Doula School Canada

Category: Health & Wellbeing

Resources on maternal mental health, sexual health, menopause, holistic nutrition, and overall wellbeing. Supporting doulas and families through every stage of life.

Doula As a Healer: Doing Your Own Inner Work While Supporting Others
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Doula As a Healer: Doing Your Own Inner Work While Supporting Others

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As doulas, we’re taught how to care for others, to hold space, soothe, share information, and advocate but doula as a healer also means caring for ourselves, noticing the parts within us that still ache and the emotions that arise when a client’s story mirrors our own or when we witness an injustice that hits too close to home.

The reality is that doula work- or really any kind of birthwork- goes far beyond simply supporting families. We stand in sacred spaces where new life enters this world. We are present at the precipice of profound transformation.

Every time we walk into a birthing space, a postpartum home, or a prenatal session, we don’t just bring the skills and definitions we learned in doula training; we bring our whole selves: our energy, our beliefs, our stories, and even our unhealed parts.

The work we do isn’t separate from who we are. A doula who tends to their inner world — their emotional, spiritual, physical, and somatic wellbeing — becomes a vessel for deeper healing. When we do our inner work, we realize that the steadiness we offer our clients begins with the steadiness we cultivate within ourselves.

Birthwork asks us to show up with open hearts in moments of raw vulnerability and, at times, to navigate trauma- our clients’ and our own. If we haven’t taken the time to explore our personal stories of pain, loss, or injustice, we may unintentionally carry that energy into the birth space.

That said, doing our inner work doesn’t make us magically immune to triggers-it helps us become aware of them (which is a superpower in its own right!). This awareness allows us to pause, breathe, and respond from compassion rather than reactivity.

Each of us is a collection of stories, shelved away either hesitantly or lovingly- and these stories shape the way we show up, both in our own lives and in the presence of our clients. The key isn’t to suppress your story, but to witness it. Notice when you feel resistance, judgment, or an emotional charge around a client’s experience- that’s often your cue that something within you is asking to be tended to.

Ways to Nurture Your Own Healing While Serving Others
- Journaling after each client: Reflect on what moments felt heavy, empowering, or triggering.
- Grounding practices: Breathwork, prayer, or gentle movement between client meetings or births to regulate your nervous system.
- Peer debriefing or mentorship: Find someone who can hold space for you without judgment.
- Therapy or spiritual counseling: Normalize seeking professional help; your clients benefit when you’re emotionally grounded.
- Rituals of release: After a birth, recite affirmations or a nature walk, to release the emotional energy you’ve held.
The key is to find a rhythm that works for you… You give, then you empty, then you refill.

As cliché as it sounds, you truly can’t pour from an empty cup- but you can pour from a full one that overflows with purpose, presence, and peace.

Author: Asma Rahman, DSC Instructor, Certified Birth & Postpartum Doula[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_column_text css=”.vc_custom_1761759265440{margin-bottom: 0px !important;}”]

About the Author: Aunjrya Fleming

Asma is a DSC Instructor and Certified Birth & Postpartum Doula, as well as a proud visible Muslim woman, activist, and mother of three. Passionate about accessible and faith-based birthwork, her approach is rooted in community care, advocacy, and anti-racism.[/vc_column_text][/vc_column][/vc_row]
October 29, 2025
Combating Shame in Postpartum Substance Use with Compassion

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Combating Shame in Postpartum Substance Use with Compassion

Many parents feel pressure to present a perfect image after birth, yet postpartum substance use remains hidden in silence. This silence creates deep isolation and pushes struggling parents further away from needed care. Shame acts like a heavy barrier, cutting off connection and worsening feelings of failure. Compassion opens the door to trust and understanding. Doulas stand in a unique position to notice the unspoken struggles and respond with empathy. As a matter of fact, compassionate conversations break the cycle of judgment and help parents feel seen. Not to mention, they create safe spaces where healing can begin. With this in mind, doulas can guide families toward hope and healthier paths without fear.

Why Shame Deepens the Struggle

New parents who face postpartum substance use often carry heavy shame, which creates
powerful obstacles to recovery. Shame tells them they are unworthy of care, while guilt says they made a mistake. Guilt can guide someone to make better choices, whereas shame convinces them they are broken. In truth, this belief drives many parents deeper into secrecy and pain. Not to mention, shame silences their voice and prevents them from asking for help.

On the other hand, guilt can push toward growth when met with support. The emotional cost of shame feels unbearable for new parents already coping with sleepless nights and shifting identities. With this in mind, doulas who recognize the weight of shame can offer compassion that restores connection, reduces isolation, and supports the path toward healing.

Compassion as a Healing Tool in Postpartum Substance Use

Compassion softens the weight of shame for parents who suffer. It reminds them they deserve care, not judgment. In contrast, shame isolates while compassion builds bridges back to support. Another key point is that compassion fosters trust between doulas and clients. Clients begin to feel safe enough to share struggles openly. Then again, compassion does not excuse harmful behavior, but it offers a path toward healing without fear. With this in mind, doulas can model empathy through presence, attentive listening, and gentle reassurance. Similarly, research shows compassion lowers stress and supports recovery. Above all, compassion affirms the humanity of each parent while guiding them toward healthier choices. Doulas who practice consistent compassion especially during postpartum substance use encourage parents to believe change is possible and achievable.

Understanding the Root Causes of Postpartum Substance Use

The postpartum substance use often begins with overwhelming stress and untreated trauma. Hormonal shifts, birth-related pain, and emotional exhaustion amplify vulnerability. In like manner, social pressure to appear strong forces many parents to hide their struggles. Shame deepens when outside voices label substance use as weakness instead of survival. To move forward, doulas must understand that addiction does not arise from one single cause.

