Community Doula Work: Preserving Community Care During the Professionalization of Doulas
by Whitney Buckendorf
Note: This ^ signs in this article indicate footnotes, which can be found at the end of the piece.
In my years as a doula, the biggest lesson I have learned is that the potent magic of doula work is born when we are in deep community and relationship with our clients.
Research shows that the continuous presence of a doula, even if absent of any care or comfort measures, drives down cesarean rates, improves memories of birth, and ends with improved outcomes.^1
Think about that again: the sheer presence of an informed human in space with you, loyal to you, your preferences, your culture, and your wishes, unrestrained from policy or hospitalized protocol, single-handedly improves measurable birth outcomes.
This research and statistics demonstrate that community care, loyalty, and camaraderie is what is needed in a space that is increasingly becoming hyper-policed and medicalized.
As we see a rise in the number of insurance-paid doulas, agencies, and professionalized doula collectives, we must also continue to advocate for the community care doulas who are the family members, friends, and neighbors of the birther they are supporting. Both “types” of doulas have a role in increasing access to clients’ diverse desires and needs and can meet folks where they are at more effectively.
That said, if we hyper surveil and micro manage doula work, we cease to preserve the magic relationship that can be done with and for community, which has been the essence and ancestral work of doulas (or birthkeepers) for centuries.
Elephant Circle in “Doula is Verb” writes “Doula-work does not need to be professionalized in order to work or be valuable for the clients and communities doulas work alongside.”^2
This statement has driven my work in community over the past three years, as more states wrestle with how to build insurance-paid doula programs. On a surface level, insurance-paid doulas significantly increase access to a profession that is in higher demand. I am a huge advocate of Medicaid and private insurance reimbursed doulas, with the tangential demand that the essence of doula work must be preserved as they are compensated by the system.
The Reality of Insurance-Paid Doula Programs
Insurance programs need to listen to community doula stakeholders who do this work for and with community. However, what we are seeing is the roll-out of high-barrier programs that often leaves many doulas out.
The system leaves out the doulas who can not afford liability insurance, who are not citizens of the US, who do not run a small doula business but rather do this work in tandem with full time jobs, folks whose first language is not English, and many more.
These insurance funded programs need EXACTLY those doulas, but the high barriers set by the system bars them from said program.
As research shows, we know that individuals who are well-versed in birth experiences, childbirth terminology, options, medical translation, and advocacy are most potent at the bedside with birthing people. The potency comes from the ability to speak the same language as your client, preserve their cultural and religious traditions in their birth, and advocate with the medical team to make space for the humanity of the birthing person.
All of these measures are not only preserving tradition and comfort of the client, but often saving lives.
And doulas are ONE of the many tools we can exercise in this regard to combat a growing maternal mortality crisis. Thus, the demand that doula work be preserved and barriers to access (for both clients and birthworkers) be minimized.
A successful case study out of Colorado, my home state, focuses on one of the largest refugee-identifying doula cohorts in the country. The cohort is made up of 45 individuals from 15+ nations, speaking 9-different languages, many of whom were midwives in their home country. As their medical degrees do not transfer to the United States, many gravitated towards doula work as an accessible career in the United States. This cohort of women has served over 400 families in the last 18 months, preventing unnecessary cesarean sections, providing medical interpretation, getting access to needed baby supplies, and preserving cultural traditions that otherwise would have been disregarded in the Labor and Delivery room.
Through the success of the refugee doulas, community members in the Denver metro area are getting access to prenatal care sooner, accessing car seats before the birth, and making doula companions a staple in their childbirth experience.
The success of the program was through a low-barrier reimbursement program funded by a local nonprofit, paying doulas a living wage for each family they worked with.
As the roll out of Medicaid takes root in our state, the nonprofit funding is no longer sustainable, and the Medicaid program we expected to create sustainability is presently not an option due to the barriers.
Given that 98% of the families that were served through this cohort access Medicaid, we hope that the program will shift requirements to improve accessibility. However, at this juncture, the cost of creating a small business, acquiring liability insurance, as well as no interpretation help for enrollment, makes the program infeasible.
Preserving Community Doula Work
Community doula work will continue to persist, despite the growing systemic interventions at the state level. However, grassroots doulas and organizers must continue to advocate for insurance-funded programs to prioritize the diversification of doulas enrolled through lessening barriers to enrollment.
Community birth is the safest option for low-risk pregnancies and many birthing people attest that having familiar people in their birthing space with them provides the comfort necessary to have uncomplicated births. Maintaining community and cultural preservation in a birth space should not be limited by medical circumstances. Birthing in community, with the birth team of your choice, is central to maintaining autonomy no matter how the birth unfolds, and often time can improve outcomes.
This work can be preserved through a variety of measures. Most notably: not requiring centralized training organization or competency exam for new doulas, allowing for a rich diversity of business manifestation, and allowing for doulas to provide care in the way that best fits their clientele and community. As we know, doulas are non-medical birth experts who educate and preserve the autonomy of their client. We do our communities and profession justice when we allow for doulas from all backgrounds, educational stages, cultures, and values to create their particular flavor of care work and hold them all in equal regard.
To donate to the continued preservation of the Refugee Community Doula Project you can donate via Venmo to @Careworkbirthcollective
Footnotes:
Sobczak A, Taylor L, Solomon S, Ho J, Kemper S, Phillips B, Jacobson K, Castellano C, Ring A, Castellano B, Jacobs RJ. The Effect of Doulas on Maternal and Birth Outcomes: A Scoping Review. Cureus. 2023 May 24;15(5):e39451. doi: 10.7759/cureus.39451. PMID: 37378162; PMCID: PMC10292163.
Lusero, I. (2023, September 22). Doula is a verb. Elephant Circle. https://www.elephantcircle.net/circle/2023/9/21/doula-is-a-verb
Whitney Buckendorf is a Community Birthworker, Community Advocate, Placenta Encapsulator, gardener, herbalist, and organizer. With years of experience in Refugee resettlement, Whitney became incredibly passionate about the need for Birth Justice to extend to new American and immigrant families. This passion is rooted in language justice, preserving cultural practices in birth, and making sure all pregnant people are treated as the experts in their pregnancy. Whitney collaborated with a group of refugee-identifying women to create a small organization of doulas, (Empowering Communities, Protecting Women) who provide physical, emotional, and informational support in the perinatal period, currently representing 9 different languages. Through community organizing and doula work, Whitney continues to believe birth is a central human experience that can lead to liberation.