I live in Washington state where government funded health care programs have taken a huge hit when massive budget cuts were put in place at the beginning of this year. Much of the state funded medicare for pregnancy program was changed. These cuts urged me to continue looking at the alternatives. When we can no longer look to the government for insurance during pregnancy and we cannot afford to pay the current rates out of pocket - what else is there to do? What I am about to propose is that we, as radical birth workers, step away from practicing our work with a capitalistic approach and open up to our immediate communities. I believe this involves a large scale effort to educate aspiring doulas, birth attendants and midwives to meet the needs of the women in our communities. Here I will explain my personal experience with the costs of learning to become a midwife and how I am calling for birth workers to change the way we do business.
I really didn't know what it would take to pursue a midwifery career when I began my journey a few years ago. My desire to be a midwife began with a strange and vivid dream that lead me to research the craft. Before the dream, I had no knowledge of midwifery education and knew very little about all of the different terms and classifications. My hope was to integrate my midwifery goals with my feminist organizing skills to provide services for women in my community and to those in need of support. Without knowing what steps to take, I blindly signed myself up for a doula course to get my feet wet with birth work.
The two-weekend intensive cost me in the neighborhood of $600.00 and there began an on-going struggle that I have with the costs of educating birth workers and in turn, the rates we charge our mothers.
Almost an entire day of the intensive four-day doula class was dedicated to marketing a doula business, setting fees and learning how you can offer additional services like massage, placenta encapsulation and belly casts to enhance marketability. There was no discussion of taking "clients" for free and the topic of helping low-income mothers involved a sliding-scale fee with a suggested base price of $300.00. The instructors of the class, working as doulas in an urban setting, charged as much as $1500 per birth. Compare this with a Mexican midwife that I know who charges a range from $1000 for those who can pay to as little as a chicken, literally, for those who can't pay.
Another day of the class was devoted to discussing the benefits of becoming a "certified" doula. In order to apply you must first become a member of the certifying agency ($42.50 per year for doulas in the US) and then you purchase the certification informational packet ($45.00 us) and pay the application fee ($60.00 us). I understand the reasoning behind having a regulated certification process to guarantee that the basic skills taught to everyone be equal, but is that really necessary for doulas? What is the value of certification for doulas working for free or with low income women?
The doula class left a bad taste in my mouth. I had trouble thinking about charging women for my support even if it helped to support me. Many people suggested that I work as a doula during midwifery school to help make ends meet, but I decided against it and took a part-time job to pay the bills.
There is this misconception about studying midwifery that you must first become a doula. While doula courses can be beneficial to an aspiring midwife, not all doulas want to be midwives and not all midwives were first doulas. The more time that I have to sit with the idea of what a doula is or should be, I see that doulas fill a void in our culture that was created by valuing nuclear families, devaluing single mothers and the separation that we have all felt from our neighbors and community members. I've often grappled with the idea of a professional "friend" who provides emotional support during and after pregnancy. No one should have to go without support, but the idea that some are capitalizing on our broken community structure is troublesome to me. I am still trying to figure out the balance between supporting mothers and supporting birth workers without exploiting anyone's labor or time.
Birthing in our society is an expensive venture. Plenty of companies have aimed their marketing at pregnant women and the industry seems to be growing. I have joked before that the "birth dollar" is a "good dollar", meaning there are a lot of products and methods designed to help new parents, but at a cost. Birthing classes, books, dvds, midwifery/hospital bills, tub rentals, placenta encapsulation, lactation consultants, professional doulas... The costs of pregnancy and the accoutrement on the market for birthing and handling a baby can really add up. I've met mothers who expressed feeling inadequate for not being able to afford these things. A midwife I know once discouraged a client of hers from using a $25 inflatable kiddie pool that was almost the same size as the birth specific $250 'Aqua Doula' rental, because it "might deflate a little" over the course of the labor. This midwife held a lot of power in suggesting the more expensive option with little thought to the financial burden on the mother.
During my midwifery and doula education, I lived in a town where it seemed as if everyone was a doula or aspiring doula. There were so many people discussing the politics of being a doula that I reached a point where the word started to bother me. Right after I finished the doula course I tried to start up a free collective to serve the needs of mothers who couldn't afford to pay for support. I contacted all of the doula groups in the area to see if anyone was interested in occasionally volunteering their services. Instead of receiving positive responses, I was emailed by a prominent doula who asked me to stop offering services for free, because it risked taking business away from the paid doulas. I dropped the subject.
After a year of self-study, I stumbled upon a midwifery program taking place in a town three hours away and I decided, quite suddenly, to adjust my life and attend the class. The program was expensive for me, but the teacher offered individually tailored payment plans. She had this "everything works out" attitude which I had to adopt in order to see through covering the costs. Luckily I had an unexpected windfall of money during the program that I used to pay the tuition in two large chunks (I was literally sweating while carrying $1500 in an envelope in my coat pocket) and I had enough money left over to afford a cheap car that I could rely on for the commute. Without this luck, I would have been unable to do the program and I have tried holding the "everything works out" perspective hoping for the same luck in life (I'll get back to you later on the rate at which it works...)
In midwifery school there was an on-going debate about whether or not to seek a professional license and/or certification. The pros and cons list goes on forever. From accessibility to liability, we looked at it all. From a personal viewpoint, I was flabbergasted when I looked into the process of becoming a certified professional midwife. For around $1400 and a few other fees, I could take a test, have my birth portfolio reviewed and eventually add the professional title to my name. Seeking a license in my state included more fees and the costs of paying for malpractice insurance which would make offering free care impossible.
It would appear that nothing is free under capitalism. In order to do anything, including support mothers, you must pay or be paid. My hopes for providing free care for those in need have met much resistance from others, but we need it now more than ever.
I am calling for wide scale, birth attendant/doula education so that support can always be found nearby. I am calling for elder/practicing midwives to apprentice/teach dedicated students, to share their knowledge without reservation, to drop the "pay your dues" attitude toward new midwives and to embrace a new generation. I am calling for birth workers to openly discuss compensation and how to meet the needs of women in their communities. I am calling for birth workers and educators to re-examine their roles, their privilege and their contribution to shifting the birth paradigm.
This blog was written by Meghan Guthrie, the art director and co-editor of SQUAT.
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