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A Comment on DONA

Okay I can’t resist writing about the recent issue of DONA posting a highly insensitive image. I can’t say I feel quite gleeful or even a bit of Schadenfreude (thought it’s tempting) because this controversy comes at the expense of black folks who are at a particular crossroads of hatred and invisibility in our current environment, but critiques of the establishment neck of DONA are long overdue. I’ve had personal and professional beef with them as an organization since before I was even trained as a doula, and this has only grown over the years. This recent nonsense takes the cake, though.

I’m not going to repost the image. If you haven’t already seen it, DONA posted (for the second time in less than two years) an image of a white woman wearing an afro wig and looking dumbfounded in an advertising campaign. It’s an inappropriate and frankly just bad and nonsensical photo. It didn’t need to exist. The afro serves no particular plot purpose and beyond that, of course it’s offensive when there has to be policy action taken AGAINST the notion that you can deny someone work or access because of their black hair styles. DONA should have known better to begin with, but especially after they were already called out for using this photo, they should have known better than to reuse it.

Now, it is also worth taking this mantle up so that black women, already having to engage in these ridiculous battles to HAVE HAIR and you know…not die in childbirth, can take a nap or drink a beer or play with their kids or do their jobs without having to pause to fight these battles in the first place. And where I am exhausted as a liberally minded person by the constant in circle fighting and purity testing, this is an issue that is just so damn petty and annoying and caused only because people at the top of the biggest doula training organization seem to so constantly have their horse blinders on that I feel like this is something as a policy-oriented doula and a doula who recognizes the shameful truth of the disparities in care within an already failing system that I can’t just roll my eyes and wait quietly for it to pass.

DONA

So let’s be clear, I am a WHHHHHHHHHHHite WHOOOOOOOoman. Like, Nordic and Celtic, see-through skin, made of potato and flakey white fish, born in a pile of lily white snow white woman. I’m listening to Philip Glass as rage music right now sort of white woman. I inherited the blonde hair and high arched eye brows of my mother that seem to serve as catnip for older white ladies to come up to me out of the blue and say crazy racist things at my face. I can’t tell you how many Birkenstock wearing older white ladies have approached me on the street in downtown Oakland after I walk out of my front door with my pitbull to ask me if I have this dog because I’m afraid of the black folks on my block. I truly, deeply, wish that I could chalk this up to me being a pathological liar vying for click bait, but trust me, this has happened to me on numerous occasions. It happens to me in line at the Trader Joe’s and Whole Foods — older “progressive” white women commenting on “the hood” where these stores are located (in now highly gentrified parts of the city) to commend or chastise me for my supposed “bravery” at living in such a supposedly threatening area. I wish I could tell you that I turned and screamed at them “I’M NOT ON YOUR TEAM, LADY!” but honestly, I’ve managed to be a bit more subtle in my rebuttal and for that, I am ashamed.

I see these same sorts of comments online regarding this and other issues around the black maternal health crisis. White women, most trained by DONA and CAPPA and the more “establishment” organizations, jumping into the comments to wag their fingers at more radical activists for voicing their anger. This isn’t the exhausting circular infighting that impedes some radical activism. No, this is a symptom of a strain of birth work that is all too accepting of the status quo not wanting to feel threatened by colleagues pointing out systemic problems and demanding action from the organizations that are supposed to represent doulas and help lend legitimacy and protect our livelihood. If DONA and the other major training organizations and their circle of piranhas online can’t see their blindspots, it affects ALL of us in this practice, but particularly the most underserved and undervalued of us — Black women.

Black women are 4x more likely than white women to die in childbirth in this country. We know that statistic by heart by now. We know it because it has finally crossed into the national dialogue. We know it because non-establishment black women yelled, cried, wrote, showed up, pushed forward for decades until this became a statistic we memorized. And let’s be absolutely clear — this statistic is an embarrassment. Our healthcare system is a huge and expensive joke and getting worse, but this particular component of our failing system is a particular offense and there is not a second more we can waste ignoring its causes. As indirect as it may appear, when racism runs so systematically deep that the problem with this image was overlooked TWICE when this offensive image is being used to represent literally tens of thousands of doulas, it is absolutely part of the problem. It cannot rest on the emotional and physical labor of black women alone to redirect this course.

