The train has left the station on doula care becoming integrated into the existing medical system. It’s happening, whether we like it or not (plenty of doulas do like it, and plenty don’t, for a myriad of reasons). I have worked for a doula care startup and I have worked for the company that acquired that startup….and I have a laundry list of reservations and concerns about the VC money flowing into doula care right now. Namely, what the work actually looks like, who is actually centered/leading it, and what difference this will actually make for both families and birthworkers. I am OBVIOUSLY all for more families accessing doula care, but not in a way that cheapens it or waters it down—not if the sacred relational and human-centric aspects of this role become lost in a productivity model designed to scale rather than care.

As I have said a thousand times and will say a thousand more times, doulas are not and should not be a bandaid on the gushing wound of the maternal healthcare system in this country. We need a significant overhaul that includes structural investment in expanding access to midwifery and increasing the number of midwives serving communities, community-based birth models, true continuity of care, and policies that actually support families before, during, and long after birth. Expanding access to doulas without transforming the system we are working in risks placing responsibility for further systemic failure onto us—increasing our burnout and attrition, as community careworkers who will be asked (are already asked!!) to compensate for structural problems we do not have the authority, resources, or institutional power to fix. And honestly, we doulas already know this!

Integration *could* be meaningful if we doulas are resourced, protected, and seen as respected community leaders and experts who provide a special and specific type of care that is vital, not just nice to have. The question is whether the system is willing to change enough to meet the philosophy of care we bring with us…and if millions of dollars of VC money and payer support is enough to start actually pushing it to change (spoiler alert: I’m pretty skeptical!!!!!)

I should probably just turn this into a full post at some point. 😛