On the contrary, support without judgment helps parents feel less alone in their experiences. Another key point is that untreated depression and anxiety often drive unhealthy coping methods. With this in mind, doulas should recognize how medical, emotional, and social factors all intersect. Above all, awareness of root causes empowers doulas to approach families with understanding rather than blame.

Connecting Clients With Resources Without Pressure

Shame often keeps new mothers from reaching out for help with substance use. Many fear judgment or worry that seeking treatment will reflect poorly on their ability to parent. That makes it important for doulas to present treatment resources as supportive options rather than demands. Safe, judgment-free environments allow mothers to accept care without feeling blamed or stigmatized, which is often the first step toward healing. For some, addressing physical dependence in a medically supervised setting provides the foundation to move forward. In truth, there are situations—such as having a co-occurring mental health disorder, a comorbid medical condition, or a history of using multiple substances—where medical detox is necessary to protect both health and long-term recovery.

When doulas explain these options with compassion, new mothers are more likely to view treatment as empowerment instead of punishment. By avoiding forced referrals and instead focusing on respect, doulas help reduce feelings of shame. Ongoing support combined with access to appropriate levels of care builds trust and strengthens the recovery journey. Ultimately, doulas who center their work on empathy and understanding create stronger bridges that guide parents toward lasting healing.

The Doula’s Role in Supporting Healing

Doulas stand close to families during their most vulnerable days. For this reason, they often notice hidden struggles others may overlook. Of course, their supportive presence gives parents the courage to speak honestly. Similarly, doulas can normalize difficult conversations about substance use by showing respect and compassion. Then again, clients may hesitate at first, so patience becomes important. In short, a doula’s role is not to diagnose or treat, but to provide safety and empathy. Another key point is offering nonjudgmental listening without rushing to solutions. With this in mind, doulas can validate parents’ feelings and guide them toward helpful resources. Above all, their role is to stand beside families with understanding, ensuring no parent feels abandoned during recovery.

Language Matters: Words That Heal vs. Words That Harm

Language shapes recovery outcomes more than many realize. For this reason, doulas should avoid harsh terms like “addict” or “failure.” Instead, use person-first language such as “parent experiencing substance use.” That reduces stigma and protects dignity. In truth, words that shame can close the door to trust instantly.

In contrast, supportive language keeps dialogue open and healing possible. Another key point, tone matters as much as the words chosen. Not to mention, gentle phrasing can lower fear and invite honest sharing. As a study published by Science Direct shows, doula support decreases the odds of postpartum depression by 57.5%. With this in mind, doulas must practice conscious communication daily. Above all, their language should affirm that every parent deserves compassion and care. In like manner, doulas who speak with respect help parents believe recovery is possible.

Practical Strategies for Doulas to Offer Support

Parents need practical guidance, not just comforting words. For this reason, doulas can start by creating stigma-free environments where parents feel safe. Listening without interruption helps parents open up. Not to mention, offering grounding techniques supports emotional stability during stressful moments. Also, doulas can encourage daily practices like mindful breathing or gentle stretching.

However, they should respect individual readiness and never pressure immediate change. With this in mind, doulas can communicate with clients and suggest professional help when they seem open. In like manner, referrals should always empower choice, not enforce action. Above all, strategies must reinforce trust so parents believe they are worthy of support. Consistency in care strengthens resilience and creates steady progress toward recovery.

Compassion Breaks the Cycle of Shame

Compassion transforms recovery for families facing postpartum substance use. Shame isolates parents, but empathy creates connection and hope. Doulas who support with respect and nonjudgmental care strengthen healing. In short, every compassionate act helps break the silence, reduce stigma, and guide parents toward safe, supportive paths of recovery.[/vc_column_text][/vc_column][/vc_row]

August 30, 2025
Light in the Darkness: Interview with Layla Micheals, an Infant Loss Parent

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Light in the Darkness: Interview with Layla Micheals, an Infant Loss Parent

At Doula School, one of our leading continuing education courses is our Infant and Pregnancy Loss Support certification program, which is such an important skill in our birth worker toolkit. Our gradates go on to support families who have experienced infant and pregnancy loss. It’s important to destigmatize speaking about infant and pregnancy loss because 25% of people experience loss at some point in their fertility journeys. We never want anyone suffering in silence.

Jessica Palmquist, our very own senior instructor and program coordinator for the infant and pregnancy loss programs experienced a unique journey to parenthood made possible through In Vitro Fertilization (IVF), which ultimately ignited her burning passion for fertility awareness and birthwork. Through her IVF journey after losing multiple embryos, she understands the importance of talking about loss and fertility struggles. With October being Pregnancy and Infant Loss Awareness month, Jessica Palmquist interviewed her best friend Layla Michaels, founder of Big Hearts Little Stars and she shares about the loss of her son Ryker and how she found light during her darkest time.

