doula

I’ll preface this by saying that SCOTUS’s decision on Dobbs vs. Jackson, to strike down Roe vs. Wade and ending almost 50 years of abortion access in the US, is an affront to human rights. Restricting access to abortion will only result in harm to both the pregnant person and to the baby they are forced to carry to term. I will add to this that I write using multiple terms (women, pregnant person, person with a uterus, etc.), depending on context.

That said, this will become a broader series of blog posts because there is too much to unpack for one post. Really, this series started a while back with my series on Dr. Grantly Dick-Read and his pronatalist, eugenicist, Christian beliefs about women, birth, and the “right” kind of babies. I’d encourage you to go back in this blog and read more.

My trigger for writing was not the Dobbs decision, per se. You all already know my feelings about abortion and the right to make decisions over one’s own body. My trigger was the absolutely deafening silence of both the childbirth education and the doula organizations in the wake of Dobbs. Yet, while I am severely dissapointed, I am wholly unsurprised. The sheer hypocrisy of the organizations that claim to support women’s choices in pregnancy and birth, yet who say nothing in support of the first choice a pregnant person must make – the decision to terminate or continue the pregnancy, is distressing.

If we are to say we support choice, then we must, support all choices, not just the ones we like or the ones that suit our biases. Staying neutral and trying not to offend anyone is being complicit.

A failure of this kind, from all of the childbirth education organizations and doula organizations, is a failure to support human rights, women's rights, public health, and evidence-based medicine.

Let’s talk first about who does support choice, bodily autonomy, and evidence-based healthcare. That’s at least 75 professional organizations, and counting. The link has the list of organizations and the full statement.

ACOG released a statement on the day of the SCOTUS decision.

“While the Supreme Court’s decision today is a significant and destructive setback, ACOG’s resolve is unwavering: we will continue to support our members, our community partners, and all people in the ongoing struggle against laws and regulations that violate and interfere with the patient–physician relationship and block access to essential, evidence-based health care.”
ACOG

ACNM released a statement as well.

“ACNM maintains the right to access to abortion care as an essential right of those capable of pregnancy. ACNM affirms that everyone has the right to decide what is best for their health, bodies, lives, and families. As such, we adamantly oppose all legal opinions and legislative policy that blatantly or surreptitiously seek to restrict or ban the provision of abortion care, as well as any efforts at any level to render it less accessible. ACNM will continue to support efforts to increase access to midwives as abortion providers and engage with stakeholders to make abortion care accessible to the people and communities midwives serve.”
ACNM statement

Childbirth Education and Doula Organizations did NOT release public statements about the Dobbs Decision.

At the time of writing (7/11/2022), no childbirth education organization or doula certifying body has released a public statement regarding the Dobbs decision. These organizations include Lamaze International, ICEA, CAPPA, and DONA. No public statement from any of them appears on their websites or social media. Their silence speaks volumes.

Lamaze did send a letter to the membership (i.e. the certified childbirth educators) via email on July 7, 2022. This was internal only and not designed for the general public. A fellow educator called the letter, “wishy washy,” which I think is a kindness Lamaze does not deserve for it’s failure to support it’s stated mission. The letter, in the image below, falls intentionally short of supporting abortion and human rights. While it acknowledges that a lack of abortion access will cause harm, it does not even use the word abortion in it’s letter. Noting that an issue is “highly politically charged and polarizing” directly shows that Lamaze intentionally will not take a stand to support pregnant people. By not taking a stand, like almost every other maternal-child health organization in the country, Lamaze lays their cards on the table. They chose not to advocate for women, not to support bodily autonomy, not to support evidence-based medicine, and not to support normal healthcare.

Letter from Lamaze International to the membership 7/7/2022

For as long as I’ve been teaching Lamaze classes, since late 2010, I have been told by the organization that they support women’s birthing choices. I’ve been told that they support evidence-based medicine. I’ve been told they support women’s autonomy in decision making regarding their bodies and their births. I’ve been to DC to lobby lawmakers with Lamaze for laws to improve maternal health, reduce maternal mortality, and support breastfeeding initiatives.

As a Lamaze educator, I have taught the people with whom I’ve worked that their choices about their bodies matter and they they should advocate not only for themselves, but also for the next pregnant person to improve the quality and accessibility of healthcare.

A failure of this kind, from all of the childbirth education organizations and doula organizations, is a failure to support human rights, women’s rights, public health, and evidence-based medicine.

