I submitted the following essay to Midwifery Todayfor the Winter 2012 “Doula Issue.” My friend, an editor at the publication, let me know they could not print it because it discusses elective termination, a subject they do not broach. Midwifery Today has every right to its editorial decisions and perhaps this policy prevents unproductive flame wars amongst its subscribers. Here is the original essay I submitted, discussing the growing full spectrum doula movement.
Benefits of the Full Spectrum Approach
copyright Janna Blair Slack
Full spectrum doulas support pregnant people regardless of the outcome of their pregnancy or their ability to pay. This approach to doula work requires us to peer into the power structures of our society, discover places where insufficient support contributes to human suffering, and find avenues to provide that support. To reach these places, we partner with institutions (i.e. hospitals, clinics, prisons), larger organizations (Planned Parenthood, community-based healthcare), and agencies (adoption, public health).
Since 2007, full spectrum groups have established themselves in at least fifteen states to support the spectrum of human pregnancy experience. I am a full spectrum doula though I remain wary of the limiting potential of any title. I knew I wanted to do this work before I signed up for my 2009 DONA birth doula training. This is my description of this work from personal experience, as well as a vision for its future. As increasing numbers of doulas are called to full spectrum work, the definition and potential of our profession will change for all of us.
Shedding assumptions, reaching out to connect
Emotionally sustainable full spectrum doula work is open, inclusive and non-judgmental. The full spectrum approach tells us that everyone – from clients we support to staff and providers we work with – is really doing the best they can at any given moment. Shedding assumptions provides a liberating feeling of openness and illuminates the emotional boundaries we navigate as birth workers. I’ve become more aware of the important distinction between someone else’s journey and my own and therefore can more easily give unconditional support.
When I began to apply the full spectrum approach to my doula practice, I connected with more people from a wider range of life experiences. I experience joy in connection so this was a serious bonus! The first mother I supported through pregnancy termination taught me how positive this work can be. A D&E (Dilation and Evacuation) takes a matter of minutes in the first trimester, but patients can spend hours waiting around, often completely alone. She was sure of her decision but was anxious, crying and expressing feelings of guilt – someone had told her that according to the Bible, her toddler son would be “struck down” for what she was about to do. She crumpled into my arms and cried. I tried to be as present as possible and supplied her with tissues. As we waited, she initiated conversation and eventually we were laughing and discussing the oeuvre of Kanye West. During her procedure, I held her hands and her eyes with mine, whispering the same words I say during birth – “You can do it, deep breath, you can do it, nice and relaxed.” Afterward, the woman I met a few hours earlier was gone and she moved confidently to gather her belongings and check out. With a tight hug goodbye, she walked out the door with a smile on her face. The nurses seemed thrilled at the difference in her demeanor. I felt keyed up and soon realized I was experiencing the vibrant energy I normally associate with a “birth high.”
Some midwives and doulas feel it is macabre, even
incongruous, to deal both in birth (associated with “life”) and non-birth
outcomes (associated with “death,” or even “murder”). Some worry how a broader
outlook affects birth movement public relations and messaging. All full
spectrum doulas I know constantly work to give doulas a good name. For many
staff and providers we work with, full spectrum doulas are the first doulas
they have heard of or worked with, and we feel the responsibility of
representing the doula spirit of non-judgmental support as authentically as
possible.
Providing doula employment
Bringing doula support to places it was previously unknown obligates most full spectrum doulas to work for free, proving our value to gain access. We are dependent on volunteer energy, and the passion and dedication of our volunteers is tremendous. Turnover and burnout are frustrating, persistent realities, but more and more we realize the unique opportunity we have created to become engines of employment in our field. The organizations and institutions we partner with have access to funding about which an individual doula can only dream. Doula support can often help achieve many healthcare and public health groups' goals for what amounts to a bargain.
