9.19.2011

Schism


I have been having issues lately; issues from within the birthing community. Now, all of you mamas out there who think we in the childbirth community are perfect, I'm sorry to break it to you that we aren't. For all of you childbirth professionals who read my blog, I am guessing that at least 3/4 of you are nodding your heads out there in cyberspace.

I wish I could remain blissfully ignorant. I wish we would stop this bickering. I wish we could all just get along and act like adults. 

I don't share this story much because I don't want people to think that I am trash talking childbirth organizations. Because that is not the case. I don't want people to think that I don't like certifying organizations, because that is not the case either... Let me just start from the beginning and let you, the reader, get a better grasp on my frustrations.

It all began, for me, about 6 years ago. I was blissfully teaching childbirth classes when I received a 'warning' from the certifying organization I was teaching through that I had been narked on by one of the other childbirth educators in my, then, city. Nancy (not her real name) had called the certifying organization and told them that I was advertising for more than one service along with my certification. This was not the case.

My listing, at the time, read "______ CBE teaching _________ childbirth classes and offering birth doula support. I have experience with hospital and home births, Bradley births, Hypnobirthing, Hypnobabies, Birthing from Within, medicated, unmedicated..." etc...

I attempted to explain this, and even provided proof, to the organization, but they would hear nothing of the sort, believing that they had 'caught me' marketing with numerous credentials.

The part that irks me is that Nancy was actually teaching a hybrid class of two different childbirth methods; resulting in a hybrid program that lasted 5 weeks. I, on the other hand, was simply saying I had experience working with moms who chose these different methods of birth preparation.

Their next disagreement with me came when they found I was giving more current research and studies to my students, in place of the outdated ones in my training packet.

Hello?! Excuse me for providing my clients with current research and options. Forgive me for taking the incentive and doing additional research to support my clients. 

After hemming and hawing with them for over 2 months, getting numerous requests to 'cease and desist' from my current marketing, etc... I finally requested for them to, henceforth, consider me disaffiliated/decertified.

I thought I had it all behind me...

Then another friend of mine, in another town, emailed me to let me know that they had been decertified from _____ for having been 'turned in' for attending one planned unassisted birth and one unplanned, precipitous home birth. Another good friend was reprimanded and reviewed because she let a client know that the doctor's advice didn't sound like the whole story and that perhaps she would get a better idea of the validity of the doctor's advice if she applied the B.R.A.I.N.D. principles of informed consent.

Pretty soon, the emails began pouring in... other doula friends were chastised for performing cervical checks... even though they were trained midwife assistants or midwife apprentices and working as monitrices, other childbirth educators were being persecuted for adding 'non affiliated' relaxation scripts to their clients.

I began hearing of women who, even though they had 10+ years of reflexology, chiropractic, childbirth education, midwifery assistance, massage therapy, and natural childbirth activism under their belts, they were being slandered in their communities for calling themselves a doula just because they didn't affiliate/certify.

And, finally, most recently, I came across the Doula Register. Now, I realize it is an Australian site, but it extends it's listings across the ocean. At first glance, it seems like a great idea...
One of the chief aims of the doula register is to provide clients, hospitals, practitioners and the government reassurance that the doulas in the register are working to a set standard.
but read further.
The doula has no clinical responsibility and hence does not undertake bio-medical observations even if she has been trained to do this in a different course. For example, this means that the doula: DOES NOT : listen to the foetal heart
  • DOES NOT : take blood pressure measurements
  • DOES NOT : take the client’s temperature
  • DOES NOT: do vaginal examinations
All doulas? Because some doulas, myself included, can read FHTs, BP, and assess cervical dilation (monitrice work).  And then, comes the real straw that breaks the camels back:
IN THE CASE OF HOME BIRTH :
The doula does not support a woman having a home birth unless the client has employed a midwife or medical practitioner to provide for her clinical care and that person is either present with the laboring woman or has asked the woman to labor alone.

IN THE CASE OF HOSPITAL OR BIRTH CENTRE BIRTH:
The doula does not go to the client’s house to support her in early labor unless the client has employed a midwife or medical practitioner (hospital or birth centre) and the doula has suggested that the client inform her clinical care provider (or hospital or birth centre) that she is in labor. (This is because only the woman and her cliental care provider can decide on the safety of her staying at home in early labor.)
Wow. Wow... so, really? I cannot labor with a woman at home until such a time that she wants her midwife with her or wants to move to the hospital setting?

This doula register is not for me.

