Sunday, January 25, 2009


I've felt so stirred up for so long, weeks and weeks, that now things are starting to settle and it feels like my brain actually gets a chance to rest once in a while.

Yesterday I started my class series and it definitely went directions I wasn't expecting but I think at the end it shook out to be beneficial for everyone. Interesting how that happens sometimes, my ego was a little bruised but I think I recovered well and offered what was needed in the moment.

When I got into the BFW program and started learning about mentoring I didn't get it. I guess I did get it to a point, but now that I've gone through this gauntlet these last few weeks and had this opportunity to clarify my values and where I want to go as a doula and educator, the mentoring appeals much more to me. My partner agrees and this is the energy we are taking into our work. Personally I think BFW relies a little too much on it and isn't quite as balanced as *I* needed, but yeah, I think they're definitely on to something.

Monday, January 19, 2009

Gah. This makes me nervous but...

The first five people to respond to this post will get something made by me! My choice. For you.

This offer does have some restrictions and limitations:

I make no guarantees that you will like what I make!

What I create will be just for you.

It’ll be done this calendar year.

You have no clue what it’s going to be. It may be a story. It may be poetry. I may draw or paint something. I may bake you something and mail it to you. Who knows? Not you, that’s for sure! However, I *do* promise that it will be more than just a handmade card!

I reserve the right to do something extremely strange.

The catch: You have to put this in your journal as well. We all can make stuff!

** I have a goal this year to procrastinate less (I'll get around to it.. lol) so this will be a good challenge for me. **

Sunday, January 18, 2009

Peer review again

So I'm going to do it, I've put the word out to local folks who are interested in peer review. I've polled the greater community and I feel like I understand better now after talking with a few close mentor-friends about why this idea isn't sweeping the community. That's fine. I feel like I want to go to the next level with my services, and really take ownership of the consequences of my decisions in a different way from what I previously did.

It's been hard to stay involved in lists and boards where people are throwing medical advice around - it's one thing to refer someone to information so that they can choose for themselves or take that information to their provider (or whatever they want to do with it), and it's another entirely to be telling women online what lies to tell their provider, or what herbs to use to start labor when the doula has no training, etc. It goes on and on. It's not black and white, the medical system is fucked, it lies to women more than anyone else- I think I've seen good informed consent once or twice, once at an abortion I attended where the risks associated with Cytotec took two pages which she had to SIGN (rather than "it's just a little pill" women hear in the hospital when they're being induced), and the other with my own OB/GYN. I do think I'm starting to understand informed consent a little more though and have some understanding of where docs come from when they don't feel they have to educate their patients - a lot of patients either don't want to know, don't care, or can't understand it. That doesn't excuse the provider from helping the client to understand before decisions are made though- but our system isn't set up to allow the provider in a busy clinic more than 3 minutes or whatever per patient. I mean, this system is fucked. It needs a serious overhaul.

Back to my original point (I think I had one)... I am having to really look at my connections and see if a) they're feeding me and b) if I am giving something back. I'm feeling right now that I'm more of a bur in the sides of those who like things just like they are, and that's not so bad, but it's pointless unless it drives discussion and it doesn't seem to be. So I'll just sit on my hands in public and come here (you know, my "private" blog.. hardy har har) and say what I need to say.

My friend said, "Tell the truth." I'm really intent on doing that - the truth as I know it is that the doula community has become so expansive and the definitions of doula work so broad that standards of practice (unless you're in a certifying body who tells you the SOP) are almost impossible to nail down. I frankly believe and have said many times that this HURTS our profession more than it helps us. Doulas are non-clinical care providers, but then we have midwifery students who are also doulas blending the lines... or doulas who want to be midwives going outside their scope... or doulas who think they are shields for clients and need to protect them from a birth the *doula* doesn't want her to have.

