the doula as luxury

When you hear the word “luxury,” what typically comes to mind? Probably things like:


And when you think of necessity, maybe things like:


Maybe also high on the necessity list are things like fulfilling work or hobbies, some form of love/companionship, and a connection with nature or something spiritual:


Many will also see access to medical care, education, and a feeling of safety and security as human needs or rights.


In the small circle of birth work, there is some debate around whether a doula is a necessity that every birthing person should have the option to have, or a luxury service which while certainly nice, is far from necessary.

I asked the husband, “Is a doula a need?” He laughed and said, “Please. Any doula who thinks she is a necessity needs to get over herself.” Ok, that’s one point of view.

Yet, this is how the general public would likely answer, too. I’ve recently heard doula as a punchline in 4 different contexts. There were doula cracks in an Archer episode (below), a Duracell commercial (“… like your doula, who wants you to have a dolphin-assisted water birth.”), in Oh, Hello on Broadway (Gil Faizon is a “Tony Award viewing actor” who moonlights as an unlicensed doula and has a raccoon girlfriend), and in the 2016 Ali Wong Netflix comedy special (“I hired a doula. You know what a doula is? A white hippie witch that blows quinoa into your pussy to Keyser Soze all the pain away.” Note: I have not learned this technique. Yet.)

It’s great that “doula” is making its way into the mainstream lexicon, yet clearly it’s still seen as a silly indulgent thing that other people do.

Archer: What’s your Bishop Score?!
Lana: How should I…? Wait. How do you even know what a Bishop Score is?
Archer: I got certified as a doula, which, turns out, is not that hard.

Lana Kane handles her impromptu doula, Sterling Archer.

But really, which is it? Is a doula a necessity, a right? Or is a doula a luxury for the few who can afford one and a punchline for the rest of us?

My answer is YES.

No, this isn’t a cop out. In our either/or culture we often forget that sometimes BOTH possibilities are true. An oversimplified “debate” leaves out piles of nuance and information. As illustrated above, there is a lot of grey area between the extremes of luxury and necessity, and that grey area can vary a lot depending on one’s personal situation.

What are some good analogies? Organic food? I could say that everyone has a right to fresh, healthy organic produce. It’s good for your body and reduces your exposure to toxins. But is it really a necessity? Should organic farmers donate their food to those in need? Or maybe massage therapy? It can be therapeutic and healing to many, but is it a necessity? A college education gives you more options in life, but is it a necessity? A car can be a necessity, depending on where you live.

Ok, you say, BUT! Our healthcare system is AWFUL!! It’s a danger zone in there!!! Doulas are literally the only thing standing between a woman and a system designed to make her birth experience as terrible as possible!!!!

Our outcomes are shameful, just look up infant and maternal mortality rates by country. And what improves birth outcomes? The midwifery model of care and raising the status of women and girls. There are bigger things to attend to if we truly want to improve birth outcomes on a macro level. Doulas make a difference, but putting the responsibility to ‘save’ someone’s birth on a doula’s shoulders is unrealistic and unfair.

We know that doula support has many benefits, but they do come at a price and that’s where the necessity v. luxury question becomes important. Can we, as birth workers, provide support to all families regardless of their ability to pay? Is it reasonable to expect doulas to make themselves available to everyone, even for little or no pay? An unpaid or barely-paid doula is then paying to attend births, a significant investment.

The obstacles to quality doula support extend beyond the doulas themselves. As summarized on Birth by the Numbers:

Choices in Childbirth surveyed 111 doulas in New York City as well as held four focus groups. The cumulative findings of this research include:

  • Cost is the most significant barrier to obtaining doula services.
  • The doula workforce is small and less diverse than the population of New York City, with women of color under-represented as well as doula services in languages other than English, Spanish, or French.
  • Access to doula care in underserved communities is extremely limited.
  • Fostering collaborative relationships between doulas, maternity care providers, and nurses would improve the impact of doula care.
  • Establishing positive hospital policies would improve the impact of doula care.
  • Doulas need support for the work that they do, including models of doula service delivery that minimize stressors and difficulties.

To view the full report, click here.