We need to continue to push against initiatives that block access to our already difficult to access yet important work through means disguised as advancement.

With great privilege comes great responsibility and that is something that the directors of DONA can stand to hear repeated lately as bills like Senate Bill S3344B in the New York State Senate begin to dictate to doulas matters of certification and what is deemed, to “be of good moral character as determined by the department. [Section 1 (e)]” As the largest training body in the world, the Board and upper reaches of DONA may wind up having a particularly privileged position to determine what is acceptable behavior within our profession in the eyes of the governmental bodies of one of the most populous states in the country. We need to continue to push against initiatives that block access to our already difficult to access yet important work through means disguised as advancement. As DONA and the other larger organizations with larger boards given more access than many other certification bodies in policy decisions take up the mantle of professional recognition, they need to take heed of their modes of visual representation and know that their views don’t reflect those of a large portion of the birth workers in this country. If they want the seat of power given to what they proudly tote as the supposed “world’s best”, they must accept greater responsibility, pull in more diverse voices, and pay attention to their negligence. **

I personally, have long felt that DONA does not represent me as a doula. I actively avoided being trained by this organization from the outset. In the months leading up to choosing my doula training, I was working at a non-profit in Holland doing legal research for under-represented persons around the globe. I didn’t feel compelled to spend the little money I had to train under an organization that didn’t seem that focused on combatting the systemic issues within the American healthcare system that made doula work as critical and political a profession as it is. I talked to too many DONA trained doulas who felt unprepared for the realities of how political and challenging their work would be fresh out of their trainings and I wanted better. I wanted more. I wanted to be challenged. I wanted the tools to challenge the system. We all should have those skills so that fewer of us get burnt out after just 2-3 years in this field. Initially in my practice, because I chose to train outside of DONA, I was barred from volunteering at many programs (YES, VOLUNTEERING) and those who were blocking my access were very vocal about why they thought I was unworthy of supporting their efforts. I was admonished openly in doula gatherings (and this was in Seattle and Tacoma — the birthplace of DONA) and told to just make cookies for nurses and not cause too much fuss.

That was a decade ago (just had my 10 year anniversary as a doula earlier this month!) and I feel that the gap in the reality of this work and what DONA as an organization promotes as doula work is ever widening. I am proud to have been trained by toLabor and proud to work with more radical training programs like Cornerstone. I am proudly developing my own training program that has a particular bent toward more activism and policy goals and means to bust this broken system from within and without starting this fall. Doulas need more diverse and BETTER representation than they’re getting through DONA.

So what can we do here as allies? There are three main things, as I see it :

  1. Stop giving DONA money, if you can. If you disagree with their policies and practices, don’t continue to train with them or pay for your continued certification through them. At this point, certification is not required to practice as a doula (there are some issues with that, too, but for another day). When you have the opportunity or need to take more classes, choose ones not taught by DONA (there are LOTS). And if clients are concerned about your certification status, you can give a brief explanation of why you chose not to continue with this group. You can still do the work to keep up with your advanced training, but don’t continue to fund an organization that doesn’t represent you or take criticism of their bad practices seriously. They don’t have to remain the top organization in the world if they aren’t living up to that standard. Like it or not, we live in a capitalistic society and money talks.

  2. Whether you choose to stay with DONA or not, SPEAK OUT. Don’t leave it up to someone else to voice your concerns about practices that you don’t agree with. If you don’t want to wade into the swamp of social media with this issue (and I honestly do not judge you for that at all), you can write a personal letter to the board at DONA, a blog post, a letter to your DONA trainer, etc. If you are part of an agency, collective, or group that requires your certification through DONA or if you have a newer doula looking for recommendations, you can speak up on why you’d like them to seek alternatives. I know this gets lost in our digital age, but this work is still fundamentally word of mouth and comes down to making ripples in person in our own communities. This area of our work is no exception.