I am so disappointed in my organization. Even though I no longer teach childbirth classes or attend births as a doula, I still have an affinity for the group that shaped my life for 12 years. I feel somewhat like a child, who has learned that their parent is flawed and not what they had believed. Let’s explore the details of Lamaze’s failure and the failure of the other organizations in not joining the other 75+ maternal health organizations in condemning Dobbs and supporting the right to abortion.

Breaking Down the Failures of the Childbirth Education and Doula Organizations

These organizations say they support evidence-based medicine and information.
- Abortion is an evidence-based medical procedure.
These organizations say they want to reduce maternal mortality and morbidity
- Abortion reduces the risk of maternal mortality for that pregnancy and it drastically reduces maternal morbidity since the pregnancy is ended early.
These organizations say they support women’s choices and autonomy in all things pregnancy, birth, and parenthood.
- Except, apparently, for the first choice, to continue or to terminate the pregnancy. If this first choice is not supported, then are women’s other choices truly supported or is it dogma? How can you claim to support women’s choices, but not for abortion? Simple, you don’t support women’s choices.
These organizations say they support shared decision making with a medical provider.
- When the law disallows abortion, shared decision making with a medical provider is squashed.
- How can a person even have the conversation with their doctor or midwife in a state where abortion is outlawed and it becomes a crime to even help a person by driving them to have an abortion or telling them how to order medication online? Women many skip the doctor entirely and choose online resources that may cause her harm or be ineffective because abortion isn’t legal in their state.
- Abortion must be legal and accessible for shared decision making to take place.
These organizations say they have a mission to advance safe and healthy pregnancy.
- Safe and healthy pregnancies are had when abortions are accessible. Safe and healthy includes mental and emotional wellbeing in addition to physical. Without abortion, many unhealthy (for adult or fetus) pregnancies will be forced to continue.
- Pregnancy is a huge drain on the body’s resources, and can cause permanent harm or death. The risks of pregnancy on the body must be entered into with open eyes, evidence-based information, and proper prenatal care which includes access to abortion.
- Emotional wellbeing is essential to being a successful parent. Not everyone is emotionally ready, nor is everyone financially ready, nor do they have proper social and familial support.
- Poverty and the social determinants of health play a huge role in how safe an healthy a pregnancy will be.
Advocacy
- This is a rough one for me. I’ve been to DC to lobby with Lamaze. I’ve written letters, I’ve spoken with local, state, and federal legislators on maternal health issues.
- Abortion is the one topic Lamaze and the other organizations won’t touch with their advocacy.
These organizations have chosen the feelings of some of the membership over the reality facing pregnant people. (note: I haven’t seen a poll as to whether or not doulas and childbirth educators support abortion rights. Do we have data on that?)
- By Lamaze choosing not to make a public statement to pregnant people and those outside of the organization, Lamaze ignores those who matter most. The people we serve.
- Noting that this is a controversial issue sidesteps the real, direct issue of human rights and women’s health.
- Taking a firm and direct stance like the 75+ other maternal-child health organizations would send a direct message in support of all people who have the ability to become pregnant. It would support human rights, women’s rights, public health, and most importantly, it supports the health, wellbeing, and autonomy of those people who own a uterus.
- Noncommittal responses are the same as supporting anti-abortion legislation. It’s like voting 3rd party and therefore helping a reasonable candidate lose because your vote didn’t count.
- Being “wishy washy,” staying out of politics, trying not to hurt someone’s feelings is doing direct, irreparable harm.
- Silence is doing direct irreparable harm.

Our local Midwife Center for Birth and Women’s Health also released a statement. So did Healthy Start.

“This includes the belief that our clients are the experts in their health care choices, social environment, and influences, including when and if they choose to become parents. In the United States, the maternal mortality rates and economic disparities currently affecting women and families of color, especially Black women and birthing people, are already at a crisis level, which means that access to comprehensive reproductive services is more critical than ever.”
Midwife Center for Birth and Women’s Health

“As a community that is focused on public health, health equity and centering the lived experiences of marginalized people—in particular Black women—this decision presents an affront to our safety, security and bodily autonomy. What is at stake is bigger than the perceived morality of a personal decision about pregnancy; but the duality of a society where women, children, poor people, people of color, people who are disabled and people of nonconforming gender and sexual identities are oppressed through policy and legislated hatred. In particular, this ruling will have a disproportionate impact on Black women.”
Heathy Start

Ok, but why are these organizations silent?