I am just really having a hard time wrapping my head around this. I can understand why midwives and obstetricians have a hard time seeing eye to eye at times... they have a different perception of birth. But us? Midwives, doulas, childbirth educators... us?!?! 

And then I read of blog posts like this one.. where she is cautious to say 'I'm not saying my way is right'.. but she sure goes out of her way to paint other choices as wrong (BTW, since my comment on her blog and this response post she edited her original post - I wish I had screen captured it). I'm not trying to pick on her, but these types of articles only deepen the schism further. I would have liked to have seen a more balanced tete-a-tete between a certified and uncertified doula.  

Since when have we not all been working toward the same goal?

Kathy Oakes, of Serenity Birth Services recently noted on Facebook how disenfranchised she is with the direction that this 'all or nothing' attitude is taking Midwifery practices in Michigan, my home state.
"As many of you know I have been volunteering for Friends of Michigan Midwives for a few months now.  Yesterday I turned in my resignation for my position.  When I started working with them, I was under the assumption that this included ALL midwives.  And that our goal was openly supported by ALL midwives.  Afterall...we were their friends.  Friends help each other out.  After my last conference call with several other volunteers, I was left was a sour taste in my mouth.  Something was stated (that I have now been told I must have misunderstood) that just didn't sit well with me, so I started digging.

Upon my research, this is NOT a group that includes all midwives.  This is a group whose sole purpose is to push/back/support a bill, that on the surface (imo) seems great.  Making Midwifery legal in the state of Michigan.  Upon digging, and asking questions...not so great. ...

... The claim is so there is a standard of care.  But I have seen OB's...they are suppose to have a standard of care, right?  And they are elminating vbacs, pushing epis, pushin inductions, pushing time-frames on moms/births... So for me, standard of care doesn't really mean much.  What I want is midwives that trust birth.  As a parent who spent a lot of time researching homebirths, and researching midwives I feel that moms, and dads are 100% capable of finding a midwife with a GOOD record, a midwife they can trust.  A midwife with experience, and education (which doesn't always mean "book taught").  The more I think about state licensure for midwives, the more I realize the power that is being taken away from parents. " - Midwifery and The Great Divide

She goes on to add that, through legislative efforts, Michigan midwives may very well have strictures and limitations put on their practices, limiting the options of the families that the midwives serve, as well as the midwives themselves.

I lived and worked within this atmosphere in Michigan. I see small strains of it here in Texas.... CPMs against CNMs, both against LMs, and all three against most doctors and hospitals. This movement has created a deeper schism than what we started with in my opinion.


(BTW, this is not a big shout out against the Big Push, I personally think that there are pros and cons to it. My personal thoughts? I think it is a good idea to have a standard of training, educating, and assessing... but too often the protocols and SOP restrict midwives to the point that it takes away parent's rights)... 

Recently, I also found out that this extends into other areas of the childbirth and parenting fields... It seems that a Le Leche League leader, Nancy Mohrbacher, was summarily dismissed from her local LLL when they found out that she was also certified with another organization.
"My crash-and-burn summer continues with the news tonight, delivered in person by my brand-new La Leche League Area Coordinator of Leaders (ACL), that despite my intention to continue as an Illinois LLL leader after almost 29 years, she is removing me from her roster.  Why did she take this action against my wishes?  Here’s the reason she gave:  I made it known that I recently became an accredited breastfeeding counselor with the new mother-to-mother support group Breastfeeding USA and I wanted to represent both organizations." - Goodbye LLL of IL
She goes on to say
"... After all, as the saying goes, “Well-behaved women rarely make history.” As you might expect, my opinion on the issue that led to my actions has not changed. If anything, I am more convinced than ever that LLLI’s directive that Leaders must choose between LLL and BFUSA is divisive and therefore destructive to breastfeeding.

In recent weeks, people on the inside have confirmed that the goal of this directive is to undermine BFUSA, which includes ex-LLL Leaders among its founders. One fact I found particularly damning is that in the recent past concerns were raised by LLLI’s legal advisors about LLL Leaders representing both LLL and Attachment Parenting International, two organizations very similar in philosophy and purpose, yet these concerns fell on deaf ears. The insurance issue given as a reason for this directive is clearly a red herring.

LLLI is headed down a slippery slope. In Illinois, nearly half of its Leaders have resigned in the last two years. It’s clearly time for it to look in the mirror and reevaluate its Leadership and its strategies." - Settling Into My New LLL Home
Really? A woman is so passionate about breastfeeding and supporting women to breastfeed that she took the initiative to expand her training and education. And what does she get for that? A slap on the wrist.

