This post is written by Pat James, aka “Mr. DoulaMatch.” DoulaMatch.net is a two-person wife-husband team, with Kim James being the connection to the doula profession and Pat handling the technology required to deliver DoulaMatch. Kim and I recently attended the DONA International 2023 Summit in Minneapolis. We supported the event as corporate sponsors. I learned quite a bit, and we came away with several new relationships for follow-up on new ideas for how DoulaMatch.net can connect even more families with their perfect doula.
This post shares highlights of what I learned. My goal with this post is to amplify what I learned and to share the great work being done to improve birth outcomes. First, I’ll share some general comments on the conference, and then I will provide some highlights from a few of the conference sessions.
Our sponsorship gave us the opportunity to include a few small gifts in the “swag bag” the conference provided to each attendee. We had some fun putting the swag bag together with a branded cherry SPF15 lip balm, a 3d-printed pelvis, and a small wooden “doll” that fits through the pelvis. We also included a little marketing collateral and a special offer for those who made the trip to Minneapolis. I spent about a month and 2 rolls of filament printing over 250 pelvises with my 3d printer. Kim and I showed our swag bag items to Penny Simkin, who immediately joked that “you could apply the lip balm to the pelvis, and then the baby will just slide right out.” Penny’s wit and charm are as sharp as ever!
Conference General Themes
The conference topics covered a wide range, but there were two bad news/good news themes in common to many of the sessions. The bad news is the continuing poor and declining state of birth outcomes in the US as compared to other wealthy nations, and in particular the disproportionate impact on Black mothers and babies due to racism. The good news is that there is great work happening across the US to expand access to doulas. Community doula programs, private and public grants, 3rd party doula reimbursement via Medicaid, private insurance, the military (Tricare), and employee benefit programs are enabling more families to benefit from culturally concordant doula services. We are in a time of great change for the doula profession.
I was one of two men that I saw in attendance, and the only white man. Shout out to Juan Irby “the Dudla” who received rave reviews for his presentations in the trainers’ track and concurrent sessions. Halfway through conference day one it dawned on me that on a personal level I was having a new and singular experience: never in my life have I been pretty much the sole male, surrounded by hundreds of women, all united in their mission to improve birth outcomes. There was something special about the lack of any baggage that comes from a mixed-gender setting. Many of the doulas in attendance were known to me by reputation, email, or Zoom, and some of them have spent time in my home where I have met them in passing but without the opportunity to deeply engage with them and their work. I received as much benefit from the informal conversations and connections over breakfasts and breaks as I did from the sessions.
I had not anticipated how powerful the positive energy and constant “lifting up” of one another would be. If I was to point out one person who best exemplified this, it must be Nikia Lawson. Kim had previously shared stories of Nikia’s positive influence on the doula profession with me, but like many things at this conference, hearing about it second hand and witnessing it firsthand are two very different things! It was a special treat to meet and see Nikia Lawson in action: she brings a boundless energy that always left the crowd laughing and fired up. There were many references to “filling your cup”: I am sure everyone present returned home with renewed passion and energy for this work.
Disability and Doulas
This was a session Kim wanted me to attend while she was sequestered in the trainers’ track. Actually, Kim picked most of my sessions for me. I took notes and we debriefed over dinner each night. Kim had previously experienced Dr. Abby Jorgensen's workshops and assured me it would be interesting, and that Abby would do a great job presenting.
Abby and her co-presenter Kristen Schell are disabled doulas raising awareness of how we can all do more to be inclusive, and that not only does this help the 1 out of 6 adults who are disabled, but it also makes it easier for everyone regardless of their abilities. And that at some point, every person will experience a disability even if only temporarily. This message resonated with me: every member of my family including myself has personally experienced disability at some point, and one of us has a rare congenital skeletal disorder that is near-invisible but does rule out common abilities we all take for granted. Abby and Kristen shared many details of their personal journeys as disabled people, and how it affects their work as doulas.
