Latest / The Birth Lounge Podcast / Ep. 451: Medicaid coverage for doulas - is it really a good thing? with Leslie Moon

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Ep. 451: Medicaid coverage for doulas - is it really a good thing? with Leslie Moon · The Birth Lounge Podcast

• On the surface it seems like a fantastic idea.
• It seems like birth equity.
• Let's get a doula into every home.
• Don't let a woman birth without a doula, which is the goal.
• We want that.
• That's a great idea.
• We love this.
• Sounds like a big win, but there is something, dare I say nefarious, about connecting doulas with insurance money and connecting doulas with having them practice under the umbrella of a system that we know, and listeners, you know this too, I am not telling you something new, is notorious for not being set up to actually support the goals of birthing women and birthing people and families that are having babies.
• Hello, and welcome back to another episode of The Birth Lounge Podcast.
• So the other day, I was talking to my friend Ashley, and she said, "You know, HeHe, you are so lucky to have 10 years of wisdom and thousands and millenias, hundreds of thousands of years of wisdom energetically passed down to you."
• And she even called me an old soul.
• And I said, "What do you mean exactly by that?" And she said, "The way that you have been so confident in your pregnancy and that no matter what each day brings, you find the joy in it.
• You find a way to be grateful that you are experiencing aches in your back, or you find gratitude in the heartburn, or you find humor in the burps that slip out mid-sentence."
• And I laughed and said, "Yeah, I think that's just my personality."
• And she said, "No, it's not.
• It is that you are so in tune with your body.
• You're so confident in the things that you know, that you have literally been put on this earth, you have been tasked with guiding other women in not only finding their voice, but truly taking control of their pregnancy and birth."
• Now, of course, if you know me, you can imagine that I started to tear up at this moment, and I just felt a great sense of, well, gratitude.
• I felt really grateful that...
• I get to hold this space for so many of you, and I can tell you that I have learned hundreds, maybe thousands of lessons over the last 10 years.
• I have supported more than 2,000 families in bringing their baby into this world.
• I have seen hundreds of different types of scenarios.
• I have interacted with hundreds of providers.
• I have seen straightforward births.
• I have seen babies that are born so fast, we literally didn't even get a chance to leave the bedroom and get in the car, and this was a planned hospital birth.
• I've seen that multiple times.
• I've seen babies born on the side of the road because they were born so fast.
• I've seen multiple six-day labors.
• I have seen low-risk labors that came from low-risk pregnancies turn emergent in a split second.
• I have seen the highest of high-risk pregnancies go absolutely smashingly.
• I'm talking, like, so smooth that everybody was in awe because when she was in labor, everything was well.
• I've seen necessary interventions.
• I've seen unnecessary interventions.
• I have seen unassisted births.
• I have seen home births.
• I have seen birth center births.
• I have seen hospital births.
• I have seen surgical births.
• I've seen elective inductions, medically necessary inductions, chosen C-sections, medically necessary C-sections, unmedicated birth, epidural birth, births that use nitrous oxide, but neither unmedicated nor epidural.
• I've seen nurses catch babies, OBs catch babies, dads catch babies, midwives catch babies.
• I've caught two babies when we were...
• Well, one was on the side of the road, and one was the baby that was born in the bedroom before we could even get to the car.
• I can tell you that I am so confident in birth because of all the things that I have seen, and in addition to that, I do feel this deep sense of connection to this ancestral wisdom that, I don't know, it just feels like it's part of me In addition to all of that, don't forget I do have a master's degree in human development and family studies.
• And so not only do I have the skill to read research, but in true nerd fashion, I actually genuinely enjoy it.
• There's nothing more that I enjoy.
• Well, maybe some things like chocolate and being at the beach, but very few things do I enjoy more than going through a scientific article.
• And I, I want to know about the methodology.
• I want to know how many people participated.
• I want to see what your P value is.
• I want to see what your confidence interval is.
• I love to know how you actually put your study together and then conducted it.
• And who were the people that when you got to the end of your study, you had to take them out of your study because, well, they didn't, they didn't really meet the criteria of the study at the end of the day.
• I want to know the tests that you run.
• I want to know how you got to your conclusions, and I want to see how you present those conclusions, and is it honest and transparent? Now, I know this is not everyone's thing.
• I know not everybody likes research.
• I know that not all articles are easily read.
• I know that not everybody feels this confidence and joy or that deep ancestral wisdom.
• So here's what I've done for you.
• Well, I put it in an app.
• I put it all in The Birth Lounge app, and I hit all of those pieces.
• I share all of those births that I have attended over the last ten years.
• All the knowledge that I've gained from that, it's all yours.
• The data and the science and the evidence-based, backed decisions that you can make in labor, also found in The Birth Lounge.
• I'm telling you what those articles say, and then I'm linking it for you too so that you can go and read it should you desire.
• And I'm also looping in that ancestral wisdom.
• I want you to know what did birth used to be like, and how come we've gotten so far from that, that now it's over-medicalized and every single person that walks through the door gets Pitocin.
• Everyone signs up for an unnecessary thirty-nine week induction.
• Why are our C-section rates skyrocketed? And why do so many women have birth trauma? Plus, how do you avoid that for yourself? If there's one thing that I've gotten really, really, really good at over the last decade, it is helping you avoid birth trauma so that when you leave your labor experience, you feel empowered, you feel so happy and satisfied with the way that it turned out, and you are proud of yourself.
• You're not crying, you're not traumatized, you're not spiraling, you're not stuck thinking, "What in the world did I just go through?" Instead...
• You think things like, wow, I did that.
• Oh my God, look at this baby that I grew and I birthed.
• Holy cow, am I, am I a superwoman? If you're craving deep education that is not only going to prepare you for an amazing birth experience, absent of trauma, where you get to be the decision maker, but you're also craving a community and you're craving the data to help you make those decisions.
• Plus you want to learn how to be this confident in your birth and in your pregnancy and in your parenthood too.
• Download the Birth Lounge app.
• Head to your respective app stores, whether you're Android or iPhone and type in The Birth Lounge and it will pop right up and you can get started literally right now.
• I hang out in the app.
• I'm always updating it with new information and it's way better than scrolling social media that's going to numb out your brain.
• Instead, scroll and empower yourself to have a better birth.
• Download the Birth Lounge app today and I'll see you in there.
• Bye.
• Today we're gonna be diving into a topic that I actually don't cover that much, but I stay very involved in behind the scenes.
• Many of you probably are familiar that I have been dabbling in, dipping my toes in legislative work because I do believe, I've recently learned in the last few years, in the last, uh, about four years, that real change can happen on a national level if you are willing to get involved with politics, which, huh, obviously I have no business being involved in politics, nor do I have a desire to be, but because I've learned the power of talking to our legislators and having the ear of our state representatives, and truly getting to the people who are making the decisions in our country, I...
• Well, I've just kind of resigned to the fact that this is something that I have to do.
• Today we're gonna be talking about how Medicaid coverage of doulas seems really great.
• It seems like a huge win.
• It's shiny, it's roses, it's balloons and confetti.
• But underneath it all, it actually may be more harmful than helpful.
• I'm so excited to be sitting down with a fellow doula, Leslie Moon.
• She's also a single mom of two, a birth photographer, and a childbirth educator based in Nebraska.
• Leslie understands better than anyone just how important it is to educate families on how to navigate a system that was not designed for birth.
• She's the co-founder of the Birth Alchemy course where she teaches parents how to understand their options, advocate for themselves, and trust themselves throughout pregnancy and birth.
• Today, we're really going to be leaning into her passion about protecting relationship-based community-centered care and helping families feel confident when making decisions that align with their values and we are going to be trying to figure out exactly how we can increase access to doula care, midwifery care, and overall better options for birthing families.
• We're going to be talking about how we might be able to fix this problem where there's not enough midwives in the country and there's certainly not enough doulas in the country.
• And for the midwives and the doulas that do exist, the limitations that they are having to practice within due to poor legislation.
• And when I say poor legislation, I mean legislation that's really overstepping boundaries and it is compromising the care of these two professions.
• We're going to talk about what doulas can do and the power that birth workers have when it comes to supporting families in this system.
• And how can you resist taking insurance money when the government is making it look so shiny? I'm asking the hard questions too.
• Like I want to know about the potential downsides and unintended consequences that Medicaid coverage might bring to families.
• I also want to know how Medicaid-funded doula programs could compromise the autonomy of doulas, which therefore compromises the autonomy and quality of care that our clients receive from us.
• Plus, we're going to dive into, well, it's covered, but by just how much are doulas actually making a living wage? And in the states that they're not, how does that impact the care and the relationship between a doula and a client? And in true HeHe fashion, I'm not going to bring you a problem that I hadn't already thought about a solution for.