The full spectrum approach must embrace a core tenet of financial compensation, accessed through our established partnerships, with as little headache and administrative cost as possible. We don’t all need to become c-3’s to fundraise effectively. Here are two examples of full spectrum organizations who have found ways to compensate their doulas: the first, partnered with a community healthcare organization in California, developed a relationship with a board member who made a gift which was nominal by the standards of western medicine but easily provides stipends for their doulas. Portland’s Calyx Doulas are the second. Partnered with an adoption agency, doula reimbursement will be a part of the birth-related expenses of birthparents, paid for by the adoptive families.
Surmounting socio-economic divisions in our network is crucial. Insisting that our society’s money move toward the work that we do creates opportunities for more diverse populations to consider this as a profession. This overarching goal complements and expands our vision. Most of the full spectrum doulas I know come from some level of privilege and many women who want to do this work cannot for financial reasons. We can all try to take responsibility to create opportunities for them and for all doulas seeking employment.
The endless conversation
As we feel our way into this new frontier and all it promises, we must treat ourselves with the same patience we try to provide each person we serve. Our growth is dependent on continuous reexamination of what we do – asking ourselves how we achieve greater states of openness, compassion and inclusiveness.
If you are interested in learning more about the full spectrum approach, get your hands on a copy of The Radical Doula Guide: A political primer for full spectrum and childbirth support by Miriam Perez (published in August 2012). “Radical” can be a scary word, but the Radical Doula Guide is not a manifesto, it’s “a starting point to understanding the social justice issues that interface with doula and birth activism.” The RDG addresses these issues from a doula perspective, articulating philosophical aspects of the full spectrum approach. I hope I didn’t lose you at “philosophical” because this Guide is truly readable and relatable for all of us! I strongly encourage you to get your hands on a copy and join the conversation.
I feel especially conscious and respectful of opposing viewpoints within the birth community. The full spectrum approach listens to, honors and learns from the concerns of our colleagues who may be opposed to our work. As we pursue growth and expansion for all of us, your voice and thoughts on the matter are important. If you have concerns or words of encouragement, full spectrum doulas are always open to conversation. We are all responsible for the future of our field and for creating space for it in our culture.
[Note: Carol Downer attended "LA LECHE LEAGUE OF SO. CA/NV Supporting a Breastfeeding Culture, A Parenting & Healthcare Professional Conference”, May 24-26, 2013 at the Marriott Newport Beach (CA) Hotel & Spa]
SUMMARY: We were censored! Although we had cleared all our materials in advance, we were informed at the last minute that we would not be able to display any literature or items that dealt with birth control or abortion. I stayed despite these limitations and talked to many wonderful women, and spread the word about Self-Help, our women’s clinics and the Pro-Woman Agenda. I found new friends and allies, resources and gave away over 20 speculums!
ATTENDEES: Based on the high number of small children at the conference, many in the care of their fathers, I concluded that most of the attendees are breastfeeders, and that they were either LLL “leaders” (they volunteer and facilitate the monthly meetings of breastfeeding moms). There were also a number of midwives, doulas, lactation consultants, childbirth educators, nurses.
CENSORSHIP I put out a call for support to come with me to set up my table, but unfortunately it was too late to get anything more than moral support. Fortunately, the moral support that results from a women’s health movement from the last 40 years and the work that we have collectively done to fight for women’s rights to birth control and abortion strengthened me to walk into a environment hostile to women’s rights to birth control and abortion that WHWH stands for and achieve a amicable resolution with the conference organizers. I removed from the table about one-half the items with “birth control” or “abortion” on them (including A New View of a Woman’s Body and the Del’em and pictures of the female condom) and in their place, I posted signs saying “CENSORED”. The organizers told me that U.N. regulations prohibits La Leche League from mentioning birth control or abortion. Other than this limitation, they were quite cordial and helpful.
SPECULUM GIVE-AWAY Many women, especially those who appeared past childbearing years, turned down the offer of the speculum with “I don’t need that”. Some said that they already had a speculum (usually midwives) or that they already used one. A few women didn’t know what the speculum was. The 20 women that took away speculums were delighted.
