First things first, this is going to be a really LONG post. That being said, I think it is important to look at the bill itself (as it stands, having passed the Assembly and waiting on the Governor's approval or veto).
This legislation is a direct result of Cuomo's Medicaid Doula pilot program. Any provider seeking MEDICAID reimbursement must be in some way credentialed. To protect the very population that Medicaid serves the credentialing must be standardized to minimize those seeking financial gain at the expense of the poor. In order for the Medicaid pilot program to become a full fledged program this standard must EXIST. This is the background of this bill and the identical bill in the Senate. It is unlikely that the Governor will veto the bill that allows his previous mandated program to run.
The reasons I have been bludgeoned over the HEAD with are that regulating the Doula industry will make Doulas beholden to the Hospital through the State, that Doulas are not medical personnel so they should not be regulated, and that is is bad for Black and other minority Doulas and potential Doulas and thereby clients in the same standing.
There are a number of professions not just medical/healthcare (barbers, cosmetologists, teachers, etc.) that are regulated in some way by the State. It can sometimes be a headache, and I am sure for some a burden or barrier to those professions, but it will not in anyway make Doulas beholden to the Hospitals and their policies. No more than they ALREADY are. State Certification of the profession elevates the profession and may give the profession standing to lobby against the hospitals for protections for Doulas in hospitals. The issue here is not the State but a fro profit hospital/medical system.
If the doulas of privilege, that are spending countless hours fighting against this legislation, would put the same effort in to LISTENING to organizations like Ancient Song and support those voices when it comes time to create the list of approved training programs we might have a more balanced list of approved training organizations. Now approved training/education isn't just pulled out of a hat. There are guidelines: minimum hours, mandatory topics to be covered, credentialing of instructors (this one might prove to be a place of concern as the "credentialing" is typically done from a white privilege point of view) and then organizations wishing to have approval will apply for approval (again, yes there may be financial barriers here), and those wishing to take programs not on the approved list will have the opportunity to present their organization as meeting the criteria and ask that it be allowed (yes still some concerns with time, money and knowledge of the process for some).
There are areas that could limit or act as a barrier to some people becoming certified doulas for the purpose of Medicaid reimbursement, but if the same number of voices come together to support the voices from those groups negatively impacted (instead of speaking FOR or OVER those groups) there is a great chance of equity in this Certification process.
As for DONA's lobbying against the bill, they are doing so because if "Certification" is $40 and there is a list of approved programs, DONA stands to lose a large amount of income from it's NYS pool of potential trainees. And the annual re-certification fee as well.
The Following is the Language from the Bill itself. This link will take you to the official page with the bill and it's status.
My thoughts appear in the bill inside [square brackets]:
A364B (ACTIVE) - SUMMARY
Authorizes the professional certification of doulas; only those certified may provide doula services defined as continuous emotional and physical support provided by a certified doula throughout labor and birth, and intermittently during the prenatal and postpartum periods.
[This language is vague as this ONLY applies to Doulas wishing to be Medicaid Reimbursed Doulas, but I fully support regulation of the WHOLE Doula trade as there is no uniformity and there have been too many times that Families believe they are getting one thing, are told by their prospective Doula that they are in fact getting that one thing (actual continuous labor support from whenever the families calls for it until after the baby is born and they are settled in recovery) and what they actually get is something less than that.]
A364B (ACTIVE) - BILL TEXT
S T A T E O F N E W Y O R K
________________________________________________________________________
364--B
2019-2020 Regular Sessions
I N A S S E M B L Y
(PREFILED)
January 9, 2019
___________
Introduced by M. of A. PAULIN, GOTTFRIED, GALEF, JAFFEE, L. ROSENTHAL,
COOK, SEAWRIGHT, ARROYO, BLAKE, DICKENS, PICHARDO, THIELE, McDONOUGH,
SOLAGES -- read once and referred to the Committee on Health --
committee discharged, bill amended, ordered reprinted as amended and
recommitted to said committee -- again reported from said committee
with amendments, ordered reprinted as amended and recommitted to said
committee
AN ACT to amend the public health law, in relation to professional
certification of doulas
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1. The public health law is amended by adding a new section
2509 to read as follows:
§ 2509. CERTIFIED DOULAS. 1. DEFINITIONS. AS USED IN THIS SECTION:
(A) "CERTIFIED DOULA" MEANS AN INDIVIDUAL CERTIFIED UNDER THIS SECTION
WHO PROVIDES CERTIFIED DOULA SERVICES.