  3. Show up. SHOW. UP. If you feel that DONA is not representing you, start representing you. This cannot be done just online and it can’t be done just with black women having to do all the work themselves. Submit issues of access in townhall meetings. Start a letter writing campaign. Form strong, local doula community networks so you can show up as a team with an efficient plan and collective voice when issues of determination arise at the local and national level. If you don’t want DONA to be the only seat at the table, you are going to have to whittle together a goddamned chair. That’s just reality. And if you show up and get others to show up, that means that we can divide the work. Someone can take on paying attention to when issues of racism and insensitivity come up. Then another motivated person can formulate comments and official statements against them. Someone else entirely can help make action plans to make sure these issues arise less often. Yet another person can be paying attention to when bills are going to be brought to the floor and how to get more diverse representation in the meetings. No one magical person can do it on their own. It was a team of folks who allowed that image to spread through DONA and onward and it takes a team of people to get it down. We need to show up for each other. That is self care. That is community care.

And I’m going to walk the walk here. I’m not going to cave and pay DONA hundreds of dollars a year to have my courses count for their CEU’s. I was on the fence about it since I feel the doulas they train deserve to have a spectrum of courses offered to them for professional development and because they do have many trainers I respect tremendously. However, I feel that this money I have to grind my teeth in my sleep with stress over getting could be redirected toward scholarship programs, creating more access to my activism training, and supporting the efforts of communities of color having to shoulder so much unnecessary and petty work just to survive a normal biological event in this country.

You are, obviously, allowed to disagree with me about DONA’s structure and trainings in general, but I hope that you will join with me in promoting stronger activism efforts and a push for greater representation in the movement for the legitimacy of our profession and the rights of black persons to have access to safe and supportive reproductive care. If you want to talk more about how, please email me at doula@rosewoodconsult.com or fill out a form on the Contact page.

**[Amended] The original posting of this article incorrectly mentioned that DONA and ProDoula were part of the legislative endeavors of NY Senate Bill S3344B. The original source of that information was incorrect and appears to have since been taken down. This article has been adjusted to reflect that. Sincerest apologies for the confusion that had caused.

Books are Open for Oakland and San Francisco Doula Contract Consultations

Hi Oakland and San Francisco Doula friends. I’m heading back up north for a long weekend and am available July 25th, 26th, 28th, 29th for private and small group contract consultations. They’re two hour sessions to go over contract edits or where we can begin if you’re hoping to have me draft contracts for you.

oakland doula san francisco doula doula contract

Check out the Contract Writing page to learn more about these services and email me what days and times you have open in my trip window and whether you’re in SF or Oakland.

Looking forward to working with you!


Why Do Postpartum Doulas Cost so Much?

Money is always a tricky subject, especially when working within a profession in the "healing arts." For many birth workers, this profession is seen as a "calling" as much as it is a job. Add to that the fact of these caretaker roles being traditionally held by women, being seen as "fringe" or outdated, and still sometimes viewed as a luxury item despite mounting evidence otherwise, and with no set national standardization for the profession a leaving a host of intricate and competing economic influences driving the fees for these services in every direction.  

postpartum doula bed sharing santa cruz infant sleep

When I first started out as a doula, I was living in a community where bartering was the norm. In many ways, I really enjoyed that concept. There was always communal food, carpooling, couchsurfing, skill sharing, etc., and I learned a lot in my nine months there. On the other hand, I was making about $500 a month for a job I was way over qualified for and could barely pay my bills.

I was twenty-two, fairly fresh out of college staring at a five-figure student loan debt and trying, desperately, to grow my doula business. I spent hours upon hours learning how the internet worked (funny, as I almost failed my web building class in college), calling every doula and “alternative” practitioner in town, forming study groups, forming community groups, volunteering at childbirth ed classes, and scrounging for clients, all with zero pay.

