I’ve learned a lot in the past three years. Birthwork (as a doula, educator & lactation counselor) feels like an extension of my nursing career. As a nurse, I’d say goodbye to patients & wonder what their lives looked like beyond those hospital doors. Now, I get to witness the rest of the story with my clients. That’s pretty special.

I’ve met doulas who’ve been doing this work for a decade & more, with over a thousand births under their belt. Their wisdom is unmatched. In the birth world I’m still considered a new-ish doula & I respect that.

So, I wanted to share some random thoughts & observations that live rent free in my head, along with a few lessons I’ve gathered over the last three years of being a birth doula.

Reality Is A Hell of a Drug

When I stepped into birthwork I had no idea where to start, what to do or how to do it. Doula training was great in that moment, but when the reality of building my own business from scratch came into play, I wanted to do nothing more than slide down the wall. I took a free webinar about starting a business & marketing to potential doula clients. We were given a step-by-step set of instructions & of course the first one was creating a social media space. I am not the biggest fan of social media, but I created my Instagram business account & was immediately met by pregnancy content filled with fear mongering, false promises, misinformation, bros marketing-it was a sight to behold. The marketing strategies seemed pretty consistent across the board. One of the first reels I saw showed my girlies pop locking on Insta to promote their business. I was ready to head out. Nothing against them, I love that for them, but the people that are close to me know I’m not about that life, at least not for the world to see :) I already lived a life of service; in the beginning I found it difficult to translate that to marketing. I have no issue admitting that I looked for marketing classes that were introvert friendly. If you ever catch me dancing on social media, just know I finally won the lottery & it will be the last time you see me. When it comes to the business of birthwork, there’s room to take the path less traveled. Your definition of success might not look like anyone else’s. That definition will shape how you build & grow your practice.

Doulas Are Not the Last Airbender

As much as we wish we could (& as much as I adore Aang), we’re not here to save the world, it takes a lot of doulas time for that reality to sink in. I wanted to help every family who needed support, but I’m just one person. The guilt I carried when things didn’t go the way I hoped for my clients was heavy. And now, with birth doulas being seen as a solution to our nation’s maternal health crisis, the pressure has only grown. While our clients might benefit from our services, we need the healthcare system to know that even though we are here, they still have a lot of work to do to address the disparities they’ve created.

Divided We Stand

After completing my training, I followed the advice given to new doulas: get out there & meet other doulas. Say less. I was waiting for that moment. I joined online & in-person groups, connected with doulas locally & around the country. One day, a first-time mom posted a question within a doula forum about her scheduled induction. Simply asked about doula’s experiences. The responses were aggressive, love & light was not in the chat. The advice she was given was well beyond our role. Anyone that offered a different perspective got dragged. It was disappointing.

The division continues within the doulaverse-radical doulas, doulas who denounce medical care altogether, doulas who encourage strangers on social media to free birth. Our different vantage points shouldn’t cause friction. Division does not incite change. The harsh judgments, the gatekeeping, the refusal to see the systemic disparities, are part of the problem, too. I’ve gotten into it with many doulas that force their ideals onto their clients. It’s not your birth, sis.

This doesn’t just happen among doulas. Parent groups, too, can be divided. Women judge each other harshly, from how someone gave birth, feeds their baby, stays home from work, returns to work, how they parent, whether they choose to have children or not. The judgment runs too deep. Even with our shared history, our shared challenges, we struggle to show up for one another. That we doesn’t include me btw lol.

Fortunately, I’ve Met Doulas Who Get It

And families that get it too. We’re not turning our heads away. We care deeply about reproductive health & reproductive justice. These terms aren’t trendy-they’re the framework for how we move. We show up for social, political & economic issues. We speak up when policies & laws fall short. Any issue that affects our families, affects us. Privilege is not a shield of armor. If something affects one person, it has the power to affect us all. Our babies, their babies, our future. Unjust treatment should never be acceptable.

I’ll try to say this in the kindest way I can. I hate to be the bearer of googleable news, but I often hear people talk about how broken the healthcare system is. How broken all the moving systems in this nation are. These systems definitely need massive work, but these systems were never broken. They were built to serve some & exclude others, which is exactly why those who benefit fight to keep them intact. These antiquated systems were established by men. Men that had a vision that didn’t include a majority of us. We all know this system didn’t even include women. The very people that birthed these men. There are plenty of people who believe this system was built for them, that they’re part of the vision these men had. Truth is, there’s a good chance they aren’t. Please don’t feel bad if you’re one of those people, you are in good company (hey friend). This is the history of our nation. God Bless America.

Whoever sows injustice will reap calamity, and the rod of their fury will be broken.
Proverbs 22:8

Doulas Are Woo-ish

Who started this rumor? Some families have been hesitant to work with me because I offer Reiki & sound therapy-flag on the play for many. I’m glad they felt comfortable enough to share that with me. Both modalities are used with patients for acute & chronic care management. Their benefits are documented & continue to be researched. Some hospitals have even integrated Reiki as part of patient care.