(B) "CERTIFIED DOULA SERVICES" MEANS CONTINUOUS EMOTIONAL AND PHYSICAL
SUPPORT PROVIDED BY A CERTIFIED DOULA THROUGHOUT LABOR AND BIRTH, AND
INTERMITTENTLY DURING THE PRENATAL AND POSTPARTUM PERIODS. [This does not prohibit non-certified doulas from providing support, it prohibits them from saying they are certified]
2. USE OF TITLE. ONLY A PERSON CERTIFIED UNDER THIS SECTION SHALL BE
AUTHORIZED TO USE THE TITLE "CERTIFIED DOULA". [This is where all the hackles got raised. There are plenty of Doulas in NYS who have paid good money $250+ just to be certified, plus training sessions, plus additional classes, plus CEUS, plus annual fees to the certifying organization. This has up until this time be reserved for those who are financially privileged, as the poor can generally not afford the training and certification to become a privately certified Doula. State Certification creates uniformity and equity, leveling the playing field for individuals from poor communities who wish to become Doulas to others in their community]
3. CERTIFICATE. THE COMMISSIONER SHALL ISSUE A CERTIFICATE AS A CERTI-
FIED DOULA TO AN INDIVIDUAL WHO APPLIES FOR CERTIFICATION AND WHO QUALI-
FIES UNDER SUBDIVISION FOUR OF THIS SECTION.
4. REQUIREMENTS FOR A PROFESSIONAL CERTIFICATION. TO BE CERTIFIED
UNDER THIS SECTION, AN APPLICANT SHALL FULFILL THE FOLLOWING REQUIRE-
MENTS:
(A) APPLICATION: FILE AN APPLICATION WITH THE DEPARTMENT. [OK]
(B) EDUCATION: SATISFACTORILY:
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted. LBD01668-04-9
A. 364--B 2
(I) COMPLETE AN EDUCATIONAL PROGRAM, IN ACCORDANCE WITH THE COMMIS-
SIONER'S REGULATIONS; OR [Uniformity of bare minimum trainings, I'm OK with this]
(II) SUBMIT EVIDENCE OF CERTIFICATION, THE EDUCATIONAL PREPARATION FOR
WHICH IS DETERMINED BY THE DEPARTMENT TO BE EQUIVALENT TO THE FOREGOING,
FROM ANY STATE OR COUNTRY, SATISFACTORY TO THE DEPARTMENT AND IN ACCORD-
ANCE WITH THE COMMISSIONER'S REGULATIONS.
(C) EXAMINATION: PASS AN EXAMINATION SATISFACTORY TO THE DEPARTMENT
AND IN ACCORDANCE WITH THE COMMISSIONER'S REGULATIONS. [All fields regulated by the State have to pass some form of exam, proof that you understand 1)the training you took, and 2) your scope of practice]
(D) AGE: BE AT LEAST EIGHTEEN YEARS OF AGE.
(E) CHARACTER: BE OF GOOD MORAL CHARACTER AS DETERMINED BY THE DEPART-
MENT.