I was burnt out and exhausted before I even had my first client. I moved out of that community after less than a year because I could not hack it on little to nothing. I traveled (by bike) south to San Francisco with the woman who was becoming my doula business partner, Jasmiene. We figured that if we could split the cost of owning a small business (and doulas are small business owners), and the time trying to acquire new clients, that we’d have a better chance of turning a profit and not getting burnt out.

Postpartum work in Olympia at that time was almost non-existent. When it did happen, it was often birth doulas and midwives who recognized that their clients needed more support and came over more often out of their own pockets. In the few instances where they were paid, the going rate was somewhere around $15 an hour. 

In San Francisco and the surrounding area at the time I moved here and wrote an original post on the costs of being a doula (around 2010) postpartum rates were around $25/hr. Even with the increase in the cost of living (my rent was $850 a month back then), the rate at which doulas were being hired, how organized they were as a group, and how many opportunities there were to continue our education for a smaller fee made this move seem like a wise decision. My birth partner and I tenuously increased our birth rates to $800, but after just two births, we realized we were grossly underselling ourselves…plus we could barely pay rent on one birth a month. Eventually, we were up to $1,000 per birth and $25/hr postpartum ($30/hr for overnight care). 

Currently, $35-45/hr is a pretty standard national rate for daytime postpartum care. In major cities, the rate varies from $35/hr for a doula-in-training to $75/hr for a more experienced doula, overnight doula, and / or a doula with advanced lactation support training. 

Now, $45 an hour for a doula might seem totally ludicrous to some (and currently, it’s on the low end of the fee spectrum for doulas in the Bay Area), especially when folks still often don’t understand that we’re more than just glorified babysitters, but I want to break it down into what the doula is putting into her services and what you are getting out of it:

Doulas are business owners:

  • In most cases, doulas are interviewing for new clients constantly. That means they are driving to you, either to your home or to a cafe, and spending money (on drinks and food and gas) and time to get about 1 out of 3-4 interviews ending in a hire. At one point in my career, Jasmiene and I were going to 2 or more interviews every week and shared no more than 6 clients in our practice at any time. More commonly, we had half that. And parents should want to work with doulas with a low-client base and with the ability to rest and take days off to ensure reliability and presence of mind during appointments. That means that they have to pay for that accommodation so we can subsist on this work.

  • Advertising alone is an incredible financial burden and it’s often hit or miss. Printing business cards, pamphlets, flyers, advertising online, in newspapers, and keeping up a personal website really adds up. In the Bay Area, we were spending about 15% of each fee for these costs alone. If we took a hit one month or couldn’t take on more clients for some reason, those costs still existed. IT IS A BUSINESS.

  • Printing other materials is just as expensive. We always came to our prenatal visits with a wealth of information as well as necessary documents to fill out so we could be the best support persons possible. Contracts, hand outs, sleep plans, feeding advice, favorite articles, readings specific to each family situation, etc. We weren’t employees of an office with a big, efficient printer, either. Every other month, we would go to the office supply store and buy several hundred dollars worth of printing materials ourselves. We also regularly had to go to a print shop to get things done more professionally and that cost really added up, despite having to do that maybe once every three months.

  • Despite having the same needs as many other small business owners and freelancers, since doulas are still considered to be working in a "fringe" field, it is rare that we would qualify for small business loans, adjustment programs, grants or scholarships for continuing education, and other perks offered to small businesses in this country. However, we’re still taxed at 40%. It’s rare that we qualify for tax write-offs other businesses might have— like an “approved” home office — since we are in-home support. In-home provider tax credits max out at just under $5,000, by the way.

  • Parents increasingly want us to be able to process payments electronically, which is more convenient for them, but we are still charged the 1% transfer fees or the up to 10% credit card processing fees, which we are unable to make up down the road in volume, the way other high transaction small businesses often can. Other electronic business tools range from costing $15-65 a month, which adds up quickly in a solo practice, but are becoming necessities in some markets to stay competitive and keep doulas from burning out on non-billable hour work.