Doulas are not heroes. We aren't the protectors of women from the 'big bad provider'. It *disempowers* women to be their voice for them, we are no better than the providers from whom they think they need protection! For me, this means teaching my clients how to discern whether this provider/birth space/decision is right for HER, not for me, not for her outcome, but for this moment, right now, with the information and intuition and resources we have in THIS moment. If my client says she wants a 'natural' birth, what does that mean? "Natural" birth is just a word with a really nebulous definition. Does it mean no pain meds? Does it mean narcotics are okay but not epidural? Does it mean no Pit? Does it mean no vaginal exams? Does it mean homebirth? I might think my version of natural birth is what she's trying to achieve but if I don't listen and really hear my client, we might be moving in two different directions.

Doulas are not quasi-providers. One thing that drives me up the freaking wall is the 'doula as herbalist/homeopath/nurse/midwife'. Wear one hat, girlfriend, you only have one head. I don't know how to word this without sounding bitchy and I'm only half worried about that, so I'll just say it. *Doulas have no place giving medications, herbal or otherwise, to their clients unless they are herbalists!* Oh, and this one... *Doulas have no reason whatsoever to have their hands in a client's vagina!* Even in an emergency situation (unless the doula is the only one present), a father/partner can catch their own baby, there's no reason for the doula to get involved except to continue to provide support and encouragement. Of course there are exceptions, maybe dad fainted or something, whatever, but it's safer for everyone if the doula errs on the side of letting the mother's body do what it needs to do and helping dad to stay calm and present. Is a doula trained to manage a dystocia if it happens? Sure, we've all read/heard about the Gaskin maneuver but do we all know how it works, or what signs to look for that it's working or not? And what happens if we think we know what to do, try something and screw it up worse? Whose responsibility is that?

I don't think that we need to practice in fear at all. I think if doulas stick to what we're there to do, love and support the couple, share resources so that they can make decisions, we really don't have much to fear with regard to the law, or overly controlling doula policies in hospitals.

So what do I say when I see doulas bantying medical advice between them trying to clarify what to tell a client about the risks of something? Right now, I say nothing. I'm too fired up about it, so I'm just holding my breath until I can be settled in myself and calm. It feels good to write, though.

Saturday, January 10, 2009

What is a doula, anyway?

After six years I find I'm rediscovering it. It's not (for me now) what I thought (it was), and I'm not moving in the direction I feel is right anymore. I used to identify myself as the 'knowledgeable' doula and now I find that I want to learn more about mentoring, working alongside my client in a very different way. I think this is what attracted me to Birthing From Within (even though the love got lost along the way, I retained that value), the idea of mentoring and growing and learning alongside clients rather than being the keeper of the knowledge.

I don't like, nor agree with the perceived authority that comes with being the knowledgeable one. When a client looks to her doula and asks, "What are the risks of this decision?", the doula becomes the authority figure and the energy shifts from the client being in charge, the provider being responsible to distribute information, benefits and risks. Suddenly the doula is pitted between the client and provider as the 'trusted' person. No wonder providers don't like doulas! When did our role shift from being loving heart and hands to being the extra encyclopedia that clients could bring to their births?

What if we put the onus on the client to hire a provider she trusts, choose a space in which she feels safe, instead of hiring a doula to act as her encyclopedia, lie detector, advocate and defender? How many potential clients have I turned away when their inquiry was around me telling their provider NO if necessary? No wonder providers look at doulas as potential witnesses in lawsuits. If clients are trusting their doulas over their providers, who is legally responsible for a bad outcome? No wonder these waters are so muddy, and the bridges almost impossible to cross.

I'm learning to ask more questions than answering them. Even my teaching involves asking questions and helping them find access to answers (with a foundation of basic knowledge). I think the whole point of my classes is not so much to teach them about the benefits and risks of every possible thing they might encounter, but rather give them the tools with which they can get the information they need in the moment to discover that information for themselves. I really believe that that is where the power and strength lies in this work, because these are tools that the parents can take with them as they go forward and parent their child.

