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I'm Hysterical

My brain is a little fried from the news lately. It’s easy to get worked up and feel like there’s nothing we can do but scream. The word “hysterical” comes from the Greek word “hyster” or uterus. It translates into “wandering uterus.” In the days of Antigone, it was thought that women were empty save for a brain (generous) and a uterus. When they were being “hysterical,” it was because their uterus floated up to their brains and was causing mayhem. The cure for this was to tie a very tight rope around a woman’s waist in the hopes it would keep her stray womb at bay. Misogynist (also a Greek word), yes, but also sort of fantastical and cute compared to the resent assaults and misunderstandings about the internal machinations of womb-owning in our current medical and political bodies.

I rewatched the second season of Handmaid’s Tale, finishing up just before the news coming out of Alabama and Missouri a few days ago. When that show first premiered, half of the people I knew wanted me to watch it to get a doula’s take on it. It felt all to familiar, was my response. I watch women (and other pregnant folx) being told that they’re not good enough to take care of their own bodies or their babies constantly. The scene in the second season where June picks up Hannah from the hospital and is grilled about not being a “good mom” sounds like half of the concerns coming from the lips of the parents I work with in postpartum.

fuck these abortion bans

fuck these abortion bans

Pregnant people over the age of 35 are considered “geriatric” like their pussies are going to collapse in on their precious cargo just for having a fucking birthday. AJOG released research in 2011 outlining how 2/3 of OBGYN practice in the US is not based on high level evidence, but on doctor opinion. No shit. And it’s clear that those opinions can be racists, misogynist, and just downright wrong. So if the people supposedly in charge of understanding our changing bodies can be so brazen, can it be so shocking that 25 white men (and some particularly vitriolic women) who are convinced women are vessels and murderers don’t understand ectopic pregnancy? Or that you don’t need to cut into a uterus to remove 12 weeks of dividing cells?

We are an increasingly unscientific nation. I see that in how parents talk about research they come across (usually poorly digested in mommy blogs and the hellscape of Facebook) and feeling shamed into doing something against their intuition.

For those of us who work with folx in the childbearing year, the burden often falls on us to calm the storm, find and present valid information, and to fight diligently. And we do it as grossly unpaid and structurally unsupported persons in the shadows. Compassion fatigue is high. Burn out is fast and furious.

I’m reclaiming the word Hysterical.

And yeah, this is a shameless plug for the things I’m trying to do with Rosewood. My mission in birth work was always structural. It was always to support the people who support reproductive health and I’m finally carving out more than a marginal space in my life to do so. I want to do more to help doulas collectivize. I want to do more to help prepare birth workers with high level research. I want to help them make their businesses succeed so that they can be sages at 6 years, 9 years, 25 years of practice and not have to walk away from their passion after 2 years of begging to get paid for sleepless nights and combating structural injustices. I want to help birth workers get paid decent incomes so they can take on more volunteer and sliding scale work and serve those who need support most. I want other birth workers to feel that they can move into a position of policy and profit because they have done the groundwork and are ready to create larger platforms for others doing this essential care work.

I don’t have every answer to what’s going on politically. I shouldn’t and won’t be the voice that starts a revolution or changes the world. I had that vision of myself at some point when I was younger and working in non-profits and teaching myself international law in college. Then I was confronted with how much ego gets in the way of progress. Now, after a decade of being in birth work in many different communities, I see how being shamed into retreating too far away from ego, my fellow birth workers are setting themselves up to be taken advantage of (even if not maliciously) and why our profession stays in the margins. I believe that there can be individual triumphs, revolutions in our solo practices, and teamwork across our small communities to create incredible change for ourselves, the families in our care, those not wanting to create families who need our support and guidance, and on a much much bigger scale by showing up for ourselves and each other.

My place in this whole thing will be to help doulas set better expectations for themselves and their clients through their contracts and professional presentation. I will take my experiences of building sustainable non-profits to as many doula groups as I can in hopes that they can great organic, productive, and structurally sound collectives to protect and promote themselves and their colleagues. I will mirror these approaches in the workshops I give to parents and caregivers so they can understand and start to dismantle the influences that want to convince them their not good enough and connect with the passionate care providers who know that they are. I will do my best to listen more, allow my own biases to be dismantled, and to not shut up.

My goal for this year is to be in at least 10 different cities with these classes and consultations. I’m also writing a book on contract writing that focuses heavily on sustainable birth work and joining forces in our communities and country to make changes. If you would like to work with me, please reach out. This work can be exhausting and isolating and it’s not possible to do on your own.