• So Leslie and I are going to brainstorm, brain dump, and hash out some possible, not fully thought out yet ways that we might be able to fix this problem facing our nation's families.
• If you are an expecting parent out there, this is a conversation that you really need to hear because it will help clue you in to some of the behind the scene politics that impact your doulas, your midwives, and your OBGYNs every single day.
• And then if you are a birth worker, whether you are a community birth worker, a licensed birth worker, a certified birth worker, or a hospital-based birth worker, this conversation is going to tickle your soul in a way that you probably didn't even know you were yearning for.
• Without further ado, Leslie, welcome to the show.
• Thanks so much for having me, HeHe.
• I'm really excited to be here.
• Oh my gosh, of course.
• Okay.
• So I just told our audience that I had found you through a viral reel that you have that went, you know, kinda crazy with you calling out the problems of doulas being covered by Medicaid in the state that you practice in.
• And I didn't tell everybody what the problem was in the intro because I want you to do that.
• I think that Medicaid coverage is tricky, right? It's something that has been buzzing around for several years now.
• On the surface it seems like a fantastic idea.
• It seems like birth equity.
• Let's get a doula into every home.
• Don't let a woman birth without a doula, which is the goal.
• We want that.
• That's a great idea.
• We love this.
• Sounds like a big win, but there is something, dare I say nefarious, about connecting doulas with insurance money and connecting doulas with having them practice under the umbrella of a system that we know, and listeners, you know this too, I am not telling you something new, is notorious for not being set up to actually support the goals of birthing women and birthing people and families that are having babies.
• So I don't...
• i'm not gonna get on my soapbox.
• Let me hand the soapbox to you, Leslie.
• Yeah.
• Tell us why this on the surface seems like a huge win, and we instinctually wanna be like, "Yes, yes, yes," but what are kind of maybe the potential downsides that might come with coverage of Medicaid for doulas? Yeah.
• So I'm happy to stand on that soapbox all day long.
• Um, and I wanna start off by saying that, like, I am not an expert in insurance or anything like that.
• I am just a passionate birth worker who has a very wide lens.
• I'm a community birth worker, so I've seen everything from unassisted home births, where it's just me, mom, and dad in the room, and that's it, and I have seen all of that all the way up to planned cesarean sections.
• So I have a very wide lens to be able to kind of like see this big picture, and I'm also a Medicaid recipient.
• I'm a single parent, and I'm self-employed.
• So like, as a Medicaid recipient, I get how hard it is to get things paid for and to be low income.
• And so I totally see how this is really exciting.
• You know, we're always pushing for- More doula support.
• We want more people to have doulas.
• We want more people to have that support in the hospital.
• But the problem comes when we are handing over essentially that title to the system.
• Because like you were saying, the medical system, the system that we currently have for maternity care in the medical world is not set up to support women.
• We have all of the, this data, um, we were talking about this before we started recording.
• We have all of this data about the benefits of having a doula in the space, and that is incontrovertible, like the research is there.
• The research of, you know, less interventions, less risk of cesarean sections, less risk of complications, all are benefits of having a doula in that space.
• Not to mention, just lessening trauma, helping families feel more autonomous, things like that.
• That making sure that their voice is heard.
• But yeah, s- but, but all of that research comes from community-based doulas, right? Because it's, it's been very, like recent that we have started even entertaining this idea of having insurance coverage for doulas.
• It's a pretty new thing.
• So all the research that we really have on doula support is based off of these community-based doulas.
• And where I really stand on this is doulas are the absolute last bridge between community-based care and the medical system.
• We used to, I mean, I'm sure your listeners know this and know a little bit about the history of midwifery, but if you don't, um, obviously for years and years and years and years, decades, generations, you know, millennia, we had women attending to women.
• We had midwives attending to women, and they were systematically taken out.
• They were systematically removed so that women were in the hospitals with male doctors, and I could stand on that soapbox for a long time, but we don't have time for that entire soapbox today.
• But basically, midwives were completely shoved out.
• Well, then families started speaking up, and they were like, "No, we want our midwives."
• So what did the medical system do? They took that term, they defined it, they regulated it, they gave them a license, and all of the midwives and the families rejoiced because now they had their midwives, except they don't.
• Except they don't.
• Midwifery care in the medical system in this modern world that we have is not true midwifery care.
• And I love our midwives.
• I love the midwives that I work with, so this is not like a, a jab against midwives.
• It just is the reality of the system that we're in.
• So if we do the same thing with doulas, if we take that title and we put a label on it, and we put certification requirements on it, and then, heaven forbid, we put a license on it, now all of a sudden we have lost our very last community-based care provider for birthing women.
• Oh, my God.
• I just, like, had to lick my teeth so many times because the rage that comes up in my body when we talk about the way that the system has slowly chipped away at taking every single fucking ounce of control that we have and just monetized it.
• They've taken it over.
• They've taken it right out of our hands, and some of it we've handed over, but a lot of it, it was stolen from us, and it pisses me off so badly.
• Oh, my God, it makes me literally rage so much, and I try to control it 'cause I know that I can be a very intense person, and I don't want anyone to be like, "Wow, HeHe is cuckoo bananas off her rocker."
• But it genuinely is so infuriating to think that we used to do birth so right.
• We used to do it so correctly.
• You know? Mm-hmm.
• And I just love when your really indoctrinated, traditional OBGYNs are like, "Well, everybody used to die in birth," and it's like, no, we actually didn't.
• Mm-mm.
• We really weren't.
• We weren't doing it that badly.
• Now, you may not have gotten the true story because why would your textbooks teach you the true story, right? Why would you get the information that midwives were doing it better? Why would you be taught that home birth is arguably safer and better for the largest portion of the population when you're going through medical school? Of course, they don't want you to know that.
• Of course, they don't want you to be a proponent or an advocate of home birth or midwifery care, like true traditional midwifery care.
• And I do think that, I think there's a space, it would have to be intentional, and we'd have to completely tear down the system that we have now and rewrite it completely, but there is a space that we could have traditional midwifery care in the hospital system.
• It's possible.
• We see it in other countries.
• We could very easily replicate that here, and we just refuse.
• What do you think that's about? Why can't we just, like, get our head out of the sand and, like, get it right? What's the freaking problem? Yeah.
• So back to what you were saying about, like, oh, women were dying in childbirth un- until the medical system took over.
• Maybe.
• Maybe we had higher rates of death, but we also had higher rates of death from the flu and colds.
• And so a lot of that was just based off of, like, not understanding germ theory.
• You know what I mean? So, like, yes and also, yeah, the whole idea of bringing midwives and having traditional midwifery and kind of like this unassisted births in the hospital situation, that would be fantastic.
• We actually had kind of a situation in the state where I live in.
• I'm in Nebraska, and we have probab- we are probably the worst state in the entire country to give birth in.
• We are the most expensive.
• We got a D, um, by the March of Dimes for our maternity care, and we have zero out-of-hospital options.
• So if you wanna have a home birth in Nebraska, you either need to do it without a provider present or risk find an underground midwife, and that underground midwife is risking their livelihood, essentially, because it has been found that it's a felony in the state of Nebraska if you attend a home birth.
• It used to be only CNMs.
• So certified nurse midwives legally were written into law they cannot attend home births, but the other kinds of midwives were kind of ambiguous.
• And then we had some a, a legal case that went within the last few years, um, where that judge decided, okay, if you are calling yourself a midwife in any capacity, regardless of your, you know, certification or whatever, it is a felony to attend a woman at home in the state of Nebraska.
• We had, up until a few years ago, one freestanding birth center in the capital city of Lincoln, and it closed.
• The reason that they gave us that this birth center closed was because there wasn't a high enough demand for it, which is wild.
• If you look at the data, the numbers were climbing every single year even though, even though the restrictions on this birth center, you had to essentially be a unicorn in order to give birth here.
• But putting that aside, every single year they were having more and more births, and it closed.
• Well, come to find out, the same woman...
• So the women started coming out with, like, their hospital bills, and women who had given birth at the birth center versus giving birth at the hospital, and they say, "Okay, look, I had a baby two years ago at the birth center, and it was very straightforward.
• No epidural, n- obviously, 'cause we were at the birth center.
• So, like, no pain medication, all natural labor."
• They go to the hospital because they're told, "Oh, it's the same care.
• You're gonna get the same environment, the same everything," whatever.
• They had a very similar birth, similar interventions, and their hospital bill was double.
• So just simply walking into the hospital is gonna cost more money, which means the hospital's making more money And we've had legislation going on in our state forever, but especially over the last six years.
• And every single time it doesn't go anywhere because the Nebraska Medical Association, the Nebraska Hospital Association gets their fingers in there with their lobbying and paying off senators.
• And so it, it comes down to money.
• The reason that we can't have low intervention births in the hospital is because low intervention births don't make very much.
• You don't get much profit off of that.