When DONA (the oldest doula certifying organization in the US) was founded, their mission became “a doula for every woman who wants one.” That sounds wonderful! But the devil is in the details.

Whose responsibility is it to make sure that every woman who wants a doula can get one? This was never fleshed out and as a result, the assumption was that the doula should make the sacrifice to be available for as many pregnant people as possible. This likely happened for several reasons:

  1. our views on money (money is inherently evil and taints any interactions it touches; birth and loving care should remain free of such base concerns)
  2. a calling, labor of love (if you truly love what you do, money is irrelevant!) 
  3. our views on charity/giving/volunteering (being a selfless martyr is romanticized and venerated; women especially are expected to put others first), and that one’s training and profession should also be where they do their volunteering or charity work (you’re trained in this area so you should do it pro bono when possible)
  4. our egos (it feels so good to be needed!)

Additionally, it was easier to shape the budding new doula culture, rather than the wider social norms and assumptions around birth and maternity care. Then immerse all of this in our sexist patriarchal world where female-dominated/nurturing  professions, women’s work, emotional labor, and women’s bodies are not valued, and why invest in this sort of service?

Let’s take a closer look.

1. Money isn’t inherently good or evil. It’s a tool we use to exchange goods and services. And yes, it is a necessity. A pregnant person needs it to cover various medical and newborn essentials, and a doula needs it to compensate her time and professional expenses. Sure, it can feel good to do doula work, but warm fuzzy feelings still don’t pay the rent. Expecting doulas to work for little or free also promotes a lack of diversity in the doula community.

It benefits everyone when we treat ourselves, our work, and our time with respect and value. For better or worse, the main way to show value and respect in today’s world is with money.

2. Something can be your calling and you can be awesome at it and love it and being paid well doesn’t change any of that. These things don’t cancel each other out! This is an issue in the nonprofit world, too, and teaching. We have this weird assumption that if you are working to better the world, you should be content with low pay. This leads to resentment and burn-out of excellent talent. Everyone loses! Investing in great people is important and beneficial all around.

3. Volunteering—not everyone can afford to do it. It takes time and time is money. There are many ways to give back and you have to do what works for you and your family. Also, volunteering as a doula is unique. For example, if I volunteer at a homeless shelter a few hours a month, I can schedule it and make changes when necessary. Volunteering as a doula is very different—the demands of life on call, the unpredictability of when labor will start and how long it will last, prepping back-up and childcare, the intense emotional and physical toll—this makes volunteering as a doula a very different sort of commitment. Of course, it can be joyful. It’s still a tremendous undertaking.

4. And it’s important to check our egos. No one is irreplaceable, certainly not a doula. In Lamaze’s 6 Healthy Birth Practices, support is the necessity, not a doula.

So, how do we truly make birth better for parents and babies? Access to better evidence-based health care, growing the midwifery model of care, education, and access to contraception. More immediately, encouraging people to find a care provider and birth location that feels best for them, when options are possible.

And how can we make birth work sustainable for doulas?

  • good compensation—the ability to pay for business and personal needs comfortably and not burn out
  • a support network and positive relationships with other birth professionals
  • insurance reimbursement would increase access to doula care and help doulas make a living
  • different models of doula care, like hospital-based programs (e.g., working pre-scheduled shifts) or collectives and nonprofits such as Ancient Song or Operation Special Delivery, which are able to offer more affordable doula options to clients while still fairly compensating the doula for her work


The necessity for birthing parents is physical, emotional, and informational support for the birth experience. And one of the best ways (but certainly not the only way) to get this support is through hiring a doula—which is a luxury! As birth professionals, our goal should be to help create a reality that meets these needs without sacrificing our own health and livelihood in the process.


Further reading:

Midwifery and International Maternity Care—Marsden Wagner on how to improve birth outcomes in the US and globally

Birth by the Numbers—excellent collection of reports and short videos on birth statistics in the US and globally.