Jessica and Layla’s friendship began in the early 2000’s when they worked together at a Lululemon pop up store in Moncton, New Brunswick. Nearly decades later, after both women went through Assisted Reproductive Technologies they joyfully were pregnant together, both expecting baby boys who would one day grow up together and be best of friends. Jessica delivered in October 2019 and Layla’s estimated due date was Easter 2020. Layla’s water broke unexpectedly at 25 weeks gestation and she was hospitalized. Layla was in constant contact updating Jessica daily. Two weeks later, Layla delivered her son Ryker who lived a life too short and he died in her loving arms. When Jessica received the news of Ryker’s passing she held her newborn son Hudson tighter than she ever had and sobbed uncontrollably. Her heart had broken that day along with her best friend’s. Layla and her partner Adam had big plans for their son and had already built a life for him. Jessica and Layla had dreams of what their boys’ future would look like. This is another side of loss that often goes unspoken – the loss of the future and the loss of a family’s hopes and dreams. Loss is more than the loss of a life, it is the loss of a life and so much more. Jessica regularly asks about Ryker and Layla gingerly shares pictures from Ryker’s short stay in the hospital and the mementos in their home. Whenever Jessica and her family have the opportunity they honour Ryker on his birthday, holidays, and whenever she writes a letter to the family he is included. Jessica has been Layla’s biggest cheerleader as she has been trying to conceive after her loss. After four long years, Layla is pregnant and Jessica is excited to meet Ryker’s baby sister.

Get to know Layla, as she shares her loss story:

Would you like to share your story of infant loss?

We became pregnant with our son, Ryker, after two years of infertility and seeking out the help of a fertility doctor. The pregnancy was perfect, I wasn’t sick, and had that pregnancy glow and blissful ignorance thinking nothing would go wrong. Until it did.

At 25 weeks my water suddenly broke and I was hospitalized. Then at 27 weeks our son Ryker was born via emergency C-section. He was 2lbs 7oz and a fighter! It was touch and go in those first few days, but then he turned a corner and we thought everything would be ok. Then overnight, he developed a brain bleed that wasn’t something that could be treated or survived. We spent the remainder of that day with him, surrounded by our families, as we said goodbye so soon after we had just said hello. It was heartbreaking. But also during that time we created beautiful memories with him and said everything we needed to say. He died in my arms after about an hour and half from being taken off life support.

What was your experience with our healthcare system?

There is a big gap in experience across the country when your baby dies. But one universal area that I found is that there is not much direction or support for what to expect when you leave the hospital without your child. Your milk still comes in, you are still in active postpartum recovery, but it all feels very foreign and different when the baby you grew is no longer with you. The only check-up is the standard 6 week check-up, which felt years away. You are trying to heal and trying to process immense grief at the same time and it is truly too much to handle.

What did you find the most helpful in your journey?

I found the pro-activeness of friends and family to be what was needed. You often hear people say “if you need anything, let me know” or “call me” but when you are in the depths of grief, there is an inability to understand what you need, or have the courage or mental capacity to ask for the help. People would show up at our door with food, or to check on us, or the messages that came in reading “you don’t have to respond, but we are thinking of you and how you’re doing”. Those messages made me feel open to talking and I would respond every time. Asking me about Ryker and using his name helped as well. My advice to people: “do not ignore what has happened, it may be uncomfortable for you, but it is far worse for the family who has lost their child and are surrounded by people who do not acknowledge the space they are living in”.

You’ve been supporting the pregnancy and infant loss community for many years now. What was your motivation to start Big Hearts Little Stars, an organization that supports families who have experienced the loss of a child?

My motivation for Big Hearts Little Stars was to fill the gap that exists when parents experienced the loss of a pregnancy or child. It initially began with donating books on Ryker’s first birthday, 10 books of stories written by Mothers to Mothers, and 10 of Fathers to Fathers.

It organically grew from there into what we now refer to as our Comfort Boxes. We supply both our local hospitals with large and small comfort boxes that include items to assist families through the grief process after their child dies. Items include a teddy bear, baby blanket, memorial candle, books for parents and young siblings, a booklet of resources (local and other) and some other meaningful items.

We also offer a private support group on Facebook so that grieving parents have a safe space to speak and ask questions with others who have been on a similar path.

What services does Big Hearts Little Stars offer?

Directly we only have our support group, but we do have connections to a lot of community resources and access to contacts across the province. We will do whatever we can to assist families who reach out.

I have also gone to coffee with a few people, as sometimes it is helpful to have an in-person heart to heart when dealing with such an emotional and difficult time.

How did you find light in your dark time?

When you lose a child, there is no hope for their future. You can’t hope they’ll get better or magically return home. The reality is, they are no longer here and nothing changes that. The hope or light I found was in sharing our story and the story of Ryker’s life. In sharing our story, I have been told that it allowed other people to find the courage and strength to speak about a loss they had suffered and had never talked about. In being open and honest about the experience it has allowed other people to feel less alone in theirs. That is the hope that I hold onto, the hope that if we are able to help one person feel less alone in their loss, that we can all carry the memories of our children who walk ahead.

What advice can you offer parents who have experienced infant and pregnancy loss?

Take your time, and give your grief the time it needs. This can mean many things. There is no rush to feel better, and no linear way that you will move through your grief. There is no moving on, but you will learn to put one foot in front of the other, and as you do you will always bring their memory with you. The grief will stay with you forever, but it will not always feel as raw as it does in the beginning. You will grow around it, and it will grow around you. I would encourage you to share your thoughts and feelings if it feels right to you, but if not, that is also ok as well. No two people navigate this the same way (including you and your partner).

Are there any resources or recommendations that you would share with parents who have experienced an infant or pregnancy loss?

There are a number or very good organizations within Canada, the US, and abroad that offer support. Here are just a few:

Pregnancy and Infant Loss Support Centre (Calgary) www.pilsc.org

PAIL Network Sunnybrook (Toronto) www.pailnetwork.sunnybrook.ca

Return to Zero (RTZ) Hope – US based www.rtzhope.org

Saying Goodbye – UK Based www.sayinggoodbye.org

There are also many groups that are geared towards specific issues that may have effected the loss of a pregnancy or child. Stillbirth, Preterm Premature Rupture of Membranes, Termination for Medical Reasons, and each of these (and more) have their own support sites as well.