• And I think with healthcare in general, but especially maternity care, that's really what it comes down to.
• I'm literally sweating.
• My body is literally moist because I'm so enraged hearing these things.
• It's so frustrating to think that the place, a hospital, that we're supposed to go and be able to trust that they're keeping us safe, is actually putting profit over people.
• It's putting money, an ROI, a bottom line over our experience, our health, our preferences, our outcomes, our goals, our trauma.
• Yeah.
• I mean, maybe if men were giving birth, things would change, things would be different, but- Bingo.
• So there's that.
• But yeah, and this whole idea of, you know, going back to the Medicaid thing and having insurance cover doulas, I just spoke with a family the other day who happens to be a military family, and they have TRICARE insurance.
• And so they got a doula.
• They were in Virginia for their first birth.
• They got a doula, um, and they were just telling me about how, you know, everything went awry.
• The hospital providers just, they had kind care.
• You know, it was kind.
• The nurses were kind to them and everything.
• But there were just all of these different things that were happening where I'm just like, "God, this shouldn't have happened."
• And one of them was pushing on her back.
• She did not wanna push on her back, and she essentially was told by the, the doctor or the nurse or whomever, you know, "Maybe we need to push on your back 'cause it'll be faster," whatever.
• And she was so exhausted by that point, she was like, "Fine, whatever."
• And her doula was also being like, "You know, are you sure? W- let's just try pushing on your back."
• And that is just not, that is not a doula's role.
• That is not what we're there for, but this doula was...
• And I'm not saying that TRICARE or insurance or whatever made that doula say a thing, but what I'm getting at is when you have doulas that are working for the system, then they're working for the system.
• They are working to make the system's job easier.
• They're working to not...
• Because if they don't, then they're gonna lose their livelihood.
• The same with OBs, and the same with the midwives in the med- medical system.
• And I am, again, I am not against any of those people.
• I truly believe that all the people within this system, most of them, come at it with great intentions, and they want the best for their patients and their clients.
• But the reality is they're working within a system that doesn't allow them to do that, that doesn't allow them to center the women and the families in their care.
• Because they have their own families to worry about, and their own livelihoods, and they're worried about getting sued, and all of these different things.
• So you were right on the nose when you said we need to burn this entire system down and start from scratch.
• Because it is possible.
• You can have it both ways.
• We could absolutely have fully autonomous birth in the hospital where there's life-saving care if needed.
• And how lovely would that be? Like, imagine if the US went from equivalent to a third world country in our birth stats and our birth practice to being an actual leader, where the world looks at us and goes, "Holy mess, what is the US doing? We've got to do that.
• We have to implement that.
• We have to imitate that."
• Like, what is the United States doing to have such a low infant mortality rate, to have every woman have amazing births? And for the people who have what I refer to as organic birth trauma because things like AFE happens, postpartum hemorrhage, stillbirth, how are we taking care of those women on the, on the other side of that experience and helping them, supporting them as they navigate that experience after living through it? Like, I want the world to look at us and go, "How did they do that?" And it's, it just...
• Oh, my gosh, I feel so frustrated that we are just, we're...
• W- right now, people look at us and say, "I would never have a baby in the US."
• Mm-hmm.
• "I would never travel to the US in my third trimester because what if? What if I had my baby in the US?" People don't want to come here and have their baby.
• They don't even wanna risk traveling here for vacation to have a baby.
• That should be really embarrassing to us, and I feel like the people who are making the decisions, I wanna say they don't know that that's the truth, but I don't know how that's possible.
• I don't know how you live in the US and you haven't realized that this is our problem, right? And so I'm really not one to make excuses for people, so it makes me think they don't care.
• That's what it makes me think.
• It makes me feel as if they know it's a problem, there has to be a different solution, and they're intentionally ignoring it.
• Mm-hmm.
• We're more worried about gas prices, to be perfectly honest.
• I mean, women's health, whatever, no big deal, but gas prices, we really need to worry about that.
• I'm dead.
• I could stay on that soapbox for a long time.
• But yeah, you're absolutely right.
• Like, we are, uh, as the greatest country in the world, we are failing.
• And not just birth, either.
• Yeah, like you said, you know, taking care of women after this experience, too.
• Like, the number of people that I talk to who not only had a traumatic birth experience, not because of, you know, stillbirth or anything like that, but just because of the way that they were treated.
• Avoidable things, right? Avoidable stuff Things that didn't have to happen.
• Yeah, exactly, or not being told the full truth.
• Like, I talked to another mom who was, who was given a narcotic when all she wanted was Tylenol after her birth.
• And so, like, and then she was loopy and didn't remember, you know, those first hours postpartum.
• So I'm like, and this stuff happens all the time.
• Like, the number of stories that I'm hearing, it's wild to me.
• And it, you're right, it's not matter of them not having the information, and I feel that so deeply because watching, when we had this legislation going over the last few years, the legislation was essentially trying to find, trying to get licenses for CPMs so that CPMs could practice legally in the state of Nebraska, which is a whole nother conversation we don't have time for today.
• However, 'cause that comes with its own problems.
• However, the number of times that we would sit in front of these senators and give them the stats, like, give them the information and not just like, "Oh, this is our passionate, fiery opinion.
• This is the, the hard numbers," it's like they didn't hear.
• It just completely went over their head.
• Um, there's one senator in particular whose wife is a, a labor and delivery nurse, and so he was always like, "Well, my wife, the labor and delivery nurse, you know, she has seen all these terrible things."
• And I'm like, "Well, then there's all the terrible things that happen in the hospital that wouldn't happen at home" but that's, again, a whole nother conversation.
• And I also truly believe that if every single hospital-based provider was required, as part of their training, to see undisturbed home birth that's just left alone, like they are there not to do anything.
• They sit on their hands, and they just witness women giving birth.
• That would change things overnight.
• Okay, so I have ruffled so many feathers.
• I had a doctor literally stop being my friend over my opinion of this, and it is that I'm so sorry to say it, but I think you need an additional year in medical school, and I hate that for you.
• I do.
• I'm not trying to increase your number of years that you have to study, and I'm not trying to increase the number of years that you have to be in school or pay for school or whatever.
• I think you should be required, as an OBGYN, to do one year of clinical practice under a home birth midwife and attend and practice with home births.
• I just don't know how you can call yourself an expert, the guru, I'm the person to go to for birth, but I've never seen a home birth.
• I've never seen a breech baby.
• I, what? I, I, I mean, and I, I know this sounds like, wow, HeHe's really, like, dissing these...
• It's just that you can't be an expert if you've not seen it all, and, and that's just the truth.
• It just is, and it's gonna require traditional hospital trained providers to sit down with a mirror and do a little self-reflection and reflect on, okay, what is missing in my training? Where have I been failing my patients, and how can I get my hands on this information and step up to start to serve them better? And I don't ask that of you because I just want to.
• I ask that of you because everybody else is doing that.
• Mm-hmm.
• Doulas are doing it.
• Women who are having babies are doing it.
• We're starting to see men and partners doing it.
• Home birth midwives are doing it.
• Some OBs and some hospital-based midwives are doing it, but it doesn't work unless everybody is doing it, right? Because the number of OBs, while we have a grave discrepancy in the number of actual, you know, birth professionals in the hospital that we need to serve our country, we're still greatly outnumbered.
• The number of OBs, yes, it's not enough, but you still greatly outnumber the doulas, the home birth midwives, and the hospital-based midwives incredibly.
• So even if we're all doing our part, 100% of us are doing our part, even if 25% of you are doing your part, you still are not doing enough to make a change, right? We've got to have 100% of both groups doing it, and, uh, while I'm on this topic, I will just say The number of OBs in our country is actually probably appropriate.
• What we're missing- Mm-hmm is midwifery care.
• Mm-hmm.
• We don't need every woman to be being seen by an OBGYN.
• They are a surgeon.
• They look at it through a surgery lens.
• They, I'm not here to say that they want to cut every person open, but I am here to say they don't hate it when they end up in the OR, right? They are a surgeon, which we need.
• We need surgeons.
• Yeah.
• We would hate to have birth without having access to surgeons, to OBGYNs, especially our high risk, our MFMs.
• We need these people.
• We're all part of an ecosystem, but the problem is you have made midwifery almost ex- extinct, and now we're trying to replace midwifery care with OBGYN care, and it doesn't work.
• We have to have our ecosystem that is flourishing with every single spot, role, playing in their appropriate way.
• And I think that instead of trying to increase the number of OBGYNs that are in our country, we would really fare so much better if we started to pour, I'm talking millions and millions and millions of dollars into midwifery care.
• So if we really want to change our country, and we really do wanna be that leader of the world and have people look at our country and go, "Oh, my God, what is the United States doing over there?" I want the answer to be, "We're prioritizing midwifery care.
• We're prioritizing doula support, and we're truly"- Mm "truly honoring autonomy, and we're supporting women how they want to be supported."
