AmeriCorps doula job posting

As I noted in my post on AmeriCorps doula opportunities, I don't generally have any info about what's currently out there. AmeriCorps programs and positions are constantly changing and I don't even know what's happening with my old program, much less anyone else's! But I have a friend looking for AmeriCorps positions in Seattle right now and she sent me this posting:

Member Duties : Two positions are offered for members who will train as a Birthing Doula with Seattle Midwifery School. Members will then serve as part of Seattle's MSS Department providing pre and post labor education as well as labor support to clients who lack a support system. This position requires independence, sensitivity, a willingness to work independently, and the ability to handle a demanding on-call schedule as well as bilingualism in Spanish and English. To learn more about the role of a Doula visit www.dona.org. IN ORDER TO COMPLETE YOUR AMERICORPS APPLICATION, PLEASE COMPLETE AND SUBMIT THE SUPPLEMENTAL QUESTIONS LOCATED ON THE SEA MAR WEBSITE. These questions can be found by clicking to www.seamar.org, then pulling down the menu "Jobs", clicking on "AmeriCorps" and clicking to "How To Apply".

Program Benefits :
Childcare assistance if eligible , Education award upon successful completion of service , Health Coverage , Living Allowance , Training .

Terms :
Permits attendance at school during off hours , Permits working at another job during off hours .

Service Areas :
Community Outreach , Education , Health

Just reading the job description brought back such wonderful memories of my work as an AmeriCorps doula! I still describe that job as, hands down, the best job I ever had. If you're interested, go for it! (I promise my friend won't be competing with you... she's more interested in estuarine ecology.)

"Los dos" and an awesome new campaign

From the moment my AmeriCorps team started doing breastfeeding education and support in Denver, we came up against "los dos" (literally "the two", better translated as "both"). The majority of our clients, particularly at newborn visits, were Hispanic (largely from Mexico). When we asked them if they were breastfeeding/planning to breastfeed, the answer was almost invariably "los dos" - both breastfeeding, and giving formula by bottle.

I've had a post coming about this for a while - it's a very frustrating thing to deal with and as an inner venting strategy I've composed this post many times in my head.

Why so frustrating? Well, at my current work I see that often "los dos" begins in the hospital. Moms tell me "es que no tengo leche" - "It's that I don't have any milk" - even when I help them hand express abundant colostrum, they don't believe that their colostrum will be enough to sustain baby until their milk comes in. This supplementation often tends to feature HUGE volumes given by bottle (think 1.5 ounces on Day 1, with a baby whose largest feed should probably be 1/3 of an ounce. There is a separate, also long, post about volumes coming - not just about Hispanic moms either.)

Babies get used to the fast flow and firm nipple of the bottle, and they come to expect huge volumes which colostrum cannot provide the first few days. They become fussy at the breast and the mother tells me "es que no quiere el pecho" - "he doesn't want the breast" or "he's refusing it". There seems to be a perception (and believe me, this needs a lot more research) that a large percentage of babies just don't want the breast - with no specific cause or cure - and that if not, you should just give up and bottle feed.

(This, as a side note, is why I think all the people who say nipple confusion is a "myth" are full of it. Over and over again at the newborn clinic in Denver, we'd hear "es que no quiere", slap a nipple shield on, and baby would nurse happily with mom's newly-in milk supply and a nipple that felt more like what they were used to.)

If baby doesn't become nipple preferenced (which some manage to avoid) then continued supplementation often starts to affect milk supply. Mothers tell me they weaned their last babies at one or two months because "no tenía leche" - "I didn't have milk", and "se desesperó" - "he got frustrated" (although used slightly differently it would be mean "to lose hope" which seems so fitting for those babies!)

There seems to be a strong emphasis on babies getting fed a lot, as often as possible, and it's hard to convince/convey to many Hispanic mothers that their babies will get MORE breastmilk if they supplement LESS. Instead, the response to this frustration and dropping milk supply is of course to offer more bottles and fewer breastfeedings. Baby quickly learns where the real supply is coming from and the mother tells me that with her last baby after a few weeks, "no quiso el pecho" - "he refused the breast".