What about the parents who want to try again after the death of their baby. What challenges might they face when trying again? Do you have any suggestions that might support them on their journey?

I don’t think there is ever a right time to try again, if that is something that you wish to do. I strongly believe in therapy as it will help you navigate the decision and also the emotions that will come up during the trying process, whether that includes fertility treatments or you are able to conceive naturally. Once pregnant again, there will be obvious and not so obvious things that may trigger you along the way, based on your history with a previous loss.

There is a really good app and website for Pregnancy after loss (pregnancyafterlosssupport.org) that I have personally found helpful while navigating this pregnancy. In addition, there is a great book called Pregnancy After Loss by Zoe Clarke Cotes that has day by day reading and journaling which helps families navigate their pregnancy after loss.

Is there anything else you’d like to share?

Take care of yourself during this difficult time. Set boundaries where needed, and know that your feelings are valid and you are not alone. When you are ready there is a whole community out there that will help you navigate the days, months and years ahead, and honour you and your baby.

About the Author

Layla Michaels (she/her), is a passionate advocate for fertility and infant loss awareness. She is the founder of Big Hearts Little Stars, a nonprofit based in Moncton NB, serving families who have experienced the death of a child through pregnancy to infant loss. Her nonprofit was founded in 2021 after the death of her first son, Ryker in the NICU in 2020. The mission of Big Hearts Little Stars is to bridge the gap felt by parents in caring for their grief after loss, and knowing they are not alone. Families are provided a comfort box from their local hospital with items and resources to assist them in navigating their grief, as well as an online support group. Layla has also volunteered with Fertility Matters on their East Coast Miracles committee, who worked to raise awareness, conversation and political pressure surrounding fertility benefits and access in the Atlantic Provinces. Her personal fertility journey has taken her through multiple procedures in Canada, overseas, and then finally having to seek treatment out of province. It is Layla’s hope that access to fertility care becomes more accessible for all persons wishing to grow their families, alongside compassionate care for families experiencing loss as well.

Connect with Layla:

IG @laylabun IG @bigheartslittlestars Tictok @mamagotguts

Interviewer- Jessica Palmquist (she/her), Doula School’s fertility & loss support program coordinator and senior instructor works with a diverse population and believes education, reproductive health, and wellness services should be accessible and customizable. In addition to Jessica’s training as a certified Fertility, Birth, & Postpartum Doula & Infant and Pregnancy Loss Support Specialist, she is a certified yoga teacher and has worked in the public and post secondary section sector for nearly 20 years. Her own unique journey to parenthood made possible through IVF paired with a passion for teaching, learning, and helping others led Jessica to birth work.

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October 21, 2024
Breastmilk Isn’t Free: The hidden cost of human milk

[vc_row][vc_column][vc_column_text title=”Breastmilk Isn’t Free: The hidden cost of human milk” css=”.vc_custom_1724336247678{margin-bottom: 0px !important;}”]August is Breastfeeding Awareness Month, or as I like to call it, Human Milk Month. In the birth world, most of us can rattle off the numerous benefits of bodyfeeding in our sleep. The probiotics, the antibodies, the bioengineered brain growing magic – the list goes on and on. In addition to the numerous health benefits, there are many practical incentives to feed human milk. Formula is exorbitantly expensive for lower-quality food. It’s easier to put a hungry baby directly to the breast in the middle of the night than it is to coordinate a sterile bottle mixed with sterile water while bleary-eyed. But we are way off base when we tell new and expectant parents that human milk is “free food”.

Singing the praises of lactation is tone-deaf to the fact that a need to return to work or school is the leading reason why new moms and birthers give up on nursing before 6 months. It takes a lot of privilege to produce on demand, unlimited food for another person for 6 months. Exclusively breastfeeding a newborn is a full-time job that doesn’t pay. It’s accessible to people who have the means to keep a roof over their heads and food for themselves in the fridge while absent from the workforce.

In Canada, we are fortunate to have the option to take maternity leave for up to 18 months. But there are several catches. Legally, your employer is required to reserve your job for up to 18 months. They are not required to compensate you during that time. If you are eligible for employment insurance (EI), the government will pay you 60% of your usual pay, up to a maximum. For most people who were working full time, this amounts to a significant loss of income. About 20% of employers in Canada will top up these EI payments to varying amounts and timeframes. The EI program makes payments for 12 months, therefore if you want to stay home for 18 months, the final 6 months are “self-funded” – i.e. you have zero income.

As for the many people who are not eligible for EI, unless they were in a position to set aside 18 months worth of savings or have spouses or other family members who are in a position to support them while they’re on leave, they will find surviving for even 6 months with no income quite difficult.

Unsurprisingly, racialized, Indigenous, low-income, and single birthers are more likely to need to return to work less than 6 months after they have their babies. During Indigenous Milk Medicine Week and Black Breastfeeding Week, we reflect on why breastfeeding rates continue to be lower for Black and Indigenous women than their white counterparts. This is a huge part of why. Until we address economic disparities, talking up the benefits of breastfeeding will not change outcomes.

We need to start framing the birthing person being home for at least 6 months as a human right for the baby and the birther. In the US, employers are only required to hold jobs for 6 weeks. This needs to be framed as a human rights violation, for mother and baby. So-called “breastfeeding friendly” workplaces do not cut it. Usually, this just means that there is somewhere other than a bathroom for lactating parents to express milk. This completely overlooks the logistical challenges of pumping and storing enough to keep a young baby fed during the workday and the emotional and psychological benefits of direct feeding.