• Yeah, exactly, and midwifery care in the traditional sense.
• And not, not saying, you know, it was 200 years ago when we didn't have antibiotics.
• I'm saying the, the skills and the attention and the relationship building, gosh, that is what's missing mostly from our maternity care.
• And that, like I said, I think that if we had more hospital-based providers seeing this, seeing how birth actually goes, and not seeing how birth goes in the hospital system when you're poking and prodding and causing problems because you keep poking and prodding.
• "Oh, thank God I was there because all of these things happened.
• And also, thank God I was there because, or thank God I'm here to save you because if you had been at home, my God."
• So yeah, I think having more midwives and just closing that gap between the providers because it doesn't need to be a war of the midwives and the OBs.
• They are separate professions, for sure.
• One is not better than the other.
• We need them both, but they have to also And especially on the OB side, they have to understand what they're actually doing, like what midwives are actually doing.
• Because a midwife is, as everybody knows, a physiologic birth expert.
• They can spot when things are going wrong probably faster than an OB sometimes because it deviates from normal.
• OBs don't even know what normal is.
• You can't see the forest through the trees.
• Don't say that online.
• You'll have your comments section filled with OBs going, "I have seen this, I have seen..."
• How many, though? How many have you actually seen? One? Two? Five? A handful over your- Mm-hmm what? 10 years of education? In one year, I get to see literally over 100 births that go right, and then I have a couple that don't go right.
• And so when we're thinking about how to actually do birth and who's truly the expert here, I just struggle to say that it's our OBs.
• Mm-hmm.
• In an unmedicated, low-risk birth.
• Now, do I think that midwives should be attending people who are high-risk and, like, probably gonna end up with a C-section and/or needs a scheduled C-section? No.
• Those people need a high-risk MFM, right? Do people with quadruplets need to be seeing a home birth midwife? Maybe not.
• Maybe you do need a high-risk MFM.
• But maybe that is where you choose to have your baby, and that's where I think I get the name of being a little radicalized, is that I trust women, and I genuinely mean that.
• I don't have to agree with you.
• I don't have to think that it's safe.
• I don't even have to think, "Wow, that's not what the evidence says."
• If this is what you want and you're informed and you're educated and you know what the risks are and you've talked about your other options and you're still choosing that, I trust you.
• And I had this fear before I had Saggy that having my own baby would change who I was as a doula.
• And I thought, you know, what if it does? What if it changes me? And it did, and it radicalized me even more because there were two places in my birth, a very long three-day labor, and I pushed for many hours.
• And for several hours of pushing, I had contractions that were 20 minutes apart.
• So in a 60-minute span, I was having three contractions, you guys.
• And so that led to a very long pushing stage, and twice my midwifery team came to me and my husband and said We think that we should maybe talk about the conversation of transfer.
• And the first time I said, "No, I'm not gonna talk about this.
• Is my baby fine?" And they said, "Yeah, your baby looks, like, literally fantastic."
• And I said, "Well, what do I look like?" And they were like, "You also look great, but we're starting to get a little worried about your energy."
• And I was like, "That's not for you to decide.
• When I start to feel like my energy is going, I will come to you way before it's an emergency.
• Trust me on this."
• And they backed away and they said, "Okay, we trust you.
• We're, we're trusting you."
• The second time was after I had been pushing for many hours, and they said, "You know, we're just starting to get a little concerned with how long this has been going on.
• We wanna talk about some of the options.
• Like, your baby's looking great.
• You look fantastic.
• You're reporting to us that you have a ton of energy, that you don't feel exhausted, but what are we gonna do if we do reach that point?" And we had that discussion, and again, I went against their clinical advice, and I had the best birth ever.
• I mean, I literally have zero birth trauma, and twice my clinical team came to me, shared what they thought I should do, allowed me to decline, and then trusted me and still gave me compassionate care going forward.
• There was no belittling.
• They never were making snide comments.
• They weren't making me feel guilty.
• They never said, "This is kinda negligent."
• They never said, like, "I mean, you can if you want.
• I personally wouldn't do this.
• I wouldn't recommend this if this was my sister.
• I would never want my wife to do this."
• They just said, "Okay, HeHe, we trust you.
• Please come to us if you start to feel any different.
• We don't wanna get into an emergency situation."
• And I said, "I'm good.
• You can trust me."
• And it...
• I just trust women so much, right? I just trust that women know their bodies.
• They know what they want.
• They know their g- d- their goals and their desires.
• They know their capabilities, and I do believe that when you have a healthy spread of options, whether it comes to choosing your provider, choosing interventions, choosing places to have your baby, choosing Choices and decisions in labor.
• If we are able to lay all these out for women and not just give them one choice, not back them in a corner, not make them feel negligent or, you know, fear them into a decision, we can trust that they will make the right decision.
• Now, does that mean that we're never gonna have emergencies? No.
• Does that mean we're never gonna have any sort of fatalities? No.
• Does that mean that birth trauma is just gonna be like, poof, gone, non-existent? No.
• But all of those things are inherently part of this process.
• It's like life and death.
• You cannot have birth without death, right? And so to think that any of those numbers would be 0% is unrealistic, but I do know that it would lower them.
• We wouldn't have a 33% C-section rate.
• We wouldn't have 45% to 60% of women coming out with birth trauma.
• We wouldn't have a 30% to 40% induction rate.
• Mm.
• We wouldn't have this war between midwives and OBs.
• We could cohesively work together harmoniously, and not only would that make OB and midwife jobs better, you would enjoy your job, but also patients will feel that.
• They will feel supported, loved, cared for.
• And just by way of all of that, look at all the trauma that we have prevented from our patients, but also our midwives and our OBs and our hospital attendants.
• Mm-hmm.
• Absolutely.
• And going back to the topic of, of discussion with insurance and Medicaid coverage, we will lose that.
• Like, mark my words, if this becomes a thing like it was with our midwives if doulas become a regulated, maybe even licensed profession, you...
• We will see those statistics that we currently have of the, of the benefits of having a doula will just fall right in line with the rest of the maternity care system.
• Oh, my gosh.
• Okay, do you have concerns about certification and licensure of doulas? Okay, you're shaking your head yes.
• For people who are not watching on YouTube, same.
• I share in that same thing.
• I'm not a certified doula.
• I've never been certified.
• I went through a certification process when I first became a doula, as we all do, because that's just what you do.
• Yeah.
• And it was very quickly, I just realized, like, eee, this- doesn't seem like it's for me.
• I feel like I'm gonna be being told what to do, how to practice, who I can take, what I'm allowed to do and not do, and not that I don't think that there should be a scope of practice.
• I love the idea that You know, doulas understand their role and we're not doing cervical checks.
• Like, that's not the role of a doula.
• I love the fact that, like, we're not doing fetal Doppler.
• That's not the role of a doula.
• I would not know what to do with either one of those.
• I've only checked one cervix in my life and it was my own, right? I've never done a fetal Doppler scan.
• Like, those are skills that I don't possess.
• I shouldn't be doing those to women.
• However, to have some sort of organization, whether it be a doula training organization, an insurance, a hospital, tell doulas what they can and can't do, now we're skirting on the idea of doulas losing their own autonomy, and if we don't have autonomy, how can we advocate for the people that we're serving? Absolutely.
• Yeah.
• And along with that, so I also, I'm, I am certified.
• I got my certification through Still Birthday in 2020, um, because it was 2020 and I needed a piece of paper to get in the hospital.
• And also, at that time I was, I was technically just a photographer.
• I was still doula-ing my clients but I wasn't, like, an official doula yet.
• And I knew that if I did birth work long enough I would have a loss, so I was like, "This is a good training."
• I'm also certified through Birth Becomes You just because they're amazing and I'm a birth photographer.
• I started this work as a birth photographer, so of course when they came out with their doula training I did that.
• But that other, that other, like, scope of practice piece, like, I get that we have to have a scope of practice, but also what about your doulas? So, like, for me, I am a neuro-spicy, multi-passionate person, right? So I have...
• I'm a doula, I'm a birth photographer, videographer, I design websites, which is random.
• But also, like, I love homeopathy.
• I'm learning homeopathy.
• And in this bill that's going through Nebraska right now, and this is gonna be very similar everywhere else, is, um, you know, doulas cannot, what is it? You know, diagnose or treat in any modality.
• Okay, well, what if I have a mom who's got, you know, some nausea or something and I give her homeopathy for that? All of a sudden now I'm outside my scope of practice and I'm gonna get in trouble for that.
• So I'm not a great rule follower to begin with.
• I don't love rules.
• I think we should trust people more than we do.
• And so yeah, I do have real concerns about as soon as we call this term a legal term and it's, shows up in legislation as a doula, now there's gonna be all of these chains and handcuffs and we can't actually do our job.
