Transcription

Sophia

 Would you like to start by introducing yourself? 

Tayo

Sure. So my name is Tayo and I'm a birth and postpartum doula and I own Chicago Birthworks Collective with my mom. We are a maternal wellness company that provides full-scope birth support, so that's birth, postpartum, lactation support and education, and child birth classes. 

Sophia

 That's incredible. Could we have you talk a little bit about your path towards becoming a doula? And what advice you might give to people who are either curious about becoming doulas or interested in working with doulas in the future?

Tayo

So my journey to becoming a doula was really inspired by my own childbirth. I had my first child when I was 21 and I was turning 22, so I was a very young mom fresh out of college, pregnant in college. And then I had my second kid almost exactly 2 years later, and I realized that things had gone much better for me than a lot of people who were older than me, had a greater socioeconomic status than I did, had been married longer than me, so I was like, oh, I don't know how I skated through here. I had 2 vaginal births in the hospital, and not many of the things that we now know doulas can help reduce, like, in most cases, unnecessary interventions, prolonged labors or increased chance of a C-section. I didn't have any of those things so I was like, how was I able to get through 2 pregnancies kind of back to back and not having issues, and I realized that it was my mom, and that my mom played the role of doula. So I was like, yeah, everyone needs one of these. Everyone needs one of these. She answered all my questions. She was physically there for me. She labored with me during both labors. And so when it all started to connect for me that I had a doula twice, I was like, yeah, every person deserves one of these. And it should be someone from their own community. So, them being able to choose a person that makes them feel the most comfortable was really important. So I was like, mom, you and I should become doulas together because you were so good at it and I would love for you to be other people's doulas. And she was like, what? And then as she started to reflect, she realized that that was kind of the role that she played in our family. She was the person that people go to. She's the oldest of 6 sisters. She was the person that everyone went to to ask those questions about pregnancy, motherhood, childbirth, healing, breastfeeding, and she was present at almost all of her nieces and nephew's births. So, she realized that she had already been doing this sort of support, standing in that middle space, educating, and providing hands-on support for our family. And I'm like, we should just get formally trained, and then we'll start to do the agency together, and we'll find some other black doulas. And then we early on discover, it is very hard running a business and being a doula. 

Lily

I can imagine. 

Tayo 

It's really hard. And so I would say a tip for any person who wants to become a doula is learn how to separate the business from the birth work. Being an entrepreneur requires a lot of strategy and systems that will support you being a profitable entrepreneur. But doing birth work is very separate from the capitalist idea of trying to build revenue. And so it's super important that you don't inflate the two kinds of goals of having a very impactful career as a birth worker and then being a profitable entrepreneur as an individual doula. And if you have the opportunity and it aligns with your values, join a collective or an agency. Be a part of a community. So that the burden of being a business owner and a direct service provider doesn't begin to diminish your work as a birth worker. 

Lily

Thank you. With that in mind, I can't imagine balancing running a business with the very personal and patient and time intensive work of being a doula. Across our research, we've noticed that doulas are often most accessible to folks of higher socioeconomic status, and I'm curious what you think needs to be done to make doulas an accessible resource for patients everywhere, you know, especially everybody experiencing systematic neglect and all these other barriers and forms of marginalization in healthcare. 

Tayo

 I think there's a lot that's already being done to increase access to doulas, but the first thing is socialization. People need to understand that doulas are not an inaccessible commodity. They are people who belong to the community. Doulas are people who are from a community who have extensive birth and perinatal knowledge, knowledge about pregnancy, birth, postpartum, parenthood, and they should be a part of the community. That should be your neighbor. That should be your auntie. That should be your grandma or your cousin or whoever in the community that you go to when someone's pregnant to ask questions. It should not be that we have to hire outside of our community and pay money to those people. Now, doulas should be compensated for their time, but there is a really clear model of healers and practitioners of all kinds, serving their community and their community taking care of those healers. So we don't let the grand midwife of the community or the grandma who cooks all the food when people are sick and those are the remedies, we don't let her go without having her needs met because she's such a valuable member of the community. We ensure that she has everything that she needs and more, and it's very similar, the way that doulas are able to show up, when their needs are met. So we want them to be paid, yes. But that doesn't mean that we want to pass that cost directly to the person receiving that care. So I always say, Look at what is standing between the doula and the provided or the patient population. We want to make sure that the doula doesn't have anyone standing between them and the patient population, not even a funder. That could be insurance. That could be grant funding. Doulas should be so accessible that someone else is managing the money. The money should not get between the doula and the person they care for. It should be very similar to when you go to receive any other kind of healthcare. You don't give the doctor your money. We keep it separate. And so to preserve the integrity of what we do as doulas, it is really important that we separate those things. And then in terms of what is already being done in Chicago, we advocate extensively and we are unwavering about it. Like pay people upfront for doula services, pay the organizations that are doing this work, don't have them bill you because people need to be able to build out their entire care strategy and not wait on an unknown. Will this person come to all their prenatal visits? Will I make it to their birth so that I can build it? So one of the things that we advocate for is if you contract for doula services. Pay the organization upfront and give them the money because billing insurance is extremely cumbersome.  

