in white wine vinegar.  Slow eating.  Choosing to stay in one place for the moment.  Walking barefoot on the earth.  I need that reminder to be here now, but being on the right path makes it easier to give to myself.  

I've never felt this self-assured of my own joy.  It's pretty wonderful.

Manifestation

I'm overwhelmed.  

The blessing that came my way today is my sign, really the culmination of the task I've had at hand- pave way and open space for the gifts of the universe to unwrap themselves for me.  Over the past year I've had two major break ups (three if you count a business partner), I moved out of my first home, quit (and got fired from) a few jobs, stopped taking classes, and opened my heart.  I surrendered my sense of control, of beating my life into submission, and learned to just be.

You know what happened?  Pregnant moms started to call on me.

The Goddess (or who/whatever you will) made it unmistakably clear that serving the rite of birth is what I'm supposed to be doing.

People often wonder how I got into birth in the first place.  Well, my interest in women's health happened on accident- I went to Plan-It X Fest in 2006 where there was a workshop on self cervical exams put on by DC's Down There Health Collective.  I was blown away.  I went home from Bloomington with an arm full of zines, including Alicia non Grata's Take Back Yr Life and Hot Pantz.  That was how I first was introduced to herbs, the idea of inducing your own miscarriage, and not using tampons anymore.  I was 18 and it felt good to be a woman.  

When I moved to Denver, I had no inhibitions about teaching a free school class (if these ladies could do it, so could I!)  So for six months every week I taught a class called Positive Menstruation.  It was wonderful.  It resulted in the safest space I had ever been in, a lovely fluidity of topics from feminist spirituality to anatomy and physiology.   We talked so much about how not to get pregnant using the Fertility Awareness Method that it didn't occur to me (at age 20) that birth was part of this circle I was a part of.  I first learned what a doula was through my tribe of women there but I didn't feel called to that until I was pregnant myself.

All the while, in the back of my head, through births, talking with women about their most intimate details, getting emails asking me questions from what kind of vibrator to get to difficulties with arousal and heavy menstrual flow, receiving phone calls from women in crisis, and seeing a clear need for holistic, understanding, compassionate health care for women and their allies, I've had a dream of what my practice would look like.  How can I best serve people?  I need somewhere that people (women, genderqueers, and men) can come for workshops, to buy supplies, to receive consultations and services such as screenings and pregnancy tests.  I need somewhere to teach natural birth control, childbirth education, and herbal intensives.  And by somewhere I really have thought "something".  I just want this dream to turn into a thing.  To manifest.  I don't know if as my business, as a non-profit, or as a collective.  I just know that this is what I want to pour myself into and that there is a need for it.  

Today I was given a space for it.  

I have access to two beautiful yoga studios, plenty of storage space for educational materials and medical supplies, and the potential (if we grow) to move into an office space of my very own- one that I could see my clients in, do treatments in...  It's in a beautiful house which held a Buddhist temple there for the past several years.  The woman that owns it wants to see this happen (almost) as badly as I do.  I can't believe it.  I have to believe it.

So now the pressure is on.  If I don't make it happen, some karmic apocalypse will have me for dinner.  Lots of decisions to make, lots of energy to give to the design of this project.  

I need help.

Sexual assault, the mind-body connection and birth.

I'm picking this up again because I find myself posting much to Facebook, it not being quite as gratifying as I wish it were, and I have lots more to say these days than that space allows.

Back to back births this week and I have yet to debrief with another doula- I will resist the urge to do it here.  I will say, however, that for the first time I saw the powerful grip that sexual trauma can hold on a woman's body and learned how essential it is to address that deep shit in pregnancy.  I'm finding that my work in the future is in creating deeper safe spaces with women, addressing our relationships with our pelvises, genitalia, getting to know our cervixes, and letting go when we are surrounded by love.  Creating spaces of safety and love for women.  Healing universal and personal trauma.  Opening our hips.  Letting go.  

I need to get a copy of Penny Simkin's "When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women"  I'll review it once I do.  There have been hints lately that this is where my work will take me- I want to bridge gaps between disaster relief, emergency medicine, midwifery, sexuality education and sexual assault awareness.  I've been asked by a few women this week if I have been sexually assaulted and I've admitted that I have not.  (I should count the time I woke up with a man's hands down my pants.. and all the times my step dad hit on me or told me about how much sex he wasn't having with my mom..)  I do however feel highly tuned in to institutional baggage and the rape of the Earth.  I believe in a past life I was persecuted and murdered for being a healer (were my breasts cut off of me?  dragged through the streets and killed in front of my family?)  I feel these things, but I know I am safe now and that nobody can do that to me here.  Perhaps it's my job to let all of these other women know that it's safe here for them, too.  And that nobody can hurt them here, right now, in this space.  That their labor is not the enemy.  That their bodies are not the enemy.  


The pain of birth, of change, is safe.


