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with me came when they found I was giving more current research and studies to my students, in place of the outdated ones in my training packet.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