  • Office insurance plans, paid time off, sick leave, paid vacation, family leave…none of those things exist for doulas. If we miss a client visit, we miss upwards of $500. This is why I stress to the doulas I work with on contract writing having some system of rescheduling and illness clauses that don’t leave them super vulnerable. The reality is, though, a few times a year there will be a situation that arises that takes money out of the pocket of the doula that can’t be made up. Keeping doula rates to a livable amount ensures this work can remain as an available and accessible option at all. And it can be seen as a two-way street where the high rates can keep a doula accountable to their clients out of respect for the transactional nature of this beautiful and important work.

Doulas require continuing education:

  • Most parents are concerned about our credentials. Not only is it expensive to get and keep up with our certifications, most families are looking for doulas who are constantly continuing their business education. These classes aren’t cheap. There are workshops starting at around $35 for a one-day session and they go up to $5,000 for courses offering a specific credential. This can often cause a catch-22 situation where it’s not always the “best” doulas (or the “best” doula FOR YOU) who is able to advance herself and her business, but rather the ones that can afford it and will thus generate more business and be able to get more clients.

  • Doulas often gather in collectives to help learn from one another and support one another. This takes up an extraordinary amount of time. Like it or not, time is money. We’re not paid hourly for the work we do outside of our interactions with clients and we’re not on a salary. Same for the amount of time we spend reading research articles, books, blogs, and discussing / debating this information with one another. If our collectives don't put money aside for subscriptions to various journals (and most can't afford to do it), those become out of pocket expenses, too.

What are parents getting out off all those behind-the-scenes expenses anyway:

  • Doulas make themselves available for parents in a way most other traditional care providers can or will not do. They cater their business to their birth / postpartum experience. They are often the only ones there specifically for these families and not for some outside agenda of profit, public health number, political pressures, hubris, generational opinions, etc.

  • Too few parents understand how alone they will be in the postpartum period. There is an increased awareness about postpartum depression (luckily), but there is very little education and support around the non-pathological changes in the early parenting period. Ditto to the manifestations of postpartum depression that don’t look like sadness — like the prevalence of postpartum OCD and anxiety that is often culturally dismissed as being “thoughtful” parents. Postpartum doulas are trained to recognize and support these mood fluctuations from the normal to the severe and to help families get the support they need. Doulas can then adapt and adjust care according to these changes unlike the many apps and gadgets meant to replace human guidance and interaction in health and parenting.

  • All that education and community building is what makes doulas the gurus in pregnancy and beyond. Attendance at childbirth education and parenting classes is steadily declining, unfortunately. It’s been shown that most parents are getting the bulk of their information on pregnancy, birth, and postpartum from books and increasingly from websites and social media. Where that might not seem terrible at the outset, but isolating that information doesn’t leave much room for personalization or nuance. Or conversely, there is often too much chatter in the comment sections without any particular vetting or emphasis on sourcing. Parenting books and websites are known hellscapes of opinion and bias, and often have less to do with research driven support than cultural trends and efforts to create a broad network of further brandable items. That’s in no way impossible to avoid in working with a postpartum doula, but there are ways of thoughtfully combatting the shallow and judgmental nature of those sources in working one-on-one with a doula who doesn’t have any incentive to push a particular system upon a family. That level of connection and trust takes time and effort to build, which can happen with a doula contract, but not with a book or blog.