(F) FEE: PAY A FEE OF FORTY DOLLARS TO THE DEPARTMENT FOR CONSIDER-
ATION OF AN APPLICATION FOR CERTIFICATION. [$40 fee is lower than that of the LARGEST and BEST known privately certifying organization. DONA requires a $50 packet fee, with a $110 Certification fee, plus an annual fee of $110, and CEUs. I am unclear if you have to pay the $50 each year to prove that you have taken your CEUs and remain certified with DONA]
5. SCOPE OF PRACTICE. NOTHING IN THIS SECTION AUTHORIZES A CERTIFIED
DOULA TO ENGAGE IN ANY ACT WITHIN THE SCOPE OF PRACTICE OF ANY OTHER
PROFESSION UNDER TITLE EIGHT OF THE EDUCATION LAW OR ANY OTHER LAW,
UNLESS THE CERTIFIED DOULA WOULD BE OTHERWISE AUTHORIZED TO DO SO BY
LAW. [This language specifically exists because NYS Doulas are taking Spinning Babies training which was designed for Nurses, Midwives, Bodyworkes, Chiropractors, etc. who are advised during the training to remain within their OWN professional scope. This means as a NYS LMT I won't do something that falls in the Chiropractic field or Midwifery field. The number of times a Doula says they can massage their client is sad. We all know they mean untrained rubbing of back, arms and legs (which feels good) but is NOT massage.]
§ 2. This act shall take effect on the ninetieth day after it shall
have become a law. Effective immediately, the commissioner of health
shall make regulations and take other actions reasonably necessary to
implement this act on such date.
The following is language that accompanies the bill: "In an effort to combat maternal mortality and improve the health of newborns in New York State, Governor Cuomo introduced a series of initiatives including a pilot program that will allow doulas to be reimbursed for providing services, which would make doula services more accessible through overcoming income obstacles.
In order to standardize who may be reimbursed for doula services, this legislation provides the definition of a certified doula and states that only a doula certified under this article shall be authorized to use the title of certified doula. Furthermore, it outline s the requirements for certification including age restrictions, education and examination requirements.
Ensuring that certified doulas are properly trained and credentialed so that they are able to deliver the support and services that are so valuable to patients is essential. Additionally, certification will bring greater awareness to the critical work of doulas, which may increase availability and access to doula support services. Note that the bill does not create an exclusive scope of practice. It creates the title "certified doula," provides for becoming a certified doula, and restricts use of the title."
The reason that this language that accompanies the bill is important is because it clarifies the reason for the bill and it's intent. The intent is to create a standard ("Certification") for reimbursement of doula services, making doula services more accessible through overcoming income obstacles via MEDICAID.
In order for the Medicaid program to move OUT of the pilot phase and make it possible for MORE poor families to have the PAID support of a Doula there must be some regulation. Are you really suggesting that the regulation should be in the form of white privilege if you can AFFORD to buy certification from DONA, MATRONA or 30 or so OTHER white centric Doula training and certification programs is really a BETTER option then ALL of the privileged doulas rallying with organizations like Ancient Song Doula to ensure that training organizations that center in Minority cultures and practices are among those approved (along side DONA - this is a GIVEN!) as "Acceptable" training programs. AND please let's stop giving DONA a VOICE in this debate. That is like allowing EXON to run the EPA (oh wait, we allowed that too). DONA makes money by selling Certification to those who can AFFORD it, they WILL in FACT be hurt, not only by a $40 certification fee through the State but in having a ready list of approved organizations through which to do their training. MANY people currently chose DONA because it is the ONLY organization they have ever heard of and are WARY of having the ability vet other organizations.
