The word doula is one you probably aren’t familiar with. It is a Greek word originally meaning “servant”, but is now most often defined as a woman supporting another woman through labor and the postpartum period. Being a doula is a relatively new profession, first appearing in the US in the 1960s and gaining in popularity since the 1990s. A study in 2003 showed approximately 5% of women in the United States use a doula during childbirth. One can practice as a labor support doula, a postpartum doula, or both. A recent study at the University of Michigan found that the presence of a labor support doula calms women and often reduces the length of their labor, leading to a lesser need for certain medical interventions like the use of forceps, vacuums, episiotomies and Caesarean sections.
Doulas are not medical professionals; they provide non-narcotic, emotional support to the laboring woman. Doulas also take their knowledge and expertise into the home of the newly postpartum, providing nurturing support during this critical period. In the home, doulas can facilitate breastfeeding success, family bonding and confidence for new parents. With national organizations, like dona (Doulas of North America) and alace (American Labor Assistants and Childbirth Educators) there are many ways to become a certified doula or to join with larger national community if you are already working as a doula. In Chicago, there is a large group of women working around the city and the suburbs, supporting women in their homes. This article will look at some of the ways this community works in solidarity to provide better care and to effect change in the areas of women’s reproductive health and family planning.
“In the doula community, you’re either for God or the Goddess,” jokes Deb Lawrence, a Chicago doula and secretary of the North Eastern Illinois Doula Association (neida). Lawrence came to doula work after her experience as a Christian missionary in the Philippines, as well as being a childbirth educator in the Bradley method, a natural childbirth method. Lawrence is one of the founding members of neida, (“as in need-a-doula!”) a group that organized in 1999 to provide “a structure for networking, support, education, political action, and professional support” to doulas in Illinois. The idea for the group grew out of kaffeklatch meetings at the homes of suburban doulas. The women of neida also started the chicagodoulas listserv, a Yahoo group, open to the public. The listserv was a way to “build resources, knowledge of doulas and Illinois laws,” as they got neida off of the ground.
The listserv, now with a life of its own, currently claims 224 members, including doctors, midwives, lactation consultants and herbalists, who post on a regular basis. Most of these women are independent doulas, some are certified through a national organization like dona or alace, and some are not. They connect with clients and establish professional relationships as independent contractors. Lawrence works in this manner, charging enough that she can offer a sliding scale fee to those that need it—allowing her, she says, to support more mothers. The chicagodoulas listserv is a way for those with more experience to share stories so that others, who are just starting out, can learn. Often an inexperienced doula will be able to connect with a more experienced doula, and then shadow or apprentice. Chrissie Richards found a doula mentor on the listserv. She originally became interested in doula care while working at the Chicago Women’s Health Center (cwhc) and joined the listserv to see what being a doula was all about. On the listserv she met her current mentoring partner, a suburban doula married with children: the complete opposite of the “bike-riding, single urbanite lifestyle” Richards says she is accustomed to. Involved with the reproductive health community for 18 years from Planned Parenthood to cwhc, but having no children of her own, Richards was a little unsure about being able to provide authentic support to mothers. Her commitment to women’s health advocacy is strong, though. Through her mentor relationship—built first online, and then in person—she is able to continually develop the experience she needs to provide nurturing support to laboring mothers.
Richards, attracted to doula care because of her politics, now finds that they take a back seat when it comes to providing care to women. She says: “Not surprisingly with my background, I tended to politicize birth early in my doula work. But I find it necessary to resist doing so, because that sort of makes it about me or something else when in fact each birth is about a baby, a mother, and a new or growing family. Each birth is a small yet momentous occasion, an intensely intimate and personal event.”
With its twenty-four hour availability, Richards hypothesized, the internet is an invaluable tool for connecting the birthing community, mothers and their supporters. “At 3 am when you are breastfeeding, that might be the only time you have to hop online and network with other mothers or supporters.” But time alone to breastfeed is itself a precious commodity for many mothers, let alone the time and access to participate in internet listservs. Only a part of the population can engage in this kind of digital information sharing and community organizing, because they either lack access, time, or both. Too often, mothers are hurried back to work to support themselves and their new families financially, leaving out the necessary emotional support they and their new babies need. According to numerous studies, the United States compares poorly to other industrialized nations in its efforts to defray costs of child rearing. US companies and corporations offer little in the way of paid parental leave, taking away from the critical bonding period of the first few months. This continues despite studies showing quality infant and early childhood care would be economically beneficial for the government through a reduction in crime and welfare expenditures 1. Supportive doula care inspires confidence in new mothers in this critical period. Most women that contact a doula, on their own, can afford the cost of nurturing doula care, but there are other Chicago organizations that help those who cannot afford the service even at a sliding scale rate.
