A Doula For Every Woman?

Doulas who are members of DONA have just received this news:

DONA International is pleased to announce that a new code for doulas in the United
States has been approved and defined by the National Uniform Claim Committee. This
code will come into effect on October 1, 2009 for services rendered after that date.
Pat Burrell, a birth doula and registered nurse from South Carolina, was successful
in lobbying for the assignment of the code, which will allow doulas to be assigned
provider numbers to submit claims to both Medicaid and third-party payers for their

“While this does not guarantee third-party reimbursement, it is an enormous step
forward in our mission to ensure a doula for every woman who wants one” says Debbie
Young, President of DONA International. “Individual doulas will have to apply for
a provider number and comply with other requirements that have yet to be determined.
Regardless, we are excited to announce Ms. Burrell’s success with this initiative,
which will benefit thousands of women and families for years to come. This is an
exciting day in childbirth in the United States.”

For further information, please contact Jessica Atkins, DONA Third Party Reimbursement
Chair, at 3PRChair@DONA.org [mailto:3PRChair@DONA.org] or Stefanie Antunes, Director
of Public Relations, at PublicRelations@DONA.org [mailto: PublicRelations@DONA.org].

 **End of DONA mailout**

When I read “enormous step forward”, “excited to announce” and “exciting day in childbirth”, I had a sinking feeling that we are  being sold a bill of goods.  Why does this obtaining of a number equate to a breakthrough and why do the DONA members need to be hyped?  What do you think?

Here’s what it says on the National Uniform Claim Committee site:
Under the Nursing Service Related Providers Type, the Doula Classification was added:
Doulas work in a variety of settings and have been trained to provide physical, emotional, and informational support to a mother before, during, and just after birth and/or provide emotional and practical support to a mother during the postpartum period.

It’s going to be interesting to see if any DONA doulas point out the obvious to their leadership.

  1.       Getting an assigned provider number is a good way to give the government access to every move you make.   That might be okay if they were paying you, but they are not and they do their best to avoid paying so it’s highly unlikely they ever will.

  2.       Although DONA’s stated intention is to provide a doula for every woman, the truth is more likely that they’d like doulas to get paid without the messiness of asking for money or turning down clients who don’t value the service enough to pay.  It seems that some women are so allergic to the concept of asking for money that they will sell themselves to the devil to avoid saying “Can I get a cheque from you today, please?”

  3.       Probably, if Medicaid or other insurers were paying doulas, the doulas would get an “attitude” and stop giving their all at births.  In fact, they might even start requiring clients to hire yet another woman to do the back rubbing and staying up all night while doulas do the more professional doula work like filling out papers for Medicaid.  Then, those back rubber women will form an organization and want the government/insurance companies to pay them, too.  And so on, and so on.Here’s a link to a wordier document on the insurance committee at DONA.   http://www.dona.org/PDF/3PRDONAStatement.pdf It’s copyrighted in 2000 so I don’t know if it’s current.

 All I can say to the DONA doulas is “Sometimes the devil you know is better than the devil you don’t know.”  Take a long, hard look at these documents and ask yourself where the inauthenticity is.  Don’t, for a minute, think that a government agency or insurance giant is going to give you a handout without exacting a heavy price.

  Previous related post:  Licensing, registering and certifying midwives–at what cost?   


26 thoughts on “A Doula For Every Woman?

  1. Are they insane?? ARGH!! *runs screaming from the interwebz* Has no one noticed what’s happened to midwives because of all this guff??!!

  2. Uh ohhh… I know this *looks* good to some doulas and clients… but agree, based on known modern history of midwifery, it is probably NOT a good thing at all!! There are many other ways to fulfill DONA doulas’ commitment to “a doula for every woman” besides selling ourselves down the river.

