I very recently broke down and returned to Facebook, exclusively for work purposes. I joined a half dozen doula groups on there, and for the most part, have been enjoying the connections and conversations that pop up. Our work is severely isolating, and having some low-to-no cost ways to creatively crowdsource ideas and support is enormous, so I’m grateful to online platforms for providing some form of that.
There’s one aspect of these group threads is really irking me, though. It’s an issue that bothered me as a brand new doula and it’s one that peeps it’s head up to poke at me every now and again. It’s one that on its face seems to be something hardly worth complaining about, let alone worth dedicating a whole post to, but I believe strongly that it speaks to so many of the battles we face as non-clinical care providers in an under-respected, marginalized, underpaid, high-stress job working in the field of women’s health that is so fraught with enormous physical and cultural implications —I’m sick and tired of doulas being told that they need to make baked goods for nurses and give presents to their clients.
Okay, I know what you’re thinking,
“Em, seriously? What’s the harm in this? Nurses work hard and we want to connect with our clients.”
What I’m arguing is not that you’re wrong for doing these kind things. Not at all. My problem with these things is multilayered and nuanced, so I hope you will hear me out and even if you come out the other end of this post thinking, “I’m still going to bake some cookies for some nurses,” that you will have at least taken the time to consider some of these larger political questions about the whole scope of our profession.
Exploring the Motivations
My concern with this particular issue is not about whether or not you’re making a generous gesture. What grinds my teeth is how the prompt for the conversation about bringing treats to nurses is about a doula’s desire to either be “liked” by the nurses or that she would otherwise feel she is “bothering” them by her presence if not for coming with a bribe of sweets.
There’s a lot to unpackage here. ...like all of feminism and then some… I want you to consider the framework of the situation where you need someone to “like” you in order to potentially take you seriously and in turn, perhaps “allow” your client to be their own advocate and have a higher chance of their desired outcomes in birth. And I’m not pulling at strings from the far ends of some conspiracy theory in making this point. I have sat in on more than one doula group meeting where some older (not necessarily more experienced) doula has told me that my issues with the rights of my client being trampled on by medical staff could have perhaps been alleviated if I had convinced them to appreciate my presence via brownies.
Let’s consider that equation starkly :
Cookie bribe + nurse’s personal approval of doula = fewer medical interventions
Excuse me, but WHAT?
This is sincerely a huge motivating factor for me in switching over from client-based work into training doulas. I came into birth work through working with refugees in non-profits, using legal research to appeal for grants and media coverage so that the concerns of refugees and migrant persons (largely women and children) don’t get pushed to the wayside. I came into birth work with a radical perspective on the necessity of change. It wasn’t too long into this career that I realized that EVERY DOULA if doing their job correctly, is radical. That all of birth is political. Therefore, the work that we need to be doing is not being the fairy godmother delivering gifts and cookies and paying for our clients to get massages and pedicures or worrying about whether or not a nurse thinks I’m like...fun, or whatever. The value of my time and presence is to be a knowledgable advocate who won’t stand silently by — both in the birth setting and in my non-billable hourly work.
If you show up as a professional, you do your job well, you stand firm in your beneficial role in the birth space, you feel solid in the fact that you are there because your client CHOSE YOU and that your responsibility is to that client and not toward making sure medical staff aren’t having an “off” day, you will earn the respect and care of the staff and your client. The hierarchy of concern toward the client is not dictated on muffins. You are an equally important member of the birthing team and having to gift your way into being respected is, in my opinion, even a bit demeaning toward nurses as professionals.
Again, if you’re coming from a place of making an offering out of respect from one hardworking professional to another and you simply enjoy making things or giving gifts…by all means. However, if you’re motivation is to earn some “niceness” cred or that you think that your worth as a doula is predicated on pandering, you are likely going to experience some sense of failure that is overly personal and might crush you out of this calling, because it is unlikely going to alleviate or safeguard against witnessed trauma. I hear stories about this constantly. Your (reasonable, considering) insecurity about your ability to be a “good doula” in this case is likely more about a disgusting misanthropic culture of misogynistic medical abuse, than about your personality or about some effing cookies. So your time might be better spent on ways of righting those wrongs over baking things for the actors in those scenarios.
Bleeding Hearts and Bleeding Wallets
Someone HAS to talk about the economic and access issues here and how it shouldn’t cost more to be a doula than we’re getting paid—which is often the case for newer doulas and doulas in certain communities.
The first time I was told that I would gain some sort of approval by baking for nurses was when I just started out as a doula about a decade ago. I graduated college two months before the stock market crashed and walked away from my fancy college with only unpaid internship offers and a five-figure debt to sort out. About a year later, I decided to train as a doula and moved across the country with my then boyfriend who was finishing school in Washington State. I was extremely fortunate that his economic status covered my being able to live with him rent-free for a few months. Still, I had an extraordinarily hard time finding any paid work— in or out of the birth world — and despite having some sort of work everyday, made next to nothing and was on food stamps for the first six months I lived there.
Imagine working your butt off every day to learn this trade, take on the mandatory volunteer and low-fee clients many training organizations and doula groups require, spending work days glued to a computer learning about SEO and creating business cards, finishing academic certification requirements, and dealing with the stress of being underemployed with $500 a month student loan debt and THEN having someone suggest that spending more time and money on sweets is what will make someone “like” you enough to have them not treat your client poorly.
