How The Doula Biz is Like the Wild West - And Why That Needs To Change.

Definition of Wild West. : the western United States in its frontier period characterized by roughness and lawlessness.

It's quite possible a lot of people wont like me after I say this....but, I think there are doulas out there doing more harm then good for birth in the US - and, that desperately needs to change. Now.

We have a lot of followers and readers from all over the World, so, I want to make sure anyone reading this first understands the particular situation we find ourselves in in West Michigan, as, I can only truly speak to the experience we're having directly - though, I have spoken about this issue before to fellow colleagues and have had others tell me this is definitely not a problem exclusive to this area. But, nonetheless, let me paint a picture for you.

West Michigan is a very conservative and medical area. Business is good, but, it certainly isn't booming in this area for birth workers. Most people here still do not know what a doula is and if they do they often have a false impression of what they actually do (ie: a LOT of people think we just attend home births and/or deliver the babies, etc.), and, very few care providers (including home birth midwives) will recommend them to their clients. If anything, we're experiencing more and more of the opposite - WARNINGS NOT to use doulas. 

Why would they do that? If they knew how much a (good) doula could benefit their client - and actually make their jobs easier in many ways - wouldn't they be eager to jump on board? You'd think. So, why don't they? Lactation Consultants and Child Birth Educators are in - so, why not doulas? 

Now, of course there is the motive that the natural birth movement and birth workers could argue...that a less informed, more "go with whatever you suggest" kind of client is ideal in a lot of ways. Not only will you pretty much be in complete control, high intervention births are profitable. I'm not saying I disagree with this, because, I DO think there is a lot of "big business behind the curtain" stuff going on here. But, I don't think that's the full reason this is happening. 

There is at least 1 CNM and I've heard of a couple other OB's locally who will not work with doulas. 
This is a BIG deal. 

Just a few things I've "heard on the street" from CP's, Nurses, Midwives, and Mothers: 

• "She locked herself in the bathroom with her client and delivered the baby."
• "She gave direct advice to her client repeatedly and it resulted in death/injury."
• "I was accused of voyeurism/rape/molestation."
• "She smacked the nurse."

whoa. Say WHAT?! 

I know, I know....the grapevine, right? Believe me, I take all this with a grain of salt.... I understand how things can get distorted and misinterpreted even to the people directly involved. I also know people are far more apt to tell a bad story than a good one. Still. This IS what's being said - and it is at least one of the reasons care providers are hesitant to work with doulas.

So, what's the deal here?

I'll tell you:
There are absolutely NO regulations in doula work. ANYONE can just start saying "I'm a Doula" regardless of training or actual experience.

So, you'd think getting certified would change that, right? Qualify them and give them a network of support and someone who mentors them and/or holds them accountable? 
If you thought that you would be wrong. 

The truth about becoming a Doula: Where Certification Falls Short
I can't speak for every certification process out there because there are SO many. Crowning Lotus included. I have looked into most, however, and can tell you that the following isn't super far off from general requirements for becoming a "certified" doula.

When I became a doula, I went through DONA because they were the longest standing and seemingly most reputable (and accessible) certification out there (most doulas who are certified are certified through this agency). I began my training all wide eyed and eager to serve my community. SO excited to meet all the amazing women doing this work. So, I paid my money and took all the proper steps to achieving my certification. This is what that included:

• Pay money
• Attend a weekend long workshop covering basic childbirth education and doula work
• Read a specific amount of books in different categories (but, I did not have to produce any sort of proof that I had read them)
• Take a breastfeeding class
• Start practicing on women (attend 3 qualifying births in which the parents and CP's must fill out a very short survey for, and, I had to also submit notes and summaries of each birth.)
• Agree to their "Scope of Practice" and "Code of Ethics" (An essential part of this process, however, there isn't much of a way to enforce it unless someone reports abuse of it).

Now, this is important: We were told NOT to shadow an experienced doula, we were NOT given a superior or mentor who got to know us and offered support other than someone who went over our certification packet or would call us if there was an issue or complaint.

What surprised me is 60% of the women in my certification class had never even attended a birth. I had already attended 2 before I discovered the word "doula" and decided it would be a good path for me. I thought, knowing how hard being on call was, 'man, how could you invest all that time and money and just not 'know' for sure this is what you want to do?'

It then occurred to me then that at least some percentage of women were going to figure out that they are actually NOT doulas while attending someone's birth. And, given a lot of women look for bargain or cheap doulas and end up with someone in training, I worried that this might be detrimental to the industry. And, I was unfortunately right in that assumption.

Here are just a few things I've heard from mothers who have had this experience with their doulas:

• "She kept taking smoke breaks, then after 8 hours said she was tired and going home. By then, I was glad to see her go."
• "She didn't show up because she decided to go on vacation 2 days before my due date."
• "She really didn't do anything at all."
• "She argued with my nurse and made us all really uncomfortable."
• "She just seemed like she expected them (the nurses/CP's) to do something wrong and it created a weirdness. She was great to us and did a good 'job', but, it was just kind of awkward."