We can look to examples in Europe, especially Nordic countries, for human rights models of lactation and new parenthood. In Sweden, new parents are entitled to be free from work and receive benefits for up to 18 months after their child is born. This entitlement can be shared by a couple or used by a single person. Unsurprisingly, Sweden and other Nordic countries have higher breastfeeding rates at 6 months than other high-income countries.

When my wife and I were born, mothers were entitled to 6 months’ leave. When I had my son 12 years ago, we were entitled to 12 months. Now people are entitled to 18 months. These are steps in the right direction that make sustained lactation and adequate bonding and recovery more feasible for many people. But there is still room for improvement, especially more support for working and working poor families. We need to see subsidizing the cost of human milk as an investment in a healthier future for children and families.

Keira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][/vc_column][/vc_row]

August 2, 2024
2024 Medicaid & CHIP Beneficiaries at a Glance: Maternal Health

[vc_row][vc_column][vc_column_text title=”2024 Medicaid & CHIP Beneficiaries at a Glance: Maternal Health” css=”.vc_custom_1718910346497{margin-bottom: 0px !important;}”]In the United States, publicly-funded healthcare is provided through Medicaid and CHIP (Children’s Health Insurance Program). These are joint programs of state and federal governments that provide health insurance to low-income people, children, people with disabilities, and pregnant people. These eligibility parameters mean that there are individuals who are eligible for coverage during their pregnancies and the postpartum period who are not eligible at other times. Medicaid finances 41% of births in the United States. Federal law requires states to provide coverage up to 60 days postpartum. A bill in 2021 gave states the option of participating in an extended coverage program offering coverage up to one year postpartum.

In May 2024, Centres for Medicaid and Medicare Services (CMS) released an infographic summarizing beneficiaries’ maternal health data. CMS collects demographic data on age, race and ethnicity, and geography. They collect outcome data on maternal mortality and severe maternal morbidity (SMM), underlying causes of maternal mortality, dental care access, postpartum contraceptive utilization, spacing between pregnancies, chronic conditions, timeliness of prenatal and postpartum care, smoking, behavioral health and substance use, neonatal abstinence syndrome, postpartum depression (PPD), preterm birth, and low-risk cesarean delivery. Additionally, they collect health system data on healthcare service provider distribution, state quality improvement activities, and state participation in an opt-in extended postpartum coverage program.

Key Take Aways

The data highlight key areas of disparity for Medicaid beneficiaries and provide an important road map for healthcare policymakers and system designers regarding where care could be enhanced. For example, the data show that Black birthers experience mortality 2.6 times more often than their white counterparts. This finding corroborates other research and supports advocacy efforts for publicly funded doula care as an intervention to reduce Black maternal mortality rates. Another useful observation is that birthers under the age of 19 experience higher than average rates of PPD (22% compared to an average of 17%). This suggests that in addition to universal PPD screening, additional attention should be paid to this group during the postpartum period.

This 9-page resource provides invaluable information to support US birthworker advocacy on expanded access to birth and postpartum doula care, freedom of provider choice and birth location, and mental healthcare. For birthworkers in Canada and other jurisdictions, it is an illuminating example of what can be learned from comprehensive demographic and outcome data collection practices.

Keira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.[/vc_column_text][/vc_column][/vc_row]

June 24, 2024
Embracing the Postpartum Mind

[vc_row][vc_column][vc_column_text title=”Embracing the Postpartum Mind” css=”.vc_custom_1715196675524{margin-bottom: 0px !important;}”]One of my biggest frustrations as a doula is the inattention paid to women and birther’s postpartum health and recovery. It’s a stark, ongoing manifestation of medical misogyny. Historically, women were seen as vessels for babies. Our health during pregnancy was paramount because a healthy baby was the priority. Once the baby is born, the focus shifts to the baby’s health. Moms and birthers get put in the corner. This is reflected in the growing body of research on the benefits of doula care, most of which focuses on birth support, with little attention paid to the benefits of having a postpartum doula.

Among other concerns, this sweeping aside of birther’s postpartum health contributes to postpartum mental illness, both its development and escalation as it goes unrecognized and untreated.

In every postpartum interaction, I ask the birthing client how they are doing. This often elicits a response about the baby. I hold space for this, answer any questions, and then bring the focus back to how they are doing. There’s often a sense that focusing on themselves after having a baby is somehow “bad parenting”. I use the routine guidance we’re given on planes as a metaphor: You have to get your own oxygen mask on before you can help anyone else. When new mothers and their health concerns get left behind, it’s like we are asking them to sustain someone else’s life with no oxygen mask of their own.

Prenatally, I review what routine postpartum care should include so clients know if anything is falling through the cracks. I also review things that aren’t routine but should be. This includes how to tell if you should be assessed by a pelvic floor physiotherapist, as well as how to tell if you are experiencing postpartum mental illness that should not be dismissed as “baby blues”. In our birth intention setting practice, I ask clients to reflect on the mental health interventions they are open to if the need arises. I ensure that I have referrals at the ready to culturally appropriate therapy, support groups, and self-help resources, along with information on pharmacological and naturopathic options.

Whether they remember any specific information or not doesn’t matter to me. The goal is to ensure that they know that I am a trusted person they can disclose if they are not feeling mentally well after they have their baby. They know ahead of time that I view mental illness as normal, non-shameful, and usually impermanent if the right steps are taken.

A 2022 US-based study that explored birth and postpartum support found that having a postpartum doula lowered the odds of having postpartum depression and anxiety by 57.5%. This data was drawn retrospectively from Medicaid claims in three states that fund doula care. It’s a great example of why our services need to be accessible.

