Systematic Racism In the Hospital Setting for Doulas

In 2020, We are constantly being reminded of America’s Systematic racism, from financial standpoints to socioeconomic issues within the community, we are now faced with hospitals attempting to implement policies to diminish the support of doulas in their hospitals.

Doulas are privately hired to ensure transparency between medical professionals and patients to ensure and encourage informed consent. Doulas provide culturally appropriate emotional support to the laboring mother, helping her to cope with labor in their own way. Whether mothers feel more comfortable with the lights dimmed or turned on, whether they want to birth their baby in a specific position that works best for their bodies, Doulas are a life saver.

The greek word Doula means “women Servant”, that is who we are and what we are about, serving another women from pregnancy to labor and even after laboring, we are there for mothers. We develop a relationship between mothers’ and their families, so that they can ask any question without having to fear not being heard. Doulas never leave the side of the birthing body, unlike nurses and doctors who must be present for all of the labor and delivery rooms. We are able to immediately alert doctors and nurses in the event that something should go wrong. We are trained to coach our clients through pain relief, to ensure they do not birth alone, and to prevent birthing bodies from common consequences of obstetric negligence and abuse that occur in hospitals. 

We want to be able to protect the integrity of a Doula while protecting our clients. We aren’t there to serve the hospital but the client only and that this is what we want to continue to do. When reading the vendor packet it states that we as Doulas will be mandated to explain our vaccine status. We want to reiterate that we are NOT a hospital employee, we are not selling anything to the hospital, and that WE are privately hired/contracted by our clients. Mothers, fathers, grand parents and siginifcant others will never have to provide their status, so WHY should we?! Denying birthing people access to their doula of choice infringes on their human rights.

Doulas have PROVEN to reduce outcomes for cesareans, medical intervention as well as ensure healthy, happy, living babies and bodies. The infant mortality rate according to Roy Cooper, the governor of North Carolina, decreased by 9% in 2016, thus decreasing the outcomes for black babies still to double the chance of dying than white babies. nnThe policies implemented by Novant Health in North Carolina and possibly others include:n- Doulas must sign on to hospitals as VENDORSn- ANNUAL FEE of 385-485 for NON vendorsn- Drug Testn- Background Testn- Up to date on all vaccinesn- Full Certification nnFor example, the processes for DONA certification, takes years to complete, and REQUIRE that we are in hospitals doing births IN ORDER to be certified. This will effectively remove uncertified doulas, which disproportionately removes doulas of color. This further requires a demand for increase in pricing for doulas, of whom ordinarily work on a sliding scale to be sure they are capable of offering care particularly to birthing bodies unable to pay upwards of 1100 dollars for support. nnThe business of medicine is not the business of doulas. These policies are a stark reminder of how we came to the 1 in 3 black maternal morbidity rate as well as the 12.5 infant mortality rate for black children. Very simply, this implementation would reverse our efforts to empower and educate our birthing people and place them in a dangerous return to a darker time in medicine. As doulas who have practiced for many years and as a collective, we are concerned that the requirements to become an “approved vendor” may in fact limit our clients’ access to doulas. We are hired privately by our clients, invited to birth by our clients, and are actively regulated by our certifying agencies.

We are very excited to be considered part of making birthing with Novant a remarkable and safe experience, but truth be told, we have always been the midst of Novant combatting maternal death rates and infant mortality, as well as other hospitals in and around the United States. nnWe feel that the other qualifying requirements impart discriminatory implications on doulas in the following areas:nn1. Financial imposition posed by costs of Novant orientation, screenings and background checksnn2. Privacy issues in regards to immunizations and background checksnn3. Fees incurred to become “vendors”nnWe are reiterating that we DO NOT provide any type of medical care to clients, we are not affiliated with Novant as employees or contractors, and work through private hire by our clients. Upon reading your Code of Ethics regarding vendors, we do not qualify as a vendor for Novant, and therefore should not have fees and regulations imposed as such. We have not, nor will we, actively solicit clients on your premises per regulations. This also eliminates us as “vendors”. Policies needs to increase access, not reduce or limit to only a select group of doulas. Discrimination both in skin color and economic ability and contributing to the destruction of small businesses indirectly causes economic discrimination.

Mothers and Babies are experiencing trauma and some are dying while we wait to be allowed back into the hospital settings. We can safely do it by showing certification or a business card at the door, health screening for illness, wearing a mask and staying with the client. nnThese vendor fees and requirements also can indirectly cause economic discrimination, in that the fees required to become a vendor will inevitably be reflected in our cost to clients,, thus making it unaffordable for clients previously supported by pro bono or low cost doulas. Also, by removing uncertified doulas you will disproportionately be removing doulas of color. Black and brown birthing people and their babies are significantly more at risk of death and morbidity during childbirth, but having the doula of their choice helps to mitigate this risk. We are aware that by your Vendor Code of Ethics, this would be in direct violation of your anti-discrimination policies.nnTo avoid potential discriminatory issues with doulas in training, doulas that work pro bono, and doulas that may not have the financial ability to pay the “vendor fees”, we suggest the following criteria to ensure proper vetting and assure that the role of a doula is not abused by the public:nn1. Proof of certification or a doula training or an active doula businessnn2. Signed consent to follow Novant safety practices (including Covid protocols and Bloodborne Pathogen guidelines)nn3. Identifying badgennThese guidelines can easily be implemented by security at check in points and/or pre-registered online.nnAttached you will find other hospitals’ policies regarding doula regulations during covid. As you will find, none are considered “vendors” and there is no mention of fees for supporting clients. The guidelines set forth by other care facilities prevent the public from abusing the role of “doula” while enabling birthing people to access the doula of their choice.