Head on over to my Doula Trainings page to see what workshops I can bring to you. If you’d like me to come to your city this year, please fill out the form on my Contact page with details about you and your doula community and let’s get the ball rolling together. I offer a trade deal for anyone offering to host my workshops in their town. It’s a great way to collaborate, keep this momentum organic and unique to your particular area, and to connect with one another. Plus, you get to take my classes FOR FREE! Looking forward to working together.

Cesarean Awareness Month

cesarean awareness month

It’s #CesareanAwarenessMonth so I want to talk a bit about the discussion around cesarean rates and place of birth / chosen care providers.

I take some issue with this statement by Dr. Neel Shah (Director of the Harvard School for Public Health) in that if you’ve been attending births as long as I have, you can really start to understand why some hospitals have higher rates of surgical births than other.

There is a hospital in SF that is notorious for it’s induction and cesarean rates. The culture of the interactions between doctor and nurse, doctor and laboring person has at times been so hostile that many doulas refuse to take clients choosing to birth there. I am one of those doulas. I’ve seen too much there where I felt my clients were disrespected and put into unnecessarily risky situations, as well as overhearing some disturbing things while walking the halls among the doctors and nurses and no longer feel like my practice benefits from supporting pregnant folks seeking care at CPMC. I’ve lost a ton of potential working opportunities by sticking to my guns on this, believe me, but I felt my will to continue to do this work and the liability aspect of my practice suffer by attending births there. I never looked back.

I’m not the only one who has made this hard choice. The topic has come up with peers and it’s clearly a difficult one. Some doulas do very well in that hospital, they feel comfortable there, their clients are able to be treated well. Those doulas tend to have been working for a long time and are confident and outspoken in their normal lives, let alone in the birth space. I, however, don’t feel like it’s my role to have to fight every arbitrary decision being made for my clients around misused testing and labeling in pregnancy and the lightening speed toward interventions. At the end of the day, these folks chose where they are planning to give birth, chose their providers, and deserve bodily autonomy.

HOWEVER, despite not taking clients at this hospital, when folks email or call me for an interview and tell me they are planning to give birth at this hospital, I often spend some time talking about why I don’t take births there, rather than just funneling them along.

I can say the same things about pretty much every hospital and why the cesarean birth rate is too high (the tipping point is thought to be somewhere around 19% of all births), but there are definitely some practitioners and some hospitals where the outcome of a cesarean birth is much more likely. I feel like I owe it to my clients to be forthcoming about this.

Furthermore, I owe it to them to talk about the non-clinical reasons why most unnecessary cesareans occur, which start building LONG before the day of labor and have EVERYTHING to do with practitioners and where they get their care. If my client describes their visits with care providers with lots of, “well, they don’t ALLOW that,” or “I asked about X but they told me I had to do it anyway,” I don’t shy away from brining up that their care providers aren’t actually able to make them do or not do anything. Ultimately, my clients are in charge of their care and that of their fetus, so they should have the final say in refusing interventions, when they come into the hospital in labor, who is allowed in their room, what tests they may refuse, interventions they may refuse, firing nurses or doctors who make them feel uncomfortable and who’s decisions they don’t agree with, leaving the practice at any point in care, leaving the hospital if they don’t agree with the decisions being pushed on them, and what can and can’t happen to their baby after birth. Too often, doulas are the only gatekeepers to this important dialogue and unfortunately, we’re often the lowest rung on the ladder of care since we are non-clinical providers working with families often after they’ve gotten negative messaging from their clinical providers since conception.

Not all cesareans can or should be avoided, but there is a crisis in maternal care in this country and overuse of technology, interventions, and operations is a large part of the worsening picture. As doulas, we are obligated to speak up about the realities of why this happens. Too many doula trainings shy away from teaching newer doulas how to navigate these gray areas of scope. I do think it’s valid for us to stay within our physical scope of practice in terms of what we can do to help direct outcomes, but it is ABSOLUTELY our role to be forthcoming about systematic neglect of evidence and widespread abuse of role if we see it time and time again in certain places of care. More doulas need to be told this and we need to be more supportive of each other in navigating these tricky territories.

We are not magical talismans to ward off cesarean surgery if our clients are going to be told that their “high risk” from conception without good reasoning. It is not our job alone to protect our clients from unnecessary interventions — we guide them to the sources of empowerment, but they must ultimately empower themselves. And we must collectively empower one another to take the professionally risky move to speak up to our clients prenatally about the abuses we see. Remember that medical bullying often comes with a smile and a reminder that it’s the woman’s fault she’s high risk. We need to fight that language in our own practices and not shy away from telling the truth about certain places of birth.