GUESTBOOK & VISITOR RESPONSE Only 9 women signed the guestbook. It seems that people are trying to keep the number of incoming e-mails down (I know that I’ve become reluctant to be on someone’s e-mailing list). One of them, Mary Strack, is a founder of La Leche League, and very kindly offered to keep in touch with me and share what she has learned about the international breastfeeding situation; she is LLL’s international representative. Likewise, Betty Crase, who wrote The Motherly Art of Breastfeeding” also agreed with the key words on the display [FULL SPECTRUM = PRO-WOMAN AGENDA].
After giving the visitor a copy of my card with the website info, I summed up our message, “We believe it’s important for the women’s health movement to work together on all the interrelated issues concerning women’s sexuality and reproductive rights”. Many expressed wholehearted agreement.
Our 3 leaflets, “What to expect When You Go To The Hospital fora Natural Childbirth” by Molly Remer, “Shodhini” announcement and Cedar RiverClinics’s “Fertility Awareness for Birth Control” (Yes, they did allow that one) were popular. The Shodhini leaflet caught the interest of a substantial number of women. I found it very interesting that of these women, many were Latina. Although I don’t know all the social forces that are at play, in Southern California at least, there is a upsurge of interest in learning more about our bodies and networking with other women among Latinas. I predict that Shodhini will be getting calls.
EXHIBITORS In addition to booths with literature from organizations that promote breastfeeding, or offered products to facilitate breastfeeding, there were several homeschooling booths, health and beauty products, and toys. I was especially interested in one booth, “The Daily Grind”, run by two sisters who are trapeze artistes who were with Le Cirque du Soleil. They have devised stretches and exercises to be done during the daily routine. I’m going to try to get together a group to put our money together to bring them from Mar Vista to Eagle Rock to demonstrate these to us and to help us to learn how to do them properly.
YouTube Title: Gates Foundation: Giving A Fortune Away
Time: 13 minute segment
Date Aired: October 2010
"...It found that, by tradition, childbirth is considered unclean here. Babies are often left on dirt floors, uncovered, while the mother is tended to first. The foundation tested solutions, trained health care workers to use sterilized tools and taught the mothers to keep the babies warm; simple, inexpensive ideas that have reduced deaths here by half..."
Doctor's traditional way of eliminating independent midwifery, has been to call midwives untrained and dirty. Melinda and Bill Gates blame the high infancy death rate in India on midwives not sterilizing their instruments and leaving newborn babies on the dirt floor, because birth is "dirty".
The Gates new $1.5 billion program seeks to create millions of midwives, but under whose control will these midwives be? And how many babies will be "risked out" to go to hospitals to get high-tech medical care which generally ends up being C-sections or episiotomies and bottle-fed infants. See this 12 minute interview with Melinda Gates to witness this vicious attack on midwives--blaming them for the high death rate--not extreme poverty, and patriarchal oppression.
Gates Foundation: Giving A Fortune Away
Video Transcript:
SCOTT PELLEY (voiceover): The north of India, where it is a short drive from the big city to the Middle Ages. In the countryside of India`s most crowded state, Uttar Pradesh, often, food is scarce, electricity nonexistent, women and infants die in childbirth, and medicine remains in the realm of superstition. It`s exactly what Melinda Gates is looking for-- a neglected crisis where her investment can save the most lives.
MELINDA GATES: Our belief is that all lives, no matter where they`re lived on the globe, have equal value, all lives.
SCOTT PELLEY: What are you global priorities?
MELINDA GATES: HIV/AIDS, malaria, mother-and-child deaths, in that order.
SCOTT PELLEY: Why those?
MELINDA GATES: When you looked at where the largest number of deaths were on the planet, they were from things like AIDS, malaria, and these childhood deaths. And nobody was giving voice to them. And no one was really tackling them. So, we said systematically, "Those are places that we want to go and work."
What kind of decisions have you all made that have impacted the village?
