Updated: Feb 26
Since entering the realm of maternal support & birthkeeping 6 years ago, I have met a large variety of attitudes about birthwork regulations and qualifications. I have met seasoned certified doulas who primarily serve clients birthing outside of their homes, radical birth keepers who are committed to upholding boundaries around serving women who are birthing at home freely, and of course others on this spectrum of caregiving. More interestingly, I’ve noticed an increasing amount of discussion about doula regulation over the last year, including the promotion for doulas to create those regulation requirements. Imagine this: a mandatory framework which must be met to ensure that aspiring birth support professionals have indeed been educated and (ahem, conditioned?) properly as not to interfere with existing or potential dynamics regarding the client and the medical attendants. I am challenging this proposal.
The push for the widespread regulation of doula care, for some, is for the advocacy of increased accessibility of care. Insurance companies may be more likely to cover the costs of doula support if it was standardized. This would likely extend to only include hospital-based doulas which do not have such ample opportunity to provide longevity of care throughout the antenatal period, a vital aspect of deep intimate support within a mutually trust-rich relationship. It also brings to attention that hospital based doulas are first and foremost employed by the hospital, and therefore by the industrial obstetric system in which so many women are routinely abused, rather than employed directly by the birthing women themselves.
Surely, there must be another way to increase accessibility to care. I firmly believe that the solution is not through standardization, but rather by uplifting families through the reintegration of community care for newborn families and the remembrance of the power of sovereignty. It is time for us all to recognize the difference between knowledge led to us by others, and the wisdom which comes from within us. Harnessing this strength and returning it to the village is how we reclaim intergenerational lifelong wellness that touches us on every level of our being.
A misconception lives that unregulated doulas are dangerous, and that the only qualified helpers are endowed with a capitalistic certificate stating so. Standardization, as approved by the “big guys,” makes doulas less threatening to them. Some doctors and nurses are opposed to working with doulas present in the birth room in fear that the doula might diminish or degrade the medical staff’s perceived authority over the birthing woman and her baby. Regulating doula agencies integrate counseling about communication in this dynamic, but nonetheless encourage doulas to stay small and silent if the medical staff acts unjustly, abusively, or even illegally.
Studies show that having a doula present during your attended birth decreases the rate of interventions including episiotomies and cesarean sections. It is clear as day that this is partly due to the increased accountability of medical caregivers when a wise, third-party eye is present with the birthing woman.
Minimizing this also minimizes the value of service that non-medical birth support personnel will be to women. With the onset of the perceived Coronavirus pandemic early last year, birthing women were denied access to their support systems during one of the most intimate and profound experiences of their lives, with the occasional exception of a partner or certified doula who was able to present proof of her certified status to the hospital staff.
Lastly, I have encountered numerous blog posts written by nurses, obstetricians, and mothers who offer their guidance to fellow women that wish to hire a doula for their upcoming births. The primary focus of these blogs has unanimously been to ask for information about the doula’s education and certifications prior to hiring them, as well as the education and certifications of any and all back-up doula partners that may be involved. I find it utterly mind blowing that the value of passionate, devoted caregivers in this sacred work of witnessing and holding space for birth to unfold is so quickly dismissed. I see this as a reflection of the greater picture: that our society turns a cold shoulder to the holiness of birth and families in favor of honoring the hierarchial structure of western medicine, even in times of prime health.
What might regulated doula care look like?
We are seeing the first stages of regulated doula care already. Science and medicine continues to divide into numerous subtypes and specialities. With each person’s workload constantly increasing, there is need for delegates to provide the routine face to face tasks that mirror everyday life. Unlicensed nursing and medical assistants fill the gaps between patients and their licensed care providers. Without activism against it, I see “doula” becoming a word to describe a division of certified nursing assistants who work in the birth room under the supervision and direction of the nurse and/or physician.
Today, the doula's role in education, inspiration, and reassurance to birthing women also includes keeping intuitive and logical insight to the physical and emotional needs of the birthing woman and her family. This might be include the applicatpressurecounterion of hands-on interference: counterpressure , guided breathing, focused progressional relaxation of the body, and suggestions for position change. These modalities can absolutely be helpful to the birth process, and my question is "how deep into regulation does this extension of birth care need to be before the doula's roles become those of obstetric nursing assistants?"
What is a traditional birth attendant?
"Doula" translates to "servant." More specifically, it is a Greek based word for women's servant.
Traditional birth servants are present to witness and support physiological birth by providing a loving, grounding container for women to birth in. Historically, traditional birth attendants were elders such as aunt's and grandmother's who understood birth as a natural biological process, tended to the home and other children within the home. They provided psychosomatic and spiritual comfort to the mother during and after birth. The birth attendants were called upon by their families, communities, and by the passions burning in their hearts as healers that walked with others between the spiritworld and the earthly plane. Many of these traditional birth keepers were paid very little and yet were an invaluable resource for all who brought forth life, and all who crossed back into the heavenly realm through death.
The willingness and capacity for anyone to witness the unfolding of these processes, with unwavering love, respect and guided by intuitive insight is a gift of spirit. This gift cannot be tethered.
Intuitive care, provided through a variety of means allows women to choose which caregivers and which type of care best resonates with them, and reap the benefits of their decision. We can not simultaneously prioritize women and the medical-birth industry.
While the terms nurse and midwife have already been monopolized into allopathic systems, and that we are all grateful for the service of kind-hearted members inside this industry, it remains imperative that we maintain observance of the implications of this model of care and stay attuned to our moral compass at all times. That said, there will always be dedicated, passionate women ready to serve birthing mothers outside of every government system, offering birth care that is as wild as birth itself.
Those who are passionate about serving women, supporting birth, and maintaining the innate joy of of the human experience will continue to serve women. We will name and rename ourselves for eternity. We will serve as friends and sisters. We will stay grounded in our mission and in our passion as wild doulas and traditional healers.
Do you want more of this conversation?
By the way, have you checked out Free Birth Society's Radical Birth Keepers School
This content is not reflective of any individual person, institution or choice, but remains critical of allopathic systems which profit off of the abuse and oppression of women and mothers.