Pro-Doula; Violence, Victims and Vindication

Let’s be clear that Randy Patterson isn’t getting rich being a doula. She is getting rich on the backs of doulas. This is an important distinction.

The hard working doulas that line Randy Patterson's pockets are trying to make her business directive fit with what is generally understood about the role of the doula. I imagine that they are afraid that the organizational violence will be turned on them as happened with this former ProDoula. In an article entitled “What About This One?” (Pyramid Scheme Alert) authored by consumer educator, Eric Scheibeler, there is a list of seven reasons why people don’t warn others about falling victim to MLM schemes. Among those reasons are shame, embarrassment and cutting losses. I'm sure that many, maybe even most, ProDoulas are honest, hard-working doulas that offer evidence-based care; but there's no skirting the fact that they are associated with a dangerous and unethical organization known for its organizational violence.     

While I worry about unsuspecting doulas that are taken in by ProDoula tactics, I worry more about the consumer who doesn’t see this coming. While consumers are likely to be wary of someone hard selling them vitamins, spices or cookware, they might not be as savvy to the person calling herself a doula and aggressively “warm chatting” them. It’s unlikely that many consumers would understand the differences between an ethical doula and an unethical one in the first or even subsequent meetings, and therein lies more danger. These families don’t just wind up with a bunch of unwanted vitamins; they are victimized at one of the most vulnerable times of their lives. New parents may never really know what their birth experience might have been with a doula that they interviewed and chose without any pressure and with only their needs in mind. To make it worse, they likely aren’t able to warn others if they become aware of what they gave up because they’re exhausted new parents just trying to survive. 

One of the hallmarks of classic MLM schemes is “paying to be trained to work for the company” according to the Pyramid Scheme Alert. ProDoula candidates are pressured to take multiple courses and to pay for private "business advice," which often is more about recommending the services of Randy's family members than it is anything of any real value. To anyone considering this type of "training," I say run for the hills. Better yet, find a doula training organization that offers good and affordable doula training based in evidence. While no doula organization is perfect, there are many good ones out there.

Build your reputation and business proactively and ethically. Get involved in leadership in your community of doulas; share information and support one another; diversify your skill set; seek certification; and network with your community stakeholders, care providers and families.    