What have I come away with from all of this? I feel, more strongly than ever, that I made the right choice to disaffiliate with the childbirth education organization that I had trained under. I feel, more strongly than ever, that I made the right choice to not certify with the doula credentialing organization that I trained with. But not happily so.

Do others truly believe that I like being a 'rebel doula', a doula with no home?  No. I wish from my deepest heart of hearts that we could have certifying organizations that provided a mother-friendly standard of care for childbirth professionals to operate under. I am finding, more and more, that I cannot be a part of most of these organizations and still provide women with every option that they have a right to... or I have to lie to the organizations that I might be affiliated with.

Instead, I am happy to say that I have passed the certification test for one childbirth education program, but can happily help you, the mother, through many methods of childbirth, since I have studied most.


Instead, I can say that, although I did sit through a 4 day doula workshop and pass the proficiency test for birth doula support, I am not affiliated with any organization. On the other hand, I have apprenticed with a chiropractor, a massage therapist, and now am apprenticing with a midwife.


This means that I bring a wide range of experience and large set of skills to the births I attend, and am unhindered by the politics of many of these organizations.

But I'm not happy about what it takes for me to be able to provide this. I have come to the hard realization that, to take initiative, to further their education and expand their repertoire, often comes at a huge cost to those who pursue it.

I am tired. Tired of the back biting, the in-crowds, the ____-only clubs... I am tired of announcing that I am a doula of 12 years but not certified and see other doulas start whispering.  I am tired of watching people with multiple certifications getting lashed at by their organizations. It's a 'damned if we do and damned if we don't' affair. (excuse my language).

Have some of us become so far removed from the heart of this calling to remember why we started in the first place? It was to provide women with valid options, loving support, and honest care.

A better question is, what can we do to mend this fracture.. this schism... and unify once more for the betterment of the women we so want to serve?

Additional Reading:
Some Thoughts on Doula Certification
The History of Birth Partners
Getting To The Heart
Doulas Scope of Practice
and, for the other side of the coin, Certification: Why Not

11 comments:

Kristi said...

This post makes me a bit nervous as I am beginning my doula journey. I feel alone on my journey most of the time. I was sad to see that even "I" as a doula working towards certification, have done things wrong. How could that be? Already? I labored with a mom at home before going to the hospital and trusted her to know when to go. And we made it in plenty of time. Anyway, I am really not into drama, so I hope around here there is not a whole bunch of drama.

I still have not been able to officially meet you, though I sat right behind you at the birth stories night this weekend. I enjoyed hearing yours. I was too shy to share mine, or even to speak really. Maybe next time.

Nicole D said...

Kristi -

I didn't know you were sitting right behind me!

Thankfully in our area, there are a large number of us that DO get along... and I just try to stay out of the drama and continue to advocate for choices.

As a psychologist friend of mine used to say "you cannot reason with unreasonable people". This means, unfortunately, many of those doulas, IBCLCs/lactation educators, and midwives who need this message most will simply discount it or refuse to consider the 'other side of the coin'.

So surround yourself with reasonable ones. For the most part, you are surrounded by them Kristi! :)

Nicole Yunker said...

I think this is very well said, although I don't know if I am a rebel doula, I prefer the term "rogue" ;) I am often weary of "doula groups" because I have found that events can get catty and people start pointing fingers at just the mere suggestion of questionability. I state on my website that I do not maintain my certification as a doula because I sometimes work as a midwife assistant and I am expected to perform clinical skills. There is a very grey line when it comes to this business. As an Unassisted Birther myself, I have a hard time aligning myself with any association that doesn't support autonomy if that is the chosen road for a woman; so therefore, I don't have any initials after my name, because there just isn't any association like that right now. I am in this business to support and empower women because I am passionate about natural childbirth. I am capable of doing many jobs but I choose this one because it is satisfying to me. I hope to be a Trust Birth midwife someday, and I am against the big push campaign for many reasons..... I am torn on the issue really. I get that everyone deserves healthcare and midwives deserve to get paid but the standard of care that will be required if this bill goes into effect, leaves much to be desired. It is definitely no model of care I would EVER lobby for. Ah here I am getting on my own soapbox on your blog lol. I say good for you for standing up for what you believe because it isn't easy to go up against the big man. It takes a special kind of person to make others open their eyes and be proactive in their own healthcare and that is part of what this business is all about.
Well...
it should be anyway.....

Rebecca said...

I sympathize with your frustration with the infighting and territoriality that can come up. LLL seems to be trying to self-destruct on the leadership level, sadly, even though I know many regional and local chapters are alive and healthy.