SCOTT PELLEY (voiceover): It might be occurring to you right about now that you haven`t seen the world`s richest woman before. She`s not the type to stand on a red carpet with million-dollar earrings. Melinda Gates, forty- six years old from Dallas, is a former Microsoft executive who managed eight hundred people in software development and marketing. Now, the work of the foundation is her obsession. This isn`t a photo-op. In fact, it took us a year to convince her to let us come along. She travels often, probing for facts, analyzing needs, measuring the misery.
MELINDA GATES: I have to be here. To see it, and to feel it, and to understand, you know, what motivates these people. What is it that they`re doing for their livelihood? Unless I see it and feel it and touch it, I just don`t feel like I can do the foundation justice in terms of what we`re trying to accomplish.
Oh, she`s gorgeous.
SCOTT PELLEY (voiceover): What she`s trying to accomplish here is saving lives at birth. In India alone, one million babies die every year before they`re a month old.
Because I wonder which ladies in this audience have lost a child shortly after childbirth? Oh, look at that. One, two, three, four, five, six, seven, eight, nine, ten, eleven, twelve, thirteen, fourteen, fifteen, sixteen. It`s a common experience in this village.
(voiceover) This is a great example of exactly how the foundation works. The foundation poured money into research to understand the problem. It found that, by tradition, childbirth is considered unclean here. Babies are often left on dirt floors, uncovered, while the mother is tended to first. The foundation tested solutions, trained health care workers to use sterilized tools and taught the mothers to keep the babies warm; simple, inexpensive ideas that have reduced deaths here by half. Part of the foundation`s strategy is to team up with governments and other charities to make the money go farther and spread the best ideas.
MELINDA GATES: These deaths of children under five have come down substantially; 1960 it was twenty million children under the age of five that died. Now it`s nine million children. That`s still too many.
SCOTT PELLEY: A year.
MELINDA GATES: A year. Every year, nine million children die. We can get that down.
And as for those other priorities she mentioned, the foundation is working on a vaccine for HIV and nothing less than the eradication of malaria and polio, taking on everything at once.
MELINDA GATES: Part of what you`re doing--
SCOTT PELLEY (voiceover): Melinda Gates is analytical and driven, not unlike her husband. She likes hard facts, strict accounting, and expects everyone around her to measure up--very much the CEO.
MELINDA GATES: What has been the thing that women are most reluctant to change?
SCOTT PELLEY (voiceover): She talks about spending a billion here, a billion there, and pretty soon you realize that billionaire philanthropists aren`t like you and me. There was a funny moment when she was going through some of the figures and in an uncharacteristic slip she said she`d pledged one billion to vaccines when it`s actually ten billion.
You know, it just occurred to me you had misplaced nine billion dollars. Now, I misplace change at the end of the day. But you had actually forgotten about nine billion dollars.
MELINDA GATES: I think I missed a zero in there.
SCOTT PELLEY: Most people would remember that kind of a number.
MELINDA GATES: You know, I-- for me, I think more about the possibility of what it is we`re trying to change. So, if I have to go around the health statistics in the world, I don`t tend to get those wrong. But the amount of dollars we put in, I am always more focused on what`s the result we`re going to get, no matter how much money we`ve put into the issue.
SCOTT PELLEY: Now I`m from Texas too, so I can say this: You don`t wear your wealth like a Dallas gal. You don`t seem to be a big consumer of jewelry and cosmetics.
MELINDA GATES: I don`t find great joy in those things. I find much more joy in connecting with people. I`m much more at home being what I call out on the ground, doing this work. And for me, that`s where I find meaning. I don`t find meaning in-- in material things.
SCOTT PELLEY (voiceover): This village had nothing material to give but music.
You know it`s a long way from Microsoft.
MELINDA GATES: I like this a whole lot better.
SCOTT PELLEY: Do you?
(voiceover) Seven thousand miles away, back home in Seattle, the Bill and Melinda Gates Foundation is building its new headquarters. There are eight hundred and fifty employees figuring out which science or development projects are worthy. And listen to what they have spent already: four and a half billion for vaccines; almost two billion for scholarships in America; and a billion and a half to improve farming in Africa and Asia, just to name a few. The foundation`s wealth ranks up there with America`s biggest companies, just behind McDonald`s and ahead of Boeing.
