The Quantification of Doula Care.
Doula care is impactful. Most parents will say that they couldn’t have done it- their birth and/or postpartum time- without their doula. But the most important components of doula care, and the “it” that parents speak of, are often not categorizable. And the quantification of doula care can reduce its impact.
However, some within the insurance/medical complex would have us think otherwise. There exists an inherent need for measurable outcomes, charts, spreadsheets. And it is up to program administrators, not necessarily parents and doulas, to define “success”.
When parents and doulas are defining success, doulas can be successful even if there aren’t clinical words for it.
And they aren’t checking all the boxes of measurable outcomes. And parents are struggling with things like postpartum depression. Or baby not gaining weight according to the charts. Or low milk supply. Or all of the above. (Especially all of the above.)
Doula care really isn’t about quantifying outcomes based on a predetermined list of goals set by an outside administrator… Getting x hours of sleep. Producing x ounces of milk. Baby’s weight gain, birthing person’s weight loss. Getting onto a schedule. Getting “back to normal”. And all the other gettings and producings and gains and losses that we have become so obsessed with tracking.
Instead, the whole entire point of being a doula is to nurture, witness, comfort. To help parents foster a sense of being well resourced and cared for, on their terms. And what if we celebrate those things as accomplishments, equally important and as essential as all of the measurables?
Even calling doula care “work” can be reductive. Yes, it is work. It can be challenging, frustrating, hard. But I came into this as a vocation, not a job. A calling, though called by what I’m still not sure… A desire to change the narrative and practices of birth and postpartum that were causing harm? An impulse to help parents feel supported and heard? A wish to leave this corner of the world better than it was when I got here? Yes, and then some. Like creating more access to doula care for parents who may otherwise not have it.
How are we currently creating access to doula care within the capitalist system we find ourselves living under?
Many individual doulas are offering free or reduced cost services, thankfully. But most doulas also need an income to pay their bills, so that’s not sustainable over the long term. Community-based doula programs are being created, thankfully. But there is a high rate of burnout and turnover. And often an annual budget that is dependent on the whims of grant funding. This is also not sustainable in the long term.
And now there are insurance companies and Medicaid programs that are beginning to cover and reimburse doula services, thankfully. But at what cost? What cost to the doulas and the parents themselves? And how do we perceive doula care when it is reduced into billing codes and quantifiables? As we’ve witnessed in other caregiving professions like nursing, social work, and teaching, when it becomes more about charting and bureaucracy, people suffer as a result of the decline in care.
Doula care is radical, wild love in action; it doesn’t always fit into tidy checkboxes for reimbursement. When we reduce care into categorization, we lose part of its power. Like reducing our vital, creative life force down to a mechanistic model of human beingness.
I don’t write any of this from a place of having answers. Rather, I think keeping an eye on the questions themselves is how we can best navigate this new territory. Out of the questions will come creative solutions, along with a lot of bumps and growing pains along the way, just as in birth and new parenthood.
