Tuesday, 22 September 2015

Bologna for Breakfast....lunch and dinner.

This face book post was recently brought to my attention and I find it troubling on several fronts. 

If they [doulas] are giving so much of their time and energy to be with a person in labour and birth, but are not compensated appropriately, they become attached to an outcome.

1) No evidence was provided for this weighty declaration and it has the potential to lead many astray. This statement is not only absolute nonsense, it’s dangerous self serving falsification. If this were accurate there would be no need for critical incident management; there would be no PTSD or vicarious trauma.  We’d just need to increase salaries and it would magically take care of itself!  *poof*.   

2) For doulas, exploring emotional intelligence, good boundary setting and debriefing skills is imperative. You can’t turn your feelings off like a faucet when the bill has been paid. Doulas can only be compensated monetarily for time and expenses there is no magic number that will relieve you of your emotional stress and misplaced attachments.

3) It's asinine to think that doulas don't have an eye on outcome.  Our main focus is "how will she remember this?"  Considering outcome is part of what we do and it requires that every doula is trained in an environment that provides fertile ground for self awareness.  A great doula is clear on what she can and can’t control, what she brings to a situation and how to keep herself emotionally safe.   

Look for workshops and continuing education that help you with this skill set and that don’t promise that a “wage” solves everything.  Be discerning and require evidence. There’s a lot of bologna out there.   

Friday, 18 September 2015

"You Honor Me" vs "You Owe Me"

May 6th 1988 I awoke in early labour and a few hours later I held my blonde baby boy in my arms as the sun shone on his head and I was incredibly proud of myself.  I had *rocked* that birth.  I sought out the nurse that had been there when our son was born; I wanted to thank her.  She was sitting at the nursing station with a couple of other nurses and I waited for the conversation to lull.  Her response to me has rung in my ears for 27 years. “Yah, no problem...it’s my job”.  I felt utterly shamed by that. It was the biggest triumph of my life and to her, it was just a job. In that moment, my doula self was born.  That comment would propel me into the world of labour support to be the person at a birth for whom it wasn’t just “a job”. I’d be the person who resonated with the miracle of it and the honor of being present for it *every time*.   

And so it was for most of us trained in the first 20 years of the doula movement.  We marveled at being invited to attend births and held it as an honor.  I do believe, looking back over the 15 years I’ve been doing this and talking to other long time doulas, that this was how we helped to create the doula profession . The industry was built upon the backs of women who were honored to attend births for a wage commensurate with the amount of training we had and we felt privileged to make the emotional investment that it required. 

Now that we are in the next evolution of the effort to have doulas as a standard of care for all women, I see a troubling and aggressive entitlement amongst doulas.  They feel they can take a 3 day workshop and then demand to be paid a rate that would be more appropriate for someone who had earned a degree and had many years in the field.  They go on to berate and attack anyone who doesn’t ascribe to their bullish tactics.  I struggle to think of another profession that wants both acceptance amongst highly trained professionals AND to earn close to as much as those who have worked years to become experts in their fields.  This is really arrogance disguised as some sort of feminist principle.  They have replaced “you honor me” with “you owe me” and there’s nothing more repugnant than having to buy someone’s feelings and belief in you.   I recently saw a post by a doula that went something like “for a 1000 bucks I’ll be as non-judgemental as you want”.   What an empty and callous thing to say.   It has put one of the key values of the profession on the auction block.  Pay me to care.  Pay me to believe in you.  I rise against this ethos for a million reasons not the least of which is the women who deserve better.   We’d all do well to remember and honor the women who fought so hard to create standards of practice and codes of ethics to forge this profession.  Give your head a shake if you think you deserve to make as much for attending a birth as the health professional that is responsible for the mother and baby.  Get your egos in check and give some thought to what it really means to be a doula.  Find the honor in the work or maybe rethink your career choice.  

Monday, 14 September 2015

Dear Mom, I'm running away.

My sister is 18 months younger than I am and when we were quite little she asked me to deliver a note to mom.  I dutifully obliged and I remember my mother's shoulders slumping and her eyes looking worried when she read it. She was exhausted, frazzled and up to her arm pits in chaos.  Of course, I had peeked and I knew what the note said.  "Dear Mom, I'm running away.  P.S. I'll be in the back yard."   I made my way out to the back yard and there was my little sis sitting cross legged in the blanket fort she had made out of the clothes line.  She had her dolls sitting along side her in a sad vigil.  I'd like to think that I said something mature like " I'm sorry you are so sad.  Would you like to talk about it?" but it's more likely that I said "Mom is a poo head".   I'm sure I didn't get it right as a big sister and I am positive my mom didn't get it right either.  It was an impossible situation that we all had to get through as best we could.

When I read things like THIS BLOG by Catie Mehl, I think of that day in the back yard.  I hear that Catie didn't have her needs met.  I hear that she expected more of DONA and that she has run away. We see where you are Catie and we know why you went.  I can't excuse you using my blog out of context but I understand your desperation and that you felt that you were let down.

Here's the thing... if any of you run away to find another "family"(and while I understand you are professing to be "professional" there is liberal use of the term "family" in the pro-doula battle cry) be sure you haven't worsened your position.  We don't know what happens when more pressure is placed on the consumer of doula services and caregivers are enticed with bobbles and goodies.  It's probable that this will serve as good incentive for insurance companies and health authorities to scoff at doula support as a standard of care.  Take great care before you send the message that doula support is a luxury for women that can afford it; it's likely to back fire.  
As a DONA trainer, I take leadership very seriously.  Hundreds of women have brought their voices to the DONA board table over the years.  Some of our ideas and concerns have been rejected and some accepted and it's hard on both sides of the table.  It's grueling, hard, sweaty, thankless work and it's necessary.  It is imperfect and it has failures and it's important.  For those that have hung on I thank you and I see you and I am excited for what is coming.  People I love and respect have worked their guts out, sacrificed and pushed forward. 
For those that have run away, be careful out there.  

Monday, 7 September 2015

CUPCAKES; Bribes and Ethics

As doulas we beat the drum for caregivers and systems to adhere to good evidence.  We help our clients locate and use evidence based information to make their decisions and we benefit from good science that shows why we make a difference. 

The Cochrane update by Hodnett et al, 2012 confirms that continuous labour support has a positive effect for mothers and babies and the best results occurred when mothers had the support of a doula who was not part of the mothers’ social network or an employee of the hospital.    (http://evidencebasedbirth.com/the-evidence-for-doulas/).   This is a vital distinction.  When the support person’s allegiance is in question, i.e.: she is employed by or somehow aligned with the hospital or the caregiver, the effect wasn’t as great.

Let’s imagine that you spend time and money winning over caregivers in order to secure referrals.  The caregivers, who you bribed with gifts, meals or more, then assumes you'll influence the mothers’ choices in exchange for those referrals. Who do you REALLY work for? If you are counting on the referrals from that physician or that midwife you could be taking a risk by not doing as they ask.  If your client has the perception that you are aligned with their caregiver, this can zero out the “doula effect” and negate the very thing that makes you effective. 

Not only is woo-ing caregivers with gifts and goodies distasteful, it ignores the current evidence. Until we have some good data on what happens when doulas use these types of marketing practises it’s vital that we do what we expect of caregivers and follow the current evidence.

Think long and hard before you, as a doula, engage in bribery of caregivers in any way shape or form. It doesn’t foster the type of collegial respect that we’re all working so hard for.  In the end, it may cost your clients the support they deserve and you run the risk of “being for sale”.  Earn respect the right way, with hard work and tenacity and never, ever, be co-opted by back door deals and un-ethical pay offs.