Why Doulas Should Work with Contracts

I had the great privilege of being interviewed by Esther Gallagher for The Fourth Trimester Podcast on why it’s important to have a doula contract — both for the doula and for the client.

Framing this as an opportunity to use the contract to open dialogue, instead of it just being a boring or intimidating part of our profession, I brought up issues around setting expectations, strengthening our community and individual practices, and other fundamental components of our demanding practices.

These are some of the key issues I address in my contract writing workshops and individual contract edits for doulas, midwives, and nannies. I also cover things like :

  • Termination vs Cancellation

  • Deposits and fees

  • Scope of Practice and Practice Restrictions

  • Doula - to - Doula Paperwork and Partnership

My next workshop will be on January 17th from 4:30-7pm in Oakland. Sign up before Jan. 5th for an early bird discount! You can register on my Contact Page or contact me directly for more information. All types of in-home, independently contracted care providers are welcome to join us.

CONTRACT WRITING WORKSHOP FAQS (2).jpg

I highly encourage parents and providers to take a listen to this episode, as well as the other incredible interviews Esther and Sarah have conducted over the past year. Please consider subscribing to The Fourth Trimester Podcast on Patreon so they can keep this resource going!


You are not allowed to not allow me

When talking to families in interviews or prenatal visits or in my childbirth education classes, I can’t stress enough how important it is to choose your care provider wisely. This amazing article on Pathways for Family Wellness (a site well worth checking out) does a great deal to emphasize some of the red flags you should be aware of when meeting with potential doctors and midwives and how to empower yourself with appropriate questions to weed out those that might not be a good fit. 

I know in my prenatal sessions and classes, couples tend to get anxious waiting for me to FINALLY get around to the things they thought they were coming in for–What does labor look like? How do I know when to go to the hospital? What are the tools for having a “natural” birth?–as I spend the entire first pregnancy consultation or the first two hours of my first prenatal session talking about your birth team. 

I have to remind them that all the squats and yoga breathing and mantras in the world aren’t going to make an impact if you have a care provider who doesn’t believe birth is an event not necessarily full of management and intervention and doesn’t really seem committed to helping you have an unmedicated birth. 

One of the ways you can figure out if they are going to be harmful or helpful to your goals of a physiologically appropriate birth is by paying attention to language like “We don’t allow” or “I don’t do that.” If you’ve done your research and know you want to have a water birth, why would you stick with a care provider who says something like, “Oh some doctors/midwives do that, but I don’t.” or “We don’t allow births in the tub here.”? It’s amazing how often I hear pregnant folks say something to that extent and either don’t know that they can switch providers, or know that they have other options, or for whatever reason just don’t think it’s going to be a big deal in labor. IT IS A BIG DEAL! And though having a doula can be enormously helpful in advocating for your wishes in birth, we can’t make decisions for you or fire a nurse a doctor or a midwife for you, and so there’s only so much we can do in the end. 

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Sadly, we in the United States have grown accustomed to poor medical care, a lack of true informed consent, and being told that we can’t possibly know much about our bodies. With most women hearing horrible stories of near-death births left and right, they’ve grown to think that they must also have this kind of traumatic birth, so it doesn’t matter if they “like” their provider much, as long as they’re there to rescue you and baby. It’s precisely this culture of fear and misinformation and lack of choice and trust in care providers that is driving the rising maternal mortality rate in this country (we are the only country–developed or otherwise–which boasts a rising rate). 

So, it does matter who your provider is and where you choose to give birth. If you are currently seeing a provider who uses language that takes away choice and support, SWITCH! Even if they have a nice smile and good bedside manner, if they’re not on your team, fire them. Now and not when you are fighting them in labor. That’s not fair. If you are early on in your pregnancy interview a bunch of different providers. Seriously. How much time did you spend picking out a stroller or car seat? Spend 10 times that amount talking to care providers and staff at the place where you choose to give birth and don’t stop till you’re sure in your gut that you’ve found the best fit. Take a month to do it. Make them sit down with you for an hour and answer all of your questions. 

If they don’t want to give you their cesarean rate, but avoiding a cesarean is your biggest concern in pregnancy, keep hounding them or leave and never look back. 