Boy, his and hers offices. I`m not sure a lot of marriages would survive this.
BILL GATES: Oh, it works out great.
MELINDA GATES: We actually like it a lot.
SCOTT PELLEY (voiceover): The Gates live in a secluded hi-tech mansion with three children. This is an early picture. The kids are now eight, eleven, and fourteen. Bill and Melinda met at a Microsoft meeting twenty-three years ago.
What did you think? I mean, it`s not everyday a girl gets asked out by the richest man in the world?
MELINDA GATES: Oh, no, it wasn`t that, it was that I didn`t think it was a very good idea to date the CEO of the company.
SCOTT PELLEY (voiceover): It was back in 1993 on a vacation in Africa that they began to think about giving away their money.
BILL GATES: Well, if you have money, what are you going to do with it? You can spend it on yourself, you can have, you know, thousands of people holding fans and cooling you off. You can build pyramids and things. You know, I sometimes order two cheeseburgers instead of one. But we-- we didn`t have any consumption ideas. And if you don`t think it`s a favor to your kids to have them start with-- with gigantic wealth, then you`ve got to pick a cause.
SCOTT PELLEY: You don`t consider it to be a favor to your kids?
MELINDA GATES: No, absolutely not. We think--
SCOTT PELLEY: To give them enormous wealth?
MELINDA GATES: No, they should go on to pursue whatever it is they want to do in life and not feel cheated by that by being given something, given a whole lot of wealth. They would-- they would never go out and figure out who they are and what their potential is.
SCOTT PELLEY: Have you talked to them about this? Have you said, look, we`re going to give most of this way?
MELINDA GATES: Absolutely.
SCOTT PELLEY: And they`re okay with giving the money away.
MELINDA GATES: They are okay with it.
BILL GATES: Yes, they reach different ages, they may ask us again, "Tell me again, What? Why?"
SCOTT PELLEY (voiceover): The Gates` kids will still be massively wealthy. But their parents have already given roughly thirty billion to the foundation and they told us they`ll give ninety percent of their money away. Add to that the contribution of the Gates` close friend, Warren Buffett, who has committed another thirty billion to the foundation. This past summer, the Gates and Buffett challenged billionaires to give half of their wealth to the charity of their choice. So far forty have signed the pledge.
The foundation, you, have made certain choices about what you`re going to fund. And some people might ask, "Why not drop thirty billion dollars on a cure for cancer," for example?
BILL GATES: Well, there`s a huge market for cancer drugs. And there`s dozens of pharmaceutical companies that spend tens of billions on those drugs. In malaria, when we announced a grant for fifty million, we became the biggest private funders. And so, the fact that it kills over million children a year and yet has almost no money given to it, you know, that struck us as-- as very strange. But it became the thing we saw, "Okay, this will be unique. We`ll take the diseases of the poor, where there`s no market and we`ll get the best scientists working on those diseases."
SCOTT PELLEY: You`re trying to find the places where the money will have the most leverage, how you can save the most lives for the dollar, so to speak.
BILL GATES: Right. And transform the societies.
WOMAN: Good morning.
SCOTT PELLEY (voiceover): Another society they want to transform is America`s, particularly through the schools. They have pledged nearly one quarter of all the foundation money to American students. And we followed Melinda to the Friendship Collegiate Academy High School in Washington, DC.
I wonder what you think is the most alarming thing about American education?
MELINDA GATES: I think it`s most alarming that we`re only preparing a third of the kids to go on to college. That`s a frightening thing for our democracy to say a third of kids are prepared to go.
SCOTT PELLEY (voiceover): If only a third of high school seniors are academically prepared to go to college, the Gates believe that a revolution in teaching can go a long way to pushing that up to their goal of eighty percent. They`re funding research to figure out what makes great teachers great.
MELINDA GATES: Do you feel like you`re prepared? That you could go on and succeed in college?
CHILDREN (in unison): Yes.