Maybe you CAN imagine that because you’re living it, too.
If you live in an area where you are making say $600 per birth client, how much of that should you be expected to spend on nurses and gifts for your clients? And why isn’t it a two-way street? If a nurse shares their bag of chips with you, do you think it will improve your performance? And at the end of the day, is it going to benefit your client and potentially create a safer and more enjoyable process or benefit someone’s ego to have an expectation of exchanging presents?
I think this conversation plays into the idea of doulas as tokens of a certain type of birth and as some sort of talisman to ward off selected procedures. Those things are fundamentally ignoring the point of why doulas are effective and necessary in the system of birth care we have in the United States.
This is a profession that urges, Give Give Give. Give of your spirit, give of your time, give of yourself. I would not advocate that away. The cooption and removal of this in birth work has created “medwives,” predatory sleep consulting, charging hourly for attending births, and other unsavory elements of status quo-protective birth work. However, giving, in the sense that a doula owes her clients gifts at the onset or outset of a contract or that a doula owes nurses gifts for being “allowed” to do their jobs in partnership with medical staff whose accommodation of doulas is within their professional requirements in deference to the clients, is to reinforce the idea that as a doula we must beg and apologize for our presence. It is to reinforce the notion that we are an accessory when the work that we do is important and should stand up on its own.
Additionally, being a small business owner is expensive, there’s no two ways about it. Though many doulas come into this work after having full careers in another area and are not using this line of work as a primary source of income, that’s not universal. There are more and more politically passionate birth workers entering the field, and where there is always room for the nurturing hobbyist doulas of the world, the bulk of contemporary doulas are seeking meaningful employment through this calling. Professional expenses add up quickly, we’re taxed at 40% like other freelancers, and there is a growing understanding of the reality of the value of our hours spent working when not directly interacting with our clients. These are costs monetarily, emotionally, and for the legitimacy of our profession as a whole. To be then taxed additionally with some arbitrary need to provide snacks to medical staff is a burden of access — economically, culturally, and in how our time is valued.
An endless cycle of material and spiritual gift exchanging can drain the pockets and the life force, and for what? For a doula starting out who wants to create lasting change in her community, should she be counseled to spend $20 on a bouquet and card for her client or toward additional training? Which scenario will serve her client more? Their community? And before you get huffy like $20 isn’t much, for the newer crop of folks drawn to this work, many younger and unmarried, straddled with student loan debt and high rent, it is a lot.
And we need those doulas! We need fresh and motivated doulas. We need doulas of diverse economic backgrounds willing and able to serve folks with diverse economic backgrounds. We need doulas fresh out of their Gender Studies majors. We need doulas who are not here to cuddle cute babies (even though we all do), but are here to help dismantle a system of “care” which continues to perform procedures against a person’s will and then turn around and blame them for it.
Telling a struggling doula looking for advice on how to strengthen themselves against these staunch and scary cultural norms via pastry is shallow at best and irresponsible when done from a place of ego and judgement.
Who is This Even Helping?
Nurses, for all their hard work and how put upon they are, work in a framework which provides health insurance, an HR department, union support, sometimes in-house counseling and certainly in-house legal counsel. I’m sorry, but they don’t need your damn cookies, so we need to stop acting like it’s valid currency in buying favor with them.
But again, more importantly I think it’s about how we talk amongst ourselves about our professional purpose. If I were to write out the Scope of Practice for a doula — which I am tasked to do often, lately — no where would you find anything about being a provider of baked goods or gifts.
So again, this is not to say that you should never feel inclined to provide a treat or gesture, but rather that it has to stop being such a go-to in our mentoring of other doulas. It’s a lazy response to a colleague seeking the advice you’ve likely earned giving. And we seriously need to stop suggesting that someone is not a “good enough” doula for not bringing presents to anyone. That’s absurd. It’s also patently wrong.
Too often, women who are called to work in traditionally female-dominated and care professions (and this includes also non-binary and marginalized folks working in a variety of undervalued fields) are made to feel like they have to give far beyond the norms or their means in order to earn their place. It may seem like this whole rant is some worthless, petty vendetta against baking (and I actually worked in a bakery for 5 years and made homemade pie crust as therapy yesterday, so I can assure you it’s not) or against nurses, but it’s the way these things are talked about that stokes this ire. And it’s the way that doulas turn in on each other sometimes. It’s the purity testing and expectations of supreme sacrifice or how all doulas have to fit into some soft, eternal gift-givers that just points to the steady trends of burn out and compassion fatigue that holds this profession back from reaching more legitimacy.
The point is this — being a valuable, thoughtful, questioning, calm, confident member of the birth team who engages with medical staff by asking for more information and support in their role is not “bothering” anyone. It’s showing up as a professional to do your job well. You don’t need to apologize for your presence with pandering presents. You don’t need to dip into your wallet to prove that you are of worth.
Call me extreme, but if doulas were spending less time and money bribing nurses and more time reading the NY State bill on certification and seeking to understand it, then showing up in their doula groups to have an open discussion about it’s ramifications, we could be moving ourselves toward a greater goal and (indirectly but efficiently) helping nurses do their jobs better, too.
So make those cookies...for yourself, because at what point do you think a nurse or doctor is going to show up and hand YOU chocolates and flowers simply for helping them do their jobs?