Supporting Doulas to Increase Birth Equity in New Mexico

Ampersand LLC for Tewa Women United, February 2024

In recent years, New Mexico has leapt forward in recognizing the value of doulas as a powerful support for birthing families. Thanks in part to the persistent efforts of BIPOC-led community-based organizations and coalitions, the state has seen increased investment and new policies that aim to retain practicing doulas and to promote career paths.

Doulas themselves hold the deep knowledge that is essential to build out this new landscape. Doulas who are part of and practice in rural communities and among Indigenous, Black, and other communities of color, in particular, have the wisdom and experience needed to effectively train and retain doulas to help address the health disparities many New Mexican families face.

For Tewa Women United, training and supporting doulas is part of longstanding efforts to increase birth equity and reproductive justice for the families they serve. They and their colleagues understand the significant barriers that can prevent interested rural and BIPOC people from gaining training and experience to position them to work as doulas in their own communities. They are aware, as well, of the isolation and burnout that can drive practicing doulas from the field.

In 2023, in response to widespread interest in expanding access to doula training programs within New Mexico, Tewa Women United conducted a deep dive into doula training and retention efforts in the state. Building on key learnings, TWU conducted a state-wide survey and convened 36 practicing doulas and representatives of doula-serving, mostly BIPOC-led community-based organizations to identify challenges and opportunities facing New Mexico’s doulas today, and to seek solutions from the people best positioned to recognize them.

This online report describes the outcomes of that effort. It includes recommendations for funders and policy makers as well as TWU’s draft next steps in doula training and retention. The report is organized into four sections:

We recommend you start with this landing page, which provides an overview and serves as an executive summary. Then, follow the section links to sub-pages that will take you deeper into the data and details.

The authors of this report, at Ampersand LLC, are grateful to the many birth workers and birth equity advocates who contributed to the work, and who continue to lift up New Mexicans as they choose whether, when and how to bring children into the world.

Tewa Women United has supported doula trainings since 2008. In 2018, they began conducting their own.

TWU’s Yiya Vi Kagingdi Doula Project started in 2003 with a simple but transformative act: assisting at the first home birth at San Ildefonso Pueblo in over 50 years. In the years since then, the YVK Doula Project has provided doula care to hundreds of families, with doulas trained through a variety of programs. But TWU’s approach to birth justice is unique, and YVK doulas needed training to match that approach.

Drawing on multi-year processes of reflection, research, and extensive community input, YVK developed a doula training curriculum and certification program that focused on healing and addressed the needs of the local community. The first cohort launched in 2018. The COVID-19 pandemic required a shift to virtual, and two more cohorts, one fully virtual in 2020 and one hybrid in 2021, were successfully conducted before TWU paused for research and reflection.

Interviews and focus groups with YVK-trained doulas, as well as with the project creators and facilitators, identified both strengths of and opportunities to improve the curriculum and its implementation. The seven month training nurtures relationships and builds awareness while conveying core knowledge necessary to successfully doula. While other programs condense and deliver basic information in four days, the Yiya Vi Kagingdi training leads and supports trainees through a trauma-informed journey of reflection, connecting to cultural strengths, honoring ceremony and the sacredness of birth, and centering healing.

Visit this page to learn more about the YVK project, and about the unique assets Tewa Women United can mobilize to strengthen doula training and retention efforts in its region.

A wide range of voices informed the project.

New Mexico benefits from strong coalitions of Black, Indigenous, People of Color-led organizations working together to improve maternal health and birth outcomes and promote equitable policies and practices in the field. Members of these coalitions, along with independently practicing doulas and other, similarly-focused organizations led by white allies, brought their voices, experiences and passions to this project.

From the Dine’ Doula Collective in the northwest quadrant, to the New Mexico Breastfeeding Task Force in the south, to the UNM-H Birth Companion Program in Albuquerque, ten organizations partnered with TWU to explore the issue of doula training and retention in New Mexico. Another ten practicing doulas contributed their thoughts, perspectives and stories via one-to-one interviews and by participating in the convening.