So what does it look like?  This woman was crawling out of her contractions.  She looked like she was in transition so we checked her and she was dilated to 3 centimeters.  And I think it was at that point when her confidence melted away.  After that, she was completely frustrated with her body, angry actually.  Later she described feeling her body pull up every time she tried moving her energy down, as I suggested she do.  I kept saying, "Don't crawl out of it, sink into it."  She would move the energy down, feel baby move down, but her pelvic floor (and her cervix) tightened up in complete resistance.  Truly, this woman suffered.  At one point, we had her running the hospital halls during her contractions to try and open her cervix.  I pulled her aside to tell her, "I don't know what you've been through, but moving through this will make you a stronger mother."  She just looked back at me and said, "I don't know what I'm doing wrong."  At one point, only I could be near her.  She paced a part of the hall, gripping the hand rail- literally crawling it, battling her contractions.  She said at one point, "I wasn't prepared for this."


And it was partly my fault.  This woman did everything right- worked out 4-5 times a week, did acupuncture and massage, yoga, and ate great.  I took for granted that her lifestyle meant she would have a peaceful, lovely natural birth.  Before labor starts, I tell all of my clients that it's impossible for their contractions to be bigger than them because they are them.  Something bigger than her got in her way, took her strength and sent her on a ride.  


It's amazing what comes up during birth.  You find out what you think you've let go in your mind but your body has held onto.  Isn't it incredible the power our bodies have despite our minds, and our minds over our bodies?

Vitality

LIFE.

I've been full of it lately, feeling really connected again to my sexual power, my vitality.  I am sliding down a little, intoxicating my body with coffee, smoke, and fatty foods, preparing my journey back inward on this slope toward the darker me in my cycle.  Taking advantage of my wild heathen, getting a lot of good love-making in while I can.

I recently did my professional labor assistant training with toLabor (The Organization of Labor Assistants for Birth Options and Resources).  I'm a doula!  A doula with no births under her belt, but a few I'm holding in the hands of my future- a mama due in October, one in December, and I have an interview this week.  I'm just so eager to put all of the wisdom I was handed into practice already.  I'm being as patient as I can.  

Just checking in, I guess.

New VBAC recommendations- Yay or Nay?

I started school back up after a 5 week summer break and it's been a difficult transition.  I've been pretty distracted by the internet- the new Feministing layout, doula stuff including my upcoming ToLabor training and a feature on RadicalDoula.com, and several pieces of news that have dominated my mind.  

The first thing to share is the new recommendations from the American College of Obstetricians and Gynecologists (ACOG) on VBACs (vaginal birth after cesarean).  "The preponderance of evidence suggests that most women with one previous cesarean delivery with a low transverse incision are candidates for and should be counseled about VBAC and offered TOLAC."  Not that we didn't already know that, but the fact that the ACOG is coming out with a more positive opinion on VBAC is encouraging.  Take it with a grain of salt, though- we all know the trend of caregivers ignoring the medical community's recommendations (take circumcision for example), but I'm hoping this will give women seeking a VBAC some leverage when looking for a care provider.  How do you think it will effect birth options?

On the abortion front, several women in Mexico have been found being held in prison, serving 20-30 year sentences, for having abortions (one of which reported to be a spontaneous abortion, i.e. miscarriage)   The worst part is that the same district that is incarcerating them (while denying it) refused to teach sexuality education in it's schools.  Read the complete article here.

On a more positive note, I just got the first issue of SQUAT in the mail.  I'm really excited to see the beginning of a wave of radical birth journals and zines (including Outlaw Midwives Vol. 1).  It's making me think that I should probably work on my writing skills... 

Of unquantifiable value- radical doula services in a capitalist society.

I'm beginning the process of putting together a sort of childbirth education discussion group with my back up doula and a yoga teacher I'm friends with.  I really appreciate it when things just come together organically, as far as organizing things goes.  There have been so many times I've tried to put things together after sitting on it for a long time, only to find that the idea was so much better than actualizing it will ever be.  But this morning was refreshing.  No second guessing, no hang ups.  It's a really sweet thing to find an effective, efficient group of folks who are passionate about getting something done.    

It's making me consider my feelings about charging for my services, though.  As an anarchist, I am definitely cost-prohibited (in reality as much as in theory), not to mention that I think doula services are something that every mama has a right to.  I know that this is something that other radical doulas have struggled with.  What are the implications of applying the capitalist system to childbirth?  Beyond just the thought that health care is a right, but is it appropriate for me to adhere to a hierarchical cash exchange over something with unquantifiable value?  Does that make sense?  I just feel a little hypocritical sometimes with the thought of engaging my sisters in a system that is often oppressive to us (especially mothers).  My practical, mothering mind says, though, that this is what I've got to work with, and that my time and skills are valuable- I am an intelligent, gifted woman who wants to help others- and until we are set up in a different framework, I have to find someway to make my life sustainable now.  I just always feel like I have one foot in and one foot out with a lot of this stuff.

Oh, and to update, I got lazy with the emmenagogues.  I guess I just get to a point where I ultimately trust my body to do what it needs to do, instead of trying to control it or coerce it to doing something that's comforting or convenient.  That's what it's all about, anyway.