Dear Julie,

I’d like to address your Jan. 4, 2017 blog post directed to me. Thanks for taking the time to express your disappointment in me and in DONA. There is no need to apologize to me for anything. You have made choices that were best for you and have found a good home with ProDoula.

The widening gap between ProDoula and DONA (and perhaps other doula organizations as well) was highlighted by the recent BuzzFeed Post, “Inside the Million-Dollar Get-Rich Doula Clique,” by Katie Baker. This gap is not unique to doula organizations. It is an example of the growing pains that come with success in small organizations. Differences of opinion on goals and what constitutes fair and ethical treatment of each other and of the public cause divisiveness, anger, and hurt. I think what we’re seeing here is a strong negative reaction by ProDoula to the original values that drew people to becoming doulas. Many birth doulas who had life-changing (positive or negative) birth experiences became inspired to help others have to positive births. Some find fascination with everything about birth. Some are moved by the inequities in our society that penalize those without privilege. Some are dismayed by the state of maternity care in their countries, and believe that as doulas, they can help improve outcomes “one birth at a time.” Many are willing to sacrifice financial gain because of their commitment to these values.

It’s true that altruism and passion for childbirth in themselves, are not enough compensation to sustain many (most?) doulas. Money is a necessity (not a luxury), and it is very sad when experienced, highly skilled, ethical, beloved doulas must leave the field for financial reasons. I think ProDoula was founded as a strong reaction against these values, and offers a totally opposite view of doula work than what I have described, including the tenet that doula care is a luxury and that financial success should be the primary goal for the doula. I’m very glad for you that you and others have found a home in ProDoula, where your described right to provide a luxury service to those who can pay high fees are emphasized. There is no reason for you to apologize to me for anything you have done, including being disappointed in me for my comment in the BuzzFeed interview, paraphrased by Katie Baker, the article’s author:

“The doula movement was founded on the needs of the woman. . . . ProDoula’s business strategy will do nothing for improving birth in this country, and only improve their pocketbooks.”

(I would like to note that I also told the reporter that by continuously meeting the emotional and physical comfort needs of laboring people, birth outcomes are actually improved.)

That statement may sting a bit, but isn’t that the point of ProDoula, eloquently and colorfully laid out by co-founder Randy Patterson? With certainty and pride, she boasts that ProDoulas can earn a high income if they promote doula services as a luxury item for those willing to pay very high fees. I do feel very sad when comments are made that denigrate doulas who bring different values to their work, such as “A doula for every woman who wants one” (DONA’s vision); willingness of some to volunteer their services or adjust their fees; supporting agencies and individuals who are increasing access to doula services for underserved families; ensuring that women have an ally and guide as they navigate the complexities and stress of today’s maternity care and birth itself. The difference in values exists, but shouldn’t lead us to disparage each other.

You point out that you weren’t able to earn enough as a DONA doula and that your business and income are much greater as a ProDoula, now that you’re charging high fees and focusing only on those who are willing to pay those fees. It sounds as if you have found a great way to make money doing what you love, without being concerned about those who can’t pay what you require. I don’t know if you and Randy Patterson and other ProDoulas realize that many DONA Doulas are also able to meet their financial goals with their doula work, which may be combined with other birth-related work (postpartum doula work, massage therapy, childbirth education, lactation support, placenta encapsulation, etc.). DONA Doulas’ business promotion techniques may be less aggressive than ProDoula’s, and they follow a strict code of ethics that requires, among other things, respectful treatment of other doulas, all clients, the public, and professional care providers. These DONA doulas work very hard and many do well financially, even while sometimes offering a sliding scale or volunteer for someone who can’t pay.

As DONA and other organizations have evolved to meet the changing needs of the growing numbers of doulas who want to make this their life’s work, many opportunities have become available to master business skills and build a financially and emotionally sustainable life style, despite the challenges and unpredictability of being on call, and never knowing when or how long their clients will need them. It remains critically important to DONA to maintain its original values, which are based on the needs of childbearing women and the strong evidence that birth outcomes are improved by continuous support from a trained doula. It is very possible for doulas to succeed without disparaging other doulas. Only 6% of women in the United States have doulas, and fewer than that in most countries. We all should be working to spread the word among the childbearing public about the true benefits of doula care. Instead of wasting our energy and our dignity denigrating other doulas, let’s meet the needs of expectant and new parents with excellent support and guidance toward the best birth possible, as THEY define it.

In the doula spirit,
Penny Simkin