Monday, November 14, 2005

doula weekend

After a few months of distance from doula work, I spent both weekend days back in it.

Saturday I participated in a DONA doula training session, representing the "real doula" perspective to the seventeen or so participants. I had brought my doula bag and thought I'd spend time going through it. I had only about five minutes at the end of my two-hour slot to show off my toys. The rest of the time we talked about building a business, handling difficult situations, what questions are typical in a phone interview, and so on. I had to offer the caveats that I have only been to about 20 births and by no means make a living from doula work. I am never comfortable putting myself forth as the expert on anything. Collaborative sharing, sure.

I had a moment of humility when one of the trainees asked if I had ever encountered the situation she recently did: A Latina immigrant contacted her for birth support. But this woman, in the tradition of her culture, was planning to birth at home with only her husband in attendance. The trainee, a Latina herself, said this is common in many Central American and Carribean countries, particularly among poor women. The difference is that in their home countries, there are relatives or community members who serve as midwives, whether they are trained or not. For women who have transplanted themselves to the U.S., they lose the community base from which to draw support, but not the sense of This Is How Things Are Done.

The doula trainee's dilemma was whether to say no, because she did not want to end up catching a baby, and leave the woman unsupported AND facing health risks, or to sign on as a doula with the knowledge she'd be asked to do more.

I could only point her to the DONA code of ethics, encourage her to talk to the trainer, and point out that she could be a hugely valuable resource for this woman in terms of helping her find affordable care she was comfortable with. The question prompted a lot of discussion among all of us there. For me it was a reminder that I work with very privileged women (i.e. those that can pay) and would like to find a way to reach out to other women, too.

I won't say that my clients don't need, deserve or benefit from doula care. Compared with the kind of client the trainee described, however, my clients have a posh situation: health care, citizenship (!), friend or family support networks, education, access to information. The difference a doula makes for these women is much greater than for someone who hopes to avoid an epidural or wants to make sure her baby spends the first hour on her belly or breast.

An example of this latter woman is the new client I met with Sunday. I am very excited to be working with her. We hit it off well. (She is one of the "doulicias" that contacted me back in September). She got nearly the birth she wanted her first time around except that without support, she finally caved to the nurse's pushing of an epidural, only to deliver her child 80 minutes later. This time she wants a doula to help her through that transition period of self-doubt. I'm more than happy to do so.

I just feel that for every client like her I work with, I should work with a teen mother, an immigrant, a single mother. I keep saying once our financial situation is better I will. And I'm hopeful that it will improve in a year or so. Until then, I can't escape a little twinge of guilt as I sip tea in cheerful sun rooms and talk with clients about lavender-scented oils.


Blogger angie said...

it's nothing to feel guilty about. if this country could get an insurance program to help pay for "alternate births", i think many more women would have the support to go without an epidural. i'm faced with this, knowing that i will have a hospital birth and, most likely, any and all pain relieft available. it's kind of sad.

2:40 PM  
Blogger Julie said...

This reminds me of conversations with the midwife in town who regularly goes to, I believe, Guatemala. She pointed out to me that home birth is not such a great alternative when it means giving birth on a dirt floor with no running water, etc.

10:48 PM  
Blogger I am a Milliner's Dream, a woman of many "hats"... said...

Good for you for sharing in the workshop and for pointing to the DONA COE & SOP.

I've had to deal with the "unassisted birth" question...!


2:49 AM  
Blogger doulicia said...

Angie, you're right. All women deserve an empowering birth.
(By the way, a friend can make a great doula if you're looking for "free" suppoer)

4:28 PM  
Blogger Kristina said...

I hear where you're coming from. I went into this work intending to work solely with teen moms and economically challenged women- and so far I have worked with 2, in three years. I get paid well, and I live comfortably, and I have to say- I've been that poor woman with few resources, and I still don't feel guilty about being where I am today. I know that I simply can not invest the amount if time that is necessary to support the demographic- it is a much larger task than just two prenatals, birth, postpartum visit. I can't provide that level of care right now, with small kids at home and a husband who feels that two clients a month is critical mass. I have learned that there are doulas for every woman - and like missionaries we all need to go out and 'spread the word' about what we do, but that there are doulas out there who can take the time to work with those moms who desperately need it. I am just not one of them yet.

As far as the unassisted issue... I have mixed feelings about telling doulas to go to an organizations SOP. For one, there are doulas like me who have no intention of certifying with said orgs, and so the SOP is a nice guideline but not probably as meaningful to me as it would be to someone who was certifying. On the other hand- because it does exist, it might help the doula clarify for herself her own feelings about attending unassisted births. I am still on the fence about this issue myself. I have been invited to two possible unassisted VBACs- these moms don't WANT to birth unassisted but they are literally out of options if they want a vaginal birth. Fortunately these situations are resolving and both moms have found care that meets their needs- but it has come to the point in my commumity where unassisted birth is something that women are considering rather than face another surgical birth. I think we doulas are going to see this request more and more as our birth rights are removed.

Your blog is BEAUTIFUL! Great job on the redesign!

11:41 AM  

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