A non-profit group called the Harris Foundation provided initial funding and research that started two such Chicago organizations in the mid-1990s. These organizations, Ounce of Prevention and the Chicago Health Connection, now help low-income women gain access to doula care and family planning. The groups partner with pre-existing community health programs, like Parents Too Soon, Early Head Start, and the Marrilac House on Chicago’s west side. The organizations were originally part of the Chicago Doula Project, which developed the “community based doula” model. This model trains women from the low-income communities being served to work as doulas, on the theory that they will be better able to relate to the clients, and thus provide better care. The organizations use the research about the benefits of having a doula in the critical period at the beginning of life and combine it with existing public service networks. According to Rachel Dolan-Wickersham, an independently practicing doula since the early 1990s, and a doula trainer with Ounce of Prevention:
“The Illinois community-based doula serves atrisk parents who are usually adolescent, and often low-income. These doulas work in statefunded programs that are embedded in existing community-based programs. Young mothers and their partners are provided with approximately five months of free doula services and then up to five years of ongoing family support by the same program. The Chicago Doula Project has grown to 17 sites across Illinois, employing 36 doulas. Over the past 8 years 3,600 mothers and their families have been assisted. Last year alone 850 were served.”
The community-based doula program has been modeled in many other cities nationwide with the help of the continued funding of the Harris Foundation. Dolan-Wickersham, also a neida member, makes an interesting observation when she points out that these two doula communities, the “independent doula” and the “community-based” doula, work in solidarity with each other but remain for the most part separate. “The independent doula is focused largely upon planning for and attending the birth itself. For the community-based doula, birth is just a small part of it. These doulas, in addition to being knowledgeable about childbirth, are also experts in adolescent development, infant mental health, child development and teaching parenting skills. It truly seems to be a separate profession, or an advanced stage of doula-hood, which is why, I think, these two kinds of doulas have remained mostly separate as communities.”
I have been employed as a postpartum doula since 2005. I am neither an independent doula, nor a community-based doula, I work with Birthways, Inc. an Andersonville-based postpartum and labor support doula service provider. Jeanette McCulloch, director of Birthways says, “Mothers in our society do not get the support they need to nurture themselves and nurture their babies.” Although the Birthways offices are based in Andersonville, the organization sends doulas out all over Chicago and the suburbs. Often women who wait until later in their life to have children will seek out doula support. This is common in Birthways clientele, as well as in the clientele of independent doulas. These women may have no family around or have no experience with children, but they are financially able to afford doula care. Ellen Richter, an independent Chicago post-partum doula says, Many women today have not grown up taking care of siblings, marrying and having children. They get degrees, become professionals and define themselves as such. When they do have a child it can shake that foundation of who they thought they were. Now they are a ‘mother’. That can be frightening at first because they have no frame of reference. A doula can listen and help them discover their innate instincts. A doula in a home is constantly modeling the behavior that one’s mothers, aunts, sisters, and cousins would have done. Richter comments, “Historically, women have always nurtured and educated the new mother. And when women are isolated from their family and friends, that would have done this in the past, a doula can lovingly step in.”
Chicago doulas work in diverse ways, organizing through the internet, in homes, both independently and with managing organizations, but always in solidarity because of the common goal of supporting new mothers. Across all neighborhood and class boundaries, new mothers are an underserved population. For women and their families the alienation of modern societies is increased with the birth of a child; from larger geographic distance between relatives, to little or no paid time off from work, to poor government subsidies for child care, to the simple phenomena of not knowing one’s neighbor, there are many things that contribute to this modern alienation. Doulas work to alleviate some of the isolation caused by this lack of cultural support by visiting mothers in their homes across the city. Doula care helps these new mothers build strong relationships with their children and families, which will ideally strengthen the larger cultural fabric. Ellen Richter puts it best, “I believe with every cell of my being that we, as doulas, have the opportunity to bring about a more peaceful world by attending, in a loving manner, to mothers and babies during this very intense time in their lives.”