  • Postpartum doulas come directly to parents, which has well researched and long lasting health benefits and offers a great deal more than a 15-min office appointment with a pediatric care provider. It’s also very draining on our end. There is a great deal of physical and emotional trauma present in birthing in the United States. Sometimes that comes from situations beyond anyone’s control, often, though, it is a symptom of our failing healthcare system. Many new parents fall through the cracks of our assembly-line style of care and it is not uncommon for parents to feel hurt and alone after birth, on top of the normal amount of healing, joy, and exhaustion. Postpartum doulas are there to listen, validate, and counsel parents in this position. It is a calling, and most doulas are happy to do it, but that does not mean that it doesn’t take away from our emotional and physical reserves. So $45 is a bargain compared to the cost of the psychologist couch we’re often keeping families from having to jump into or the expensive and overused treatments like surgical tongue snipping, pushing medications on infants for normal gastrointestinal changes, or unresearched supplements or dietary suggestions. There is a great deal of value in preventative and patient emotional care in this vulnerable time period.

  • Doulas are there for families soon after baby comes home / the midwife team leaves. They know us. They trust us. That helps when it comes down to figuring out the myriad of details of being a new parent. Doulas may be the only ones that notice marked changes in mood and can stave off worsening postpartum mood disorders. Doulas may be the only ones supporting the choices for feeding, sleeping, pacifiering, diapering, etc. in these families. The community resources doulas work exhaustingly to gather extend into the postpartum support community as well. Doulas are often experts on breastfeeding and infant massage in addition to doing laundry, holding baby so they can shower or go for a walk. They talk families out of late night deep dives down the black holes of mommy blogs and their false alarms. They can be crucial lynchpins against the rising anxieties often falsely pushed upon new parents.

  • Studies show that this support reduces the need for all sorts of interventions, items, and gadgets, which in the end not only makes the experience more enjoyable and empowering for most folks, but actually saves time and money. Plus, added perk — better for the environment!


postpartum doula cost infant doula sleep santa cruz

The sad truth is that our obstetrical care system does not fully support pregnant people and their families. The US has rising rates of maternal and infant mortalities it is slow to properly acknowledge let alone address. Making the investment of hiring a doula does not form a magical protective shield around you in birth or postpartum, but the studies point to numerous benefits to having this continuous support in pregnancy and early parenting. It is worth the investment in time and money to consider hiring a doula that suits your needs. 



Here are some ways you can afford to hire a doula:



  1. Ask for part of the fee covered through baby shower gifts. Truthfully, you DO NOT NEED THAT MUCH BABY STUFF! If someone was going to spend $50 on baby clothes, that could easily go toward your doula fund instead.


  2. Ask your doula if they accept payment plans or work on a sliding scale but please keep in mind everything that she is putting in in order to be a great advocate for you and your baby.


  3. See if there are programs at your hospital, birth center, midwife practice, or community center that can help either connect you to a doula who works on a reduced budget, or one who’s fees are covered by a program or foundation. There are programs for young parents, homeless folks, recent immigrants, veterans, those without insurance, those with lower insurance coverage, high risk parents, and more in many communities, but it takes a bit of effort to find sometimes. Some church programs might have connections to these centering and doula groups, too.


  4. Consider hiring a newer doula. The studies show that working with any person who is there just for you, providing continuous support and encouragement in labor increases safety and satisfaction in the birth process. There are many benefits to working with a doula who has been practicing for a long time, but if they are out of your price range, you could potentially still get a lot out of hiring a recently trained doula for a fraction of the fee.


  5. Call your insurance agency and see if they will cover your postpartum doula costs. This may take calling and asking for several people at different times. It’s all about finding the person with the magic code, asking for specific details for what information you need to have laid out on your claim, and following through. Some doulas are well versed in how to write up their invoices to maximize coverage. If you have Medicaid in some states/cities, there is now growing insurance coverage, so it’s worth asking.


  6. Some midwives and birth centers offer discounts for working with doulas. Every so often, a doula will match that discount (I do!). That can save you upwards of $1000.


  7. Start putting aside money early in pregnancy for support like doulas, lactation consultants, acupuncturists, postpartum care, etc. Resist the urge to spend that money on needless things from Amazon Prime and think about the investment you are making into a smoother transition into new parenting.


I hope you found this rundown helpful in explaining the costs and benefits of working with a doula.