SCOTT PELLEY (voiceover): The foundation is at work in schools in nearly all fifty states. Sort of like "national parents," Bill and Melinda Gates have helped pay college tuition for twenty thousand American kids.
BILL GATES: The country is built on ingenuity. It`s built on having lots of very well-educated people. And if you were from a poor family, how are you going to be break out of that? Well, education is the only way. Education is the thing that twenty years from now, will determine if this country is as strong and as just as it wants to be.
SCOTT PELLEY (voiceover): One of the boldest efforts of the foundation is unfolding in the slums that we visited in Delhi, an attempt to eradicate polio. No one in America has seen this since the 1960s. We found, in a Delhi hospital, a polio ward full of paralyzed children.
MAN: This young boy, Sahil. He is ten years old. Sahil has got paralysis of one side of his body, one leg. See what he`s doing, he`s trying his best, he`s bringing his hand, but he cannot move his leg.
SCOTT PELLEY (voiceover): In a country where water often runs next to sewage, the virus, which is spread through human waste, finds new victims. Polio has been cornered to just four countries on Earth, so the Gates have teamed with Rotary International to bang on every door to find the last child who hasn`t tasted the vaccine.
Do you believe you can do that, actually eradicate the virus from the face of the Earth?
MELINDA GATES: It`s been done with smallpox. And that`s what gives us the hope and the belief.
SCOTT PELLEY (voiceover): While in India, we were invited to a ceremony that every new mother prays for. Because so many newborns die, they`re not given names right away. This family had waited a week to bring their daughter into the light and name her "Durga," which means "Invincible." It was during the ceremony that we saw what it was that has moved a no- nonsense executive to give away her fortune.
MELINDA GATES: Can I hold her? Oh.
SCOTT PELLEY (voiceover): Durga`s first blessing was from the sun. Then she received a second, a future free of polio.
The Shodhini Institute is a radical international movement comprised of individuals that are questioning and re-envisioning the way we understand our bodies, health, and how we interact with the world within the framework of self-help.
"Shodhini' is Sanskrit for female researcher. We are inspired by the Shodhini's of India who wrote the book 'Touch Me, Touch Me Not.' We are a growing network of healers, bodyworkers, transmen, masculine of center womyn, doulas, midwives, nutritionists, yoginis, scholars and sheroes out to revolutionize the face of Western medicine regarding our bodies, minds, and spirits. Join us!"
Shodhini is currently fundraising to create a website that will provide information on their workshops, Shodhinis and radical self-help = $75 (5 Years). Also, Shodhini wants to sell "Self-Exam" kits on their current BIG CARTEL account = $120 (1 year). In the last chip in campaign Shodhini made $40. Therefore the total price is $195 - $40 = $155
By donating, you will be entered into a gift raffle. So, if you support the work of Self-Help/Self-Examination; please donate. Their fundraising goal is $155 and the last day to donate is December 30th.
When I began to apply the full spectrum approach to my doula practice, I connected with more people from a wider range of life experiences. I experience joy in connection so this was a serious bonus! The first mother I supported through pregnancy termination taught me how positive this work can be. A D&E (Dilation and Evacuation) takes a matter of minutes in the first trimester, but patients can spend hours waiting around, often completely alone. She was sure of her decision but was anxious, crying and expressing feelings of guilt – someone had told her that according to the Bible, her toddler son would be “struck down” for what she was about to do. She crumpled into my arms and cried. I tried to be as present as possible and supplied her with tissues. As we waited, she initiated conversation and eventually we were laughing and discussing the oeuvre of Kanye West. During her procedure, I held her hands and her eyes with mine, whispering the same words I say during birth – “You can do it, deep breath, you can do it, nice and relaxed.” Afterward, the woman I met a few hours earlier was gone and she moved confidently to gather her belongings and check out. With a tight hug goodbye, she walked out the door with a smile on her face. The nurses seemed thrilled at the difference in her demeanor. I felt keyed up and soon realized I was experiencing the vibrant energy I normally associate with a “birth high.”