Recent podcasts on the importance of saying no and setting boundaries, and the push-back we get when we prioritize ourselves:

Flatbush Doulas owner Yael Yisrael talks to doulas about the importance of paid work:

Doula Ariel Swift on being a Scapegoat Doula


[cover photo: Goldie Hawn as the quintessential ‘rich bitch’ in the movie Overboard! (1987)]

building a better birth class

A few months ago in anticipation of teaching a new type of childbirth class, I created a survey and shared it across the land to ask parents why they had or hadn’t taken a class, and to find out what was most useful, what was lacking, and what was a disappointment for those who did take a class. I was concerned about launching a class amidst online forums full of parents saying birth classes were a waste of time (note: there are also many who loved their classes!).

The results were incredibly helpful and I’m eager to incorporate such useful feedback to make the class stronger and more relevant to what expectant parents most need and want to know. Many classes have been structured around what we think you should know. Since this is based on peer feedback, it’ll make a huge difference. This knowledge, coupled with the personalized Your Birth Experience (YBE) approach, builds a childbirth class perfect for busy New Yorkers.

There are so many choices out there— Lamaze, Bradley, HypnoBirthing, Birthing from Within, and various private instructors and hospital-based options. How do you know which class is right for you and why choose a YBE class with me?

This class is for you if you:

  • are busy (who isn’t?)
  • want to get clear on your personal wishes for your birth,  versus what the interwebs and your family wishes for and believes about birth
  • want a better picture of what to expect in labor and how to best manage it
  • want to understand the various options that will come up through the birth process, which you prefer, and communicating this with your birth team and medical staff
  • want to leave the class with a draft birth plan to review with your doctor or midwife, and a plan for handling those early weeks with a newborn

The small group class is one 4-hour class with a follow up call for further questions. If 4 hours is still too long, you can always opt for a shorter private consult with a tighter focus on your unique concerns.

For more information, visit our page on childbirth education in New York City.

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the doula as spanish tortilla

Once upon a time, my husband (then boyfriend) and I were able to spend time taking short trips around Europe. Since we were vegetarian at the time, and most places in Europe weren’t super veg-friendly, we learned how to ask for a cheese sandwich in every language.

In Spain, where they like to slap some pork on everything, we were sustained by tortilla. We ate SO MUCH tortilla. I had never heard of it. Tortilla Española is not the flat flour or corn-based circle we are used to here in the US for quesadillas and such. No. Not even close.

It is great for any meal or snack. It tastes amazing. It is probably impossible to mess up. I couldn’t get over the deliciousness. What is in here? I wondered. Is it REALLY vegetarian? It just tasted so rich, I thought there MUST be something else there that the Spanish were keeping hush-hush.

But no! It is a deceptively simple concoction of potatoes, onion, olive oil, eggs, and salt. That is it. While I know potatoes are sent from heaven, I never would have believed that something so yummy came from this short list of common ingredients. Thus, the Spanish tortilla is always what I think of with regard to the phrase: the whole is greater than the sum of its parts.

Because that is exactly what I think whenever I try to explain doula work to someone! It can appear that a doula is just someone to hold your hand, whisper encouragement, get you a snack, and so forth. And it can be all of those things, or at least, it looks like that on the surface.

What you DON’T see is how I’m carefully watching you and your support person. Reading how you’re feeling. Figuring out what might be helpful, and if the time is right to suggest it or if silence is best. Thinking about HOW to say something in a way you’ll find useful. Finding the balance between fading into the background and being a strong presence. Willing the right words to come out of my mouth at the right time. Remembering that what worked like a charm for a previous client might be annoying as hell for you. Knowing when to use a supportive touch. Translating labor and your needs for your partner, and letting your partner interpret you for me.

After digging deep into my knowledge, experience, intuition, and tuning in to your unique family, your preferences, and your particular situation, squeezing your hand might be the end result. That’s the part you see. 

A good doula is greater than the sum of his or her parts. The best doula makes it deceptively simple. You might think I’m just a standard issue Idaho potato, but  you’re gonna get a tortilla that will blow your mind.



learning birth stuff

In the months and weeks leading up to your first baby’s arrival, it can feel like your to-do list is a mile long and there are 5,000 baby supplies that you MUST have and what do they do and where do you put them? Add to that the emotions and unpredictability of this major life change and it can feel like a bit … much.