  3. BECAUSE I value my work as a doula- meaning I KNOW what the support means for birthing women regardless of their financial circumstances- I do work for gas money only. I value what I do and show it by providing the same high level of care and respect to those who pay me well as those who can only provide me with gas money. There is NOTHING wrong with doing work for discounted price, for coverage of transportation costs or even for free if necessary. I have NO problem with doing my work, knowing that it’s more important than the amount of cash I generate. It’s no hobby for me either. I have worked with women, children and families in my community for decades (at least a couple by now) in various ways over the years. I knew I was not going to get rich doing it. I knew I might not make much of a contribution to my family’s income doing it. However… there is also NOTHING wrong with making a decent income and contribution to one’s family either, by doing the work one loves.

    Service is just something I have done forever and it suits me. We’ve done so knowing that subsistence doesn’t hurt- simplifying one’s lifestyle can lead to joy and fulfillment. I’ve been homeless and I’ve been quite well-to-do. It’s up to each doula to make her choice about the aim of her work. We all have things in common about our values, but we also diverge. So those who feel drawn to the insurance reimbursement capability should go there and do that thing. Others with diverging sensibilities will do otherwise.

    I realize I am lucky. I do have a part time job that is very flexible- my bosses know that birth comes first AND they approve of that and support it- I know I am lucky that I can follow my calling in my own way, but so can everyone else in their way.

    And you know… historically, there was a time when the community supported their service professionals like their children’s teachers, their country doctor and the midwife- with goods and services in kind as well as money when it was available. Centralization of any service never really works in the long run- we’re seeing it with education, health and maternity care, as well as with food production and other things. Those days are returning due to the slow motion failure of infrastructure we are experiencing- much like the frog in the slowly heating water, we don’t perceive what is going on necessarily. Insurance may well eventuallyl be worth squat and I agree that this new and improved doula access may well serve well, but be mindful of the double-edged nature of this sword: it does also provide those with certain interests with yet another way to gain still more yet different control.

  4. I’m a midwife in a state not legal, I bill insurance and I have absolutely no problems, I think you’re generalizing there…I already posted on the facebook posts…if nothing else, I think it’s insulting to sell doulas so short to think they will become lazy and not work as hard or not be good doulas, I think Gloria you have little faith in doulas and that’s the sad part here, not about the insurance issues, but that someone those of us who do except insurance and want it available are just after it for the money…I also do free and prorated births and my kids are getting free lunches right now….women who work in this field DESERVE to be paid well, deserve to make a fair living. I don’t think all doulas should bill insurance or medicaid and many will not want to…but for those that want that option and for the women who want that option, lets talk about choice…and the fact that not everyone should have to do things the same way…

  5. I’m really not surprised, but also still upset.

    I took my dona certification and have chosen to wait out to see what was going to happen to them as a company. I’m not certifying with them.

    A huge step. A massive step. In the wrong direction.

  6. yeah it does make you very suspicious about the government’s intentions, doesnt it? the doula’s employer in that case would be the government instead of the birthing mother. I just can’t see that going in a good direction.

    I find it interesting to read the comments from women who are insulted because you say that women who do pro bono doula and midwife work dont value themselves. I can see their point, but I agree with you, gloria. especially in the context of other posts Ive read where you’ve spoken about doing free midwife work when you couldnt even pay your bills or feed your kids! I guess if women are being supported by a good income from their partner, then they have the choice to do volunteer work. it doesnt seem like a doulas/mw’s should have to choose between following their charitable intstincts and feeding their children. if it comes down to that, I think you better feed your children.

    Im of the opinion that if women cant bother to find a way to pay for health services that they feel are so important, they cant live without them, then they dont really value their health or that of their child enough. if they’re willing to make the midwife or doula’s family go without so that they can have the birth attendants they want, that’s a bad sign. women who wont pay for their birth are sending the message that they think having a good birth is free or just as easy as asking for it. they’re saying “I can get birth helpers to do the work for me, and I dont have to do anything myself.” it doesnt bode well for a woman taking charge of her own birth and being responsible for her own outcome!

    I know that if I wasnt able to pay my midwife, I would not feel comfortable calling her to my birth. that’s just the kind of person I am. I dont feel good about putting someone out and asking a lot of them if I give them nothing in return.