• So somebody asked me recently, "Okay, well, what's the solution then? Like, what are we supposed to do if-" If you don't want doulas covered by insurance, but we also need to get more doulas.
• We need to, um, have more families have access to doulas.
• And I thought long and hard about that question.
• I didn't have any answer at first.
• I was like, "You know, I don't know what the answer is."
• I do know that it needs to come from the community, and that truly I feel like is the solution.
• There, there's so much going on in the world right now, and it's not just in the birth world.
• In, in so many different areas, we just need to return to community.
• The support needs to come from the community.
• The fundraising needs to come from the community.
• It can't come from these systems that are not designed to actually support women and families.
• The other thing is if we must, right, if we must use insurance or Medicaid to cover support in the hospital, and this is just my own opinion, and I don't think it's gonna matter, but don't call it a doula.
• Call it a patient advocate because then we're actually defining that role as an advocate, which is gonna be somebody who may go against what the medical system is doing.
• Is it gonna be the same as the doula? Is it gonna be perfect? Absolutely not.
• But I have real concerns about taking the term doula and creating a, yeah, like a, a legal, a legal term out of it.
• So let me push back on you on this just a teensy bit.
• I have two ideas that I have been stewing on for a long time, and I've talked about them here and there.
• I've dabbled in them.
• I'm gonna throw the first one out, and we can chat about it, and then I'll throw the second one out.
• What if every family, just like your insurance covers a breast pump indiscriminately, no proof, you don't need anything.
• For some people, you need a, um, you know, a prescription from your doctor has to write the prescription, but you just get it.
• It's just assumed.
• Every single insurance, you just get it.
• Okay? What if we took that, and we made it into a stipend, and every single family...
• I don't know who would fund this.
• I haven't thought that far into it.
• There are a couple of options.
• Insurances could fund it.
• There could be a fund, a national fund that funds it.
• Um, it could come from some funding that comes from your state.
• That one is, is really likely because the stipend would also need to be based on The prices of the doula in that area, right? You wouldn't be able to give the same stipend to someone who lives in Mississippi as you do to someone who lives in New York or California, Boston, Chicago, something like that.
• The cost of living is much higher, right? And so what if every family was eligible for a stipend? It didn't matter who you hired with that stipend, but it had to be used for birth support.
• So they could be a traditional birth attendant, they could be uncertified, they could be a certified doula, it could be an agency.
• You know, what if there was just this pile of money and when you got pregnant, you submitted your name, your address, a couple of stuff, and they, I don't know, sent you a check, wired you the money.
• And here's my other thought.
• Let's say in the state of Massachusetts, our stipend is $2,800.
• Well, you find a doula that works for $2,100.
• You get to keep the 700 and then you could apply it to things that you need for your baby, diapers, wipes, baby gear, formula should you choose that, overnight care, postpartum support, lactation support that you didn't even anticipate needing, right? On the opposite end of that, you get $2,800.
• You choose a doula that is working for $3,600.
• You've got to make up the difference.
• So there is no sort of like, "Oh, we're going to apply for this much."
• No, everyone gets the same amount.
• It's got to be per state and it has to be, and it's per child too, right? So if you're having twins, then you would get, in, in this case, you would get a little over $5,000, right? If you have a baby in 2022, you get the stipend there.
• You have a baby in 2024, you have a stipend there.
• You have another baby in 2025, you get the stipend there.
• It is every single child that you bring into this world, you get that stipend.
• And I think there would have to be regulations in place too to protect families of premature babies- Mm-hmm stillbirth babies, right? Of babies of surrogate, adoption, things like that.
• So it is per birth, per baby, this stipend would be given to families and they can do what they will with that.
• And the government cannot tell you who to hire or what their credentials can be, but it does have to be spent on birth support, right? Yeah.
• I don't know how we would necessarily govern that to make sure that there's no fraudulent stuff happening, but I just I would love to see that happen.
• What are your thoughts about that? Yeah, I actually really like that idea.
• I never loved the idea of like, it, it's, 'cause it sounds like in order to get it, you would have to like register that you're a pregnant person, which whatever, we're doing that in all kinds of different ways anyways.
• But it reminds me actually of like Title 20.
• Oh.
• So like way back in the day when my 18-year-old was little, I qualified for Title 20 daycare, and it was a very similar situation where it didn't really matter who you hired.
• In fact, my sister was the one who, um, was babysitting my kid, and the state was paying for it.
• So yeah, I feel like that's a, that could be a really great way.
• The, the trick is, again, yeah, getting it funded.
• Like, who's, who's gonna pay for that? Because clearly we've shown in this country that families and you know, babies are not, not, well, families, especially in the postpartum, are not our priority, so.
• Yeah, I mean, the money is there.
• I'm not worried about the money.
• The money is there.
• You might have to sell your yacht.
• You might have to- Uh-huh not take money from lobbyists.
• So, uh, the money might- Yeah have to be reallocated, but you'll never convince me that the money doesn't exist, 'cause it's- Mm-hmm certainly out there, and we see it, right? The American people know that the money is there.
• We just know that it's in deep pockets, and it's not being, you know, injected back into our country or our healthcare or our wellbeing, and I think that really burns me up, too.
• Um, okay.
• Mm-hmm.
• My second point is, I love to hear that you love that.
• That makes me feel so happy.
• My second point is what about instead of certifying doulas, we create a board certification, and this just simply ensures that doulas have a certain level of education, but when I say education, I don't mean formalized education.
• I mean a certain level of knowledge, of intelligence, of understanding.
• It needs to be about the birth process, the hospital process, the insurance process and the medical kind of realm.
• You also need to carry a certain level of professionalism.
• There would probably be a portion of it in business understanding.
• Regardless of whether you were gonna be an entrepreneur and open up your own business or you were gonna work for an agency, I still think having a foundational understanding of business is a really good idea.
• Not only will that help you as a doula, but it will help you understand kind of like how all these systems interact with one another because there is money obviously being exchanged.
• However, the trick is, the key is, the catch is, and this is where I lose people There's no scope of practice after that.
• This board certification doesn't tell you what you can and can't do.
• It's not a regulation.
• Mm-hmm.
• It is simply an assurance that this doula has education, understanding, and professionalism of a certain degree, and then from there, that doula gets to go on and practice however she wants to practice.
• So some doulas are gonna offer homeopathy.
• Some doulas are going to be former L&D nurses, and so their scope is gonna look a little different from someone like me, who I don't have any medical training, right? Like, I just think that there's a way that we can strike the balance of...
• And this all stemmed from, I continue to hear from medical professionals about bad experiences and bad run-ins with doulas who are unprofessional, who convinced their client to do certain things that did not end well.
• Mm-hmm.
• That caused catastrophic outcomes, that caused that parent to make a negligent decision, but had that doula not been there, the counseling probably would have looked a lot different.
• Mm-hmm.
• Things like that, and I don't...
• I hate that, right? I don't want doulas to have a bad name, and I don't necessarily think those doulas set out to do that, but that the bottom line is that you did, right? You did.
• You caused something bad to happen, and now it's a reflection on all of us.
• Mm-hmm.
• And so I am searching for a way that we can present something to the hospital staff to say, "I have a certain degree of professionalism, education, and understanding, and you can rely on me, and you can give me a little bit of just inherent trust, even without knowing me, because I am board-certified."
• Now, from there, it's up to that doula to build that trust.
• She's gonna have to maintain the respectfulness.
• She's gonna have to build those relationships.
• She's gonna have to perform in that birth room in a way that is cohesive and kind and, you know, in a team manner.
• But on the very basic level, a doula that is board-certified can be trusted that she has certain credentials behind her, certain education, certain understanding.
• What do you think about that? I love that idea less.
• Yeah And the reason for that is because I think that a lot of us come to this work because we're passionate about it.
• Nobody is, is deciding to become a doula because they think it would just be fun to, you know, have to leave their kid's birthday party and stay up for 48 hours.
• Like, we come to this work because we have a passion for it, and the majority of the doulas that I've worked with at least have an attitude of, like, lifelong learning, and they are always reading books and listening to podcasts.
• So I don't think that the problem is ever a lack of knowledge.
• Maybe for those newer doulas who don't have enough experience, or they haven't seen as many births or whatever, or they're just unsure about their own skills.
• So I don't think the problem is ever a lack of knowledge.
• I think in any field you're going to have people who have not checked their own biases.
• So if anything, if we standardize anything, I think it's checking your biases, understanding, And the, the BBY, the Birth Becomes You doula course is really, really good at this.
• The major- a lot of what they're teaching is how to check your own biases so that you're not pushing your agenda on a client, because that's where we run into trouble, right? It's not, it's not because we're providing them the full scope of information that the doctors are maybe leaving some things out.
• It's because we're kind of, like, nudging them a certain way because we either had a really traumatic birth or a really amazing birth, and we want the same for them.