Sophia

Yes, it's true. I know that in California, doula services are now covered by Medi-Cal. I believe how it works is that doulas will contact the insurance companies to request compensation. 

Tayo

Or they'll build them directly. So they have a billing code for what they've done if it was a prenatal visit, a postpartum visit or the birth. And in some states there are a few other things that are available. And then they have to create a bill like, essentially, a healthcare provider, which we're not. We belong to the community. And there are a lot of areas where what we do is similar to folks in the healthcare field, but we really are folks in the community. We don't belong to healthcare in general. We don't belong to the big medical industrial complex. We don't belong there. We are situated in the community. Even the process of getting involved with an insurance payer through the process of billing is kind of like, what are you doing here? We're not OBs. We are not providers. We’re not clinicians. 

Lily

What are your thoughts on doulas supporting births in hospital settings, given the fact that, as you’ve said, doulas are community workers for the community, from the community?

Tayo

Doulas belong in the community, but that doesn't mean that we can't work in collaboration with hospital systems. It's just like spouses of any kind. Whatever the non-birth impairments, they live in the community, right? They belong there, but don't they come to the hospital? When the person gives birth, they do, so they belong here too, and we can work with them. We can work with dads, we can work with non-birthing parents. If you want to, you can, but we're gonna get some other stuff out of the house. So there's always space to bring the infrastructure around what birthing people are saying they want. Doulas exists in the community, and birthing people are bringing this part of their community to the hospital, consistently. Hospitals see how beneficial it is. So make space for the doula there. I do think that there is lots of room for hospital systems and healthcare networks to accommodate doulas, welcome them, embrace them, support them. And not just toy with the idea of encompassing them. You know, like we own y'all. Y'all are a part of us now. No, we actually belong in the community. We are always going to be in the community, but thanks for letting us be here. And thanks for welcoming us when we're here. 

Sophia

That makes sense. Going back to what you were saying earlier about how doulas are a really important part of postpartum care, I think a lot of patients sort of feel like they receive a lot of prenatal checkups in the hospital, but, after giving birth, they have immediate postpartum checkup, they have their 2 week postpartum checkup, and then that's it. And they sort of feel like they're being dropped off a cliff. How do you feel your work or your care model helps to fill this deficit in modern maternal medical care?

Tayo

So doula's care extends far beyond the birth. We're not just there to support you when you have your baby, but we watched the vagina get 10 times bigger than it ever was ever. And so we're going to have some stuff to talk about after you have your baby. We built this relationship throughout your pregnancy and then we solidified it because we were together during the most pivotal moment of your life as a parent. We already have lots of reasons to continue staying in contact and the conversation flows so safely. There's trust, there's context. And so this pregnant person doesn't have to explain to someone what happened at their birth and why they decided not to breastfeed and why they don’t want to discuss challenges that they're having. They just want to get help, you know? So because their relationship is there and it's intact, doulas play this excellent role to keep people connected. You're not just falling off the side of the earth because your doula is checking on you. And she's like, yo, are you still bleeding? And you said it smells weird. And then you said your baby's belly button smells weird too. And that you haven't eaten and you said you started getting a rash. In comparison to folks who don't have that, kind of just brewing at home trying to figure out who she got to talk to. Is this something I should bring up to my provider? And all of the nerves and medical mistrust that starts to brew in that postpartum time. If you didn't have a positive birth experience, you may not feel encouraged to go back to the hospital when you start feeling a little queasy. You might feel like, you know what, they didn't listen to me the 1st time. I don't think they'll listen to me again this time, you know? So doulas play this special role in being again. Maybe we don't belong to the hospital. So whatever feelings of medical mistrust you might have, I get to work around and underneath those. Because that's not the core of how you feel towards. 

Sophia

I know that in the hospital setting a lot of doulas sort of serve as advocates and help their patients advocate for what they want their birth experience to look like. What do you think that looks like logistically? And then also, how do you think that can help those who are giving birth have the birth experience that they are wanting? 

