June 19, 2019
 
The Honorable Andrew M. Cuomo
Governor of New York State NYS
Capitol Building Albany, NY 12224
 
Dear Governor Cuomo,
 
       Traditional Doula and Midwifery Arts (TDMA) is an international doula certification organization based out of Long Island New York, founded in 2015.  This past year we published our first book titled, Traditional Doula and Midwifery Arts, where we highlight over 100 doulas we have instructed and certified as doulas. Many of them are doing amazing work in the birth community. On June 15th, 2019, we were made aware of assembly bill A364 (senate bill S3344). On June 18th, this bill passed in both houses. This bill is detrimental to TDMA doulas, their families, and the families they serve. At this time, we respectfully request your veto of the above referenced bill.

       Firstly, this bill calls for title ownership of “certified doula” by the State of New York. This is problematic because this title has been in use since 1992. It was first used by DONA International in 1992 and has since become a universal title used by doulas both nationally and internationally. We have many New York doulas who have had this title extended to them by their certifying bodies, including TDMA.
     Another deeply concerning aspect of this bill is there are no provisions to protect working doulas who choose not to become “certified doulas” under the new statute. Typically in New York, if a person does not hold permission from the office of professions and their respective boards, they are then considered to be operating outside of the law. This bill paves the way to make doula work punishable by law.  

         It is stated that “This act shall take effect on the ninetieth day after it shall have become a law.” Since doulas typically are hired months in advance of a birth, where will this leave the birthing people who have set up doula care agreements? Many pregnant people will be abandoned due to this bill as doulas often begin working with families during the prenatal period.  

       We are also greatly concerned that this bill did not have input from the doula community at large and especially those organizations who are working hard to close the gap in racial disparities. We believe that the voices of black and brown led doula organizations should be centered and should be invited to the conversation around expanding access. The most overlooked birthing population are indigenous birthing people. New York does not even keep statistics on indigenous birth. Indigenous statistics are lumped into the category titled “other” or are folded into hispanic or black categories because they don’t come from federally recognized tribes or don’t have a tribal enrollment number. TDMA is 50% indigenous owned. Dr. T’Karima Ticitl is the cofounder and co-director of TDMA. She has been a birth and postpartum doula since 2011 and is a now a recent midwifery graduate from SUNY downstate. She was certified through DONA International and TDMA. She has dedicated the past eight years of her life to doula work. She is very involved with her indigenous communities here in New York and has great concern for how this bill will affect them.  
 
          The new requirements pose as additional barriers for doulas who come from and work within New York’s most vulnerable communities. We have evidence that when birthing people are served by members from within their own communities, we have greater positive outcomes.
The additional requirements including the fee, exam and additional education will become barriers and reduce access to culturally concordant doula care that is so desperately needed at this time.

         New York is in a maternity care crisis and has been for some time. We have unacceptably high rates of mortality and morbidity, disproportionally so for black and brown birthing people. Black birthing people are 12 more times likely to die in childbirth than white birthing people. Many counties have higher than the national average C-section rates, and we have high rates of postnatal mood disorders. Currently, nine counties in the state of New York have no obstetricians, six have no midwives, and two have no midwives or obstetricians.   Standardizing and regulating doulas in this manner will only serve to reduce access to independent doula care at a very inopportune time.

        Again we respectfully ask you to veto this bill and re-introduce a properly thought out and advised version in the next session.

Sincerely,
T’Karima Ticitl, PhD, CD, midwifery graduate, co-founder and co-director
Mary Betsellie, CD, IPSP, co-founder and co-director TDMA
 

Traditional Postpartum Doula care assists a new mother in a way that was common to postpartum mothers all over the world when birth belonged to women and birthing people.  A traditional postpartum doula cares for the postpartum person so they can heal, process, integrate, care for and bond with their new baby. Prior to the capitalization, medicalization and take-over of birth by the technocratic, patriarchy, all birthing people had beautiful mother/baby centered postpartum traditions (Not just baby-centered). Mothers were not taught postpartum self-care, they were simply cared for by the community. While some cultures have had their postpartum and birthing practices wiped out almost completely, some have retained their postpartum wisdom and are sharing it with the modern birthing community. Each culture has its own techniques, therapies, plants, foods etc. but there are universal principals that postpartum traditions all share.

Rest
We have all heard stories about women going out to the field’s hours after giving birth. I challenge these old husbands’ tales as myths or sad truths of women who were forced either through poverty, enslavement, colonization, patriarchy and capitalism. A resting period of about 40 days (give or take a few) is universal. In early America is was called the “lying in” the Chinese translation of “zuo yuezi” is “sitting the month” in spanish speaking cultures it is called the “La Cuarentena,“ which translates to “the forty”.  It is also called a “confinement.”  This time is meant to be a period of restoration and bonding for the new mother and baby. This time together is important for milk production and establishing a healthy nursing relationship. It also is protective for the baby. A traditional  postpartum doula may take some of the daily burden off of the new mother and birth family so they can have the time they need to bond and get to know each other. The postpartum doula may cook for the postpartum person and the family, do light housekeeping, or keep the baby comfortable while the new mother takes care of their hygiene. The postpartum doula can also help with a postpartum plan and help gather community resources. Organized support can be found  in most postpartum traditions. 