• You know what I'm saying? So I don't see that being necessarily solving the problem, and I'm also not one to really care about whether or not the medical system trusts me.
• Oh.
• You know what I mean? Like, I'm not one to really schmooze doctors or hospital systems because I don't work for them.
• I work for my client, and so providing them with the best experience possible is my biggest goal.
• I would also say, and I, I have this on my website and I talk about it with clients and in interviews, is it really...
• Education is important, right? Having the foundation of understanding the birth environment, understanding how to respect that space and move through it respectfully and whatever is important.
• However, I do truly, truly believe that the experience that you have with your doula has far more to do with the relationship you have with them rather than their experience, their knowledge, their ability to use a rebozo.
• You know what I'm saying? Because I would say most of the time as a doula, and maybe it's because I came into this work as a photographer, so I was already kind of hands-off, most of the work that I'm doing as a doula is literally just holding space, bringing a calm presence Reassuring them, like when they're losing their mind, like, "No, you've got this, like, focus."
• And then also helping to translate and communicate between providers.
• Like, "Hey, they came in and they said, oh, they wanna put this clip on your baby's head because they can't keep the heart rate on the, uh, you know, on the monitor."
• And then so we have a discussion about, okay, here is what that clip looks like, and here's what it is and here's all the information that you need to know, and just slowing things down.
• So yeah, I, I think that having a foundation is important, but I also think that your sister who's never been to a birth a day in her life might be the best doula for you.
• Mm.
• I do love that.
• This is so complex, and I also am not a proponent of schmoozing hospital staff.
• I mean, you guys know I don't s- I don't schmooze shit.
• I'm, I'm not, I'm not schmoozing anybody, you know? I, I certainly ruffle feathers.
• And, um, I typically gain a lot of respect by pushing back on people.
• Mm-hmm.
• And I know that's a really odd thing.
• It's just a knack that I have.
• Um, when I push back on people, somehow they're like, "Wow, I really respect this girl."
• And it's like, yeah, I'm not gonna let you harm someone in my presence, and I'm also not gonna disrespect you in this conversation.
• Mm.
• I'm gonna remain very respectful, but I am going to help you see that you cutting an episiotomy on someone who is saying no is not, A, appropriate.
• Mm.
• It's unethical, and it ain't gonna happen when I'm around.
• Like, it just, it's just not gonna be a thing.
• It's abuse.
• Yeah.
• It's like- Yeah you just can't let that kind of stuff happen.
• Um, and so I, I don't want to schmooze, but I do think that, I think that trust is a way to get our foot in the door, because the same tension that we just talked about with OBGYNs and midwives and this kind of butting of heads, I see it- Mm-hmm with doulas and hospital staff, and it's much more on the hospital staff's end.
• A lot more doulas trust hospital staff and want to be a part, and of course you have the really aggressive doulas who don't want anything to do with the hospital system, refuse to step into a hospital, and I totally respect that.
• I would never try and tell somebody how to practice in their own practice.
• But if we are going to fix this system that we have, one of the gaps that we have to- To fix is that mistrust between- Mm-hmm everybody, between OBGYNs and midwives, between hospital-based midwives and doulas, between doulas and OBGYNs.
• Like, there really are so many gaps of mistrust, and I hate that.
• And I just, I'm so desperate.
• I long for an answer of how can we fill in those gaps.
• I just want to, like, I wanna just bring, like, a big pavement truck and just fill it in, and then it's a, this nice smooth road, and there's no bumps.
• There's no speed bumps.
• There's no potholes.
• It's just a beautiful, cohesive system that works together because we are just...
• Oh, we're so far from that right now.
• Mm-hmm.
• And it's easy to go straight to the education piece because that's ultimately what, what the argument always ends up coming down to, right? Is the OBs have the highest level of ed- education, so they're up here, right? And then the midwives are kinda down here, and then the nurses, and then we've got doulas, who have the least amount of education.
• Quote, unquote.
• Quote, unquote.
• Quote, unquote- The least amount the least amount of education.
• Exactly.
• Um, and that, there's historical stuff behind that, too, with the Flexner Report.
• And I don't know if you're familiar with the Flexner Report, but if you're not, and your listeners are not, please go Google the Flexner Report.
• Um- Well, tell us about it.
• So I'm familiar, but I don't know that my listeners are.
• I've never talked about it on the show before.
• Yeah.
• So, um, the Flexner Report is basically, back in the day, I think it was 19-something.
• Anyways, I'm not great with dates, but it was back in the day, we used to have homeopathic hospitals, and, like, all of the alternative medicine was just part of this cornucopia of medicine that we had.
• And then the Carnegie Foundation realized that if they were to be able to get more people to take these patent drugs that they had, which were essentially, like, extracted from herbs and made in a laboratory, that they would make more money.
• So they sent this guy named Flexner around the country, and he essentially, with no real, like, strategy or anything, it was just his opinion, shut down all of these alternative education h- or alter- alternative education, alternative medicine education establishments.
• So the homeopathic hospitals and the, you know, naturopathic and acupuncture and all of those things so that if you weren't what we consider, like, our standard- MD Western medicine- Yep then all of a sudden you were a quack, which it's hilarious.
• If you look back, the homeopathic hospitals, and again, this was before antibiotics, but the homeopathic hospitals had better outcomes than our current, like, conventional hospitals.
• So Yeah, it comes down to this is just very deeply ingrained.
• Also, if you read the Flexner Report, which you can if you Google it, it's, it's online, you can read the entire thing, it is very racist, like blatantly racist.
• If the Flexner- Sexist Sexist, yeah, and it talks about, you know, like- Classist all of it.
• Mm-hmm.
• All of it.
• So it's, it's...
• It would not stand up today, yet it is the foundation of our entire medical system, our entire medical industrial complex that we have right now, which, mind you, is a business.
• The fact that our medical system is for profit blows my mind.
• There should never be...
• Should doctors make good money? Absolutely.
• Should medical...
• Should healers make good money? 100%, please, give them the, all the money.
• But for profit, really? No.
• So yeah, I, I could...
• I think we've stood on, like, four different soapboxes today actually, but- Hey, that's why the people show up.
• They love to hear us chat- about our soapboxes.
• So on the topic of money and ROI, do you get concerned that doulas taking money from insurance is going to, um, like, make doulas...
• Okay, so I, I've got a couple of thoughts.
• Let me just lay them out here really raw.
• A lot of times when we see Medicaid paying doulas, they're paying just so much less than what a doula would typically charge, okay? Mm-hmm.
• So then that forces a doula to take more clients, which is no doubt, and no fault of her own, going to decrease the quality of care that she's able to give each of those individual clients.
• So do you have a concern that by allowing doulas to be paid by Medicaid, num- two things are gonna happen.
• Number one, we're gonna start to see doulas prioritize quantity over quality, only because of survival skills, not because they're these, like, egregious, greedy people out there, but because- Mm I'm trying to put food on my table, and if I need to make X, a number of dollars every month, I have to take X number of clients, where I used to be able to take this many clients, and now I can't do that anymore 'cause I can't afford it.
• And then number two, do you think it's gonna compromise the quality of care that doulas are then able to give? Yeah.
• E- either we're going to have doulas doing it very part-time, just as, you know, if they are a stay-at-home mom or something and they wanna do it for fun, then they're just doing it very part-time.
• We have a lot of doulas in my community that that's kind of their, their knack, and they are charging appropriately for that.
• Which It's not a terrible thing to be a part-time doula.
• The, the trick is you're just not gonna have the experience that maybe a doula who is working more births would have, right? So there's one, that's one side of it.
• But then the other side of it, yeah, if you're trying to feed a family...
• I'm a single parent, so, like, if I were to try to feed my family on the $800 that Medicaid will pay for eight, I think it's seven or eight visits, and the birth, that is banana sandwich to me.
• Yeah, it really is.
• I would have to take, I would have to take- No peanut butter, just banana and bread.
• Yes.
• And if I had to take that many clients, then you run the risk of, okay, what if I can't, what if I'm sick? What if I'm burnt out because I've been doing all of the, you know, I've been at a birth for 36 hours and I need to send in a backup? All of a sudden I have to pay that backup because, you know, Medicaid's not going to reimburse because they're not a Medicaid doula.
• And that's another soapbox I could stand on is just the amount of money that doulas are charging.
• I don't know what it is nationwide, I only know in my area.
• Um, but I think, I, I would venture to guess even nationwide doulas are not charging nearly what they need to be, which then is another problem because I know that families are already having a hard enough time paying what doulas are charging.
• So it really is a very complicated, and like I said, I am not an expert in any of this stuff, but I do know that insurance is not gonna be the way to equity, in this case.
• Well, not as it's currently written, right? Yeah.
• Because the way that it's currently written is not without strings attached, which is why I always go back to the breast pump situation.
