S01 EP02 - Casey Runck, Birth Doula: On Advocacy, Empowerment, and Inclusive Reproductive Care
Faces of Postpartum—The Podcast is a show about the postpartum period and its unique variations, hosted by Ariane Audet.
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S01E02
Casey Runck, Birth Doula
This week’s episode features Casey Runck, a badass birth doula in the DC area. We talk about weight stigma in perinatal health care, empowerment, inclusivity, and advocacy.
Please excuse the quality of my sound, as my usual microphone had died! Will be back with a better voice next week.
Casey’s Website: https://www.caseyrunckbirthdoula.com/
And Instagram: @tipsfromadoula
Full Transcript
PWC 01: Casey Runck - Birth Doula
Ariane: [00:00:00]Welcome welcome, my lovies to faces of postpartum the podcast. I am Ariane Audet, writer, mom, photographer advocate, and founder of the project. In this podcast. I feature postpartum stories from parents informal discussions with friends about parenthood and interviews with passionate providers and experts.
Everything here is evidence-based, honest and heartfelt. So stick around for unfiltered talks about the postpartum period. It's always an honor to have you here.
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Casey: So my name is Casey Runck and my pronouns are she her.
I have been working as a doula since 2016. And prior to that, I was living and working in Philly and I worked in office job and it was really fine until it wasn't . Like without sounding super cliche, I wanted to do something that, that made a [00:01:00] difference, but I also wanted to do something that I loved doing. I think that we do live our jobs. And I know that that's not a really popular belief, but I think it is, I think it feels fact to me. And so if I was going to be working until I was 65, plus, I wanted to wake up and love what I was doing.
And so my childhood best friend lived in DC and I sold my car and most of the things I owned, moved to DC lived in her basement and like not a cute DC apartment basement. I mean, I slept next to a washer dryer. And I really wasn't sure what I wanted to do. But I felt like let's move to DC and see what shakes out. And I met a bunch of people that use doulas and loved them, and that childhood friend had used a doula many years before and had used midwives and had had an out of hospital birth. And it, it was a [00:02:00] great experience. I think normal is simply what we're exposed to. And so her first birth experience was my first big exposure, close exposure to birth. And I was like, this makes sense.
And then other people I knew had babies and it, it always felt like a very different scenario. So all of this was happening around the time I just had started moving...
Ariane: Because they were not happy and they did not make as much sense, or it was just different?
Casey: It just sort of felt really detached. Whereas every time I would talk to my friend about what was going on in her pregnancy or what happened at her birth or what happened postpartum? She was happy. She described, I mean, we, I need to preface this by saying we were in our very early twenties.
She described unmedicated labor as doing a lot of laundry. You don't want to do the laundry [00:03:00] and you start, and it's hard and you're tired and you want to stop doing the laundry, but you keep going and then it's over and you feel great. She has since had another baby and would really dispute that, that statement.
But in her birth scenario, she was discharged from the birth center, which was in DC, four hours postpartum. And I that's, when I met her, like I drove down from Philly, I met her and she was happy and holding her baby. We sat on the couch, she ate cereal, like it was. It was just a very, it felt like a very happy situation.
And I that's the word I just keep coming back to. And whole. And then people came and checked on her and called her, and it felt like a complete circle of care. And I'm now able to understand this because of my work, but, and at the time I just didn't. But I just felt like I read stories online and just people that felt we have created a [00:04:00] space in this country where here's the, here's the cold hard truth: If you told someone that they needed to be physically or emotionally hurt to have a healthy baby and to have a healthy child, they would do it in a second and they wouldn't ask any questions. They would put their hands up and say, do whatever you have to, because this is what's going to make me a parent.
And that's where we're at. Is that...
Ariane: or the healthy baby? I just want a healthy baby. Yeah. Yes, of course. And.
Casey: Yeah. And specifically, like we're rounding out black maternal health week right now, the bar is for people to live. That's the bar.
Ariane: Which makes no sense in a country like the United States, no sense. It should be much more than that.
Casey: Yeah. But the thing is, is that people have these traumatic birth experiences and they accept them as normal. And then you're at a [00:05:00] barbecue. You're at a child's birthday party. You're at a baby shower and people throw in these little tidbits of like, I had an emergency C-section. I "had" to be induced. My provider "made me"... like all of these little tiny things that are just like, Bing, Bing, Bing. And it feeds this cycle of I have to get hurt or I just won't have, like, there's no other option. I get hurt to get a baby. I sort of diverge from my story about...