We went through an exercise where we examined the conference room and listed all the aspects of its design and arrangement that might pose problems for the disabled such as cords on the floor, doors that might be difficult to open, narrow aisles, and devices at heights not universally accessible. We then went on to a small group activity to extend this to what we have seen during births. I enjoyed working on this with two doulas from Chicago, Amber and Leslie, who turned to me and asked what my most recent birth was like. When I sheepishly admitted that I am not in fact a doula, they took that in stride and asked about the births of my children. While that takes me back 18 and 25 years ago, I did manage to dredge up some details to share. They shared challenges they had seen with larger birthing mothers’ access to equipment that worked for their bodies, an accommodation they often had to work at to receive.
Abby and Kristen were very effective and persuasive in opening our eyes to small things we can all do to make our businesses more universally accessible and inclusive, even if that is just including stock photos and clipart featuring disabled people in our websites.
Jen Hamilton is a labor and delivery nurse in North Carolina with 3.2 million followers on TikTok. She leavens her messages with wit and humor, and is frank about her journey from newly trained nurse to one who appreciates the different talents and knowledge nurses and doulas bring to the table. She posted a TikTok video with a few short excerpts from her talk.
Jen is a young white nurse and spoke to what she does to build trust with Black patients who do not have many reasons to believe that they will be consistently listened to and treated with respect and dignity in the hospital environment.
One of her slides that has really stuck with me described how as a nurse she “knows a lot of things about a lot of things”, but that list doesn’t always have much overlap with what a doula knows and delivers. She said that as a nurse she excels at applying hospital policies and procedures, charting, avoiding litigation risks, effectively using technology, titrating Pitocin, and as Jen admits, she can be pretty good at gaslighting a patient into doing what the nurse thinks is right. Then she went into what she has learned from doulas, including admitting that when she started nursing, she was unaware of the true history of the “father of gynecology”, a man who performed research and experimental surgery without anesthesia on enslaved Black women, and that she has learned that informed consent is much broader than getting a patient to sign a form before they go under anesthesia.
I’ve seen and delivered plenty of PowerPoint presentations in my day; Jen could go head-to-head with the very best in terms of preparing and delivering an engaging and effective presentation. And if you watch her TikTok videos you can learn about her two indoor pet chickens who wear diapers, so there’s that. Where do you even buy diapers for a chicken?
Kimberly Seals Allers and the Irth App
Kimberly is the executive director of Narrative Nation, creators of the Irth App [ Google Play ] [ Apple App Store ], a database of Black patient experiences of maternity and infant care. It is named Irth as in Birth, but without the B for bias. Kimberly is an award-winning journalist who has worked at Essence and Fortune magazines and has been published in The New York Times, Washington Post, and Slate.
I loved her summary of what the Irth app aspires to be: the Green Book for safe birth. It is a guide for Black and brown women to distinguish the best from the worst in hospitals, birthing centers, and medical providers serving their community. In 2024 she plans to start publishing lists of leaders and laggards based on the reviews collected by the Irth app. She is very hands-on when it comes to following up on the data collected in the app, scheduling Zoom calls with hospitals that have poor reviews to discuss the data and what the institution can do to change.
Narrative Nation has opportunities for doulas to help with this work in their community through their Irth Ambassador program. Doulas can apply for this role, and if accepted they will receive a stipend in recognition of their work.
Community Based Strategies for Increasing Access to Doula Care
This session was presented by Dr. Holly Horan, an doula and assistant research professor from the University of Alabama at Birmingham’s School of Medicine, and Dalia Abrams, Program Director of the BirthWell Partners community doula project in Birmingham. They shared their work to build a coalition in their community to improve access to doulas in Alabama. This is work that is still in progress. They are working to build a coalition, starting with building a case for taking action based on locally relevant data on the state of birth and doula access in Alabama.