Tayo

When you work with a doula, if you have had the ability to build a relationship with them throughout your pregnancy, you create a plan that outlines the things that are really important to you. People know that to be a birth plan. Your job is not to implement the birth plan, but to remind you. Say you were opting for the epidural. In your birth plan, you say that you didn't want to be separated from your partner. And when you get the epidural, your partner's going to be asked to leave based on the policy here at this hospital. So what can we do to ensure that this part of your birth plan, this part that was really important to you, remains intact? Do you want us to call you on video chat so that you're not alone? Getting an epidural by yourself is hard. It's so bizarre. It's so weird that they do that. And now they're saying, like, we only do this for safety because, well, number one, it's a sterile environment, and number two, they've had some partners to pass out during the procedure. But, it is also one of those standard policy things that has a crazy impact. A person is in the worst pain they’ve ever been in, which is why they're asking for anesthesia to take the sensation that they have from the bottom of their breasts to their feet away. So I'm already in the worst pain I've ever experienced. This is like the max that I can tolerate, and now I'm alone, and I'm hunched over, so that someone can insert a catheter into my back while I'm contracting. It's not like you have to put a pause on labor. And so having the support of the people you brought there with you is important at that moment. What if something is done wrong? What if I am more afraid and freaked out than I've ever been for any other procedure in my life? And now I'm in labor, about to have a child, because it doesn't negate that I'm still a birthing person who deserves all kinds of bodily autonomy and respect. Now, I'm worried like, yo, this is actually much scarier than going through this contraction and I have to sign papers, you know, and I'm getting my back shaved, it's a much bigger deal. So the doula is really just kind of there to hold space and ask some questions before that happens and prepare a little bit. Since we know that this is a policy here where folks may have to be separated, how do we prepare for that? And then how do we get that pregnant person's mind ready? This is not something that we want to take you by surprise. Our bodies are picking up all kinds of stimuli about whether the environment we're in is safe to welcome a baby. And when our bodies make that decision, there are real outcomes like your labor stalling or your baby not being in the best position because your uterus and all of the other systems that are holding this pregnancy together are not in alignment because you're actually scared. You're actually thinking about whether you just signed your rights away on the consent form that you signed for your epidural. You’re like, Dang. Did I even read the whole thing? and What if something happens to me? and Did I really want that? I don't even know what medication it is using. What if it doesn't work? And really this is the time when your body is looking for signs to show everything's fine. And so doulas are just a reminder that, Hey, this is still a normal thing happening. This is still something that we want to center this person in. It's not any other type of scary medical procedure. It's just a birth. So those are the ways that I think we're really trying to make sure that people remember to center humanity and normalcy in birth. That's how advocacy works, not us butting in like, Hey, she didn't want that. It’s really us reminding people. These are humans. You're a human. We're all humans. We're all people, making more people. We are not doctors or nurses. We're people here. And it's a lot easier to advocate for someone when their humanity is brought to the table first. So we try to just remind everybody like, hey, we're all just people here. 

Lily 

There is such a massive wealth of knowledge that seems necessary to be an effective doula, like beyond everything that you have to be aware of regarding the pregnancy and the childbirth processes and lactation, you also have to be aware of hospital policy and the specific patient's needs. Can you talk briefly about your experience going from someone who had experienced having a doula to becoming a practicing doula?

Tayo 

Yeah, I think every doula just learns on the go. No doula training is going to prepare you full scope for everything that you're going to experience and see. And that's the cool thing about being a doula, is that you come with your tools, and that basic tool bag has a screwdriver, a hammer, and a saw in it, and you'll continue on, and your tool bag, even after a year, just frequently attending births, will be so diverse, because every birth is different, and you're going to learn something different, and everybody is different. So someone's labor might look very different and you can't just copy and paste those tools. And so even the hospital policies vary from place to place. So, I would say the journey is really trusting that there is not a singular set of knowledge that's going to make me a good doula. It is the fact that I recognize nothing is the same anywhere. And I just show up ready to learn. There's nothing that is absolute in birth, truly. And it can change so quickly. So a good doula has to recognize there's not an information cap. We're all going to learn. And when you don't know, you should be in a safe environment to ask. And I know there's a lot of nerves in the beginning of your career as a doula where you're like, I should have known that and I never learned that. So I always encourage doulas to just ask a question. You are not supposed to know everything because we did not study obstetrics. Doulas really are just professional support people. We're just here to support. So it's not truly a necessity to know all that stuff and that can make your job a lot easier. Like, if you're in a hospital and we're talking about whether this induction seems justified or not, you want to know some things about obstetrics. We love to encourage people to learn at your own rate, you know, and be in community with folks who can help fill in the dots for you, which is kind of hard for some doulas because there are not a lot of spaces that are not inviting of doulas to collaborate with clinicians. 

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