So I I met a mentor who I love very much and still have a great relationship with who told me what training to take. And I took my training with a labor and delivery nurse and also a midwife. A nurse midwife here in DC and I felt like it was a really complete training. And it was, it was five years ago. And then, you know, I, I think it just sort of, it just sort of spiraled. I remember attending [00:06:00] the first birth and it was everything I had ever loved.
But the volume had been turned up. I think I really love to work really hard. I'm a very, very competitive person. Someone once said that to me as an insult. And I was like, thank you so much for the compliment. And one of the things that I think is a lot of fire to me is the competitiveness that makes every time I go to work, I need to be better than I was the day before.
And that matters to me. And I, I really love that challenge. I also think that the way people are treated in pregnancy birth and immediate postpartum, it impacts the rest of their life. And I think that it impacts how they parent. If someone feels railroaded, abused or taken advantage of, that has knocked down their confidence.
And then when they get home with that healthy baby, they don't feel confident in how they raise that [00:07:00] child. And, and people do remember their births for the rest of their life. Just the other day I was talking about my grandmother who at 86, she always told me my mom's birth stories. And at 86 years old, she was still telling her birth story.
If you say that how people are treated in this time doesn't impact, doesn't have long lasting impacts. My grandma at 86 telling her birth stories begs to differ.
Ariane: Yeah, mine too. And every single other person I met. And it's interesting because when I started this project, I would sit down with people and I'd be like, so tell me about your postpartum period and the first bit of this story was: my labor started at... And so they start with the birth unless, you know, something happened before they had fertility issues or any other events that was significant. They always start with the birth because this is the beginning of everything. It taints every single thing that's going to come after years down the line.
And so, [00:08:00] once we care for these people it will affect the rest of their lives. So you, you started five years ago. How many births that you attended?
Casey: I think this year I will serve my 300th family.
Ariane: Congratulations. It's beautiful.
Casey: I think at some point I sort of maybe stopped counting as like, when I first started, I was like nine, 10, 11. So approximately in that 300 range.
Ariane: This is awesome. So the reason why I sent you a message is because I'm writing this article about weight stigma in pregnancy, birth and postpartum. I interviewed Emily who extensively talked about that.
Of course it's hard to talk about weight stigma in that period without talking about the whole "obesity" epidemic in the U S and how BMI is taking over the medical world. But just [00:09:00] for, let's say for the exercise today, can you tell me what is weight stigma? How does that apply in the perinatal world?
Casey: So I do need to say that I feel as though I'm specifically talking to cis-gender women and we do absolutely know that not everyone that gives birth is a woman. And I really want to be respectful of that. And when talking about weight stigma, I think of cisgender women and the way that they have been exposed to weight stigma Since they were in utero.
I mean, weight stigma, it starts before a baby is born. And it starts with your baby is so big. Your baby is just your baby's very big. This is probably going to be a really big baby. And when you push that really big baby out, you're probably going to have really extensive tearing and it's really going to hurt your body.
Ariane: Or we cannot wait much longer because your baby's going to be too [00:10:00] big. Although we know that there's two pounds differences in ultrasounds, like it's not a completely accurate measure.
Casey: Yeah. And so I just think like, yeah, when we're looking at like weight stigma, it's it. Comes to us before we even recognize it.
And there was a recent tick tok that went pretty viral of a gentleman talking about how his daughter's clothes, his infant daughter's clothes were marginally smaller than the little boy clothes in the same, like in the same brand. Like he held up, I don't know, insert baby brand boy and insert baby brand girl. And the girl's clothes were smaller for the same age pocket. And even the cuts of things. We put cis-gender little girls in super tight leggings and we put cis-gender little boys in jeans. I don't really know why babies need to be in jeans. And so I just [00:11:00] feel it starts so, so early. And I feel all of that, it builds throughout a lifetime. And then we take a person who is pregnant and when is a person most vulnerable in their life, emotionally and physically? When they're pregnant. And so we have taken their entire life and this stigma and all of these subliminal, cultural and societal messages and toppled them all on top of each other.
And now we are also toppling on top of each other, the fact that we have other messages in our society that tell people the most important thing they can do is to grow a healthy baby. And quite frankly, if they don't grow a healthy baby, are they really fulfilling their duties as a mother? And that's, I mean, that's fundamentally, I'm gonna, I'm gonna curse fucked up.
Cause we know that that's not true. You are a good mother and a good [00:12:00] parent, no matter how you make your family and your worth is not dictated by your fertility or your family. You are completely whole and worthy as one person. But those messages, I think that we get are a little bit different.
