March 27, 2023

To the MLA’s of the BC legislative Assembly,

“World Doula Week” was first celebrated in the year of 2011. Occurring yearly since then, on the Spring Solstice of each year, we continue to celebrate “World Doula Week” globally, to uplift Doulas who work in service of their communities. This time of year is symbolic of both birth and renewal; as a collective of Doulas grounded in decolonial praxis, we particularly wish to acknowledge the teachings of this seasonal shift, alongside the power of natural law, which guide us in our work.

For as long as people have been having babies, trusted birthworkers have been serving their communities with love, care, autonomy and respect. Community birthworkers not only increase the intergenerational physical/mental/spiritual and cultural wellness of families, but reduce the volume of systemic harm their communities experience while navigating the healthcare system during their perinatal journeys. In today’s context, many community based birthworkers practice specifically as doulas. A doula is a trained individual who provides physical, emotional and educational support to individuals and families moving through their reproductive, perinatal and/or parenting journeys. Within various communities, doulas may also provide spiritual and/or cultural care. In many cultures both historically and currently, Aunties, Grandmothers, and Elders often are the providers of this care.

For this year’s “World Doula Week,” we gather on the traditional and unceded lands of the Lekwungen speaking peoples as BIPOC and allied birthworkers, with common understandings, experiences, and solidarity at heart. Together we recognize the value of our work, and how it positively impacts early family health. Doula care is particularly impactful for families who due to the lasting impacts of colonization, poverty, forced migration, and intergenerational trauma, are made most vulnerable by social determinants of health. Sadly, it is well recognized that due to internal biases structurally rooted within the healthcare system, simply interacting with the healthcare system puts marginalized families at risk. 

Doulas are distinct from midwifery and obstetrical care, however, the impact of doula care is just as powerful.  A large body of research exists to support this assertion, which we have included in the reference section of this letter.  With our role being primarily relational, utilizing connection, education, warmth and loving care as our foundation of practice.  We invest time and energy into creating a relationship of trust, and work directly on behalf of the family, as typically we are not employed by external organizations or authorities. This autonomy is a strength in our work, and allows us to act as powerful agents of advocacy and accountability when interacting with the healthcare system. This element of autonomy brings complexity to our working conditions, namely how our work is sustained and funded. Families who are able to safely navigate the healthcare system are most likely to have access to privately hire a doula at market rates. These rates average at two thousand dollars or more per course of care. As nearly all doulas working within the province of BC function as sole proprietors, families who experience vulnerabilities within their perinatal and parenting journeys – families who’s perinatal outcomes are most improved by doula services – are unable to access such care. The impact doula care has upon the health and well-being of a family is marked, well researched, and long lasting. For example, comprehensive doula support provided to families throughout their perinatal period is cited in neuroscience literature as having the highest impact on healthy brain development. Due to the lack of sustainable, equitable, and comprehensive funding for doulas, however, families who most benefit from our services continue to experience the impacts of social determinants of health, gaps in the healthcare system, and poorer outcomes.  

Logistically our hours are complicated as we work on-call hours, year round. The barriers to working as a doula are vast. For example, doulas who are parents and/or caregivers often struggle to find consistent childcare while working on-call. With most of us working for very little wages and as sole proprietors, we have little to no access to extended health benefits, sick time, vacation pay, and/or maternity/parental leave.  As health authorities and the Ministry for Child and Family Development begin to acknowledge the benefit of referring families to doula care, intake numbers to very small doula access programs, like the ones run out of Friendship Centres, increases.  We do not have the infrastructure to support the growing demand for our work.  Our current payment structures are frequently underfunded for the year. We are consistently turning families in desperate need of support away, as doulas are going months without reliable funding or pay.  While the impact of doula care is increasing in acknowledgment by the healthcare system at large, the momentum and progress that has been gained within the doula community who serve families and populations most likely to experience poor outcomes, is at risk of collapse. 

               Collectively, we have been in consultation with a small advisory group of doula coordinators and passionate front line doula support workers identifying some realistic initiatives to support the expansion of our work for the next five years, with the opportunity to evaluate and renegotiate at year 6.  

Enhanced funding is required to ensure eligible Indigenous and marginalized families have access to culturally-safe doula care to support a healthy pregnancy, birth and postpartum.

The BCAAFC has developed and implemented community-based approaches to birth work by creating ‘Circles of Birth Keepers’ programs in four Friendship Centres across BC. This project is building off of the success of the Indigenous Birth Keepers program at the Fraser Region Aboriginal Friendship Centre Association (FRAFCA) which creates wraparound care for Indigenous birthers to access support, programs, services, information and supplies, while also increasing capacity for Indigenous birth workers and Knowledge Keepers to mentor and support doulas.   

This project also supports Indigenous culture in birth by strengthening Indigenous traditional and ceremonial practices and protocols related to birth and new life, which have been negatively impacted through the policies and processes of colonization. This program enables birth ceremonies by providing funding for cultural supplies and honorariums, connecting birthers with Indigenous doulas, and bringing Elders and Knowledge Keepers into the circle to care for Indigenous families. 

For the four Friendship Centres currently running Circles of Birth Keepers (CBK) programs, funding has become restrictive in regards to where each center would like their program to expand to in order to maintain momentum. A full-time paid position for a Birth Keeper at each of the 25 Friendship Centre’s to run the CBK program is needed, along with additional part time Elder positions at each center. 

We are asking for your help to get the needs of so many families met. Please share and sign our petition to show that Doulas make a difference.