  7. Third party reimbursement is a wolf in sheep’s clothing and I once applauded doulas for not (as far as I knew) agressively seeking to invite someone to put even more restrictions on a woman’s choices: i.e. insurance companies. I knew some doulas were getting third party reimbursement but on an individual basis, so it doesn’t scare me so much…..it is those broad strokes that seem to effect the detrimental outcomes for women. I am not a doula and won’t presume to be an expert on this topic…..however….the close relation to midwifery makes me very afraid not just for doulas but for doula clients everywhere. Again this is something that might LOOK good on the surface BUT you have to look down the road and imagine the harm that might come from any move in the direction of MORE regulation and MORE restriction.

  8. I don’t think Gloria meant to say that doulas would become lazy, but rather point out sarcastically how things would become for us if we had to start filling out a whole bunch of paper work for insurance companies. We would possible get buried in that, need to charge more because we spend more time doing paper work, have less time to really spend … Read Morewith a woman because it all adds to paperwork, get our own asses covered because now there is a third party involved and so we can get sued much more easily (right, cause if the mom ends up with an epidural, it will be the doula’s fault because the mom will not get reimbursed). She was speaking hypothetically about how it would become for us, the same that is has become for midwives. Midwives used to do what doulas do until, in the medical establishment, they couldn’t anymore for all the above reasons and more.

    I do agree that women should get reimbursed for help they hire in childbirth. There is a code for that already, and many insurance companies will honor that. And if not, they often do with an appeal since much the first requests are automatically handled, not by a person. So that would be one step. But having the insurance companies have a say over what they will and will not reimburse, to have them set those boundaries, is absurd and will diminish our job just like it diminished midwifery.
    And that is what we are arguing against. Not that women should not reimbursed, but the slippery slope this has brought us on. We are not against women, sheesh. In fact, I think most of us looked into being a doula before or instead of becoming a midwife because there were not as many hoops to jump, at least not insurance wise. If I have to get coverage to cover my own back, it will raise my prices and I will not be able perhaps to help women for free too often.
    Insurance companies should just reimburse the original code without putting strings on us. Our jobs are well defined and we nor any client should have to suffer not getting paid because they decided our care was not effective enough. And they will charge of for that, because otherwise they end up reimbursing doula and a full theater in many cases. Nuts. This is so not about women’s choices!

  9. Probably, if Medicaid or other insurers were paying doulas, the doulas would get an “attitude” and stop giving their all at births.

    Sorry, that’s offensive, I didn’t say that I disagree with the rest, but that statement is offensive, and in my opinion, needs to be addressed…

  10. I think this will happen because of the adversarial relationship there is automatically when a third party is involved. If I have to make sure my ass is covered, I cannot do everything that I would perhaps otherwise do because it either wouldn’t fall under what the insurance company says I can do, or because if it is unclear why this or that intervention was introduced. Was it the doula’s fault? Who will say. This whole 3rd party involvement will undermine mutual trust, just like it does for regulated midwives. In the end, a cnm often ends up making different decisions than a direct entry midwife (exceptions are there of course). A direct entry midwife can much more easily let the woman make the decisions than a cnm attached to a hospital needing to make sure that procedure is followed.

  11. Maybe I am wrong on how I interpreted her words, but I would use the same sarcasm myself, so that is how I read it. We’ll see if I am wrong or not. I’d be really disappointed if I am, for sure.
    Obviously though, there are doulas who would rather be regulated and the idea that this gives them status and that they can thus offer their services to everyone is bogus. Midwives who are regulated had to give up a lot for their status and clients can often only use them in a hospital setting depending on the state you are in. Some status. It is my opinion that doulas came into existence because midwives could not provide that part of her care in a hospital setting anymore, exactly because of regulation and 3rd party involvement. In a home birth, the midwife, in my experience, serves the woman in the full capacity of midwife: she stays throughout the labor and offers all the support a doula does as well. It is in the hospital that women need an advocate without ties to anyone but herself and her client to safeguard the sanctity and thus effectiveness of the relationship. You take trust out, and you are at the beginning of the equation again, a woman in labor having no one educated on her side and her side alone.