The non-birthing parent can also experience postpartum mental illness which is often overlooked. As part of supporting the whole family, we should be vigilant about this risk and empower non-birthing clients to recognize early warning signs and see help early. Early intervention is critical for ensuring positive outcomes for any mental illness.

Spreading the news about the mental health benefits of having a postpartum doula is a great way to observe Maternal Mental Month and World Maternal Mental Health Day on May 4. It’s especially important to raise awareness among our elected provincial representatives, and health policymakers. These are the people who can ensure needs-based access to doula care.

#MATERNALMHMATTERS, #WMMHD #WMMHD2024

Keira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.

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May 4, 2024
Shining a Light on the Prevalence of Mental Illness

[vc_row][vc_column][vc_column_text title=”Shining a Light on the Prevalence of Mental Illness” css=”.vc_custom_1715195210027{margin-bottom: 0px !important;}”]At a recent public gathering, I noticed that a speaker referred to a community member exhibiting symptoms of a mental illness as “a person with mental health”. I found the turn of phrase jarring, but couldn’t quite put my finger on why. May is Maternal Mental Health Month and it’s a good opportunity to do the important work of finger placing, that is learning from what that feeling of discomfort is trying to teach.

Referring to mental illness as “mental health” is a confusing effort to euphemize states of mental ill-being. We use euphemisms for one reason: when the subject of conversation makes us profoundly uncomfortable. Clearly, being mentally ill is still taboo.

By age 40, 50% of Canadians will have or will have had a mental illness. It’s important to acknowledge that it is an unwell state that can significantly alter a person’s life. We can be strengths-focused while being honest. People with a range of mental illnesses can be resilient, resourceful, and creative. Some of the disability experienced by people living with mental illness is socially constructed, such as rigid social, cultural, and economic expectations regarding the hours and structure of paid work.

Truthfully, the acute phase of any mental illness does not feel good, and functioning to the best of what you know your ability to be, and meeting your priorities, becomes impossible. Most people would do just about anything to return to a mentally well state. Sometimes, desperation to return to a healthy state can be fatal, if people can’t see any path other than death to return to wellbeing.

Being unable to say you feel awful without shame is part of the problem. Being able to say “I feel like crap right now and I can’t function at my best, or at all” is the first step on the path to wellness.

As doulas, childbirth educators, and birth workers, we have a vital role to play in opening time and space for clients to say they feel ill. We can normalize not always feeling happy right after you have a baby. We can normalize feeling anxious rather than excited during pregnancy. We can normalize still being down months after you lost a pregnancy when everyone is saying “You can just try again.”

Recognizing that your state of ill-being is normal makes it easier to face without fear. With fear removed, it becomes easier to see that this state is temporary and become motivated to explore avenues to becoming mentally healthy.

This month we will spend time unmasking the mental illness behind Maternal Mental Health Month. It has a face, and it has a name. When we name mental illness, it’s like shining a light on the monster under the bed. We see that there’s not as much to fear as we thought and that we have more tools for safety at our disposal than we realized.

For more information about Maternal Mental Health visit the World Maternal Health Day website wmmhday.postpartum.net

#MATERNALMHMATTERS

Keira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][mk_header][/vc_column][/vc_row][vc_row][vc_column][vc_single_image image=”540566″ img_size=”full”][/vc_column][/vc_row]

May 1, 2024
Facilitating Accountability

[vc_row][vc_column][vc_column_text css=”.vc_custom_1706107261056{margin-bottom: 0px !important;}”]As birth workers, we often see things or hear things from our clients that should not have happened. It could be an ultrasound tech sharing an interpretation that is later contradicted by their primary care provider, causing the patient confusion and anxiety. It could be membrane sweeps, AROMs, or episiotomies performed without the client’s consent. Or nurses disclosing information to family members while the client is unconscious, leaving the patient to receive a broken telephone story from their family later.

These incidents range from irritations to serious breaches of practice standards, and things are more likely to “just go wrong” for systemically marginalized people. Clients are usually at a loss as to how to seek accountability or believe they can do nothing to address the harm they’ve experienced.

Some may be aware of complaints processes that exist, but concerns about outcomes on either end of the spectrum – nothing will happen, or the worker will get fired – are often a deterrent. And of course, our clients who have just had babies or experienced a loss may simply not have the time and energy to engage with a complaints process.

In truth, there are far more opportunities to address what happened than most people think. Speaking up can lead to many positive outcomes, including a faster return to well-being for the client, and learning and improved practice on the part of the care provider. The processes focus on restorative justice, learning, and growth, rather than punishing the provider. There is an understanding that the vast majority of workers in the healthcare system care about people and want to help. The options outlined below are suitable depending on the context and seriousness of what happened.

Speaking with the Care provider directly

For my clients who decide to speak up about their experience, this is usually the option they go with. This is especially true of midwifery clients who have an ongoing relationship with their care provider.

We can support clients in this process by clarifying the concerns and rehearsing the conversation to make sure key points are captured and that the client feels empowered to self-advocate.

I’ve seen improved treatment relationships and greater client well-being arise from these conversations. Especially in the case of complex births, creating a safe environment to debrief the experience with the provider is essential. Debriefing a traumatic birth with the care provider is a protective factor against birth trauma.

Engaging the Care Team

If multiple people are involved in a client’s care, sometimes a care provider with whom the client has a positive relationship can be a liaison between them and a provider with whom the client is having challenges. For example, in the case of the oversharing ultrasound tech mentioned above, it might be appropriate for the midwife or OB’s clinic to reach out to the ultrasound clinic to let them know about the impact this had on a client. This leverages the clinics’ mutually supportive relationship that should incorporate giving and receiving constructive feedback.