​I always feel terrible when I hear a story like this, because I know that now this is this woman's perception and story of what a doula is, and, that's not good for an industry that is trying to establish itself into the mainstream. 

Overstepping boundaries and having a distorted sense of what the doulas role is and should be can lead to what I would sometimes call a "rouge doula" - someone who believes it is her responsibility to protect her client from the "bad guys" (AKA: the care providers who might try to give the mother something she didn't want or plan for). Someone who either disregards or misinterprets the difference between supporting informed choice in a nonjudgmental way and giving actual advice to her client. She may even go so far as to do medical things like cervical checks, monitoring baby, etc. Now - there is a word for that - Monitrice. So, let's get this clear - this isn't about that there are people out there doing this, it's that perhaps they are doing it while also identifying themselves as doulas. 

Either way, we can't go into births with expectations to be anyone's hero. We are there to help her be her own hero - a strong woman fully capable of following her intuition and make her own decisions (even if they don't reflect what we think is "best")! For me, as a doula - I have informed her of her options, letting her know the pros and cons of every angle. That releases me of responsibility of any and all outcomes. I can sell someone some tools, but, I can't take credit for the house they build with them. You dig? 

Good Intentions Aren't Enough
Another piece of this puzzle stems from birth workers AND the natural birth movement as a whole promoting this one idea of 'the way birth should go'. In this way, we're not only making ourselves look bad - but, we are also absolutely hurting women. We hold natural birth up to the light as the most beautiful and sacred thing because we want women to know it's possible, and, for the most part - achievable....but, then it leaves the women who "could not achieve that" left to wonder how or why they "failed". When, the reality is, a woman CAN get every intervention and still leave feeling totally empowered and positive about the whole thing. The key isn't in how "natural" her birth was - it's how informed, heard, and respected she felt every step of the way.

{I digress.} 

So, what's a doula to do? Tired of this, and irritated by a weird divide in our doula community which also seemed at the time to completely lack very many welcoming arms, and, being the kind of person who can quickly identify voids and what needs to happen to fill them, I decided to start creating the community I needed as a doula. Then, I began taking on students who were eager to learn from me. While hand training doulas through an apprenticeship model I saw what was sorely missing in our traditional method of certification. Not only are most doulas not receiving any hands-on learning with someone more experienced, they are also unsupported (and unsupervised) almost entirely. So, basically, There is no one they really need to answer to, and the majority work alone in their practice.

Meaning, if they jack up someone's birth, give "bad advice" (which, they shouldn't be giving actual advice at all), overstep a boundary, or don't even show up....who are you going to complain to? 

This is why this industry is like the Wild West to me. It's lawless and for the most part it really is every (wo)man for themselves. We can't seem to agree on what is and is not acceptable for a doula to do or not do - and most honestly just do what they want anyways. This is not only detrimental to the parents and care providers who work with them, but, also to doulas as a whole. We NEED someone to talk to, to learn from, to process with - and to have our backs in real time. If we can't make it, we need to be able to provide our clients with the option to have a back up called in. If we're struggling in a birth, we need people we can reach out to for ideas and encouragement. If we see something traumatic and need to process, we need a trusted mentor or teammate  we know honors confidentiality. This is REALLY hard work! It blows my mind that most doulas do it alone.

Now, I'm not saying there aren't a LOT of really, really, really GREAT doulas out there who are doing incredible work either on their own or in an agency or collective. I know many who are killin' it!! However, there are enough 'doulas' out there falling short and it contributes to a reputation that we are now ALL getting, and I think we need to acknowledge that and begin to set a different standard so we don't shoot ourselves in the foot and end up banned from more CP's and eventually hospitals. 

I'm not saying I have all of the answers. We have our way of approaching this, and, I'm sure we're not the only ones. All I do know is ignoring or denying it isn't going to help us and that we must consider the impact our lack of action or attention to this issue could cause. 

I think more than anything what Parents and their Care Providers want and deserve the most is to know that the person they are working with is qualified, knows their role, and respects the boundaries and professionalism required to work within a team. Because, I KNOW there is a way we can all work together and make maternity care in Grand Rapids, West Michigan, This Country, and the WORLD a better place to birth. I think we all want the same thing for the most part - we just need let ego go and realize not any ONE of us are "the key" to making that happen. That actually happens when we all do our part to create a balanced whole with the mother-baby in the center of it all - and ALL their needs considered above all else.  

​WE > me.

What are your thoughts on this? Discussion is important if we want to find resolution.
Comment below!

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Juliea Paige is the founder of Crowning Lotus, a mother of 4, and a woman of many talents. She has attended over 260 births and assisted countless others all over the world who seek out her council. Juliea is a wise woman with an incredible story to tell whose purpose has become to share and grow knowledge and to cultivate healing so that each individual can feel informed, respected, and POWERFUL. 

Related Articles:

• What Does A Doula Do?
• ​Stop Telling Women They Can't Do Stuff. Especially Birth. 
• Doulas Are Not Midwives - and - Midwives Are Not Doulas
• Many Birth & Baby Experts Don't Know Jack About Breastfeeding​