The partner doulas and organizations were essential to recruiting doula respondents for the project survey. This comprehensive questionnaire drew 87 responses from across the state and from various backgrounds and experience levels. The survey provided insight into what doulas need to continue practicing; why some doulas who train never establish a practice; what doulas look for in trainings; and more. Respondents received a $50 gift card and a digital copy of Valentine’s Rainbow, a gorgeous zine written by Shileah Benally, a full-spectrum Indigenous doula.

Partly because doula care is an ancient tradition with a wide range of culturally-specific practices, there are currently no governing bodies or comprehensive certifying boards in the state. Many doulas reject the idea of certification as an effort to devalue their hard-won, often culturally unique knowledge, experience and understanding. Consequently, data on the number of practicing doulas and the number of clients they see is sparse. Survey data, adjusted by estimates of response rate, suggest that fewer than one in ten births in NM is attended by a doula.

Visit this page to learn more about the project’s methodology, and to explore the landscape of organizations and individuals who contributed.

Support for doulas is critical to developing an effective and empowered doula work force.

The doula survey, in-depth interviews with 23 key informants, and the lively exchange shared at the convening confirmed three essential periods in the life cycle of doula work where support is critical to developing an effective and empowered doula work force. This page offers deeper information on the specific supports doulas identified for each period.

Getting started.

Aspiring doulas, particularly those from New Mexico’s BIPOC communities, enter the field driven by a passion to support others through the transformative processes surrounding reproduction. While medical care is beyond their scope, doulas nurture, creatively and collaboratively problem-solve, gather resources, and in myriad ways attend to and advocate for their clients.

To prepare to do this well, they need customized, responsive training opportunities tailored to regional and community-specific needs. Doulas seek entry training that connects ancestral wisdom and contemporary medical knowledge within an inclusive, anti-racist, reproductive justice framework and an approach that is open to and respectful of all traditions and lifeways.

Transition from learning to practice.

Of the 88 survey respondents, 21 had trained but never practiced professionally. Among the supports needed at this critical transition were formal mentorship, peer support, business training, and facilitated connection to birthing families for their first few clients.

The role of community-based doula programs, like the Dine’ Doula Collective and TWU’s Yiya Vi Kagingdi Doula Project, is essential in helping newly trained doulas find clients, navigate the medical environment, and access ongoing training. Funding and policy making decisions to promote a successful transition from learning to practice should be guided by the doula-serving community-based organizations, which are alert to regionally- and culturally-specific concerns and solutions that may not be evident otherwise.

Sustaining a practice.

Perhaps most of all, the research revealed how absolutely essential it is that BIPOC doulas, especially those who serve Indigenous, Black, or other communities of color, be able to access the support that will allow them to center their doula work while maintaining a positive, sustainable work/life balance.

Our survey results show that fewer than 10% of doula respondents are able to make a living as a doula – and yet the irregular and unpredictable hours the work requires, and the intensely engaged nature of that work, make it challenging to split time with other employment. Without reliable childcare options and other meaningful supports, many trained doulas find themselves unable to sustain a practice. Training programs that fail to acknowledge and address these challenges do a disservice to those who feel called to this sacred work.

Doulas are poised to expand transformative care to New Mexico’s Indigenous, Black, and other families of color, to rural families, and to other residents impacted by the glaring disparities among reproductive health outcomes in the state. Funders and policy makers can facilitate this expansion by supporting the efforts of NM’s BIPOC-led and -serving community-based organizations to make the following changes.

  1. Increase access to free or affordable, culturally congruent, full-spectrum doula training programs that align with the needs of New Mexico’s diverse communities.
  2. Provide mentorship, business training, and other key supports to newly-trained doulas entering the field.
  3. Ensure practicing doulas are able to thrive through adequate compensation, organized regional resource hubs, and increased recognition of doulas’ value in both medical settings and among the birthing population.

Visit this page to learn more about the kinds of support doulas need to practice effectively.

Moving forward to train and support doulas.

The mandate of this project was straightforward. TWU’s Doula Training and Retention Project centered the needs of Indigenous communities as Tewa Women United sought to:

  • explore the terrain of doula training and retention efforts in New Mexico;
  • decide whether/how to upscale TWU’s YVK Doula Training Project; and
  • establish an action plan.

The results of that exploration are shared in this report. Using the information gained, Tewa Women United gathered for deep discussion. They clarified a plan and outlined the steps necessary to make it a reality.