This was a letter written by a fellow Rochester, NY doula, who I highly respect. My responses to her comments are again in [brackets]:
"Dear Senator/ Representative,
As a member of the Doula Cooperative of Rochester [I am not a member of the Rochester Doula Cooperative because I feel that the group at large is at odds with who I am and the work I do in the Birth Community. Being a member of the Cooperative is simply paying a nominal annual fee $25, last time I looked] and a certified birth doula through DONA International [And right here is the core of the issue. She went through the motions: took the initial training (I believe it was around $500, as I took the same training 3 years ago), took the additionally required Breastfeeding training course (no idea on the cost of this as I chose not to be certified and not to take the training as I didn't have the money for the course at the time), paid the $50 fee to get her Certification Packet, Completed the packet (which included reading books from a suggested list, most of these books were not available at my Library (Beautiful Birth Choices has a wonderful lending library) so some will have to spend money to get the required reading done), attended 3 births in the time frame allotted (I think 2 years), received 3 letters of recommendation from nurses, doctors or midwives at those births (this right here is where systemic racism begins to rear it's ugly head. Minority Doulas are more likely to be seen by Doctors, Nurses, Midwives, etc., as argumentative, unprofessional, or otherwise unqualified), and completed the packet with the $110 certifying fee. There is also an underlying current of being able to remain a member, and therefore certified, by paying a $110 annual fee. This is a minimum of $700 to become a DONA certified Doula not counting needing to be able to take Friday off from work and not working a job that works on Saturday or Sunday in order to take the 3 day training to begin with) , an international organization of over 12,000 members in 50 countries [DONA has a stake in the status quo as they are the largest certifying organization in the country and may in fact lose money in NYS], I am writing to urge you to oppose Bill A364B that seeks to authorize the professional certification of doulas through New York State. While the intention to provide all birthing people with access to doulas is a noble one, I believe this bill will be detrimental to the very title “doula” and profoundly impact the very people it is seeking to support in numerous negative ways. [I believe just the opposite and have started to spell out why. Financial ability (also known as privilege) is a huge current barrier to many wanting to be Doulas]
Doulas offer emotional and physical support during pregnancy, birth and the early postpartum period. Additionally we share unbiased, impartial and evidence-based information [this is a hot button topic, the information I hear being shared is pro "natural' birth with a heavy hand against Obstetricians, Hospital Staff and Epidurals or other interventions] about a birthing person’s choices in childbirth so that they are able to make fully informed decisions about their care. Among many other benefits, doula supported births are 25% less likely to end in a Cesarean Section 38% more likely to result in infants with higher Apgar scores (Evidence Based Birth Evidence on: Doulas). [Evidence Based Birth is a Nurse(?) who runs a for profit website and podcast]
It has been explained to me that the state seeks to regulate the certification of doulas so that we can seek reimbursement from medicaid and other insurance providers [this is JUST for Medicaid, but it may open the doors to private insurance choosing to cover Doula services with their own guidelines and requirements], thus expanding access to doulas for all birthing people who would want one. However, if the state were given the authority to regulate [the bill as it stands does not seek to regulate doulas, just the certification process] and certify doulas this would inherently alter the very fiber of what doula support means. [No it would not.} At the core of a doula’s efficacy is that our role and agenda is tied solely to the birthing person’s agenda.[As a licensed massage therapist in a totally state regulated field my role is still to serve my client, chiropractors that I have spoken with say the same thing.] In other words, a doula’s primary responsibility is to the birthing person - not to a hospital administrator, nurse, midwife, doctor [the bill does not change this, nor is the bill responsible for the current doulas v. hospital system that exists] or any other entity involved. State certified doulas will be tied to the requirements of the state [the requirements of the State are: approved training, uniform exam, test fee and possibly annual fee and CEU requirements, this does not impede Doula care to their client, it does just the opposite] and insurance companies [many chiropractors choose not to bill insurance companies, and instead provide a bill to the client that they can seek reimbursement from the insurance companies so as to not have the headaches, and hassles of jumping through hoops for the insurance company and focus solely on their client's well being. Massage is not currently in New York State covered by private insurance companies, however I do have clients that are reimbursed through their private insurance for my full rate] that pay them rather than solely supporting the interests of their clients. [If a provider feels that insurance companies are interfering with their ability to provide quality care then they have the option of ONLY taking private pay clients, but those individuals who CHOOSE to be Medicaid Doulas do so because they want to serve that specific population, most at need, and least able to afford a private doula. So let's call a rose a rose, this is a white privilege issue. Those who are rallying hardest against this bill have no intention of being Medicaid Doulas nor do they intend to serve the Medicaid population Gratis, so rather than allow an at risk population access to a service that could drastically change not only maternal outcomes, but with extended POSTPARTUM DOULA CARE (yes this is where I WANT to see this go) change the outcomes for infants and families as a whole, these women of privilege would rather the system stay in its comfortable status quo.]