Not every doula burns sage. Some of us are science nerds, some spiritually grounded, some religious, some holistic, many of us weave these together, fine-tuning our approach to meet the needs of our clients. The spectrum is expansive. What’s described as “woo” might actually be culturally or religious based traditions that doulas help families to tap into to celebrate birth & postpartum, traditions that are deeply personal & meaningful to them. I can promise you, the majority of doulas are not out here lugging Ouija boards to their appointments.

Doulas Are Undereducated & Worthless

This one really rings my bell. It’s sad to hear these words from the average person, it is especially sad when you hear these words come from the very people you share space with (nurses, doctors). Yes, some doula trainings are basic. A weekend course won’t cover the full scope of what it means to support birth. Many doulas leave training feeling ill-prepared, wondering what they missed. It is a time we should help guide them. Great doula trainings do exist. Each birth is continuing education. The amount of time doulas spend learning, attending workshops, studying, practicing, can rival degree programs. I see the same doulas show up, again & again, always seeking to grow & expand their practice, which speaks to their deep commitment to their clients.

Many of us came to birthwork by way of a career change. Leaving behind the familiar, downgrading the lives we’ve grown attached to, saying so long to lucrative salaries-that transition alone takes great courage. I’ve met doulas who were/are teachers, therapists, nurses, nannies, doctors, accountants, caregivers, I can go on for days. Our past experiences matter. Too many qualified new doulas are overlooked because people only focus on their doula experience, not the life skills they bring with them.

Our credibility is often dismissed when compared to nurses & doctors. Being non-medical doesn’t mean we lack knowledge. Birth doulas at bare minimum, specialize in the physical, emotional & educational aspects of birth. Medical care is essential, but it doesn’t replace the need or the power of emotional support.

Hospitals are starting to recognize our value. Behind the scenes, policies are shifting to include doulas as part of the care team. There’s a long history, strong research & countless lived experiences that speak to the efficacy of doulas.

Reimbursement Still Doesn’t Reflect the Work

When New York expanded Medicaid coverage for doula services to all its members last year, it was a big deal. The reimbursement rate for doulas increased, but compensation is still not set at a liveable wage. Doulas are supporting an array of high needs in NY state (and across the world) & are often unable to make ends meet for themselves. New York is one of the largest healthcare markets & major economic contributors in the nation. It also carries one of the highest costs of living. It is not a surprise when NY based doulas share that they receive public assistance. Because reimbursement rates are so low, doulas are taking on more clients than they can manage. Burnout isn’t the standard we want in this profession, for our clients or our doulas. NYCDA has pushed hard for change & for them we are immensely grateful. NYS DOH & Medicaid representatives have been great supporters through the process. They didn’t set the rates & I’m sure they’d change them if they could.

Other providers face similar issues. The system still undervalues essential care. But state by state, some doulas are being paid what they deserve. New York State, our turn is long overdue, I hope your ears have been ringing because we roast you, frequently. Increased reimbursement should reflect the value of doula care, not hinge on unsustainable visit requirements. State by state let’s make it clear to decision makers that providers deserve a thriveable income-our time & energy has made this world a better place. Our healthcare system will save millions of dollars through our work (especially in the reduction of c-section rates). We deserve vacations. We deserve to own a private island next to rest of the CEOs in the healthcare system. Stephen J. Hemsley would hate to see us coming.

In reality, we’re not asking to be multimillionaires, just like anyone else, we want to be able to support ourselves & our families.

The Biggest Surprises

Birthwork is the first professional space I’ve been in where tending to our own mental health isn’t an afterthought, it’s part of the work. Often, what draws us into this work is also something we might need to heal. Caregiver syndrome is real, I’m grateful for the spaces that recognize the value of putting ourselves first, because when we’re well, we can serve ourselves & our families better.

Through meeting my clients that grew up in different countries, I learned that our perception of birth in the United States is vastly different from theirs. We are heavily conditioned to fear birth here, from a very young age, so much so that it shapes how we enter pregnancy, how we labor & how we even talk about birth.

My Clients Changed My Life

I love my clients. Truly. In the beginning, it was their reflections that helped me see my value. While agencies & peers tried to erase my past experiences, my clients saw the full picture. The connections I’ve made are a testament to the ministry of presence central to birthwork.

I never shared all my experiences because I didn’t think it mattered. But it does. I encourage others to share their story in different ways, help people get to know us outside of those limited glimpses on social media.

Big thank you to my clients that have welcomed me into their lives, that send me pictures & updates of the beautiful families they’ve created. Watching your children grow, crawl, walk & eventually run really does something to me. You’ve been my tether in this space & I’m forever grateful. Thank you from the bottom of my heart.