Nourishing Foods and Herbs
Just about every culture had “special” postpartum foods and used herbs to nourish and heal after birth. A traditional postpartum doula may prepare healthy, nutrient dense meals that are easily digestible. They know that only foods that are inherently warming are acceptable. They may use herbs and spices along with foods that are blood building, warming, nourishing and promote milk production.  

Special Care for the Abdomen, Womb, Pelvis and Perineum
Belly binding, closing of the bones, womb adjustment peri steams and sitz baths may be some of the services a traditional postpartum doula offers. These are all services that have been commonly in practice in many areas of the world.
Belly binding can be found in indigenous cultures of North America, Europe, Africa, Asia, India and more. Some benefits are support for lower abdomen and uterus, promotes healing after birth, restorative to the  position of the abdominal muscles., lower back support and promotes healthy digestion .
Sitz bath is a shallow bath that a mother sits in with water no higher than the hips, usually containing soothing herbs. It is good for bringing blood flow to the tissues, helping to repair perineal cuts and tears and soothing a sore bottom area. It can help relieve hemorrhoid symptoms as well. 
Peri-steam, also known as vaginal steam, yoni steam or in Mexico it is simply known as “bajos."  This is an ancient traditional bath used in many different parts of the world. It is used most commonly for the postpartum period. It can be used a few times a week or every day for the first 10 to 40 days. It warms the uterus as well as soothe perineal tissues after birth.  Additional effects of steaming may include:  It is hygienic, it clears out  lochia,  it supports healthy elimination function and  tones vaginal and perineal tissue.
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Adjusting the Pelvic Bones
There are different ways of adjusting or closing the bones. There are accounts of traditional midwives using their feet in Kuwait and Greece to adjust the pubic bones. Indigenous Mexican traditions use a rebozo to close the hip bones and in Russia they used to use a scarf during the 7 locks ritual. Some traditional postpartum doulas offer a closing of the bones. This is usually done closer to the 40th day. Some benefits to closing the bones are: Restores the hips to pre-pregnancy position, eases back and pelvic discomfort, supports the uterus and bladder to return to their natural position, releases fascia tissue, supports pelvic stability, re-balances the flow of energy for the new mother

The Womb is also cared for as well. There is a saying,  “when a woman’s womb is off center, her whole being is out of balance” The womb grows from the size of a pair to the size of a watermelon in 40 weeks. Why wouldn’t we give it some TLC? Warm spices and herbs can be spread on the lower abdomen, over the womb, bringing warmth and circulation to the womb area. Womb massage prevents adhesions that can keep it off center. Massage techniques may be employed or the postpartum doula may be able to show teach self-massage. There are practitioners that specialize in womb massage and adjustment, many are traditional postpartum doulas.
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​Closing the Birth
This is something that usually happens around the 40th day. This helps the postpartum person let go of the birth energy and prepares them to reintegrate back into daily life with a little one. It helps mark the end of pregnancy, mentally, emotionally and energetically. This is a chance to celebrate and honor the new mother. It can be with your postpartum doula only or you can invite family and friends. There can be a ritual bath (the 40 day bath) final closing of the bones, food to share. Most important is the support and attention to mother and helping them to process the birth and recognize the changes they have experienced.

Reclaiming Traditional Postpartum Care
Postpartum mothers are slow to asking for this kind of care for a few reasons. First, many don’t know it exists. Once they are aware, it seems as if this is a luxury type of service and not the necessity that it actually is. In the United States where we have no postpartum care at all aside from our six week follow up visit to the OB/Midwife, it may seems that this kind of care is extra. Against the empty backdrop, traditional postpartum doula services may look sumptuous, even selfish. New mothers are often accused of being selfish surrounding their birthing and parenting preferences. We are conditioned to believe that the only thing that matters is a healthy baby and if we focus on ourselves, we are somehow taking away from the baby. This is exactly the attitude that has made the U.S. number one in postpartum mood disorders as well as maternal mortality in the developed world. Black and brown women are dying at rates that are disproportionately higher than white women because of systematic racism that also disconnects them from their traditional birth support practices. This kind of care is not extravagant, it is not extra, or selfish, it is absolutely necessary for well being.
 
Finding a Traditional Postpartum Doula  
Some doulas work with specific cultural traditions. There are still cultures that have their postpartum traditions intact and these doulas may have learned from their mothers and grandmothers. Some have gone to traditional doula courses to learn and remember these important skills.  At Traditional Doula and Midwifery Arts we have a traditional doula certification class. We don’t teach any one specific tradition. Our focus is not on making cookie cutter postpartum doulas. We teach these principles in depth so that each doula can use their own cultural traditions to bring to their community. Our website has a list of traditional postpartum doulas who are certified through Traditional Doula and Midwifery Arts. You can contact Traditional Doula and Midwifery Arts for a list of postpartum doulas who are not certified with us, we will be happy to refer you out if a TDMA doula is to available in your area. Our main goal is to bring these nourishing traditions back to birthing families.