To me all of this is particularly notable as Hispanic moms almost universally tend to want to breastfeed, and when given cooperative babies and milk supplies will generally nurse for a long time - particularly as many stay home to take care of their children. Moms who give up on a nipple preferenced baby will happily nurse the ones who do tolerate "los dos" for a year or two. While many Hispanic moms have yet to make the connection between supplementation and early weaning, I think most of them would prefer to breastfeed longer.

So why is this connection not made? Why is there so much supplementation and so much expectation of "no quiere"? Almost every night at work I dream of rustling up an MPH student to do some focus groups with Hispanic moms on what it means to them to "have milk", for the baby to be satisfied, what they think formula adds to the baby's satisfaction/health, what it means when the baby "doesn't want" the breast, how milk supply is perceived to be driven, etc. etc.

That's still in fantasyland though, so I am so excited that the Massachusetts Breastfeeding Coalition has a new campaign going - the first that I've heard about - targeting "los dos". (Interestingly, they call it "LAS dos" which I've never heard, but maybe it just varies from person to person.)

One poster for the ad campaign has a picture of a baby and a speech bubble saying (in Spanish): "Both (lit. "the two")? Mama, you already have the only two I need! If you give me formula, you won't make enough milk for me." Below it says "Give me only the breast."

Another has the same dialogue with two smiley-faced breasts and a frowny-faced bottle - I love the happy breasts!

And check out the fun story behind the slogan at the Motherwear Breastfeeding Blog!

Will it work? Will moms like it? I hope to hear more about this... and if any MPH/anthropology/sociology/etc. students out there want to get a little qualitative research experience, PLEASE consider this topic!!

5 things that being a doula changed about me

I think being a doula changes everyone who does it, to some extent, but I think it may have changed me a little more than average, because I took kind of an unconventional path to becoming a doula. There are many reasons people go through doula training and start attending births, but probably most start out with a real passion for natural birth and for supporting women during this special time in their lives. I thought those things were really interesting, but I also wanted a job. I was graduating college and I wanted a job where I would move to a new city, try out this whole "public health" thing, and hopefully get some new skills out of it. And I got a job in Denver that fit those criteria, through AmeriCorps, where I would do various things including be trained and work as a doula.

If I hadn't been hired for that job, I would have taken one in Minneapolis working for a refugee health organization on issues like tuberculosis control and mental health services. My guess is I would never have pursued doula training independently - I would have been interested, but never interested enough to actually put the money and time in.

So unlike other people who go through doula training, I didn't have any strong belief systems about birth going in. I had always been fascinated by birth - I watched "A Baby Story" religiously in high school. But I thought the epidurals on "A Baby Story" looked pretty sweet, and based on the stories my aunt told about her labors I had already decided that someday I'd get me one of those. I had started to get more familiar with issues of medicalization by writing my senior thesis on breastfeeding, but knew little about birth. I was not at all comfortable with homebirth - I thought it sounded unnecessarily risky. But that was kind of it.

By the end of the year I had attended over 30 births, all in hospitals, taught childbirth classes, newborn care classes, and done breastfeeding support. How did all that change a birth neophyte?

1) I became much more proactive about all aspects of my own health care. I no longer expected that health care providers would just tell me the "right" thing to do, because I realized that in many situations, there was no one "right" thing to do. Instead, I followed up medical advice with my own research and judgment. I asked more questions in the doctor's office ("What do these numbers mean? What would be normal? What if instead of taking action, we wait to see what happens?") Ultimately, I realized that I made my own medical decisions - and always had, even if that decision was just to do what the doctor said.

2) Correspondingly, I also came to believe that the goal of all women's health care should be empowerment. Pregnancy and birth are a great time for women to begin to take ownership of their health care, because it's such a crucial time period and involves so many health decisions. But why wait until then? Every significant interaction with the health system - annual paper smears, check-ups - should be a chance to involve women in their sexual and reproductive health.

3) When it came time for me to give birth, I no longer wanted the automatic epidural. Yeah, it looked pretty sweet on "A Baby Story". But they didn't show (or at least attribute) the stalled labors, or women itching and itching because of the medications, or such heavy epidurals that women had no idea how or where to push, or epidurals with a "hot spot" of pain. They didn't discuss how a woman with an epidural can't move around to speed her labor or move a malpositioned baby. I wasn't anti-epidural: I saw them as a great tool, where women stuck at 6 cms. for hours finally relaxed, and progressed to complete in 30 minutes. But applied indiscriminately, it seemed like they caused more problems than they solved.