• If our insurance would cover doulas similarly to how they cover breast pumps, which I will say there are some strings attached there.
• You're usually limited in who you can order from and which breast pumps are covered, but it's pretty good in terms of, like, US insurance coverage.
• If we could replicate that in some way- Mm-hmm to have the no strings attached but get the funding, I just think it would be such a better system than what we are currently trying to push.
• Okay, we've talked a lot about the insurance piece, something that I think both you and I have recently seen online, doulas being forced to sign contracts with hospitals before they- Mm are allowed in.
• Are you just, like, dying on the inside? Because I know I am.
• Yep, 'cause it goes right back to the, "I don't work for you.
• I don't work for you."
• And as soon as y- It's like, it feels like signing a deal with the devil To have permission to be there.
• Like, a- and again, I'm not calling the people in the system evil, whatever.
• The people themselves are great.
• The system itself is terrible.
• But yeah, I, I cannot imagine having to sign a deal in order to be at a hospital in order to serve my client because at that point, if you screw up, quote unquote, or you don't follow the, if you're, if you don't toe the line, which means at that point you're not serving your client.
• Why is autonomy so threatening to the hospital system? Women's power is threatening to society.
• And women are, literally, we are the most powerful beings on the planet.
• We quite literally bring life into the world.
• And so if you look at this historically as well, men are scared of our power, and men run the medical system.
• So as soon as women have autonomy again, it's why, it's why we keep coming back to taking women's rights away.
• The fact that Roe v.
• Wade got overturned in the 21st century, like come on.
• So it's, this is, it's not just in birth and reproduction either, it's, it's everywhere.
• Women are threatening to the s- powerful women who stand in their power, who are autonomous, threaten the entire system, the way that it's built.
• Why do I have this, why do I have this urge to like growl right now? Like, and the- Like, hear me roar.
• Right? Howl at the moon.
• Seriously.
• Yeah.
• Be a wild woman.
• Oh my goodness.
• That's like- We all need to get in touch with our feminine rage, 'cause that's how we're gonna get through this.
• Yeah.
• That's how we're gonna make a change.
• I feel sad that's been beaten out of us to a point where we have to come back with rage, because I don't think that's how it had to be.
• If women had been honored kind of throughout the decades in a way that we should have been, and in a way that really honored that yin and yang of the masculine and the feminine, just imagine what our world, especially our nation, especially, especially our birth, could be like today.
• Totally.
• And we don't have, we don't have healthy masculine right now either, and that's part of the problem.
• That's true.
• 'Cause the ma- the masculine energy that's, that's running rampant right now is not healthy masculine energy.
• What would you change about that if you could change that? I've been saying forever now we need to go back to a matriarchal society, and a lot of people say that, or a lot of people that are fr- threatened by that think, "Okay, well, that means that men are subservient and women are gonna take over the same way that they've structured the patriarchy," right? But that's not what a matriarchal society is.
• A matriarchal society is a circle with children in the center, right? So we're not saying women should take over and subdue men.
• That's what they're afraid of.
• They're afraid that we're gonna do the same thing to them that they did to us, but that's not, that's not it at all.
• It's all about community and working together and having that village and making sure that the most vulnerable people are taken care of instead of going straight for how can we be bigger, better, more profits.
• It's, yeah.
• You think we'll ever get there? I do.
• I don't know if it's gonna be in our lifetime.
• Oh, man.
• But I feel things shifting, and people are, people are talking about it way more in the last year even than they have forever.
• And so I do think things are shifting, and I hope it's in my lifetime.
• Me too.
• Oh my God.
• Mm-hmm.
• I would just probably run around naked if we lived in a matriarchal society.
• Yeah.
• I mean, I would just be...
• If you guys think I'm wild now, I would be- Mm-hmm really feral.
• I mean, I would just feel like I am the queen of the world if we lived in a matriarchal society.
• Yes.
• I do think that everyone would benefit, and, um, it's so funny to me that men think that we would do what they do even though we're so opposite of you.
• Like, why would we ever do what you do? We're women.
• That's not how we operate.
• That's not how we see the world.
• That's not our belief system.
• It's not how our nervous system works.
• It's not how we interact with the world.
• It's just we're just different.
• Okay.
• What safeguards do you think should exist or be put into place in order to protect doulas and help them remain, uh, client-centered and, and, and woman-centered versus being forced to succumb to, you know, being insurance-driven or policy-driven, a- and again, forced in the way of this is where their livelihood comes from, not because they're choosing this, but because if they don't, there won't be food on the table for their families? Yeah, I feel that question so deeply because I could get you know, certified or whatever to take TRICARE in my state, and they pay pretty well.
• And I'm thinking to myself, "Okay, there's definitely enough clients, and I could-" Earn a good living as a single parent without having to worry when the next inquiry's gonna come from.
• And it's very tempting to jump on that bandwagon and just, you know, all right, fall in line.
• Do what we gotta do.
• So I think, you know, the safeguards is, first of all just being aware that this is even an issue to begin with because there are so many people out there that are cheering this motion on and like, "Yes, this is what we need.
• This is what's gonna be good for doulas, and it's gonna be good for families" And it does seem that way on the surface, so we just really have to remember our herstory and think critically and you know, recognize that this is not all rainbows and butterflies, you know? We have to remember that this is a system that's in place that is pulling us in because we are vulnerable, because we need work, we need money and we need to put food on the table and all of those things.
• And then, I don't know if this is a safeguard, but just kind of the way that I think of it is l- learning how to toe the line.
• You know, learning how to kind of find those loopholes so that you can toe the line, make the system happy, but then also figure out how to serve your clients in a way that you know.
• And I know a lot of that comes down to, like, when we talk about advocacy.
• So instead of being the one to speak out for your client, "Oh, sh- that's not on her birth plan" or, "Oh, she wants to do this", we turn to our client and we say, you know, "Did you wanna feel the cord before you cut it? Do you wanna see if it's still pulsing?" Or, you know, things like that.
• So just finding th- those little ways that we can recenter our clients without getting us in the fire, essentially.
• And that's privileged, right? I mean, we're two white women that are working with primarily white doctors.
• Yep.
• It, this experience is not gonna be the same for non-English speakers or people who have darker skin than us or people who are the only Black person in their community, and the entire hospital staff, maybe even including their client, is white, right? Like, I, I recognize the privilege in that, and I think that the ability and accessibility to speaking up and to being an advocate is very different depending on who you are, where you live, what you look like, the languages that you speak.
• And that sucks, too.
• I mean, it sucks that- Mm-hmm all of that is so dependent on how successful you're gonna be in this role and/or how, uh, serious you're gonna be taken, question mark.
• Mm-hmm.
• Yeah.
• And I think that just like anything, there's going to be- people that are spearheading the way, people that are fighting back against stuff, and there's going to be other people who are just in the stream going along, doing whatever they do.
• And that's just the nature of things too.
• So I tend to be somebody who pushes back and gets people to think different ways, and I'm not afraid to say it, obviously.
• Otherwise, I wouldn't be here with you right now.
• So I think just for those of us who, who do see kind of the writing on the wall, not being afraid to speak out and not being afraid to kind of, y- yeah, push the status quo just a little bit.
• Oh my gosh, I love that.
• Okay, so for, for any doulas that are out there listening who are maybe in the same predicament as you are or they are in the same thought process that I am, which is I could reach so much more, so many more people if I do take insurance money.
• It would help accessibility so much.
• But they know deep down in their heart that they're gonna lose autonomy and that their role is gonna be fundamentally changed.
• What do you have to say to those doulas? Yeah.
• Um, the, the same thing that I would say to any client is you have to do what's best for you.
• So nobody's gonna make that choice for you, right? You have to weigh the, the risks and the benefits and do whatever's best for you and your family.
• I personally am toying with some different things.
• Again, like I said, I am a single mom and, you know, I utilize government insurance, so I have to think of other creative ways to fill that gap.
• So one of them is, and I know that this has been kind of tested in our market, is having different tier levels for my doula support.
• So, like, at the highest tier level for those people who can afford it, they know that they're paying it forward so that I can create a fund so that every, you know, a couple times a year I'm able to take a family who otherwise wouldn't be able to afford my services or who, you know, would have to pay, like, a very discounted rate.
• So, and if it...
• It's also worth remembering that I think a lot of us as doulas, like, we wanna help everybody, we wanna save everybody, and as a, as somebody who does marketing and kind of, like, business consulting for doulas, I have to remind them all the time, you are not the right doula for everybody.
• Like, you speak about you and who you are, and those right people are gonna come to you.
• But the same goes for, um, you know, taking on those lower income clients.
• You're not gonna be able to save all of them.
• But if you can be there for one or two clients a year and, you know, with whatever fund or whatever you've got set up to be able to afford that so that you can give your services, Just think about the ripple effects of, like, how much that's going to change.
