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Harming Black Mothers with Doula Regulation

Updated: Jun 2, 2023

Yes, we understand that there are "best practices" and protocols and evidence based standards laid out for maternity care. We won't even get into how those very things are in themselves biased toward white patients. Save that for another day. What we want to get into right now, is how regulating doulas actually harms black, indigenous and mothers of color.

When you create barriers of entry into any caregiving profession, you are not just creating obstacles for the person trying to get into the profession, but ultimately, you create barriers for those they are meant to provide care for.

Let's look at the process of becoming a doula, under a hypothetical (but based on very real examples) governmental regulation:

  1. doula must be trained by an approved organization.

  2. approved organizations must meet certain standards and pay for that approval process.

  3. approved organizations then must increase prices to meet the requirements and potential added governmental fees.

  4. doula then must come up with higher amounts of funds to pay for this "approved" training.

  5. doula must then prove compliance with governmental regulations which will include fees for their own individual approval process.

  6. this approval process may require additional training such as CPR, HIPPA certification, proof of liability insurance and so on - just to get started.

  7. in order to get into the profession of being a doula, one must then have the increased initial "capital" money available to do so, and to maintain yearly requirements which will also have price tags attached.

  8. these fees must then be passed on to the client, increasing the prices of that doula's services.

  9. this means that families who don't have that money to afford doula care will go without it.

  10. black, indigenous and families of color get paid less for the same job as a white male in our society, so their incomes are typically less. However, their risk of death and complications within the maternity care system is much, much higher.

Can you see how this all works out against the families who need care the most?

This is very complicated issue. There are sooooo many reasons why regulating doulas is a BAD idea. We need to make sure doulas have intense, in depth, well rounded, and culturally sensitive training. However, it's a double edged sword because doulas who don't have good knowledge, training, skill sets, and the wisdom of how to navigate the challenges of maternal health aren't actually out there creating positive change, they may be out there acting as vigilantes, and sometimes they create animosity between patient and medical team which prevents patients from getting the care they need, (racism within a stubborn provider only gets more dangerous when their ego is engaged in confrontation). All this can and does end up harming families, other doulas and ultimately everyone within the birth community.

Women have been caring for each other during birth without motives and without ill-intent for as long as babies have been born from vaginas. If you believe in the birth process and the ability of humans to reproduce, and the innate wisdom of a baby to find their way into this world, you'll understand that it's not "rocket science" and that unhindered, undisturbed birth where the birthing body is respected and honored, results in good outcomes. Yes, it's a good idea to have those around us who can "help" when something isn't quite right, but to take this NEW attitude that birth is always a medical event where the baby needs saving from the birthing body, is spawned from a hatred of women and is the root cause of most of the bad outcomes we see in this modern age. You might think that is strong language, but it's true. Add to that hatred of women, a racist viewpoint and you've got a really ugly systemic problem.

If you limit what a birthing person is allowed to do with their own body, including choosing their birthing location, their caregiver, the additional support they receive (like doulas, or other nurturing birth attendants), this limits their ability to make decisions for their own body and baby because it limits what they are allowed to know as well. Think about it. In a regulated environment, who is going to teach above and beyond the answers that the government says is acceptable?

Along the lines of limits, the money aspect controls everything. Right? We have the whole idea of insurance paying for whatever THEY decide is "enough" care...

For doulas who want to help families who receive Medicaid, we have to remember that anyone who is receiving funds from the government must be regulated. If you're going to be part of the medicaid system and support families on medicaid, and get paid by medicaid, you will be required to do what the government says, because if the government is paying you, then YOU WORK FOR THE GOVERNMENT. This means you do not work for the birthing family - but those families need you. Can you do whatever it takes to help those families, even if it means you won't get paid enough? Even if it means you may lose your funding, when you stand for what is right? Cause that is the kind of soul-selling that happens as soon as you step into the arena of government funding. SO should we not get on board with the medicaid initiatives? Only you can answer that for yourself. With our training, we hope to teach our doulas how to be savvy and wise and lean into the concept of raising the volume on the voice of the patient, rather than starting trouble themselves. ;)

On top of all that, we have to look at the reasons why government might want to regulate doulas, here's a short list of the possible reasons:

  • to exert power and control over women's rights to earn a living

  • to exert power and control over women's bodily autonomy

  • to exert power and control over the exchange of money in every industry

  • to exert power and control over who is allowed/approved to show kindness to their fellow human during a monumental time on their life, mainly as it relates to women's health, and especially to minority women

  • to exert power and control over citizen's relationships with one another, but really only the women, and especially minority women

Can you think of any other reasons why a patriarchal system may want to regulate doulas?

Can you think of any other ways that this regulation hurts black, indigenous and families of color?

Let us know in the comments below:

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