A few days ago, I read this article about social determinants of health for the perinatal period, written by Jill Wodnick, M.A., LCCE. The article is pretty interesting and makes a lot of connections between how these conditions produce longterm disadvantage for the children born into them. There is a moment in the article that sent me into a bit of a tailspin. Here is the quote:
"For too many doulas, they will be able to offer words of comfort and use a rebozo, but may never have had the training to learn about perinatal disparities and social determinants on health. We know about the high cesarean birth rate, but what about perinatal disparities which impact breastfeeding rates as well as birth outcomes."
This quote sets the writer up for her recommendation that doula trainings begin to more seriously cover information about the social and economic factors that lead to poor birth outcomes and low rates of breastfeeding. I am always excited to see this kind of information getting more attention, but the generalization that we don't know this is a generalization that doesn't sit well. There are quite a lot of doulas who come to this work not out of an interest in birth and breastfeeding, but out of an interest in being independent community health workers who can use anti-oppression approaches to support individuals and make the kind of ripples that precipitate change. And, for people who come to the work without this foundation, simply knowing about racism, classism, sexism, heterosexism and all the other garbage that people are forced to live through and just how much it sucks does not give doulas access or agency or skills to do anything about it!
I posted this on Facebook in response to Squat Birth Journal's request for input from doulas about the article:
"For too many doulas, they will be able to offer words of comfort and use a rebozo, but may never have had the training to learn about perinatal disparities and social determinants on health. We know about the high cesarean birth rate, but what about perinatal disparities which impact breastfeeding rates as well as birth outcomes."
This quote sets the writer up for her recommendation that doula trainings begin to more seriously cover information about the social and economic factors that lead to poor birth outcomes and low rates of breastfeeding. I am always excited to see this kind of information getting more attention, but the generalization that we don't know this is a generalization that doesn't sit well. There are quite a lot of doulas who come to this work not out of an interest in birth and breastfeeding, but out of an interest in being independent community health workers who can use anti-oppression approaches to support individuals and make the kind of ripples that precipitate change. And, for people who come to the work without this foundation, simply knowing about racism, classism, sexism, heterosexism and all the other garbage that people are forced to live through and just how much it sucks does not give doulas access or agency or skills to do anything about it!
I posted this on Facebook in response to Squat Birth Journal's request for input from doulas about the article:
I got a little triggered by the tone of this article. I agree with the author that doulas can be uniquely positioned to go where the need is, and I think that having trainings that share more about where the most significant need exists would be great. Still, I found her tone a little condescending given that most doulas that I know and work with got involved in the work specifically to address inequities in the healthcare system. I recognize that my peers do no necessarily represent the whole... but there are a whole lot of us out there who are working in the trenches on these issues and i think doulas are actually a lot more aware of these issues than we are given credit for in this piece and in general. Still, in order to work appropriately with people experiencing systematic oppression, a whole separate training would be helpful. As a profession, we have lots of experts out there who could take on the need for such training (and some of them have already started to, such as The Birth Attendants: Prison Doula Project and The Prison Birth Project) and I am excited to see more and more birthworkers creating there own access points to working on some of the Reproductive Justice issues that affect our clients. I'd love to more journalism about the inspiring work being done by our peers, so that newer doulas and underexposed doulas can learn about this important work. A lot of us know where we need to go to be most effective on health disparities, but struggle to get recognized as the high-impact community health-care workers that we could be... I imagine that the remedy to this is actually more programs that train people from communities most affected by the social determinants discussed in this article. I believe in the doula model of care enough to know that dropping a green doula into this complicated matrix can do some good... but an envisioning a strategy that would make real change is going to require us all to dig a little deeper.
I needed much more dialogue on this subject than I got on Facebook, so I am posting my comment here as well. I spend a lot of time thinking about 'doulas as change agents' and where the appropriate place to put my energy might be.
I am very fortunate to have an very inspiring and brilliant friend living with me and family right now, named Phoenix. The best part of this arrangement is that I often have a thinking buddy around; a high-quality thinking buddy at that! So, when I didn't immediately get the discussion I was hungry for on Facebook, I just walked into my kitchen and unloaded a bunch of my thoughts and feelings on my roomie. As usual, this discussion gave me the insight I was lacking. Ultimately, we ended up talking about the value of all doula's being exposed to social determinants of health as the author suggests in her article, but acknowledged that this alone wouldn't produce more Radical Doulas.