And I think that when, you know, I think we also need to look at the, the bracket of people giving birth. So as a whole, we are the most educated birthing people that the planet has ever seen. And sometimes we're a little older because of that specifically in urban areas, right? People go on to get secondary degrees and advanced education.
And the message that is given to people in those scenarios is: be bold, be a firecracker, punch this, go as hard as you can. And it makes people successful. And it does right. They are lawyers, they are doctors, they are heads of their department. They [00:13:00] are powerhouses. That's all rooted in a lot of control.
And then we take the biggest job they will ever, ever have, which is being a parent or being a mother. And they apply the same coping techniques they've used their whole adult life into this scenario that does require a different set of emotional capabilities. And so then when we start talking about weight, it gets very controlling, very fast because let's say that there is a one hour gestational blood sugar test done.
I'm very mindful to call them screenings and non tests because you cannot fail a gestational diabetes screening. You cannot fail your pregnancy. But so right. We're working with all the control lifelong, like since utero stigma yeah, it's a recipe for, for disaster. And then when we add in the fact that everyone is working from a different [00:14:00] place of understanding and communicating in terms of the provider and the care team side everyone could be at a different space. People are then getting a ton of conflicting messages. You know, how do I control my sugar? Well, I don't really know if we can control something that's happening metabolically inside of your body. We can, we can sometimes try to understand what's happening and make adjustments to keep every, you know, to keep things within a range.
But you know, we can't control what's happening inside of your body.
Ariane: And now we're even talking as a whole, but add to that, someone who has a higher. BMI add to death, someone who has battled eating disorder, or even if that person hasn't, and just has a bigger body into the world. Was without a doubt, probably dismissed [00:15:00] before by adopter because they probably just say lose weight and come and see me in two weeks or in a month.
And for things that might have been completely unrelated to that. I imagine you go in there with already this feeling that you're failing has a human. That you're not fitting, not only the standards. But you're failing as a parent and you have no control over what's your body's going to do during that period.
So all your life, you've tried to control something that ultimately you didn't need to control. The society kept sending you messages that you had to, and it was in your power and your power only. And now you just got to, you know, let your body do its job with also providers. And as you said, conflicting informations and opinions too, that are not always evidence-based.
As a doula, how do you support people who enter that arena without them [00:16:00] losing an eye?
Casey: I think that it's really important to be mindful and mindful of the provider that a person is working with. Because I think that doulas can, can really provide a lot of information and sometimes a shield.
But they are one puzzle piece in this entire setting and you can have the world's best doula. And if you are working with a really rough provider, the way that that doula is going to be able to have an impact it's like trying to play catch with one arm tied behind your back.
I think specifically talking about Emily and I feel very confident she is comfortable with me sharing this. She didn't have one person on her team. It was a complete circle of everyone on the same team and everyone with the same goal. And that's the story that [00:17:00] needs to happen for everyone.
And I think that it does get really challenging because we are in a major metropolitan area where she had the ability to look at what are all of my options. She also had the resources to be able to hire a doula. And quite frankly, I'm fairly expensive. And so I do work on a sliding scale but doulas are expensive, right?
Ariane: It's out of your pocket. Not everybody can afford them.
Casey: And so what are we doing for people in middle- I grew up in Ohio- middle of nowhere, Ohio who have access to one doula who is too expensive for them, one provider who treats them poorly and doesn't practice evidence-based information.
That's where we're at . And it's devastating.
Ariane: And there are also socioeconomic reasons, not just health reason for [00:18:00] people who have bigger bodies. And and, and if you don't take that into consideration, then they also cannot have probably the support, as you said, you don't have the resources necessarily.
You can't win and not only you can't win, it keeps undermining your chance to actually having a non-traumatic birth and pregnancy and and postpartum.
So have you in your career witness any form of discriminations based on, weight?
Casey: Yeah. And I also want to add we, we are in a pandemic.
We are two months ago, there was an insurrection at our nation's capital, which is where I live. You know, what else really impacts blood sugar? Stress. Where is that conversation? There is conversation happening in the birth community right now that, so typically folks will be offered a one hour glucose screening.
And then depending on the results of that [00:19:00] one hour screening, they could also be offered a three hour glucose screening. And so I, I have seen more in the past year and change people that needed to move forward or the recommendation was to move forward and they agreed with a three hour screening because their numbers were high at the one hour.
That's not a coincidence. It's not a coincidence that more people are having higher numbers at their one hour screening. I think that we are at home more, we're moving our bodies less, even in a really gentle, mindful way. We're not walking to the Metro to go to work. Maybe I'm just speaking for myself, but I am finding emotional comfort in grabbing a cookie at night.