• If somebody felt supported in their birth versus not, the ripple effects go into postpartum and go into how they show up as a, as a parent for that child and how that child is raised, and it's just like you don't have to save the whole world, but if you can get one or two here or there and you can figure out a way to make that happen, I say go for it.
• Oh my gosh, I love it.
• This conversation has been so fulfilling for me.
• Um, I could talk about this all day, right? This is- Yeah not something I cover a lot online because my consumers aren't really doulas.
• There's a portion of people that are doulas.
• But I just, I feel the need to be an advocate for protecting our role as doulas.
• I feel the need to use my platform to help spread the word that our role as a doula is under fire.
• It is really on the verge of being super compromised, if not completely robbed of us or from us.
• And, and I think that there comes a time in every timeline where you have to stand up, and I think we're here.
• Mm-hmm.
• I think that we're at that line, and I don't want it to be a battle.
• I certainly don't want it to be a bloodbath.
• I don't think that's anybody's goal.
• But we have to protect our role as a doula because it's not...
• Yes, we will pay the price for sure, but I do believe that all of us doulas could go out and find different jobs, so I'm not, I'm not concerned about the price that doulas will pay.
• It's the women and the babies that are gonna pay the price, right? And that is what just wrecks me.
• I could cry right now just thinking about people that might have to have their baby and they want a doula, they can afford a doula, they need a doula, they have access to a doula, and they just can't do it because doulas don't exist anymore, and I hate that version of the world.
• That could very easily exist, right? Like, that would be so brutal.
• If we think that birth is bad now, I am terrified to see a US birth system that doesn't have doulas.
• True community-based doulas.
• Totally.
• Mm-hmm.
• Oh my God, it, it would be, it would really be barbaric.
• Mm-hmm.
• I'm really relying on us.
• I, I'm really relying on the women, not doulas, but just women in general- Mm-hmm to lock arms, to hold hands, and to hold this line and to say, "You have pushed us too far.
• We're not going to give you this one.
• You can't take this from us.
• We're willing to work with you.
• We're willing to find a happy medium, but you won't take this from us" because you guys, I'm begging you, we cannot let them take this from us.
• If we do- It will be really bad.
• And I don't say that to scare you, I say that to say use your voice.
• You know, if you are in a state where legislation is happening, call your legislators, pick up the phone, write an email.
• There's so many templates out there that you don't even have to spend time or mental energy.
• You literally get to put in, plug in your legislator's name, and scroll all the way down to the bottom and plug in your name and send it.
• It matters.
• Mm-hmm.
• It really does matter.
• You may feel like, because every year that we vote we hear this, right? What does my vote matter? It does.
• It really does.
• I work the polls every...
• That's P-O-L-L-S, not P-O-L-E-S.
• Um, I work the polls every time there is an election, and I'm telling you, your vote does matter.
• Your voice does matter, so please, please, please use your voice.
• Send those emails, pick up the phone, leave those messages for your legislators.
• Let them know that this is important to you, and then also let them know why you're scared that this legislation may be harmful for women and for children and for your state.
• They should care that their- Mm-hmm constituents are worried about something, and they should care that their constituents are taking the time to contact them about things that are important.
• And so I just wanna leave you with that message.
• If you feel like there's nothing that you can do, and that you're staring down, you know, the barrel of a gun, and you're like, "I just don't know what I could do to change", that's it.
• Send the email, pick up the phone, make the phone call.
• Tell the people in your community to do the same, regardless of if they're pregnant.
• You could tell the 90-year-old man who's your neighbor, "Hey, would you mind making a phone call for me?" Mm-hmm.
• That is important, too, right? You don't have to be pregnant.
• You don't have to be a new parent.
• You don't have to be trying to conceive.
• You don't have to be someone with young children in your home.
• Just let your legislators know, your representatives know, that this is important to you, and that you're very fearful that if they don't stand up for the rights of women, and particularly of protecting the role of a doula and increase in midwifery access, that our country and our women and our children are going to suffer because of it.
• Oh my gosh.
• Leslie, this conversation has been great.
• It really has been so awesome, and I think for a lot of people, this may have been the first time that they've heard about this.
• I think that- A lot of times legislation is not something that a lot of us are involved in, and unless you're in a state where the legislation is active and you're also probably in doula work, birth work, you may not know about these things.
• A lot of times, probably by design, they go under the radar, right? These aren't things that our news are telling us.
• These aren't things that are making headlines always.
• Um, and so I wanna thank you for the work that you're doing in Nebraska, in your community, but also online by spreading the word to let people, particularly women and families that are having babies, know about their options and how can they preserve the role of a doula, and how can they have a better birth.
• Oh my gosh, this is great.
• Where can people connect with you? If they wanted to learn with you, if they learn from you, if they wanted to work with you, if they wanted to maybe take childbirth ed from you or hire you as a doula, if they are local to you, if they are a doula and wanting business support, how can people find you? Yeah.
• So, um, my birth business is Novita Birth Stories on Instagram.
• I also, um, novib- novitabirthstories.com.
• It's N-O-V-I-T-A.
• I'm sure HeHe will put it in the show notes.
• Uh, yeah, so if you're local to the Eastern Nebraska area, I'm in Lincoln.
• I serve Lincoln, Omaha, and the surrounding areas as a birth photographer, birth videographer, doula.
• I also have, online childbirth education that I co-created with my birth bestie, Kayla Baker.
• She is a doula in Omaha.
• It's called Birth Alchemy, and it's the Birth Alchemy course.
• And your listeners are gonna get $100 off our online course.
• It is like nothing you will find anywhere else.
• We talk about all of the, you know, the good stuff that you're gonna wanna know, like, stages of labor and comfort measures and birth planning and all of that good stuff, but we also go really deep into the history of how we got to the maternity care system where we're at now.
• Um, and we really have this thread throughout about learning how to trust yourself and come back to your own power your own autonomy, and learn how to really trust your intuition.
• We even have a whole module on, like, how to do, like, very tangible, practical ways to tune into your intuition, 'cause I know we hear that all the time, especially as moms.
• It's like, "Oh, just trust your intuition," but what does that mean? Like, how do you actually do that? So we have a whole module on that.
• So yeah, your listeners will get $100 off just for- Oh my gosh joining us.
• I love it.
• Thank you so much for that.
• You guys, thanks for being here.
• I mean, genuinely, you know I love spending time with you, and you know I love bringing you conversations that you Probably maybe have not ever thought about before or have not ever had exposure for her before.
• And if that was you today, then, you know, really sit with the idea of how do you get involved, and it does not have to look like activism.
• It doesn't have to look like taking time out of your day to march the streets.
• It doesn't have to look like making awkward posts online if that's not your thing.
• If you're someone who just posts your family and your kids and you have, you know, a very private account, I'm not asking you to get out of your comfort zone.
• But do think about do you have time to send an email? Do you have time to pick up the phone and leave a voicemail for your representative? How can you help the pregnant women in your community learn about the role of a doula and just ensure that they know that that's an option, right? I want to make sure that everyone who wants a doula, needs a doula, knows about a doula, has access to a doula.
• And obviously, that's not our current model right now, but you can rest assured that people like Leslie and I and so many more are doing the hard work.
• We're trying to make that happen.
• It is hard.
• It's challenging.
• It's difficult in a system that kind of routinely blocks us, you know? They're a little threatened by doula care, and they don't love it when you have an advocate.
• They don't love it when you show up with someone who is going to say, "Hang on, Dr.
• Jones.
• She did say she didn't want that cervical exam, so we should stop and have a discussion before you move forward," right? Like, that doesn't feel awesome to our current system.
• But I am really hopeful that if we can hold this line, we'll be able to preserve the role of a doula.
• I think that if we can be loud enough, we can start to increase access to midwifery care, and I really am hopeful, just like you, Leslie, that there's a better day on the horizon.
• I think that we can actually create a system that works for and with women, and we can start to reduce the stats that are really horrible, and we can start to increase the stats that we know that we deserve.
• All right, you guys.
• Thank you so much for being here.
• I'll see you guys in the next episode.
• Be sure to follow Leslie on social media.
• Leslie, did you tell us where that is? What is your Instagram handle? Yeah.
• It's @novidabirthstories.
• Got it.
• And then I will see you guys on Tranquility by HeHe and at the.birth.lounge.
• Until next time, head to your app store and download the Birth Lounge app for evidence-based childbirth education and data-driven postpartum support delivered straight to your phone.
• Bye.
• Thank you so much for tuning in today.
• I love hanging out with you, and it is an honor to be your go-to gal when it comes to preparing for your baby.
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• You deserve to have a birth that you love with a provider that values your autonomy and respects informed consent without all the trauma that you so commonly hear about on social media.
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• I'm HeHe, and this is the Birth Lounge Podcast.