Independent doula support is effective primarily because we function outside of a system that is balancing numerous interests, methods and motives. [This does not change. If a Doula is threatened with no longer being a Medicaid Doula unless they submit to Hospital for profit policies it will be on the privileged Doulas to band together to support Medicaid Doulas in their autonomy. Nothing in this bill has anything to do with the hoops Hospitals and some providers already place in front of Douals. Medicaid requirements are clearly spelled out, and nothing in Medicaid reimbursement or participation guidelines say that a Doula has to cow tow to the hospital for profit policies. If a Doulas does not feel they can provide the quality of care they are providing now under Medicaid then they should not become Medicaid Doulas and continue to work exclusively with private pay clients.] Our primary responsibility is to our client alone, the person giving birth, and no one else. [YES! Preach! This does not change under the bill.] We are able to operate without fear or influence from parties that may not always have the birthing person’s interests and concerns as their top priority.[This is not currently true. Many Doulas feel a need to walk on egg shells when working in hospitals, and fear being banned from hospitals. This is currently the climate without the bill and the bill has no effect on this climate. For profit hospitals want fast births, more room turn over more money. If hospitals decide tomorrow that they no longer want Doulas of any capacity in a hospital they do not have to allow doulas, there are no protections. THIS BILL actually creates an argument for protection of our services within hospitals. If the State so values the work that Doulas do that they cover the services on Medicaid, then ALL women should have the right to a Doula. Those not on Medicaid are in a position of privilege to organize and lobby for this specific protection, but lets not do it at the expense of Medicaid families receiving the support they need but cannot afford.] When we compromise on this foundational aspect of doula support, we run the risk of compromising the very care we are able to provide the birthing people that are seeking and trusting our unbiased and impartial support. [As previously stated, any individual who feels being a Medicaid reimbursed Doula compromises the care they provide can continue to provide private care to those who can afford them.]
Another reason why state regulation of the doula profession is inappropriate is that doulas are not medical providers. {Check The Office Of Professions, a number of non-medical professions, including teachers, are regulated/certified through New York State, so this is simply an uniformed argument point.] We perform absolutely no clinical or medical tasks and make it clear to our clients that we are unable to do such. Regulation at the state level and seeking reimbursement from insurance companies would require doulas to keep medical records for their clients [No it would not. It would require that we keep detailed confidential records for our clients, but as we have no medical role, we would not be keeping medical notes. Notes required for reimbursement under Medicaid (Please remember that independent insurance companies will set their own guidelines not the State) will likely include client's full name, due date, dates and times of prenatal visits with a 2-3 narrative of the nature of these visits: i.e. "discussed client's concerns about being able to nurse baby with having to return to work in 6 weeks", "Discussed clients birth plan, water, dimly lit, no extra personnel, no episiotomy ...."] but this is in direct violation of our scope of practice ( DONA International Standards of Practice: Birth Doula). [As a Licensed Healthcare provider who works with HIGH RISK families I am going to disagree with DONA (a private for profit organization with no actual standing to set industry standards) and say that I already keep information such as client stated "dx of ghb, midwife wants to induce at 36-38 weeks, discussed induction and how best to support a positive induction outcome." I am HIPAA trained and understand the difference between HIPAA and confidentiality. I believe that there will be a requirement to take a course on this information (and if there isn't, there should be) as well as HIV and communicable disease transmission prevention. BUT AGAIN any Doula or future Doula who doesn't want to deal with these regulations aimed at providing Doula's to impoverished families will still have ample opportunity to work with privileged families who can privately pay for doula care.]