I have several goals this year - I want to be profitable at the end of the year (and that can be $1 into the black, that's fine!), I want to teach four class series (at least), and I want to have clients every month that we're accepting clients. So far we have clients in March and April; I am holding the door open for clients to fill slots for the rest of the year. I just ordered a business license so I'm looking forward to taking that next step to organizing my business as a business and not just an expensive hobby.

I feel concerned at growth of this profession in numbers without the growth in integrity and clarity. I raised the issue of peer review and I am really shocked how no one seems to have any feelings around the idea, supportive or challenging. The assumption is that their needs are met by talkign with a trusted partner or their own doula collective - but where are the lines of confidentiality drawn THEN? Doula orgs have standards but doulas can be certified for years and unless a client were to complain the certifying body would never know if the doula was breaching confidentiality or not.

One doula organization says that the concept of peer review challenges their ethics and they would not support it because confidentiality for the client couldn't be guaranteed (as if midwives or doctors can guarantee it?). Another org supports the idea as a positive one and is looking at ways to create a space for their doulas to participate in this in some way online.

For me, this feels like a 'taking it to the next level' thing. This feels like it could develop into a way for doulas to be taken much more seriously than we are, and for us to take ourselves more seriously than we do. I can't even fathom the types of things we might learn about our profession, our motives, our methods of delivering our agendas (which do exist), our diplomacy within the birth space, etc.

What hesitation do we have to go to the next level, to deliver better services, and to take more responsibility?

Friday, January 9, 2009

Paying the bills

I received payment from a couple of clients in the last few days and when the check arrives I feel really excited! Five minutes later when it hits me that I have to split some with my partner (whom I love!), pay for teaching space, buy materials, etc., I wonder if there will enough left for a trip to Starbucks.

I had to buy a business license so that I can bill the insurance company of another client who is trying to get them to reimburse for my classes. I have never done this before - I really can't afford to take on a student for less than my fee if I don't absolutely have to, so assuming the insurance company pays me, will they pay my full fee? Now that I've paid out money to get paid, will I even break even? Gah!

Tuesday, January 6, 2009

Peer review

My first post back. Baby's sleeping and this has been floating around my mind for the last few days. It's just an idea at this point but it's already raised some big questions and solid answers in my own little community, so I thought I'd toss it out here for mastication by a larger crowd.

Doulas have networks, we have organizations that train us, certify us, promote a code of ethics and offer a grievance policy. We have networks that offer preceptors, apprentices, business training, networking opportunities, and referrals. We have online forums where we can ask questions to doulas all over the world about every topic we might come across.

What I've never seen is a peer review process. I know that medical providers have such a thing- using midwives as the example, this is a link to their standards as put forth by NARM. I envision something very similar for doulas- a round-table environment where the facilitator is neutral and not involved in the content of the meeting but holds the container of organization and safety for the participants. All participants would agree in writing to standards of confidentiality and these standards would be read before the meeting (maybe?). Everything said within the PR process would remain there. The doula bringing forward a case would have permission from her client to do so, but would respect the anonymity of the client by discussing only the most pertinent details to the issue at hand.

* The client's decisions would not be under review (as they obviously are her own)
* The medical decisions and behavior of the provider would not be under review

The facilitator would be on watch for discussion that tended to lead toward either of these topics (as it is very difficult sometimes to not ask WTF someone was thinking when they ____), and keep everyone focused on the doula's process.

The doula would then ask for feedback, support, and suggestions and would be able to hear back from the group.

Is there a need for something like this? I've heard some passionate desire to have this sort of thing and I've heard some dissent as well, but nothing that struck me as weighing so heavily as to make this impossible or even a remotely 'bad' idea.

The more I've Q&A'd this, the more it flushes out in my mind and the more I think that this process might be valuable to doulas as well. It's another way for us to develop our profession in a more complex and meaningful way. I'm becoming more and more supportive of the idea as it gains in complexity. :)

Feedback anyone?