5) I no longer wanted to give birth in a hospital. Over 30 hospital births taught me that anything I wanted that was out of the norm would likely be an uphill battle, and that a lot "norm" practices caused problems. It's not like I saw all uncomplicated births. I saw c-sections for fetal distress. and instrumental deliveries, and shoulder dystocia, but none of them made me feel like I would be better off in the hospital - just that I'd be fine with a hospital easily accessible if needed. Watching women spend their whole labor fighting just to have their wishes respected was exhausting and depressing. There were the occasional exceptions - like the birth story I just posted - but those (like that story) resulted from "textbook" labors where women got exceptionally lucky (not a single nonreassuring heart tone, 1 centimeter of dilation per hour, etc.)

5) I became more aware of disparities in our health system, and more committed to working to overcome them. I am coming from a place of relative privilege in getting all empowered and owning my health care and thinking about out-of-hospital birth. I have the race, class, educational, and financial privilege to easily contemplate all of these things. The women I worked with did not. Many of them did not speak English, nearly all were on Medicaid, very few had access to higher education, most were women of color. They did not have many options for their medical care and they did not have anyone suggesting to them that things could be different. When I get excited about spreading the word about birth alternatives, I have to remind myself that while I may want to make sure all my friends hear my spiel, this is one of the ways privilege works. We need to change not just our own attitudes, but the system. That's ultimately why I'm getting my MPH now - because being a doula and fighting the system one person at a time wasn't enough.

What has being a doula/involved in birth work/learning more about these topics changed about you?

AmeriCorps doula opportunities

As I said in my recent post, I wish more people knew about the opportunity to do maternal and child health work in AmeriCorps! (Still, I only found my job because I stumbled across it in the course of a massive AmeriCorps job search, so I understand why more people don't know about it.) There are amazing benefits to working for a good AmeriCorps program, not least of which is that your training is free. AmeriCorps programs are used to hiring people with relatively little training (although relevant experience doesn't hurt), so you are getting a huge resume's worth of experience for nothing up front. I became a Certified Doula and a Certified Breastfeeding Educator through my program. A good program (note that not all programs are good!) will also offer professional development opportunities, extra trainings, and opportunities to explore careers that are of interest to you. (AmeriCorps also offers you the opportunity to qualify for food stamps, although not everyone counts this as a plus.)

The program I worked for was part of the Community HealthCorps (not to be confused with the National Health Service Corps, which is for medical professionals with a clinical degree). Here's a list of the program locations, all located at federally funded community health centers. When I last knew - and this knowledge is several years old, so it may no longer be totally inaccurate - there were doula programs at the sites in Brooklyn, Denver, Seattle and Providence (although I no longer see the Providence site on the list, so sadly it may have closed). There was certainly discussion of training more, but I don't know if they have.

If you have any interest in health, some of these programs are great opportunities to get more experience. Some are aimed more at high school grads, others at college grads. My best advice, if you're looking, is to treat AmeriCorps the same way as you would treat any other job search. Look hard at the job, the supervisors, the program before you accept it. These programs are only as good as the organizations who run them, and since you're not going to get much money out of it you should be getting a great experience!

Edited to add, January 2011: After almost two years, I'm pleased that people are still finding this post and getting inspired by the opportunity to become a doula through AmeriCorps! Sometimes people e-mail me to ask for more information about doing one of these programs. While I am happy to talk to you about my experiences, I am now many years out of the program and don't know anything about the current programs available.

If you're interested in finding AmeriCorps doula programs, I suggest you try the following options:

1) Take a look at the Community HealthCorps link above and try to contact individual programs, or contact the Community HealthCorps national office directly;

2) Search the AmeriCorps program website for opportunities - unfortunately they don't seem to give you the option of keyword-searching program descriptions, so you would need to drill down looking for health-related programs and read through their descriptions to find ones that do maternal and child health/doula services.

The fastest and simplest way is probably to contact the national office directly; I encourage you to encourage them to make this information more easily accessible on the web! I would love to be able to link to a resource page with updated info on all of the programs.