As your constituent, I urge you to oppose any efforts to regulate certification of doulas at the state level. It is harmful to the doula profession and thus, it will be harmful to the very birthing people we are seeking to support. Funding community based doula organizations that champion reproductive justice and health equity such as Ancient Song Doula Services in Brooklyn and Village Birth International in Syracuse will go much farther in the way of supporting birthing people from all backgrounds and ensuring they receive the care that improves outcomes for both mothers and babies.[While I believe that private and State funding of Doula services for impoverished families is worthwhile, that is exactly what this bill and the Medicaid Doula initiative, which necessitated this bill, is all about. You will not get State funding of private charities. You might find more dollars allocated for private charities in the form or Grants and Initiatives, but this will never have the same impact and reach of Mediciad provided Doulas. And WHY DOES THIS HAVE TO BE AN EITHER OR? How about BOTH?!]
Thank you for the opportunity to hear my concern and I look forward to hearing from you on this issue that affects so many birthing people and families of New York."
I am not sure of the timing of this call (whether it was the day before the vote, the morning of, or AFTER the vote) as I was not invited to participate in this call, which would have provided a balanced view of the proposed bill.
"This morning, a number of us from Rochester, Buffalo & NYC were on a conference call with Assemblywoman Paulin, the sponser of this bill. Overall I want to stress that it was a positive call. She seemed very receptive to our feedback and had respectful dialogue with us for about an hour, making sure all concerns were addressed. She had her two kiddos at home with a midwife so I think she really wants to be an advocate for our work, but may be slightly misguided in some areas. We expressed our concern about some of the language or lack of clarity in the bill and she was mostly receptive to them. I believe her intention is to be an ally and help to elevate or validate the doula profession on a larger scale so that we can receive more recognition from other professions involved in birth. [Why do doulas need recognition from other professions in the Birth Industry? Why is this MORE important that providing Medicaid Doulas? Isn't this ego?}
The bill has passed BUT it won't be signed by the governor until the fall which means it won't be in effect until then and we have the summer to include conditional chapter amendments to bring more clarity and limit vagueness with how the bill will be carried out. [Well that tells me this call happened after the bill passed.] The following are the items we will clarify/add amendments to:[The following are things this particular group is asking for clarity or amendments to (which may require another vote on the floor.)] Removal of test requirement for certification. {Without a test this becomes a pay and be certified, which is how MOST current private certification exists. A State regulated test ensures that individuals wishing to practice as Doulas and be reimbursed through Medicaid, understand scope of practice and have a basic understanding of what Doula care entails or is expected through Medicaid to entail. This cannot be omitted.]
Clearly state that this is an optional certification. [Certification is solely for those wishing to participate as a Medicaid Doula or USE the term Certified in NYS, this should also remain as it is.]
Doulas will continue to use the word certified under their own organizations (DTI, CAPPA, DONA, Carriage House Birth, etc.) as long as those organizations as listed as acceptable under the bill. [If these training and certification guidelines are acceptable there MAY be a grandfather clause allowing those individuals to pay the $40 fee to the State and be certified without having to take a test, but other than that the term Certified becomes watered down, it would be like a Massage Therapist saying they are OSTM Licensed. It creates confusion and leads to a potential for individuals to believe they are qualified to work under the Medicaid program, provide services and then bill Medicaid and be denied because they are not State Certified, or even worse actual fraud against the poor by representing themselves as qualified for Medicaid reimbursement. How about for we adopt a different term for private organizations that offer some form of credential validation for purchase?]
There will be wording added to ensure that hospitals cannot discriminate against doulas who choose NOT to certify with the state. [Hospitals are privately run for profit institutions and the only regulations the State can impose on them have to do with protected classes of people, non-discrimination against patients based on race, religion or poverty (these protections often go hand in hand with Medicaid recipients.] Certification through the state will be entirely optional and cannot be used against doulas who choose not to certify. {Certification is optional for those wanting to participate in the Medicaid Doula program OR use the term Certified Doula to bolster their credentials.]
(We are working on encouraging her to include State Certified Doula as the language used, but she was resistant because other professions just hold the term certified.) [This will NEVER happen.]