Somewhere on most people’s lengthy list is taking a childbirth class. Maybe you are hoping for a certain kind of birth or maybe you just figure you should know a little more about what the hell’s going to happen on the big day or maybe your friends suggested it. In any case, you find one, pay up, and hopefully find it useful.

On an online message board for parents, someone was recently seeking advice about which class to take. Some people replied with strong recommendations, but most thought that the classes were a waste of time, that anything they learned flew right out the window once labor set in. This caught my attention as I now offer childbirth ed and I sure don’t want anyone to feel they’ve wasted their time and money. New Yorkers are busy as fuck and have no time for bullshit. This is why I chose to train with Your Birth Experience. I wanted to be able to offer clients something tailor-made, worthwhile, a perfect fit for anyone’s budget, availability, and questions. Something that cuts through the crap and offers the best information to support them through their birth experience.

While every course is individualized, it’s still helpful for me to hear what worked and what didn’t for others. Whether you took a class or not, it would be great if you could take and share this survey! You even get a chance to win an amazon gift card! My clients and I thank you for your help.


stacking the odds

I knew I wanted a “natural birth.” I didn’t know exactly WHY I wanted that, or WHAT it meant exactly, or that it would be such a BIG DEAL to want that. I had a lot to learn. I knew that birth could be unpredictable and potentially complicated, but I wanted to do everything possible to increase my chances for a positive, healthy, natural birth.

The way we approach birth says so much about our personalities, families, cultures, and histories. Maybe you asked friends and family about their experiences (or you didn’t have to ask because they bombarded you with stories and “advice”), maybe you jumped in and forged ahead following your gut, maybe you went solely with advice from a trusted midwife or doctor. Maybe, like me, you read 101 books and solicited advice from online forums and a few select friends.

One of my trusted friends gave me the first of the many birth books I’d read, The Official Lamaze Guide: Giving Birth with Confidence. She’d had a positive natural birth and found the book helpful. I also highly recommend it, and found it very accessible and practical, good for anyone who wants to, well, give birth with confidence.

As someone who needs facts and data, I liked how they built the case for the best things you can do to have a healthy birth. Drawing on the meta-analyses of the respected Cochrane library, they distilled and simplified the data into their six healthy birth practices. Visit their website for more information on each practice, including short videos.

Following these practices are no guarantee, but they greatly increase your odds of having a birth that’s positive, safe, and healthy for you and your baby. For me, following these steps worked well. I knew I couldn’t control it all, but I wanted to feel in control of the things I could. Just like life.

One key step that isn’t mentioned here (but is addressed in the book) is to do your best to find a midwife or doctor and birth location that you trust. Ultimately, you’ll be working with your care provider to make decisions and having a trusting relationship will be critical. Good luck!




OMFG is it winter break yet?

Only about 2 weeks to go. My family is lucky in that our work and school schedules allow us some real downtime over the holidays. We are so looking forward to seeing friends, no morning or evening rush, hanging out together doing not much of anything. Oh, the new Star Wars, of course. The grandparents have already given my kids everything Star Wars (merchandising! where the real money from the movie is made!), so a very merry Christmas to you, J.J. Abrams!

How’s your holiday shopping going, anyway? You know the whole thing about going for experiences over things, right? You don’t want your thoughtful gift to be konmaried right out of the house come spring cleaning.

The gift of a doula is the best gift I ever gave myself. It’s one of the most thoughtful, loving, nurturing experiences you can gift to the expectant parents on your list. The onesies are so cute, the tiny booties and softest blankets, the high tech strollers… but the postpartum doula is the one who will make sure the new parents are fed and rested. That the laundry isn’t piling up. That they are remembering to take care of themselves while everyone around them is asking about the baby. That they aren’t alone in the middle of the night and the baby won’t stop crying and they are too tired to see straight. A postpartum doula helps them figure out how they want to parent, the best approach for their family at that time. A birth doula cares for the family before and during that most intense and unique of human experiences– bringing a baby into the world, be it naturally, medicated and assisted, or surgically.

Every person, every family is unique in what will be most helpful to them. A doula can adapt to their needs to assist them in the best way possible. Pretty much the best gift ever.