Where BuzzFeed Fell Short

When I was contacted by a BuzzFeed reporter a few months ago to comment on an article , my first instinct was to send her away.  Her second call had me more intrigued.  She seemed to be looking at the doula industry in some detail, and I felt more compelled to contribute. I explained my beliefs around how and why ProDoula came into being and discussed  how their deviation from evidence-based doula care has the potential to undo decades of academic work.  I then called DONA International and explained to the public relations director that I had done the interview, shared its content and suggested that they would be wise to consider an in-depth response to the article.  When my two hours of interviews were distilled into a single quote, I was disappointed, but hoped that it was because much better information was available.  Unfortunately, valuable print space was wasted on Randy Patterson's personal style and office decorating scheme.  I suppose that edgy looks and profanity-laced quotes make better news, but they hardly contribute to a further understanding of what is really at stake here.
The fall out from the article has devolved into personal attacks and defences and sappy personal drivel, but we have yet to read a substantive discussion around why ProDoula is so dangerous and where to go from here.
The ProDoula ethos didn't materialize out of thin air.  It was taken directly out of the Mary Kay Cosmetics playbook.  There's nothing original about what Randy Patterson and her business partner are doing, but it is disguised in new deceptive packaging.  Having just read "Mary Kay on People Management" written by Mary Kay Ash in 1984 describing her ascension to wealth starting in 1963, I recognize much of what ProDoula is selling its members.  The "MK" philosophy swirled around a single magnanimous and bigger than life personality and targeted women and some men that were eager to succeed and wanting to be validated.  1963 was ushering in the women's movement, calling women out of their kitchens and putting them on the business stage, and Mary Kay was right there to help those women legitimize.   She stepped forward as a Svengali figurehead that stood in receiving lines dishing out personal attention and eye contact to the disenfranchised and unfulfilled.  Sound familiar?  She held elaborate rallies where women wore tiaras, took part in company chants and were pumped up to head back out and sell! Sell! SELL!  Much like the ProDoula "conferences" we see today these were not academic in nature but meant to bind the sales force using the rhetoric of the golden rule business philosophy of their leader.
It was disturbing to read the unabashed deception that is the MK business model.  It validates using and abusing relationships, manufacturing camaraderie and professing love in order to secure sales and plump up bottom lines.  In his whistle blowing manual, "False Profits", Robert L. Fitzpatrick describes the flamboyant figurehead of MLM schemes and how faith and work ethic link virtue with labour.  Sound familiar? MLM schemes use the "if you aren't successful, you aren't working hard enough" blaming tactic to keep their sales people working harder and investing more, often putting people in financial and emotional jeopardy.  It's all couched in a means to a profit battle cry that helps excuse the despicable nature of the approach.  Market saturation and bullying tactics, such as the "You are taking food from my children's mouths" cliche and the scarcity model keeps everyone scrambling for market share at the cost of ethics and morals.
What IS new about ProDoula is the combining of a service with the MLM model.  At first glance, this would seem impossible unless one could define the service as a luxury, which is precisely what Randy has attempted to do.  But doula support isn't lipstick, and it goes way beyond face value.  Marketing birth support, a deeply emotional and trusting relationship, as if it were a  product is tricky business; and, as it turns out, is also dangerous.  ProDoula is attempting to forge agreements with care providers that supersede the very autonomy of the birthing family and possibly zero out the doula effect  entirely in order to secure markets.   This promises to not only co-opt the care provider but to also confuse them as to what doula support really is, how it is effective and under what conditions.  Mothers who don't have the doulas' full allegiance because their doula has an agreement in place with the care provider aren't receiving doula care as it is described in the research, but are instead getting a pseudo employee of the birthing place.  Twelve-hour clauses in contracts serve to undermine the doula/client relationship and go completely against all that we have come to understand about continuous care.  Doulas that hijack parents in baby stores and evangelistically bully them into hiring them ignore the very premise of the doula/client relationship and destabilise the connection that leads to positive effects on outcomes.

 In fact, I insist that these women don't call themselves doulas at all.  They should find another term that better describes what it is they are selling.

  

The Sheep and The Wolves

You may be aware of the concerted effort by Pro-Doula to spear head what they call “The Doula Revolution” (rev·o·lu·tion noun; a forcible overthrow of a government or social order in favor of a new system). This is essentially a labor union (noun: an organised association of workers, often in a trade or profession, formed to protect and further their rights and interests) asserting a misguided entitlement to excessive compensation using multi-level marketing practices and disguising it as a "revolution".  

The following description of the hallmarks of MLM will likely sound familiar to you.

"Companies that use MLM models for compensation have been a frequent subject of criticism and lawsuits. Criticism has focused on their similarity to illegal pyramid schemes, price fixing of products, high initial entry costs (for marketing kit and first products), emphasis on recruitment of others over actual sales, encouraging if not requiring members to purchase and use the company's products, exploitation of personal relationships as both sales and recruiting targets, complex and exaggerated compensation schemes, the company and/or leading distributors making major money off training events and materials, and cult-like techniques which some groups use to enhance their members' enthusiasm and devotion"

MLM’s are infamous for recruiting “lost souls” into their “families” and pandering to their disillusionment while asking them to suspend critical thinking.   Why you should be bothered by MLM schemes.  

While most industry leaders consider Pro-Doula and other agencies like it, a nuisance, they also acknowledge the unfortunate pressures on the consumer to spot and avoid a doula whose priorities do not rest with the mother but rather with her own pocket book and her advancement within the organizational ranks.  We must all be prepared to speak to this unsavory aspect in our profession and help parents navigate doula communities to locate and hire the doula that best suits them and is guided by business ethics.  Our clients ought not have to sort the wolves from the sheep.  We, as an industry that has so far, escaped regulation, must do that ourselves.  

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.   

"You Honor Me" vs "You Owe Me"

May 6^th 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.  

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.  
 

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.