Because the world is on fire and I want a cookie. And then we're adding this intense amount of stress. Of course, it's happening right now. I think one of the things that you had flagged was maybe sort of trauma informed care the root of that will always [00:20:00] be to look at the entire person.
And where is that? When looking at weight stigma, when looking at sugar numbers, when looking at these screenings that are offered to people. Where is the whole person entity happening? It's it's maybe not as much as it needs to be.
Ariane: So the importance of individualized care is interesting because I was talking to a psychiatrist last week and she's like, this is really hard to assess. So therefore she can't put a price on a care insurance companies and hospitals are like, so why are we doing this? Because if your optimistic think that they have our best interests at heart, you think they're just trying to juggle the reality that they want to care for as many people as possible. Which is, you know, noble. If you're less optimistic and you think, well, they just want to make money, then it's far more efficient to just do [00:21:00] average and statistics and it's pretty systemic too.
Casey: Yeah, and I think about a scenario that really does encompass a whole care. It was a conversation. There's what happens in the room. And then there's also what happens in the hall. And a very, very, very well-meaning person said in the hall while someone was in labor. Yeah. I looked at their belly. It's going to be a big baby, big baby. And someone else said, I don't think that that's a big baby. I think that's just their body.
And it was that moment where I was like, Oh, that's so beautiful. That was such a perfect response to that. And you know what, it was not a big baby. It was a seven pound kid, which isn't totally typical sized kid. But different bodies look different.
And so, I think that the other element of weight stigma is just the way that society feels it's appropriate to comment on pregnant people's bodies. Like it's a community [00:22:00] thing. It's not a community thing, it's your body. And so, you might wake up on a Saturday and feel super great about your body and feel like, look at me, I'm a bad ass. I'm growing this baby. I'm going to put on like my super tight top, because how cool is it that I have this belly that's growing a baby. And then you go to the farmer's market and some Yahoo's like, you got twins in there? I think some people have the ability to shut that down emotionally and other people, specifically people who have felt like they have been moved along and, you know, at 13, got on a scale at a provider's office and was told , Oh yeah, you're really packing on the pounds. Right? The way that, whatever messages you've been given your whole life, then that person at the farmer's market who says you have twins in there, like those messages really do matter.
Ariane: They effect you, even, if you feel great, even they do affect you, even if you think they don't, they just like creep into your [00:23:00] head and over time it just weighs you down.
Casey: And sometimes we grow babies that are big and have trouble navigating the pelvis.
We would not exist as a species if that regularly happened. And that's why, I mean, that's my favorite thing to rely on if that regularly happened without reason and without cause, we wouldn't be here. So statistically, your chances of growing a kid that's going to be able to navigate your pelvis pretty high, pretty, pretty high.
Ariane: And if it's not, well, there's other options like to get this baby out that has nothing to do with your weight, or your BMI or none of that, really. I just don't get the reluctancy, like it's, well-documented now. But I guess change takes so much time , discrimination is very common.
There are many research about that. A lot of studies have been done about the fact that [00:24:00] BMI is complete bullshit, that it's not serving anyone . It's not serving the provider because it doesn't give you more information. And it's definitely not serving the patient because, well, you know, it's just going to be a tool for discriminating that person and possibly not offering life-saving options to that person.
So I just, what is the reluctancy ? I know it's a big, intense question because it's not just targeted to the medical establishment, but since this is where you work mostly. What's the problem? Why can't we just accept that different bodies exist, that different bodies will give birth.
And that was just the way it is. It's backed with science what more do you want?
Casey: So. I think that this is going to be a roundabout answer. So, about a a hundred years ago you know, there was a white man obstetrician, and I will preface this by saying that this system can not get [00:25:00] better if we do not all work together. And I will never, I will never contribute to anything that perpetuates discord. So a hundred years ago, this white man OB said, and it's rooted in white supremacy because at that point, the majority of births were attended by grand midwives who were black women. And this OB, said, this is the way to do it. These women will kill you and we need to get into hospital. And that's when the country really started to see a difference in like how health insurance was being built and things like that.
And that's also around the time that we started to see people accepting employment because they could get better health insurance. And so all of that started and it continued to perpetuate a smear campaign against these grand midwives. And we're still there. Why? Not everyone is a [00:26:00] candidate for, and not everyone wants, an out of hospital birth.
But an out of hospital birth, beginning to end can run you about $6,000 in DC. If you add on an very skilled doula, okay. Seven or $8,000 for an out of hospital birth. And that includes the majority of prenatal, birth, and postpartum care, with the exception of usually labs are a few hundred bucks more max. A low intervention hospital birth with midwives, your insurance is built about $30,000.