A Radical Doula is made through the melding of the doula framework and an anti-oppression perspective. If i'd had a pen in hand, this is the part where I would quote Phoenix's well-stated conclusion. In the absence of a pitch-perfect quote I am gonna have to improvise, (sorry Phoenix!) Basically, Phoenix concluded that there are quite a lot of people who come through doula training at least vaguely aware of what this article calls 'social determinants of health' and see the value of working as doulas to improve the outcomes and experiences of people whose lives are being influenced by these factors. A person can easily be exposed to data about health disparities in a standard doula training, and that is a call to action that I consider a great first step. However, a person cannot simply be exposed to the anti-oppression framework in order to be a powerful ally and change-agent. The anti-oppression framework is a perspective that becomes a part of how you move through the world regardless of what you are doing. Being a good ally means being willing to invest in changing yourself, not just 'helping' someone else. In addition to needing access to information (as the article advocates) and anti-oppression training (as I thought,) Phoenix compassionately suggests that people who have Radical Doula work in their hearts simply need to be invited.
I've been working on challenging myself to show up as a leader in my profession. Currently that is looking like facilitating conversations about Full Spectrum work among doulas and other birth professionals through my work with Calyx Doulas and becoming a mentor to newer doulas. My talk with Phoenix made me realize that another thing I can do right now, is to invite my fellow doulas to the work. Whether you are new to doula work, have a thriving private practice or just dabble in the work from time to time, there is a way for you to do anti-oppression work as a doula. There are more ways to do doula work than have been invented, but I sincerely invite you to join me and the many, many other doulas who recognize systematic oppression in learning and creating our place in the Reproductive Justice movement.
Be in touch in the comments or by e-mail if you need support as you envision and find your place in the work. Just know that you are invited, and as soon as you take the first step, you are a part of something very important.
I am very fortunate to have an very inspiring and brilliant friend living with me and family right now, named Phoenix. The best part of this arrangement is that I often have a thinking buddy around; a high-quality thinking buddy at that! So, when I didn't immediately get the discussion I was hungry for on Facebook, I just walked into my kitchen and unloaded a bunch of my thoughts and feelings on my roomie. As usual, this discussion gave me the insight I was lacking. Ultimately, we ended up talking about the value of all doula's being exposed to social determinants of health as the author suggests in her article, but acknowledged that this alone wouldn't produce more Radical Doulas.
A Radical Doula is made through the melding of the doula framework and an anti-oppression perspective. If i'd had a pen in hand, this is the part where I would quote Phoenix's well-stated conclusion. In the absence of a pitch-perfect quote I am gonna have to improvise, (sorry Phoenix!) Basically, Phoenix concluded that there are quite a lot of people who come through doula training at least vaguely aware of what this article calls 'social determinants of health' and see the value of working as doulas to improve the outcomes and experiences of people whose lives are being influenced by these factors. A person can easily be exposed to data about health disparities in a standard doula training, and that is a call to action that I consider a great first step. However, a person cannot simply be exposed to the anti-oppression framework in order to be a powerful ally and change-agent. The anti-oppression framework is a perspective that becomes a part of how you move through the world regardless of what you are doing. Being a good ally means being willing to invest in changing yourself, not just 'helping' someone else. In addition to needing access to information (as the article advocates) and anti-oppression training (as I thought,) Phoenix compassionately suggests that people who have Radical Doula work in their hearts simply need to be invited.
I've been working on challenging myself to show up as a leader in my profession. Currently that is looking like facilitating conversations about Full Spectrum work among doulas and other birth professionals through my work with Calyx Doulas and becoming a mentor to newer doulas. My talk with Phoenix made me realize that another thing I can do right now, is to invite my fellow doulas to the work. Whether you are new to doula work, have a thriving private practice or just dabble in the work from time to time, there is a way for you to do anti-oppression work as a doula. There are more ways to do doula work than have been invented, but I sincerely invite you to join me and the many, many other doulas who recognize systematic oppression in learning and creating our place in the Reproductive Justice movement.
Be in touch in the comments or by e-mail if you need support as you envision and find your place in the work. Just know that you are invited, and as soon as you take the first step, you are a part of something very important.
"The right to have a child, the right to not have a child, and the right to raise a child in a safe, healthy environment." - Loretta Ross, (defining Reproductive Justice in just a few words.)
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