The fee for women receiving aid from any assistance programs will have their state certification fee waved. [At this point in time there are programs to help individuals in need (we have a male doula in Rochester and a second male who wished to take doula training so could we please stop using gendered terms?) to be able to afford not only registrations, certifications, CEUs, etc. but to afford training, but this is ONLY for State approved programs and the unregulated, privately run doula industry does not and will not qualify for this.]
We have her ear, she will be looking to us as things are amended. Though this may not be ideal, I believe at least we have a hand in how it will be shaped. [Again, if the heart of being a doula is providing balanced, unbiased information to clients so they can make educated/informed decisions why would they not use the same process and include a dissenting voice?]
-- Everything after this line is MY commentary only -- I do not speak for ANYONE except myself:
More than a year ago I attended a Doula Coop meeting where the topic discussed was that of Medicaid Doula coverage. The majority opinion expressed was that Medicaid Doula coverage was harmful for the industry. Medicaid notoriously underpays even the most respected professionals so a disrespected and barely tolerated profession of Doula could expect no great pay. The Medicaid Doula program is in pilot form in Buffalo and the Bronx. I hope to do a post outlining that in the near future. The pay is minimal for the work expected, but I believe that has a lot to do with Doulas undercutting each other in the industry resulting in a public devaluation of doulas.
My concern with the Medicaid program is that it is designed in a way that white privileged doulas will primarily be the ones able to offer services under Medicaid. This was my concern at the coop meeting. I expressed this concern and I warned the attendees that this legislation existed at that meeting, and if it didn't that it soon would, as it was being discussed at that time. The general tone of the meeting was NOT about helping those in poverty have access to Doulas, or how to make sure that Medicaid reimburses at fair rates, but devolved into a discussion from the financial privilege perspective that, generally speaking, everyone can afford a Doula if they just prioritize.
The very next meeting was about Doulas charging enough to account for their actual time (again another blog post about how all Doulas should be charging hourly coming to this blog soon), and the meeting ended with the statement that generally speaking people can afford Doulas, they just don't prioritize. Members of the coop a few days later posted a meme about how weddings are $10,000+ but people won't spend $2000 on a Doula (my wedding for 250 was $3000). Other financial privilege memes were published and shared and liked and at that point I felt I could no longer participate in the Doula Cooperative meetings. The air of privilege and save your birth was just to strong for me so I left the meetings and kept to myself. I rarely comment on local private Doula forums.
In the case of the pleas to oppose this bill, I did not comment in the forums, but made a public post on my social media page (private page and business page). And the result was that in BOTH instances local doulas messaged me privately to tell me how misguided I was and how I didn't have a say because a black doula posted in the private group opposing the bill on behalf of black doulas. (They failed to acknowledge that this woman currently offers training in Buffalo to meet the Medicaid requirements, so if the bill goes into law she also stands to lose money. It is exactly like Exxon lobbying the EPA to relax dumping standards.) No I cannot speak for Black Doulas, but I can absolutely speak for MY OWN EXPERIENCE as a POVERTY Mother (both of my children were born under Medicaid) and I can speak as a Doula who cannot afford to certify with these private organizations. I will be able to certify with the State of New York. I cannot at this time afford to participate in the Medicaid Doula program (reimbursement rates are well below living wages, let alone fair wages), but I have a voice and it is valid.
My purpose in posting publicly about the bill and THIS blog post is not to change anyone's mind. It is instead to provide what I believe is a MORE balanced view of the bill and its intent and its potential effect. Oppose the bill, but do so rooted in information not fear-mongering. I encourage people to read this post and respond. Dissenting opinions and comments are welcome. Trolling and name calling is not.
Yes I am sending this exact blog as a letter to Paulin and asking her to sit down with me or speak over the phone as a supporter of regulation of the Doula industry and Medicaid coverage of Doula care. I AM NOT THE ONLY PERSON IN THE BIRTH INDUSTRY WHO SEES THIS BILL AS BENEFICIAL TO THE DOULA PROFESSION.
If you made it all the way through. Thank you. If you share this, Thank you. If you comment and participate in a discussion, Thank you. Change only comes from informed discussion.
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