But I do think it is important that we remain clear and consistent about what our names and terms are. This is to benefit our profession, our clients, and the health care professionals we work with. A doula who does cervical checks is not a doula; she is a monitrice. When someone says to a friend or to a nurse or a doctor "my doula did a cervical check and told me it was time to go to the hospital" you better believe that gets around. Then when I am interacting with the people who have heard that, they say "I hear doulas tell clients they can assess progress and doing cervical checks". They do not understand that these are people who are midwives or midwife apprentices. They think these are people who have done a 3-day training and are now claiming they can do checks and monitor FHTs, which is obviously profoundly unethical and inappropriate. This sets up a very negative dynamic between doulas and the health care professionals who believe this.

To put it in a somewhat more lighthearted way, when I was in Central America I was vegetarian and I kept telling people "I'm vegetarian, I don't eat meat." They would serve me chicken because "the last girl who lived here was vegetarian too, and she ate chicken". It left me really irritated with the girl who had come through claiming to be vegetarian, and leaving me to explain over and over again that I didn't eat chicken or turkey or duck or fish! A vegetarian does not eat chicken; a doula doesn't offer cervical checks, and to have people calling themselves doulas and doing cervical checks makes life harder for those who don't. Monitrice is a beautiful word to describe those services, and I think it should be used if it is appropriate.

Nicole D said...

Rebecca,

I understand and appreciate what you're saying, and I DO market myself as a doula and monitrice. But where my frustrations come from is when this additional service is not 'allowed' by organizations, either certifying or local networking ones.

When someone hires me as a doula and then asks if I do clinical assessments, I say yes, but as a monitrice, and there is a separate fee and contract for that. OTOH, in my doula circles, I am verbally stoned for offering this service.

Likewise, I do prep my clients to help everyone out by not divulging to medical professionals that I have given these assessments, unless it is, say, a midwife who appreciates my training and expertise and won't punish the client or me/our profession for offering this information.

So I understand what you are saying, but when I practice as a doula and a monitrice, but then doulas ask if I offer xyz, and then balk at it, they could care less if I state 'as a monitrice' or not, they get stuck on the fact that I am a doula 'first and foremost'.

Does that make any sense whatsoever? :)

Bee said...

It is sad that the very organizations that are meant to HELP women are now hurting them. Always with the alterior motives. It disgusts me. I feel for you and want you to know that what you said means something to me.
Best wishes,
Bee

Rachael said...

I don't have many connections to the doula/midwifery world other than a friend of mine who is a doula. This all sounds so sad and frustrating to me. Yet another situation where I can't understand why people are not thinking about what is best for women and mothers, and supporting each other.

Sara said...

I see myself going the same way after I get some more experience. I have only been to a few births, but I really wish to expand my knowledge base outside that of my certifying organizations definition of a doula, also I'm terrible at paperwork, so who knows if I'll ever get certified anyway. I'd also love to teach childbirth education classes at some point, but there is so much argument over which is better, etc. I wouldn't know which one to use, anyway, and it's not cheap to do, so I'm contemplating continuing my personal research, training, and experience, and compiling that into a class.
We will see.

Lia Joy said...

What you describe here is the very reason I will (probably - I won't say never) not become a midwife in this lifetime and why I hesitated to become any kind of "birth professional." I chose to certify as a Doula through CBI because they don't place restrictions on things like attending UCs (and I loved the program more than I expected.) For me, birthwork is an artform that is expressed many ways. I think we'd do much better insuring that birthworkers are communicating their qualifications/boundaries to the client rather than trying to fit eachother into little boxes.

Anonymous said...

ugg boot mini ugg boots uggz boots [url=http://www.hhsboots.us][b]http://www.hhsboots.us[/b][/url] uggs knit boots http://www.didyesboots.co.uk
[url=http://www.nlbootss.nl#231424860][b]uggs online[/b][/url]
[url=http://www.womukboots.co.uk#833954285][b]www.womukboots.co.uk[/b][/url]
[url=http://www.hhsboots.us#389669216][b]http://www.hhsboots.us[/b][/url]

Anonymous said...

Since Fifties users and also competitive bathers also have found wholesale ugg boots as a well-liked way for preserving hot although from the normal water. Additionally, they wore them in to the ocean because they unique Australian [url=http://www.bootsalso.com/]discount ugg[/url] were good for enhancing the fishing boats flow for the marine.http://www.bootsalso.com/

LinkWithin

Related Posts Plugin for WordPress, Blogger...

Total Pageviews