So, you know, how many people have a disposable $8,000 to throw out an out of hospital birth? Not as many as there should be. But a lot of insurance companies aren't reimbursing for that, or aren't reimbursing appropriately or holistically. And who's our most vulnerable population?
Ariane: Not to mention that gynecology and obstetric has been [00:27:00] founded on the back of black women and they experimented on them and there's also the stigma that they had a different frame of body and their body is just built differently, which is completely normal.
I don't want to imply to people with bigger body necessarily have bigger traumas, but there's definitely different things associated to living in this world bearing more weight than what is socially acceptable. In an ideal world, there would be out of hospital births. Because let's be honest, low-risk births are very common. I read a number was 85% or something like that where you don't necessarily need all of these interventions. So it's a pretty high number of people who would qualify. We talked a little bit about individualized care, but how do you approach that? For example, when you meet someone, do you ask ? Do you advise them on different things they can do to, aside from the glucose test, which seems like it's so insane. We assume [00:28:00] that bigger body will have diabetes, like there's a correlation here that is completely based on nothing but what you put you look at, which makes no freaking sense.
Casey: Cause just gestational diabetes is caused by the placenta.
Ariane: It has nothing to do with what you look like. And so how do you go in with your patient, with your clients, how you call them patients or clients?
Casey: Clients, and you know, using the word client, I think is fairly mindful in a variety of ways.
One doulas don't provide medical care. But also patient in this system, the word patient really gets to a lot of control things. Right. So we have to do whatever this provider says. I go in, I keep my mouth shut. I don't ask any questions. We're looking at a huge dynamic of control, which then perpetuates a cycle of like healthcare trauma and systematic trauma.
Ariane: So interesting. You're right. It's in the words [00:29:00] themselves. The provider, it's like an active figure. Who's giving you something as opposed to someone who's patient and just passively waiting for that person to just feel it with whatever.
Casey: Yeah. So, you know, I think, like I said, finding the right provider is really important.
But then you don't get to be selective about what issues you choose to be supportive of. You just don't. In my opinion, the role as a doula. So like, I can't, I can't say that I am supportive of all bodies, but also say like what I'm very supportive of insert, maybe sexual trauma. Or I'm very supportive of health care trauma, but I don't support LGBTQ rights. This isn't a buffet. Like you don't get to cherry pick which amount of trauma you want to support. You do, or you don't.
Emily has been trained since she was little to go in to [00:30:00] a provider with a list of questions and be professional and bold and direct. And she did that with me and it was throughout the course of that pregnancy that I just asked her if she was asking me those questions because she was scared or because she wanted to know the answers. And spoiler alert it's because she was scared.
But I think there's this element of what's the nurse going to say to me? What's the person checking in, gonna say to me, like, who works at the desk that checks me in, what are they going to say to me? What's the ultrasound tech gonna say to me? And so I think it is giving people the tools and hopefully in turn the confidence to be able to stand tall in those moments of, of what could be a very overwhelming situation. And so one of the things that we looked at was like things that we can control.
You can labor in your own clothes. Any time you go to a [00:31:00] provider, you don't have to put on a paper gown. You never do. I don't care if you're going to like an orthopedics or surgeon or a GYN visit, you don't have to put on a paper down. Your butt does not have to stick to the paper. Everyone knows what I'm talking about. Like at those GYN visits, when your butt sticks. You don't have to do that in labor and delivery whether you want a medicated birth or unmedicated birth, you don't have to put on a hospital gown. You can be in your own clothes, which makes you feel better. You're not worried about whether or not those other things surrounding you are restricting you. You can make your own bands for the monitors. We made bands to hold on the baby monitors out of towels. And it took 10 minutes and it gave someone a lot of confidence and it was not about whether or not those bands were going to come into play because heads up, she never actually used them, but the act [00:32:00] of making them, made that person feel as though no matter what was going to come up, someone was on their side. So even if, let's say a very well-meaning, we're not well, meaning nurse or auxiliary person said something crappy, that family knew that there was someone that was going to have their back and stand up for them.
Even if that meant, you know, I don't want that to sound as though that means like I'm gonna set this place on fire. As much as no, we're good. We think that this is a beautiful body. Or no, thanks, we don't need to talk about weight. You absolutely can say that you don't want to be weighed and it can be noted in your file.