You are 100% entitled to having the birth you want. There’s no being “selfish” or “smug” or “bossy” or “difficult” in asking for care that is supported by evidence and is kind and supportive. Choosing an appropriate care provider who gives you options, supports your choices, and practices according to informed consent is also not just for parents hoping to not use pain medication in labor. This isn’t you not being particularly nice to a waiter somewhere, this is arguably the most important day of your life and what happens in labor has long lasting effects for you, for baby, and for your family. It’s not about being a “smug hippie” or trying to win an award for best mom, this is about you taking control of a very normal, natural process that shouldn’t leave you battered, scarred, and needing therapy. 

Do not allow them to tell you you’re not allowed. 

If you want more information like this, sign up for a pregnancy consultation package or hourly conversation. That first investment can save you stress, time, money, and help you connect to a care provider in line with your wishes and needs in pregnancy and beyond.

Pregnancy Challenge Week #2 -- Save for a Doula

I’m starting a series of challenges to expectant parents to encourage them to take small steps toward better care, more informed decision making, and a smoother transition into parenthood.

Over the next few weeks, I’ll be posting on action item in this vein, with some information for why and some resources for how. I imagine the challenges will be steeper for some families than others. I also imagine that it will vary person-to-person which action items are more difficult than the others. Some families, too, I imagine won’t face a ton of barriers, but just needed some guidance on the fact that these things are available.

What’s on the docket for Week 2?


I challenge any expectant family to start budgeting for a doula.

budgeting for a doula


So I might need to start with answering What is a doula?

A doula is a secondary support person trained in non-clinical support in the childbearing year and sometimes beyond.

Doulas are not primary caregivers, so they work in tandem with midwives, doctors, nurses, midwife assistants/apprentices, lactation consultants, etc. Most often you will hire a doula independently, though some birth centers and hospitals have on-staff doulas you can or are required to choose from. Most doulas work primarily in a hospital setting, but can join you for an intended home or birth center birth, as well.

Evidence shows that the one of the best ways to reduce the number of unnecessary interventions, improve maternal and infant birth outcomes, reduce disparities in care and outcomes, and create more satisfying birth and postpartum experiences is to have continuity of care that includes continuous labor support. Most families are very surprised somewhat late in their pregnancies to discover that they aren’t going to get that from their primary care providers in a hospital setting (and this includes hospital-based midwives who work on a shift schedule), hospital staff, or pediatricians. This is where doulas have come in and where the evidence shows that they can help families have better birthing experiences -- both in emotional wellbeing and in reducing unnecessary medical interventions. Following the first publications of these findings, one author famously said, “If ‘doula’ was a drug, it’d be unethical not to use it.”


Most birth doula packages include 2-4 appointments prenatally to discuss your individual pregnancy and desires for birth as well as common coping practices, community resources, advice on having good communication with your primary care providers and other staff and loved ones that might be present at birth, your options in pregnancy and birth, the typical stages of labor, and some newborn advice. They are on call for you 24/7 for a window typically two weeks prior and two weeks following your guess date (it is a total guess when your baby will arrive, btw). They are available for phone, text, and email support throughout your contract. They will set a plan of communication around the early stages of labor to be your primary point person for what’s going on in your individual birthing situation. They join you when you are in active labor and need additional support and help you stay at home longer if birthing at the hospital help with the communication around when to call your midwives if you are birthing at home or a birth center. A doula will then go with you/stay with you at your intended place of birth till baby has arrived and for a short while after to help talk about baby feeding, what to expect in the first few days, and to check in on how you’re settling in after birth. Most doulas include 1-2 follow visits in your home in the first two weeks following birth to cover a wide range of topics on healing, feeding, newborn care, and other items of need.

Postpartum doulas focus primarily on care for parents and infants in the first 2-4 months after birth. Some birth doulas are also postpartum doulas and are available for extended care packages through the childbearing year. However, it is possible to hire an additional or exclusively work with a postpartum doula, too. They typically work either daytime shifts of 3-5 hours a few days a week or overnight shifts that shouldn’t be longer than 8 hours each. Though it may seem amazing to hire a postpartum doula for around the clock care, most families feel very well educated and supported with having a trained, thoughtful person come in to check on them 2-3 days or nights per week. Ideally, you are working with them on a tapered system where there is denser coverage in the beginning that fades to maybe one day or night shift a week to help you transition into caring for baby on your own once you have a rhythm established.


