Doula Rising 2

The Shift from Luxury to Necessity in Proper Birth Care

Birth is complicated. Motherhood is difficult. Welcoming a new life into the family is challenging yet richly rewarding. As a culture, we’ve known these simple facts for a long time. So why are we just now viewing emotional birth support as a necessity to the process and not just a luxury? Chama Woydak of Homegrown Babies and Cindy McMillan of Sistas Caring for Sistas are on a mission to normalize the role of the doula, a woman who provides guidance and support throughout pregnancy, birth and postpartum. They’re working hard to provide this service to every mother they can by building relationships through communication and unconditional support.

Chama says it was a gradual interest in lifestyle and women’s health that led her down this road.

“I’ve always been a farmer, so I’m really passionate about food sustainability and access to food. Not having access to food is a big form of oppression. I spent many years farming—I still do—so from growing vegetables and raising animals I got into herbalism, and from herbalism, I got into medicinal plants, then women’s reproductive health and reproductive justice. I got interested in things of that nature.”

From there, Chama ended up in a two-year program focused on her new interests, but instead of doing clinicals at the end of the program, she decided to teach instead. 

“I realized I loved teaching and that it was something I was good at. I knew to be a good teacher I needed to be on the ground and attending births.”

She attended her first birth in 1999, started teaching classes in 2002 and became a certified doula a year or two later.

“The training was amazing. It was probably the most diverse class we’ve had. … There were people from different countries, it was multilingual, it was just a really beautiful training,” Chama says of a recent doula class she led.

At the time Chama began her journey as a doula, the idea of including a doula during birth was considered a luxury, and it wasn’t a well-known service at that. 

“I found the niche of how vitally important that physical and emotional connection was for our healthcare system. There are plenty of people to do the clinical aspect, but our healthcare system doesn’t create a lot of base for that emotional support. Doulas really do fill that niche.”

Unlike the zeitgeist 20-plus years ago, there has been a shift recently in the world of birth. 

“The research has come out showing how impactful having a doula at your birth is,” Chama says. “But the biggest statistic is that doulas have caused a 28 percent reduction in the primary Cesarean. There’s less machine intervention. We increase breastfeeding rates. Generally speaking, we increase satisfaction for someone going through the birthing process. Because of this, there are more opportunities for doulas, but there’s no third party reimbursement that’s standardized across the country. We’re starting to see some states jump on it, but we’re seeing a varying degree of people who can have better birthing outcomes to those who can’t. If there’s anything that’s really changing, it’s the spotlighting on these inequities between white people giving birth in the States and people of color, specifically black and African-American people. The barriers to access are huge because if you have the money to pay for a doula, then you can get these better outcomes. And if you don’t, well, too bad.”

These statistics are leading to a lot of conversations surrounding the important role of the doula, however, many doulas are not seeing appropriate pay for their work. Rather than treating the role as one would the role of a clinician, doulas have not yet been deemed necessary, even when the numbers say otherwise.

“I don’t know exactly what the reimbursement rate is for doulas, but I think it’s somewhere between $300 and $600. We might be on our feet, at the birth, not including pre- and postpartum care, anywhere between 15 and 24 hours,” Chama says.

“All women should have access to doula services, especially due to the infant mortality rate,” Cindy says. “There’s so much shaming with women, we just need to normalize being an advocate for yourself and knowing your body.”

In order to normalize this practice, though, more women need to be informed of its importance—and its very existence.

“When we started back in 2016, we didn’t know what a doula was, but Chama came to us and offered to teach us how to become doulas,” Cindy says. “I personally almost died during childbirth, and I lost a child during childbirth, and I was like, ‘where was this service when I was giving birth?’ So now we have a group, and we meet every month. It’s called Mother to Mother, and we get together, we bring our kids, and we touch on a lot of different things. We can vent, we can cry, and we get the word out by going out in the city and starting these conversations. We’re housed in MAHEC, and as far as I know, we’re the only doula-based program in Asheville housed in a clinic facility, so that gives us a lot of access to pregnant women who couldn’t normally afford these services. We are making a lot of strides to get the word out.”

In order to make its services affordable, Sistas Caring for Sistas is backed by a grant, partners with the nonprofit Mothering Asheville and is in the process to get Medicaid reimbursement. 

To learn more about the services provided or becoming a doula yourself, visit HomegrownBabies.com.

“Build relationships first. Wherever you are on your path, building relationships will take you far. Build relationships with your healthcare provider, your partner, other mothers, and build a relationship with your body.” –Chama Woydak

“We carry these women with us. It’s a journey. Not only have we been their doula, but we continue to build relationships with them. There’s a lot of trust and a lot of vulnerability. It’s a beautiful thing. Women come together, and we rock it out. We have each other’s backs.” –Cindy McMillan