Ariane: It throws everyone off. It's insane. People yell at me, I've had people scream. You don't, you really absolutely don't have to. Yeah. It's like, but it's protocol. And every time I hear that, I just want to throw my S my head on the wall. it's really difficult. And you said you don't want to set the house on fire or [00:33:00] feed any form of discord. And I understand that because I do agree that there's just no other ways to make things happen is by coming together.
But do you see any form of education or training for at least providers who are already there because we know that medical schools maybe less so now, but in the past decades taught those things. And so you have providers and feel entitled to a bunch of stuff, which I think is not as much, not as bad now, but they are still holding the reign of power.
They have so much power and we have so few recourses against them. So it's easy to bash on a doula who did a poor job on Instagram who might or might not lose a bunch of clients. That OB? I don't know what will happen to her. Probably not much . I feel the beast is so big that I'm like, how in [00:34:00] the world can we actually make a difference? Is that going to, I mean, I mean, I'm sure you feel like that it makes a difference for depth family. It made a difference with that mother or that parent who felt like someone in that room, in the belly of the beast. Well, they had someone to care for them.
But on a systemic level or are you a hopeful person?
Casey: So I am the process of taking prerequisites for nursing school because I would like to change my role in this birth community. So I have taken a few other classes but specifically I will know bioethics and also nutrition.
They were really fat phobic. Even this morning, I was talking with someone who, who is a provider and I was like, the things that you offer that are considered trauma informed or considered weight inclusive are not things that you learned academically. They're things that you [00:35:00] learned either through lived experience of interaction with other people, other education self-study, gathering resources. And in a system where like, You know, this, this education system to be any kind of healthcare worker is incredibly demanding and is incredibly challenging.
And you are just trying to gather the information and then regurgitate it as quickly and efficiently as you can. And so when you're then just totally leaving out things, it does create this space where you're like, I don't know where to go with this. If I didn't have lived experience and interactions with folks and self study and personal education, I would take the word that I received academically that just didn't address it.
Or just sort of addressed, you know, eating too many carbs as the worst thing in the world.
Ariane: They still teaching that? Jesus!
Casey: So you know, it starts foundationally. [00:36:00] And you said something else at the end of your question?
Ariane: I was basically asking you if you're hopeful that education and training will make their way on a systemic level.
I mean, I imagine maybe not in our lifetime, I don't know.
Casey: So I am hopeful. And the reason that I'm hopeful is because of Emily Goodstein. And because she went into this process petrified that she was going to get hurt and she had real bumps in the road and she openly shared her postpartum experience.
But when she tells her story, it is one where she was supported, informed, educated, empowered, confident. And every time one person has an experience like that, they share it inside the community. And that is what ups the ante, [00:37:00] because somebody, whether they know her or not, or listen to a podcast will learn , I can change my provider. I can change my team. Maybe I afford this doula. Maybe I can ask this doula for a sliding scale. Maybe I can follow an Instagram account that really gives information that then sparks healthy dialogue between me and my provider.
And so every, every time we share a really positive story, it feeds the narrative that you deserve better. That is what gives me hope. And it gives me hope because this is a for-profit system and Hospitals make money when they have more people. And and there is this slate. I think it's a very healthy, competitive we see it with like, Ooh hospital A got a fancy new monitor. Hospital b has this cool new trick . And so now [00:38:00] we're upping the ante in terms of which providers are able to offer care to all people. And I love that sort of business competitiveness.
And, and yeah, I have hope. But I have hope because of Emily Goodstein and other people like her. I feel comfortable, and appropriate sharing her name. And there are just as many other people that I worked with that have gone into this process or delayed having their second kid because their first pregnancy birth and postpartum was such a disaster and it hurt them in a way that is unable to be described. And they worked really hard the second time to change their path and they share that experience publicly or privately.
So I have hope.
Ariane: Can we talk a second about postpartum care and what you think about that? And do you provide any as a doula or?
Casey: So I [00:39:00] typically stay with folks for about two hours postpartum at their birth location and our home. And then I check in with people at 24 hours of life, give or take, I don't call people at 3:00 AM. They're awake and not. And that's you...
Ariane: you don't want to put that in, like rub that in their face. I know I was sleeping.
Casey: And then at about seven to 10 days of life, I will do a postpartum visit and that's a lot more processing, immediate questions. But I am not a postpartum doula and I think that they're great. I know that not everyone has the resources to be able to pay for a birth and postpartum doula. I think of friends of mine that live in another state and everyone chipped in and got them 12 weeks of five nights a week, postpartum doula. It was kid number two, it changed everything for them. They didn't have a baby shower, they didn't get a bouncer or baby clothes. Everyone in their [00:40:00] sphere pulled money together and then got them this amazing gift. So, you know, I wish that it was more complete.
