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)]

are you experienced?

I’ve been a fan of Dan Savage for decades, from back when he was just a fledgling sex advice columnist in the alternative papers (Kansas City’s Pitch!) truly opening the eyes of this midwestern girl. I still have the book he signed for me in 1999. I love that he’s taken on the podcast medium where I can still enjoy him on a weekly basis.

Recently* he had a call from a guy who was very interested in a woman but concerned that she was inexperienced sexually. Would she be clumsy and awful in bed? Would he have to spend his time teaching her? Basically, was it going to be an annoying waste of his time?

Dan’s answer was that experience doesn’t matter. Someone could be a bedroom newbie, or have a Guinness Book record number of partners, and it says nothing about your chemistry with that person. Experience and fit are not related. You either click and it’s amazing or you don’t! There is only one way to find out if you’re a match. If it feels right, take the plunge.

The same is true when choosing your doula. Experience doesn’t matter. It doesn’t matter if she’s worked with your doctor or midwife. It doesn’t matter if she’s ever set foot in your hospital or birth center.

As we were watching the World Series a few weeks back, I asked my husband what he thought—does number of births make a better doula? He didn’t hesitate and responded, “It doesn’t matter! I could step in and hit a home run as a rookie, or as a 38 year old about to retire. It doesn’t matter how many times you’ve been out there, it’s your approach to things.”

Other recent examples:

  • A friend who desperately wanted a VBAC (vaginal birth after cesarean) dumped a newer doula she loved for one with extensive VBAC experience at her provider’s urging. She got the VBAC, but her doula was annoying and pushy and took away from the experience more than she helped.
  • At the very first birth I attended as a doula, the nurse told me that I was one of the best doulas she’d ever seen.
  • A doula who has attended hundreds of births over the years recently told me, “I am no better a doula than I was at my very first birth.”

So why do so many of the “how to choose a doula” articles tell you to ask how many births the doula has attended?

Well, it is something to ask. It’s something that can be measured. Culturally, we’re more comfortable with numbers than amorphous things like emotions and chemistry. But why? What information does number of births tell you? It tells you how many births a doula has attended. That’s it. No more, no less.

“Not everything that counts can be counted, and not everything that can be counted counts.”

In fact, one of the first lessons I learned as a doula was to not bring the previous births I’d attended into the room. It serves no one. I usually forget which hospital I’m in or if I’ve met this doctor before. Why? Because this client in this moment for this birth—that is my focus. That is what counts.

However, there may be another reason these articles suggest these questions. In an outdated approach, doulas were taught and believed they were protecting women from doctors and hospitals, trying to help them “achieve” a certain type of birth seen as better. In this case, maybe number of births and experience with certain hospitals or providers would matter, since the doula would be trying to game the system or whatever. As you can guess, that is not my take.

So what does an amazing doula do instead?

  • works with you and for you, the client
  • facilitates positive relations with the medical staff
  • tunes in to and supports you (and your partner, if applicable) in having your best birth experience
  • checks her biases at the door to support you fully without judgement
  • makes sure you are getting the information you need, are physically comfortable, and coping well emotionally

Attunement—compassion, respect, emotional intelligence—this cannot be taught. (We can be taught how to better apply our ability to attune to the birth environment.)

Then how do you choose a doula? Meet her virtually or in person to see how you connect. Ask about her approach to this work and her training. Most importantly, do a gut check after your conversation. Did you click? Your connection is the single most important factor in choosing your doula. This will tell you if it makes sense to take the plunge in working together or not, whether she’s fresh out of training or has attended a hundred births. Good luck!

Further Reading:

5 Better Questions to Ask a Potential Doula

Attunement vs. Experience

*The question comes up about 6:35 into this episode of the Savage Lovecast.

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.



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.

decorative gourd season

Fall is my favorite season. The turning leaves– just incredible. The cooler weather, very welcome. Tall boots. It also means another year is nearly done flying by, which I suppose shouldn’t surprise me anymore.

I’m feeling big changes in the air. Time will tell if that comes to pass or if it is just wishful thinking.

I’m looking forward to a short week— extra time with friends and family. Special foods. Not having to rush into rush hour. Getting ready to help families welcome new babies in December. We just started putting out our Hannukah and holiday tchotchkes but you can bet I’m keeping the decorative gourds out for now.

Next week, I’ll get to make a fun announcement. I’m excited for what this will mean for future clients. Good things.

Enjoy your Thanksgiving holiday! And as you review your gift list, consider gifting doula support to the expectant parents in your circle. I may be biased, but honestly there is no better gift. We’d be happy to work with you on gift certificates or a wish list.

falling into postpartum

I’m looking forward to working with clients as a postpartum doula. The role is quite flexible depending on your needs, but the focus is on supporting the mother (whatever that might mean to her) during the first 3 months with a new baby (also known as the “fourth trimester”). Set aside your other concerns so you can bond with your baby, learn each other’s patterns, and adapt to your new normal. A postpartum doula will also help you figure out your parenting style, so you feel more confident as you step into parenthood or a bigger family. Let’s talk!

is this thing on?


Well, looks like it’s about time for my annual blog.

Earlier this year, I became obsessed and re-fired up for life as a doula. I took a postpartum doula training in June so I could add that to the services I offer. I’m planning to take a placenta encapsulating training as soon as possible. (a vegan…. learning about placenta prep… that’ll be interesting.) And next I want to take a breastfeeding counseling training, too. ALL THE TRAININGS!

I’m am thrilled to be re-opening this part of my life and can’t wait to work with some families through labor and the newborn phase. Who’s in? I’m looking forward to working with you.