Patient Relations and other “in-house” processes

Talking with the provider directly isn’t always the right option. This is especially likely to be true in a dynamic where the client felt intimidated or belittled by the provider, such as a discriminatory incident. Our debriefs with clients can explore their level of comfort with the various options.

Depending on the setting in which the care took place, there is usually an internal process for raising concerns. For example, most hospitals have a patient relations department that can work with you to resolve issues. There is often a mechanism for the hospital to anonymize information raised with the provider. Staff within patient relations will investigate the complaint and decide on the best way to address it. This could include seeking an apology from the care provider, supporting them to learn from what happened, or more serious action depending on the nature of the complaint.

Regulatory Body

Suppose a client has a serious concern about someone involved in their care who is a member of a regulated health profession. In that case, they have the option of filing a complaint with the care provider’s regulatory body. In Ontario, these regulatory bodies are called “Colleges”. They may be called “Boards” or “Associations” in other places. If you’re unsure of the system where you live, I recommend searching for “regulated health profession [your province/state]” and finding out more about health professional regulation where you live, especially for the professions providing perinatal healthcare, such as nursing, midwifery, medicine, pharmacy, and diagnostic imaging.

Professional regulatory bodies fulfill a range of functions including setting educational requirements, registering members, setting professional standards, and investigating complaints and reports.

Anyone can go to the College with a complaint about one of their members. When health professionals work in settings where they have oversight, such as a hospital or clinic, management is legally required to report certain types of information to the regulator. It’s one of the reasons why it’s always best to take the complaint somewhere internal first.

A range of things can happen, such as a letter with recommendations, reflection exercises and activities to support professional development, and a meeting with an expert in an area where more learning is needed. In some instances, the regulator may take no action. In some situations, the College can pursue an internal prosecution of the member. Again, a range of outcomes is possible, including having their license to practice their profession removed. This outcome is very infrequent.

Complaints Commissioner, Ombudsman, etc.

Provinces in Canada have arms-length government bodies that ensure the quality of public services such as healthcare. In Ontario, complaints regarding healthcare can be taken to the patient ombudsman. In Quebec, complaints can be made with the Complaints Commissioner. This 2022 case study explored the advocacy potential of many individuals accessing this complaints process. In 2019, “Obstetric violence” became a focus of media attention in Quebec due to a series of articles published in La Presse about experiences during childbirth, including inappropriate comments, procedures performed without consent, and being separated from babies. In the weeks following these publications, the Complaints Commissioner received an influx of complaints that spoke to a systemic pattern. The Commissioner is well placed to liaise with government policymakers and she produced a report with recommendations aimed at improving perinatal care. This led to several outcomes, including workshops for service providers on communication, information sharing, and consent.

“It’s me, hi! I’m the problem. It’s me”

Transparency with our clients about accountability includes making sure they know what their options are if they have concerns about us! Keeping the lines of communication open so they feel comfortable coming to us with concerns is ideal. If a client has a concern about a certified doula or perinatal educator that can’t be worked out, the client can go to their certification organization. In Ontario, If clients have concerns about how their personal information was used or shared, they can file a complaint with the privacy commissioner.

Seeking accountability has the potential to be healing and empowering for clients, while providing a learning opportunity for the client. When working with diverse humans at a sensitive time, hearing critical feedback compassionately and receptively is integral to our ability to grow in our practice. It may not always feel great in the moment, but if we reflect honestly on constructive feedback, it can be a wonderful catalyst for deepening our practice.[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_single_image image=”534490″][vc_column_text css=”.vc_custom_1706107304539{margin-bottom: 0px !important;}”]Keira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities

Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.[/vc_column_text][/vc_column][/vc_row]

January 24, 2024
Our Hearts Are With You

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To our dear healthcare and birthworker community,

We are aware that these unfolding moments call us into deeper and deeper layers of service, compassion, and commitment to the families that we support, and responsibility towards our broader community.

Our hearts are breaking as we bear witness to the grief and collective trauma experienced by Israelis and Palestinians, and Jewish and Muslim communities. We know that many people have lost loved ones, friends, and acquaintances to the ongoing violence. We stand with you in your grief and share your worry, confusion, and sadness.

As allies and friends to Jews and Muslims, we are deeply disappointed and appalled by the acts of antisemitic and Islamophobic hate that events in the Middle East have spawned. We know that many members of our staff and communities are afraid to engage in public life because of these disgraceful acts and we are truly sorry. We’re aware that there are many ripples of impact and that some of you and your families are directly and indirectly impacted by the conflict between Israel and Palestine. You belong here, and you are welcomed with compassionate hearts.

We know that even those who are not directly connected to the fighting are still experiencing emotional dysregulation triggered by the onslaught of violent images and stories and the mass grief that surrounds them. We see you and stand with you.

Call To Action:

Many organizations in the birthwork community may be justifiably afraid of saying things that cause more pain, and are therefore choosing silence. While this is an understandable and human response to trauma, silence and inaction are a huge part of how the conditions for violence are created.

We might be asking ourselves in these times:

What impact can I have? How will I show up to meet the pain of the world? How can I lovingly meet my own pain? How might I contribute to more compassion instead of more suffering? How can I incorporate a trauma-informed approach in my support to do less harm?

As doulas and perinatal educators, our direct support to families is a critical intervention and action for reproductive justice. Doing this work intentionally involves recognizing the systemic pathways that connect all forms of violence, and unequivocally denouncing and confronting violence wherever it is found. We support and amplify international calls for peace.

