But where are we now?
This is my question for the doula profession. During this World Doula Week celebration, I have been grateful to see all of the honoring and celebration of our work, resiliency and gratitude for our presence in birthing and postpartum spaces.
And Doulas did really work hard across the nation to be seen as essential, not just a visitor or guest in hospital settings. We proved our training and our worth again and again and across many states and regained entry into hospitals to support families alongside nursing staff.
However, it brings up the age old question of getting approval from systems that are simultaneously not serving pregnant people in the best capacity. Inherently, Doula work is a grassroots social justice movement that has grown to hold the healthcare system accountable. This works because we work for the people not the system. And when we work to assimilate into the system, to create change from inside versus outside, the system ultimately changes the work and you.
I have noticed this over my 20 years of birth work, I am a very different Doula from years of working in the hospital then I would’ve been working outside of hospital systems. And if we think of Doula work as an emergent strategy, as a disrupter, it is harder for that to happen if we risk losing our access into the system.
When we want acceptance from a system that is actually the same system that we are trying to change and dismantle,it’s a catch 22. If we’re not validated by said system, we can’t get in. If we’re validated by said system, then we fall prey to the system’s dysfunction. And let’s have no doubt that the system is dysfunctional.
But yet, we want to be seen and heard and valued and respected by the system. We want badges, access, insurance reimbursement, but no regulation. We are still working for the family, yet we’re bound by system rules and regulations. I don’t know whether it’s possible to have the pie and eat it too.
So where do we go from here?
• Who are doulas ultimately accountable to?
• Does that change on the way they are on-boarded into hospital settings?
• Is this onboarding system (like a vendor system) discriminatory?
• Does this change if you wear a hospital badge and pay the hospital to be there?
• If these policies are discriminatory to BIPOC doulas and white doulas participate in them are you hurting the BIPOC doulas in your community?
• If working within the healthcare system, should doulas be regulated?
• If so, regulated by whom?
• Do doulas have a scope of practice?
• Should doulas advocate for insurance reimbursement?
• Will that change the care we give?
• What doula training organizations are “credible”?
• How do we address commodification and cultural appropriation in doula and both work?