I’ll give you a hint.

The two major flavors of childbirth education, Lamaze and ICEA, have their historical origins firmly planted in eugenics, pronatalism, politics, and Christianity.

I’ll leave off on today’s post with this: While on one hand, I expected better of the childbirth education and doula organizations, on the other hand, I’ve been in this world of birth professionals long enough to be a realist. There was never any way they could come our and possibly offend someone by speaking out against the Dobbs decision and in support of the human right of abortion access. Their silence is enough to make them complicit.

Expect the first post digging into the history of why in the coming days. In the meantime, go back and read the dozen posts on Dr. Grantly Dick-Read. You’ll find them a good foundation for what’s to come.

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I received an email the other day through my professional site inquiring about my birth doula services. The pregnant person told me about about herself and then asked if I was Christian and could support her spiritually during her birth. This is not the first time someone has asked such a question of me. I also see it with some frequency on social media, “so and so is looking for a ‘Christian doula’ can anyone help?” Most commonly, it is a “Christian doula” that someone is seeking or advertising themselves. I’m sure there are Jewish, Muslim, Hindu, etc. doulas out there who advertise as such, but Christian is the most common one in my experience.

As a non-Christian, I am always taken aback by these requests. I question the ethics of both seeking a doula based on religion and of being a doula and advertising your religious affiliation.

As a pregnant person, is seeking a Christian (or other religion) Doula religious discrimination or is it preference?

If a person’s religion is part of their core foundation of who they are, it may be appropriate to seek someone who shares their belief system. However, this is question of employment. The doula client employs the doula. Generally, we don’t ask or care if the plumber is of a certain religion… or the accountant, or the house painter, or the lawn care service, etc. Those are people we hire to do a job based on their qualifications, skill set, experience, etc. Their religion has not impact on their ability to fix my toilet, do my taxes, or mow my lawn.

The doula client may argue that they want someone to pray with them or perform a ceremony during birth, so they need a (religion) doula. However, that’s not a doula’s job. It is a fundamental misunderstanding of what a doula does. Doulas provide physical support (massage, change positions, offering food and drink), emotional support (a listening ear), and informational support (side effects of medications, communication skills with medical staff). Nowhere in a doula’s training or job description is “religious support.” So, the client is seeking a service for which the doula isn’t trained or qualified to perform.

At the core of this is that as an employer, one cannot discriminate based on an employee’s religion. So, not hiring a person because they don’t meet religious criteria is discrimination. No employer in the US can decline to hire you based on your religion. As a doula client, hiring or not hiring a doula with the doula’s religion being criteria for employment is unethical and, in some cases, illegal.

Ok, but what about those people who want or need to have some sort of spiritual support during birth? That is what friends, family, or a religious leader is for. That’s not a doula’s job and that person can attend a birth in their appropriate capacity. The doula’s job in the scenario is to make space for the prayer or other religious aspects so that it can take place safely and uninterrupted.

Is advertising yourself as a Christian (or other religion) Doula discriminating against those of other religions?

On the surface, this one appears to be a bit more of a grey area. It isn’t explicit, “I don’t want to work with people who aren’t of (religion).” However, by saying “I’m a (religion) doula” you are both describing yourself and implicitly telling the person who is not of that religion that you don’t really want to work with them no matter how “inclusive” you say you are. By categorizing yourself as a (religion) doula you tell the reader who you want to be working with. Bible quotes on your doula site tell people of other religions, or people who have no religion, that you are a member of a group to which they do not belong and you turn away those people. You turn away LGBTQIA+ by advertising your religion because of existing discrimination by many religions. Maybe that’s what you want to do as a (religion) doula but understand that you are excluding other from your services. That is religious discrimination, even if it is not intentional.

OK, so the (religion) doula client finds the (religion) doula and they work well together. Isn’t that why the (religion) doula advertises their religion and the (religion) client asks about religion? Is there a problem with that?

No, there isn’t a problem with that, per se. Every client needs the right doula for them. I am not the right doula for everyone. The problem arises when someone of another religion is seeking doula services or is a doula. That is where the discrimination comes in. Simply by stating your religion, as either client or doula, you implicitly tell the other person that you are not for them.

Oh, and there’s one more question you should never ask a doula because it also doesn’t impact their ability to do a good job. You’ll have to visit my other site to find out what that question is, however.