While the US is among the worst in the OECD nations for maternal mortality, Alabama is near the bottom among US states. The March of Dimes grades Alabama as an F for having a 13.1% pre-term birth rate, and the maternal mortality rate is over 50% higher than the US average.
There is no Medicaid or private insurance reimbursement for doulas in Alabama, which means that doula services there are mostly for families with significant financial resources. There is also a ban on opening new birth centers there as they are deemed unsafe by the Alabama Department of Public Health. This has recently been challenged by the ACLU in the Fifteenth Judicial Circuit Court. This poses significant challenges for rural families who need to drive long distances to get care. Alabama had a long tradition of "Granny Midwives" serving women in rural communities, but the state banned this in 1976.
Before they could start making any headway on expanding access to doula services in Alabama, first they needed to prove their case with local data. Alabama legislators wouldn’t accept any data from other states, because they doubted the relevance of other states' data to local situations in Alabama. They needed to see hard data from Alabama before they would listen further. Dalia and Holly proceeded to gather the data, mostly through interviews and focus groups. This qualitative data was grouped into themes in preparation to report the results of their analysis. Next steps will be to use this data to pursue support for more 3rd party reimbursement of doula services and grants for training more doulas serving their local communities throughout Alabama. This approach can then be replicated in other neighboring states.
Say Anarcha: Writing the Story of the Mother of Gynecology
Author J.C. Hallman discussed his new book, Say Anarcha: A Young Woman, a Devious Surgeon, and the Harrowing Birth of Modern Women’s Health. I really did not know anything about this chapter in our nation’s history. It is the story of how the “father of gynecology”, J. Marion Sims, achieved his fame and earned the respect of the world because of surgical experiments conducted on enslaved Black women, without any pain relief. This is some Josef Mengele level stuff, done right here in America, and mostly buried in historical archives until being unearthed by Hallman. It is a story I am planning to learn more about, as Kim and I plan to attend the Mothers of Gynecology conference in Birmingham in 2024. I bought a copy to read in preparation.
Racial Disparities in Perinatal Health, A National Crisis: Concordant Perinatal Doulas are Making a Difference
Dr. Jacquelyn McMillian-Bohler of Duke University, Dr. Stephanie DeVane-Johnson of Vanderbilt University, and UNC Professor Venus Standard created the LEAD program: Lived Experience Accessible Doulas. This was definitely one of the “good news” sessions as it tells the story of a program that has achieved some great successes training dozens of new doulas who have served hundreds of families in their community. They delivered slide after slide showing the cohorts of Black doulas trained and certified within an 8 week time frame, and the data showing the positive difference they have made for the hundreds of births they have supported. Funded by grants, the program is delivered at no cost to the doulas being trained and the families served. They have been recognized by the White House and featured in the media. It was exciting to hear of their success and see this program presented as a model to be replicated elsewhere.
I was familiar with many of the facts and measurements of the maternal mortality crisis, but had never heard first-hand from people who are directly affected. I knew that the US is almost rock bottom among the OECD nations for maternal mortality. I knew that Black mothers’ risk of maternal mortality (death) is three times higher than white mothers, and in some places like New York City can be as high as 8 times higher risk. I knew about concepts like “weathering” that help explain the outcome gaps Black people experience even when controlling for income and education.
Like Jen Hamilton, I knew a few things already. But there was also much that I did not know. I did not know that until recently, nursing school textbooks taught that Black people do not feel pain as acutely as white people, which results in a racial bias in pain management. This is just one example of the effects of structural racism.
And while I knew the statistics, I didn’t know as many of the stories or qualitative data that back them up. The stories of not being listened to, not being heard, being disrespected, being denied care that may not result in death but do result in more complications and an experience that fails to adequately support all birthing mothers. Most of their speakers had their own personal stories to share that demonstrated these problems. It never stopped there though. They then proceeded to tell us what they were doing about it and the successes they achieved, leaving the group with hope and inspiration to do more themselves as well.