The cost of a doula varies based on what’s typical in your community, what their packages include, and their level of experience. It is possible to work with a doula who works on trade, sliding scale, or on a volunteer basis, though I encourage you to explore the value of the time, effort, and resources this person is putting in to being your support person in this immensely intense time in your life. Having said that, if you are really wanting to work with a doula and it isn’t in your budget, there can be lots of avenues for finding a fantastic doula that can fit your economic needs. Many doulas will be more than happy to reach out to their community to find you a good fit or to connect you with an organization that offers volunteer support.

Even in high income areas, the upper reaches of birth doula fees are typically under $3,000 for full care and the national average is around $1,500. Postpartum care, especially overnight care, can run into the tens of thousands of dollars over the course of several months. The highest fees don’t always reflect the level of support you’re getting or denote who might be your best fit, so it’s worth researching a wide number of doulas and asking even the higher fee doulas if they’re willing to work within your budget or have a strong recommendation for someone who can.

For this challenge, I want you to imagine setting aside at least $2,000 for doula support if you can. According to Fortune, folks spend an average of $1,300 on Amazon per person per year. Individuals in the US spend about $1,500 each on vacations per year. The average cost of a wedding is almost $26,000, which is also an enormously important day for many, but also just a single day and doesn’t carry quite the same lasting benefits and risks as having a positive birth experience...I mean, even the cost of the cake on average is $500. What would it mean to put that towards several hours of personalized postpartum doula care?

You can make up these costs in a lot of different ways. I have an earlier post on how postpartum preparation can help save you a ton of money you can put towards doula care I’d encourage you to take a peak at, but the gist of it is

BUY LESS BABY STUFF

Can I challenge you to try this : Every time you are about to purchase something for baby, can you either do without it (the answer is almost certainly yes) and put that same amount into a savings fund for a doula? Or can you put a matching amount in that savings fund? Many useless baby items will run you about $35 a pop and will likely wind up in the Goodwill pile where $35 is about the hourly rate of many postpartum doulas. That $120 countertop sterilizer machine…? Guess what, there’s no sound evidence on sterilizing bottles and a lot of good evidence on why not to so there’s $120 closer to your birth doula fund. There is no gadget out there that can replace having quality labor support or someone helping you to navigate the tricky first months with a newborn.

Friends, family, and co-workers are often very very excited to help you greet your little one and want to show you. This often leads to them purchasing a ton of stuff, and it’s up to you to direct them into another option, if you really want support around having a doula. Don’t be shy about talking about your process of hiring a doula, trying to reach your budget goals, and that if you’d prefer it, that you’d rather have some money to put toward doula support over another book or pile of onesies.

What about expensive gender reveal or baby showers? Can you have a celebration with friends around this that isn’t full of cheap decorations you’re just going to throw away? Have it be a potluck with fun games around baby names and the like and ask your guests to chip in to your doula fund in lieu of obligatory baby gifts you might not ever use. You can ask your doula to attend, even, and talk to your guests about how beneficial their support might be to you in the long run. If it doesn’t feel too tacky, you can put out a box/jar/whatever with the label “doula fund” and even if you just get a few bucks, you’re a few bucks closer to $2,000.

Or, if you don’t feel like making a ton of swaps to your plans for celebrating before baby arrives, can you just set a goal of how much money you’ll set aside per week till you hit your doula fee goal? If you have a partner, you can ask them to do the same and set up a mutual savings spot and even make it kinda fun somehow. Maybe get an old school piggy bank and smash it when you’re ready to hire your doula!?

Did you go out for a regular giant fancy coffee drink or regular cocktail that you’re abstaining from in pregnancy? You could calculate how much that cost you per week and put that money directly into a fund for your doula, who will be your new self care and indulgence guru.

Have you ever found yourself saying something like “I’d pay $X for a nap right now?” Well, put a number on that, start setting aside a few naps worth, and think about the beneficial rest your postpartum doula will help you take once baby’s here and think about paying them to help you achieve that when you need it most.


If $2,000 is an unrealistic goal for you or is much more than you need based on fees in your community, just pick a different amount and save away!

To read a bit more about the true cost of a doula, you can check out my article on the cost breakdown here.

If you want more information on how to find, save for, and hire a doula, you can set up a 1hr phone consultation or sign up for one of my full pregnancy and/or postpartum consultation packages where I’ll talk to you about doulas, how to save money in this process, and much more.

If you participate in these #pregnancychallenge ideas and want to share, please comment below, send me an email, or tag us @Rosewoodrepro on instagram and let us know how you are doing! Happy saving!