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.   

My "Free" Births Are None of Your Business

If you are wanting to turn doula work into a "job" then don't take my class.  Please...DO NOT.   BASIC (Balance, Affirmation, Skills, Information, Confidence), our birth doula primer, is permeated with the soft skills of compassion, sacrifice, emotional investment and service.  And before you go off on a rant about not getting paid and "giving yourself away", I remind you that when we give, we also receive.  Doula work is more than a "job", it is as honoured a service as midwifery and it requires a depth of caring and investment that cannot...absolutely CANNOT be compensated for monetarily.
Your time, your expenses, your knowledge; these things can be accounted for on a balance sheet, but there cannot be a column for the emotional currency that is traded between us and the women we serve.  Often in service industries, balance sheets require some creative massaging to reflect the priorities of the provider.  Who is to say that the births I did "for no money" did not hold for me something more precious?  Not you.  You cannot say that for *me*.  You will not tell me that I have to abide by your set of priorities and charge money for all births I attend.  That is between me and my client and it is a sacred exchange.  It's none of your business.  And before you go off on a rant about my "free births" (and I haven't done many but the ones I have done were amply "paid for") I point out that there isn't a profession out there today that doesn't play some type of philanthropic role in each community.
One of our sons is a metal fabricator.  He works for a small machine shop that relies on word of mouth and a handshake.  Every day someone comes into the shop that needs something done but that cannot pay and every day one of the guys finds a way to help that customer.  Its good business and it's the right thing to do.  It, in no way, stops paying customers from coming in and it goes a very long way to creating the trust that a small business needs.
I think, in our effort to "value" the doula we have focused on one method of payment to the exclusion of others.  This is short sighted and insulting.
Full time doula work isn't for the faint at heart.  It is is bloody hard work that will cost you in ways that simply can't be compensated for.  Life on call, the stresses of a full time practise, they aren't for just anyone wanting to pay their bills and if you expect that you will be in big trouble.  We must, above all, in our effort to professionalise, not be captivated by the shtick of hard core sales-women at the expense of the true essence of what we do.  Are we throwing the baby out with the bath water as we do this?  Perhaps.

Doulas; Luxury or Right?

Are doulas a luxury or a right?  Well...Depending on what camp you sit in, either could be true.  If you narrow your opic to the individual business level you may experience confirmation bias and for your own purposes define doula support as a luxury.  With this perspective it makes it easier to be more "hard nosed" about your business model and putting earning before anything philanthropic. After all luxuries should be paid for. But this falls apart when you widen the optic and look at birth outside of your own business goals. The research is clear. Continuous Labour Support is vital to achieving better outcomes for mothers and babies.  And before you go off on a rant about how, as a doula, you are not concerned with outcomes, I remind you that many of us come to doula work to make a difference.  Most, if not all, of the student doulas in my classes self identify as seeking training to help women achieve more satisfying births.  They share a passion about helping women, in a myriad of ways, to reach for the births they want with someone at their side that shares those goals and is committed to their realization.
While the "revolution" to professionalize as doulas takes place it is shadowed by a bigger effort to take back birth. At the foundation of this movement sits compelling research that points to continuous labour support as a human right.  It's inhumane for women to give birth alone no matter where you live and is logical to think that rich industrialized countries should provide this basic right to all birthing women. It goes hand in hand with ending birth violence and entrenching the authoritarian voice of women world wide.  
So if you are struggling with the notion that doula support is a luxury perhaps your optic is wider and you are tuned into the effort to change birth.  If you have no desire to change birth, but to instead earn a living it might well serve you to consider doula support as a luxurious item for which women must pay and that those that can't can do without.   I am, however, as a person invested heavily in affecting change and educating doulas in how to achieve it, very worried about any effort to re-define doula support as anything but what the evidence supports.  It sits squarely, in terms of importance, with the presence of a loved one, as a human right FIRST.  Anything beyond that is for your convenience only.

Who Should Define Sleezy?

It doesn't take much these days to incur the wrath of doulas who aim to "professionalize".  They are, somewhat understandably, skittish.  I'd imagine that this is born out of having to blaze trails and establish new flows against the current.  The relative "newness" of their pursuits leave them distrustful and quick to shoot anyone that questions their sacred cows. I value innovators and people that speak truth plainly and for this, I give Randi Patterson and her staff mucho kudos.
As a self ascribed "industry watchdog" I'm often skewered in my attempts to bring attention to the uncomfortable.  I'm cool with this.  It means I'm asking important questions.  And to this issue I make the observation that we, as a profession, vocation or calling, need a business code of ethics.