The reason that I feel very strongly as a doula about checking in with folks between seven and 10 days of life is because with us a cesarean birth folks. Well, and we are, I don't know if you know this we're in a pandemic folks are now doing, yeah. I mean, it's just this like little thing it's probably going to go away.
Folks , if they have a cesarean birth, typically what I'm seeing is that they are doing a telehealth visit at approximately two weeks of life to check the incision, which is typically about 15 minutes. And then at six weeks they will do an in-person visit with their provider in which they talk about birth control. Talk about like how, if there was any sort of lacerations or any sort of incision, how everything's healing. And... didn't you just end pregnancy seeing your provider [00:41:00] once a week and now wait, maybe wait, hold on. You had a baby and now they're going to see you maybe once maybe if you, you know, maybe twice, maybe twice. It just gets dropped.
Ariane: And again, it's going to be people who have been more means who are going to be able to be healed and cared for before systemic changes actually are implemented.
And then other folks are going to be able to maybe benefit from it later down the line. In the meantime, people are dying. Either from, you know, complications at birth and after, or postpartum depression and they commit suicide or, and then it affects everybody. And it seems, you know, I was telling this doctor last week, it seems so obvious to think if we would just care for parents during that, you know, we're not talking... that long of a care like this the two years, let's say like, we really [00:42:00] extended like the, of the pregnant, the pregnancy, the birth. And then a year after that. Let's say we really, really, really care for these humans. If you just want to talk about like money, do you know how much money you save by not having someone who is sad all the time and doesn't want to care for her baby. And then the baby later on has speech impairment or whatever happened. It seems like so obvious. It's like preventive, not just for the person who's actually giving birth, but also for the family as a whole.
Casey: Yeah, somebody DMd me that their C-section was, their insurance was billed $75,000.
I mean, that's. That's just ridiculous and , you know, that needed to happen. But when we're doing things that are really upping the cost, you know, and in, in terms of... you know, doula is expensive. [00:43:00] And DC is working on some legislation to possibly see about having doulas reimbursed through Medicaid.
When we're looking at folks that let's say you had a $20,000 wedding . Let's have an $18,000 wedding save $2,000 and get a really great doula. Or let's have a $15,000 wedding and get a great doula and a postpartum doula. You know doulas sound expensive because they are.
And then when I think about all of the things that they offer, it feels like we're not talking about them. I think that we are talking a lot about doulas in terms of like, Oh man, like yeah, you get a really great massage. And I think it's so much more.
Ariane: I mean you do give great massage, but.
Casey: I think so. Yeah. You know, and, and so I think that that's a thing that's really, really important there. And also, we [00:44:00] can get to the business of being a doula because it's so fascinating to me. But the doula space is incredibly competitive. Essentially doulas are a gig economy. And what that means is that a lot of doulas, specifically doulas that are more experienced or like air quotes around Sr are worried that if they share information and they share knowledge that they're going to lose business. And so they keep all this information to themselves and then in turn, it makes it more difficult for other doulas to learn, because doulas are constantly learning. But then we also start to see it as reflected in price, you know, doulas don't want to charge their worth because they are afraid that if they increase their price, they'll lose business.
Someone recently told me that they looked for a doula in New York city that had extensive twin experience, right. So we're looking at like a niche specialized. But that expense was [00:45:00] $5,000. Doulas in DC just aren't that. So the business of being a doula is really fascinating and I hope you do an article on that. Let me take notes here. Yeah. Also it's like, not that friendly to cisgender women or LGBTQ women. I feel like it can be not very inclusive. I feel like it can be very passive aggressive. It's just a, it's a rough space. The major caveat to that is there are absolutely doulas who I could call at three o'clock in the morning. And they would show up on my front lawn and be like, where are we going? What do we need? Like we are here. So I think that you can find your community and feel really, really supported.
And then I think that there is also this like bigger element of why doulas are so competitive, why they are passive aggressive that sort of thing.
Ariane: It's [00:46:00] interesting because I'm going to throw it out there and I don't think I'm dead wrong. I would assume that 99.9 of doulas are women .
A
Casey: lot. Yeah. I don't think that, you know, it is there is a really excellent non-binary jeweler who serves Virginia, Maryland and DC and their name is Mel.
And then there's a non-binary doula in Baltimore and their name is Moss.
Ariane: But again, I feel like in these spaces where once again, it's the same kind of people are often spaces that don't have a lot of power. You know, you're not in a position of power and it creates those internal struggles that don't serve the people you ultimately want to serve. And it's, it's sucks that it has to be like that.