Moving forward with Tewa Women United

Tewa Women United began supporting and training doulas as a way to increase “connection and bonding and healing of families,” Dr. Corrine Sanchez, TWU’s Executive Director, said. “Doulas, or the mother’s helper, create access to [that for] families. Our internal question was, how to help families to heal from generational wounds? We created our YVK project and the training curriculum to be part of our approach of ending violence against Native women, girls and our Earth Mother.”

That curriculum is no less vital now than it was at its creation. Agencies and communities outside the region have reached out to ask TWU to train doulas in their region, to share their curriculum, or to advise them in developing their own doula programs.

“Our training is valuable,” Dr. Sanchez acknowledged. “Training people to serve our community, that is worth doing. It’s a curriculum that serves Northern NM well.” The intensive community engagement that preceded and continues to inform the Yiya Vi Kagingdi curriculum and training project is specific to this area’s experience and concerns. “But I’m not sure if it would translate to other areas of NM.”

Other communities need similar engagement to address their unique needs. For BIPOC communities, in particular, simply upscaling a program structured on a different set of needs and values can cause harm.

For now, TWU’s YVK Doula Training Project is poised not to expand but to go deeper. After careful consideration, TWU has decided to address the elements that can make the difference between training doulas and truly equipping them to practice successfully in the communities that need them most.

This project has shown that training alone, no matter how aligned and responsive it is to BIPOC families’ needs and values, is just one part of the comprehensive effort needed to reach the level of doula care that will make a significant impact on birth equity issues in the state. Support for doulas at three critical times – as trainees; in transition from training to practice; and as full-fledged, practicing doulas – is needed to ensure that care.

Tewa Women United has committed to upscaling their training process into a model that offers expanded support. New components include:

  • a restructured community doula project to integrate mentorship/apprenticeship and hands-on, supervised training for new doulas;
  • expanding our monthly, ongoing support meetings for TWU-contracted and -trained doulas to include other doulas practicing in our area, essentially becoming a regional hub; and
  • an onsite resource library and creation of culturally specific trainings to enhance the skills of doulas serving Indigenous and other underserved populations. This may expand to offer short topical courses to doulas trained elsewhere.

In early 2025, Tewa Women United will conduct its next cohort of training, continuing the seven month schedule, gradually bringing doulas into practice in the region, and ultimately celebrating their doulas’ independence as they develop their own clientele and become mentors themselves.

The organization will use 2024 to staff the effort and, in consultation with practicing doulas, design the mentorship or apprenticeship element. It will revise its recruitment and application process to emphasize aptitude for and experience in community service, clarifying the commitment expected of doula trainees. Finally, using the knowledge yielded through this process, it will complete necessary strategic and content-related changes to the curriculum and training project.

A Statewide Effort

Changing the landscape of doula care in New Mexico is too big a job for one organization. Working together, though – with each organization centering the community it serves, and all sharing in the greater strength solidarity affords – true change can happen.

Through this project, we’ve developed a comprehensive understanding of doula training and retention efforts, both within the state and nationally. Support for locally developed, culturally congruent training options, as well as positive policy changes around compensation led by BIPOC birth workers, birth advocates and reproductive justice community-based organizations, is markedly expanding the transformative, and fundamental, care that doulas make possible.

This project has pointed to some central ideas that, if resourced adequately and implemented in areas most in need, could make a significant difference. They include, among others:

  • Culturally appropriate doula mentorship or apprenticeship, which may look different region-to-region;
  • A statewide doula resource hub with multiple regional centers, especially in rural areas;
  • Regular events and opportunities for doulas to gather in learning and mutual support; and
  • Continued advocacy to promote support for doulas in medical settings and through relevant policy efforts.

Policy makers and funders can confidently take the lead from Indigenous, Black and other people of color (BIPOC), who, when equitably invested in and funded to lead the design and implementation of local policies, are poised to successfully train and support doulas to meet the needs of the state’s diverse families.

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The authors of this report, at Ampersand LLC, are grateful to the many birth workers and birth equity advocates who contributed to the work, and who continue to lift up New Mexicans as they choose whether, when and how to bring children into the world.