"Business Ethics" can be defined as the critical, structured examination of how people & institutions should behave in the world of commerce. In particular, it involves examining appropriate constraints on the pursuit of self-interest, or (for firms) profits, when the actions of individuals or firms affects others.

http://www.businessethics.ca/definitions/business-ethics.html

I imagine that a think tank/summit would be the most efficacious way to host this important conversation. Leaders in the doula world need to gather around a table and hammer out what this would look like.  Certainly, we don't need to re-invent the wheel.  The Canadian Marketing Association, a think tank of marketing gurus, makes available some compelling marketing guidelines that cleave to foundational ethical principals yet allow for maximum realisation of profit and potential.   Their position on "Warm chatting" or any other type of marketing contact is multi-faceted and contains the following:

I5.1 Marketers should identify themselves and must not engage in marketing communications in the guise of one purpose when the intent is a different purpose.

We need clear ethical guidelines in place to guide us as we move into a new business savvy era.  We mustn't take this lightly.  Our success rests on a mountain of great work done by industry pioneers and we ought not waste it by acting cavalier and not laying the tracks for what is to come.  It is truly beneath us all to be stuck in spitting contests and high-school antics.  Let's all come to higher ground and establish agreed upon industry guidelines.  If anyone can come together and get this done, doulas can.   

DOULAS;  THE NEW USED CAR SALESMAN?

I've been pretty quiet over the last year.  I've been watching the doula world change beneath my feet and I can't say that I'm comfortable with what I've been seeing. As a birth doula trainer I am concerned about the new "professional doula" that is trending. Warm chatting?  Doula win? Upselling? When did these terms enter our universe? Since when is it alright to be another person that ambushes parents in an attempt to sell them something? Its vile and disgusting. And before you go off on a rant about entitlement to a living wage just think about that for a second.  Are you asserting that you have some type of right to approach parents, unsolicited, and talk them into a doula? or to hand them business cards in elevators and coffee shops? Hell, why stop there?! How about we knock on doors and hand pamphlets to anyone with toys in the yard! We all love when people come to our homes, our private spaces and our daily worlds and try to sell us stuff right?
More and more I find myself apologizing to parents and caregivers about "sleezy" behavior by doulas in person and online. As a childbirth educator I now have the distinct pleasure of hearing from parents about how they have been targeted by doulas and hijacked on their computers or in person. How did such a noble and respectful service go so far off the rails? We are perilously close to becoming the used car salesman of the birth world doing whatever we have to to make a buck. Be careful of the rhetoric of entitlement. It can suck you in and before you know it, you are spewing the party line.
The truth is that until we have earned our way into the systems and proven over and over that we can be trusted to put the mother's needs before our own we are in danger of authoring our own demise. We stand to lose a great deal as perceptions of doulas change from a person in service of another with no personal agenda to a person furthering business goals from which parents must be protected.
It's a sharp tipping point.  While I'm sure there are many ethical car salesman out there there's no denying that they must shoulder the perception that they are cheezy cheaters out to sell us stuff we don't want or to put a shine on something that we don't need.   Are we headed in that direction?  I fear that some of us are.

Walking the Walk

I turned 50 last September.  That is significant for many reasons beyond rites of passage and a new "phase" of my life. Turning 50 in Canada triggers a medical "protocol" to find disease for which, at 49, we weren't at risk.  I dutifully went for all the poking, prodding and tests now required and behold... I have high cholesterol.   Of course I had high cholesterol when I was 49 but now it's a whole new ballgame.   Now I'm to consider jumping on the statin train.  The pressure from my care provider is significant and even as an educator who knows the evidence on cholesterol doesn't support his treatment plan, I feel that pressure intensely.   Holding steady and negotiating with my HCP is intimidating and stressful and it's only me I'm advocating for.   I know, from research, that having inherited hypercholesterolemia, means moderating stress and using other health indicators for heart health but getting my HCP to jump off his band wagon and onto mine is tricky business.

When we as doulas and CBE's toss out "you need to advocate for yourself" to expectant parents we need to consider how difficult that actually is.  There's much at stake and this type of advocacy requires a moxy that many people haven't developed for themselves and even if they have, there can be unacceptable repercussions.   Of course I've understood this on a cerebral level but lately I'm feeling more in touch with the discomfort beyond that and recognise that there needs to be another piece added that statement. It's not enough to suggest this to parents. We have to go further to discuss, in realistic terms, what self advocacy would look and feel like.  And for those of us in Canada where couples likely won't have the option to change care providers, we need to accommodate the notion that sometimes that advocacy isn't possible in it's purest form.   It's highly political and parents need ideas about how to access the best care possible given that reality.

The bottom line is that I know what I need to do for my health and I have the tools to negotiate a plan with my HCP but I'm still sweaty thinking about my next appointment.  As an educator this is valuable to me and as a doula this is vital.  I need to stay connected with how this feels and understand that for parents it's exponentially more difficult.   There's a precious child that comes first and that ups the stakes.  Its difficult, sweaty, and nerve wracking business and we'd all do well to address this right out of the gate.

As I negotiate with my HCP next week I expect I'll have to meet him somewhere in the middle.  My fitness and impeccable eating habits might not be enough for him and I'll have to find a way that pleases us both.   Its good practice for helping the couples I work with.   Wish me luck.