  12. What a great discussion! I’m thrilled to see these issues being explored. I think being lazy is a human trait, not exclusively a trait of doulas, but, since doulas are human. . .
    It’s not that birth workers will get lazy, we already are. When we make an agreement that involves money, it motivates us to earn it. Real simple. Yes, I know that lots of you do very kind things without being paid and that’s okay but, let’s get real. . . when you go out the door and leave your family to attend a birth, someone has to pay for that (gas, telephones, pagers, nutrition, equipment, courses, internet, computer, books. . . . . ). So, it’s not that I have a particularly low opinion of doulas, it’s that I think us humans are pretty comical (and lazy) in general.

  13. See my response on Carla’s thread LOL

    Your perception of humans being lazy has not been my experience, though my husband agrees with you, hahaha. Fallen nature he calls it. I guess he is right. I still have hope that we can rise above it if we do what our hearts tells us to do.

  14. Gloria, you must use your words more carefully then,just call us all inherently lazy if that’s what you mean. I know on your facebook you wrote that maybe there’s another reason we are upset according to course in miracles, and maybe you hit it on the head. I hear you mention watching language, not conjecturing, and things like that, then you turn about and make negative blanket statements like that. I’ve been called on my language before and have been big enough to make the necessary corrections…we all have to do at some point in our careers….maybe that’s the part that upsetting….

  15. We can learn from history. We don’t have to keep doing the same dumb moves over and over. “Hope” and “positive thinking” have been used to turn midwives into prisoners in self-imposed jails. Birth junkies are very easily manipulated by smarmy speeches that allow us to delude ourselves that we are the next Mother Theresa. The husbands have a better perspective. Listen to them.

  16. Now I take offense to this, Gloria. As a mother of 4, a 40 yo woman and a professional doula, I would not consider myself a birth ‘junkie’ any more than you would consider yourself one. How condescending.
    Yes, I do very much respect my husbands opinion, but I also believe in hope and positive thinking as it changes people. I am not the one hoping here that this 3rd party step will be good for doulas, nor am I one to agree with regulating midwives. I have no hope in the system, just in individuals. Mother Theresa did just what she was called to do: helping people when a system and a society told her not to. Not every one is called to do this, and that is fine too.
    But whatever, I will stay away from your ivory tower.

  17. Wow, just wow! I think you proved your point here Gloria, and I don’t have to discuss it anymore…but I’ll go ask my husband what he thinks since I’m so weak I can’t make my own decisions….

  18. Then start using us and we, because it sure sounds like you are looking down on ‘us, and in this case, on me particularly since I was the one bringing in my husband in the first place.
    I understand how you and everyone in the birth field could refer to themselves as birth junkies, but this discussion shows that not all are happily swayed in the happy fumes of regulation. The ones that want to be regulated for the perceived greater good are just as much junkies than those who don’t, so maybe a little bit less cryptic would make it easier to not confuse things.

  19. Just want to repost this here as well:

    On FB, Gloria wrote in response to a comment by me there:

    “I apologize for offending you in any way. It was not intended to land that way.”

    I really appreciate you saying this, Gloria, because I am honestly confused. I am probably totally misunderstanding your tone, I know that I always take things very literally, so sarcasm and/or self-deprecating if this is the case here eludes me completely. I would be open to a more elaborate explanation of where you are coming from. I haven’t ‘… Read Morebucked the system’ as long as you have and come from a different corner, having only stepped into the birth world after my path lead me to unassisted birth first.
    And, I respect you too much to walk away offended 🙂

    Ugh, I am sorry for getting so blown up.

  20. “For your own good” is a persuasive argument that will eventually make a man agree to his own destruction. – Janet Frame, Faces In The Water, 1982

    And its close corollary:
    “For the good of society…”

  21. This is the first time I’ve read this post of Glorias. I completely agree… I actually just recently had a debate with a friend who accused me of only desiring to help women who could afford doulas (obviously not true)and that I should call my practice “Birth Takes a Wealthy Village rather than simply Birth Takes A Village”. He argued that I should be spending my time advocating for government funding of doula support instead of just promoting my work and natural childbirth. My argument was the same as yours. The LAST thing I will EVER promote is MORE government intervention, control, regulation of childbirth.

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