Casey: I think the doulas do wield a lot of power. And I think that's why it's so important for them to be really mindful about the way that they [00:47:00] interact with folks.
Ariane: Okay. So I like to be wrong. Explain to me why do you think? And I said they don't have power. I think because I was thinking about in a hospital setting where you've been pushed away or pushed aside or told you to stay in your scope of practice or shit like that. But you do have power. Tell me how.
Casey: By means of sharing complete information with the clients that they're serving. Because the one who actually has the power is the family. And I say it often when folks are in labor, you're the captain and we work for you. And that is when we start getting to like weight stigma, and we start getting to comprehensive whole person trauma-informed care , it will always circle back with putting the pregnant person as the center of that orb. [00:48:00] They're the most powerful person in the room and in the scenario and the doula is the one fueling that. The doula has the ability to fuel that power and to fuel it in a way that does not create a combative relationship against the provider or the system.
Because if you are working as a doula and you're creating a combative relationship between the client and the provider, You're actually hurting that client by trying to take away some of their power, because then you are getting into a very legitimate power struggle. Then you're getting into a power struggle between the client who's potentially already been traumatized for one reason or another and the healthcare system.
And so instead when the doula uses that fuel line from doula to client effectively, efficiently and professionally, they're able to shift that balance of power to put that pregnant person at the [00:49:00] center of the orb.
Ariane: Because ultimately , they're the ones who are going to be paying the bills.
So, and as you said, they are working for the patient, which the patient and the client, we often forget that we are not at the mercy of what's happening there. Although we are led to believe that we have no power and this is not true at all.
Casey: Well, and also the provider is, and circling back to what you said earlier, providing information, right?
Like they're offering it up. We do demand a lot of trust between all parties in this scenario, because when there is a true emergency, that level of trust needs to be real, because that is not the time that there should be a feeling of discord between a parent and their provider.
But when that relationship has been laid between their doula, their provider, all these auxiliary people. And again, that like fuel line from doula to [00:50:00] client that if for any reason we then got into an emergency or even urgency scenario, that client has felt so empowered, safe, whole, that they, they then feel less traumatized by something that was urgent or emergent.
So, yeah, I think that doulas wield a lot of power. And I think that subconsciously or consciously, they know that and I think that's why this work holds so much to so many people. And when we look at the history of doulas and, community midwives, or so earlier this week, I was talking to someone who kept talking about community midwives and what that person meant was home birth midwives. It was a healthcare provider. And last night I was standing in the shower where everyone does their best thinking. And I was like, no, no, no. We are ALL community insert role [00:51:00] because doulas and midwives and other healthcare providers and nurses and obstetricians they're in these communities.
The history of these roles was people that looked at the whole community. And I think we've lost a little bit of that and we've also colonized it, right? Like, I, I do need to be clear that we have colonized that, that scenario. But we are in communities. And when I go to first birthday parties, which I go to often, I think specifically about my role in a community and how it is so much greater than giving a back massage.
So there's really a very fine art there. And I think that again, that loops it back to that power. But it's what you choose to do with that power. You can choose to use that fuel line from, you know, pers pregnant person and family to provider efficiently and effectively and professionally.
Ariane: It's interesting because in the word empowerment specifically, the [00:52:00] way it's been marketed by cis white women yeah, it's not really empowerment. It's like a bandaid. But beside power, there's this aspect of responsibility. And to make someone responsible for their own choices and you keep talking about that fuel line and I keep thinking about it. Yeah. That's a way to risk responsibilize your client into their own power. And then you step aside.
So basically you're merely the messenger of their own power and it's pretty powerful.
Casey: Yeah. You know, I think, I think in a world where everyone had the access to the care that they deserved and was safe, everyone on their team would almost be like pixelated. And then the only thing that would be in focus would be that specific family.
And that I think is how the system should really [00:53:00] be working is that we are all just pixelated around a family and what is in focus is them. I think people say like, I could not have done this without my doula or my doula went above or beyond it's meant as a compliment and it's beautiful and so special. But I think that that statement brings us back to, I was anticipating getting really poor care and when I didn't. I felt special. No, no, no, no one on your team went above or beyond. You got the care that you deserved. And I think that's really important.
Is that okay for you on that note? Because that's pretty amazing.
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Ariane: Thank you so much for listening to faces of postpartum the podcast. If you have any show ideas comments or inquiries, you can reach us at podcast@facesofpostpartum.com. [00:54:00]
We also have an Instagram @ facesofpostpartum and we just always love to hear from you. See you soon