We recognize that there is only so much that we and each of you can do about this astronomical and overwhelming disaster. We believe that there are small but profound practices that we can all access to take care of our pain, grief, and powerfulness. Collective healing starts inside each of us.

Mental Health

Prioritize checking in with your body and your emotional state. Maintain awareness of the impact that consuming the news is having on you and know your limits. Develop a trauma-informed safety plan that includes practical things that you can do to regulate your nervous system and process your day. Fast, accessible self-regulation strategies include taking long deep breaths, checking in with your body, and engaging in activities that help you feel grounded and connected. Reminder not to hesitate to seek medical attention if you are unbearably overwhelmed.

We are aware that those in North America who are directly impacted by the violence may need professional support. Some culturally informed North American mental health support lines that can connect you to other resources are:

Chai Lifeline Canada

1 (800) 556-6238

Khalil Centre

1 (855) 543-5752

Naseeha Mental Health

1 (866) 627-3342

Nisa Helpline for Muslim Women

1 (866) 315-6472

Talking to Kids

Letting our kids know that we see their reaction to what is happening and supporting them to begin to understand and have compassion for those directly affected is a profound action we can take to support and nurture our families.

Here are some resources to assist you with talking to your kids about the war in Gaza and Israel:

https://greatergood.berkeley.edu/article/item/how_to_talk_with_kids_about_the_war_in_gaza_and_israel

Here is some information about supporting your children’s mental health: https://www.aacap.org/AACAP/zLatest_News/Childrens_Mental_Health_Paramount_Amidst_Israel-Gaza_Violence.aspx

Trauma Informed Care

One clear action that we must take as birthworkers is to offer simple acts of self-care towards ourselves and and take action in the ways that align best with our sphere of influence. Reach out to your Jewish, Israeli, Muslim, and Palestinian friends and families that you are serving, and make sure they’re not alone with their grief. Let them know you care, even if you’re not sure you have the right words. Create safe meeting spaces where people can process their grief, listen to each other, and build kinship and understanding. We all have the power to be a light in our communities.

We hope that you are finding ways to nourish yourself and breathe through whatever is arising in your life in these times of intense upheaval. We invite you to share this information with anyone who would find it of benefit.

With care,

DTC Management and EDI Team

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November 10, 2023
Empowering NICU Parents as a Doula: Strategies for Support
[vc_row][vc_column][vc_column_text css=”.vc_custom_1696077782676{margin-bottom: 0px !important;}”]September is NICU (Neonatal Intensive Care Unit) Awareness Month. This special month is dedicated to acknowledging the challenges families face and providing them with the support and resources they need.

As a doula you will encounter times where families are navigating a baby in the NICU for various reasons. This is an overwhelming and difficult time for all of those involved. It is a traumatic separation of parents and baby. A time where navigating expectations of what parenting was supposed to be and what it is, is up against the fear of will my baby be ok.

Often times as doulas we feel scared and unprepared in supporting families as they navigate their way through this journey. Here are a few ways you can show up for families in the NICU.

Listen

Just as you might support someone going through any kind of trauma by listening as they speak, simply lending an open, non-judgmental ear can be of huge help to NICU parents. Focusing on listening ensures that you honor the experience they’re having, instead of clouding it with your insights, birth story, or advice.

Consider starting with, “Do you feel like talking?” before asking any questions about their status or that of the baby. They may really want to share with you how much weight the baby gained that day or how they’re doing on certain good days, or they may really want to vent on some terrible days. But they also may not want to talk. Asking if they’re open to talking before diving into a conversation is a way to respect their boundaries.

Support them in establishing communication with their baby’s care team:

NICU parents often feel insecure about how to provide care for their baby who is in such a fragile condition. It is important for them to know they are just as needed in the NICU as the medical team.
- Remind them they are their baby’s best advocate
- Help them formulate the questions they want to ask
- Remind them they can provide care to their newborn, changing diapers, taking temperatures, etc. The nurses will support them.
- Encourage them to keep a daily journal of their babies progress. keeping track of baby’s individual body systems, like breathing, digestion, heart, brain, eyes, and any special conditions the baby has. Keep track of milestones and ask the nurse what the baby’s current goals are. Sometimes the goals will change daily, and sometimes they will stay the same for weeks.
Offer Practical Support

As a doula this is our wheelhouse. Just as we would in the home, offering clear and concise suggestions about the type of support you can offer will help overwhelmed parents get what they need.
- Work with their support system to arrange food delivery for in hospital support and those at home. Gift cards for restaurants in and around the hospital, premade easy to heat up meals and snacks or even e-transfers will be greatly appreciated.
- Offer to do a load of laundry and bring it to the hospital ( or arrange for a family member to do so)
- Offer to be a communication liaison between the family and their extended family and friends, or help them find their person
- Remember that the birther is also dealing with recovery, help them with practical recovery strategies like pain management, pumping, etc.
Remember that the fear does not end when baby comes home

There is a lot of excitement when baby comes home however this doesn’t mean that the fear and concerns have ended. Often parents have not fully processed the trauma of being in the NICU and coming home creates a space for all of that to surface.

Find the parents counselling and peer support resources. Expect some hypervigilance when it comes to caring for baby. Patience and listening will continue to be important.

What strategies and tools do you use to support families in the NICU?

Sondra Marcon (she/her). Education and Administration Coordinator
Sondra’s background in family therapy and mental health work drives her to create environment for her clients and students that is both supportive and challenging of bias and assumptions. Teaching and development of curriculum drives her to continue to grow. Sondra’s drive to become a doula came when she saw the impact of early childhood experiences and parenting has on the wellness of both the infant and their parents.[/vc_column_text][/vc_column][/vc_row]
September 14, 2023