Exploring the Rising Need for Doulas: Podcast Episode #223
February 13, 2024

Exploring the Rising Need for Doulas: Podcast Episode #223

Kristin Revere chats with Bianca Sprague of Bebo Mia about the rising need for doulas and how their care transforms family experiences.

Hello, hello!  This is Kristin Revere with Ask the Doulas, and I am so excited to chat with Bianca Sprague today.  Bianca is a passionate educator and advocate in the doula community, focusing her expertise on supporting women and queer individuals in the fields of fertility, birth, and postpartum care.  As a self-identified super lesbian and a dedicated mother, Bianca brings a unique perspective to her work, emphasizing the importance of balancing professional doula responsibilities with personal life, especially for mothers.  She is deeply committed to addressing issues like queer care, combatting fatphobia in medicine, and exploring women’s rage and its implications.

Welcome, Bianca!

Thank you so much for having me.  I’m really happy to be on the show.

Yeah, I can’t wait to dive into this important topic.  We’re going to be chatting about exploring the rising need for doulas and how their care transforms family experience.

I have a lot to say on this topic!

Let’s start with a bit more about your background, and then we’ll get into exploring the topic.

Yeah, so I came into doula – I mean, I would say most people come into doula work because they either had a really incredible birth experience and they want to make sure everybody has that, or they have a terrible or traumatic birth experience and they want to make sure nobody has that.  And I sat – out of all the statistics, I sat somewhere in the middle.  So my plan was actually to be an OB-GYN, and it wasn’t until the birth of my daughter that I realized the relationship I wanted to have to birth was way more the relationship my doula had, versus my doctor.  And I actually could very clearly identify that I was not prepared to perpetuate the harm that comes from a system that is designed to have us not trust our bodies.  I mean, if we look at the stats for birth outcomes in Canada and the US, our medical system is not looking so good.  I remember pacing after my birth – like, I’m bouncing.  You guys can’t see me, but I’ve got that newborn bounce with the hands on the chest.

It never goes away.

It never goes away.  And I remember pacing with my daughter.  She was days old, and I was like, what just happened to me?  I had the birth that I wanted, but I didn’t have it where I wanted it.  I was in a hospital suite, and I really wanted a homebirth.  And I was like, that was way too hard for me to have an uninterrupted experience.  I felt a lot of rage around it.  I felt cheated and robbed.  And I knew that I didn’t want anyone to feel like how I felt.  I also was in an unsafe living situation, so I very quickly – you know, once you become a dependent with a dependent in a cycle of abuse, I was like, I’ve got to get out of here, and I need to change the world, and I need to protect birth.  And so I started my doula organization, and so that was about 16 years ago.  Now, we train birth workers and folks who work in fertility, birth, and the postpartum period.  And then I think as of right now, we’re in 49 countries, which is pretty wild.

That is amazing!  So much growth!  Tell us a bit about your training organization.  I know some of our doulas have gone through your program.

Yeah, so my organization is called Bebo Mia.  You can find us at bebomia.com.  My experiences as a parent have caused me to want to go into doula work, and then the experience I had with my doula training, which at the time, I loved, but it wasn’t until I went to my first birth that I was like, oh, I’m wildly unprepared because you can’t learn everything you need to know in a weekend.  Then I started building a community where we were building a training together of all the things we’d wished we had.  That’s really how Bebo Mia came to be.  We used to teach in Toronto, and then we had so much – you know, there was a lot of requests from people who lived outside of Toronto.  We moved exclusively online in 2012, so we’ve been teaching in the digital space for a while.  We really want people to come out and go into the field of doula work feeling really supported, understanding how to run their business, understanding feminist values, and having them and their family ready for the type of work they’re going to do.  Tying into the question that we’re talking about today about the rising need for doulas, there’s something particularly magical about doula work.  It’s a cycle.  And so doulas protect birthing and new families, and the work of being a doula also is really healing for the doula and their families because you get to be that voice you didn’t have, or you get to reconnect to that feeling of empowerment that you did have if you were supported in your birth.  So I would say being a doula – not only have I protected hundreds and hundreds – no, thousands of families over the almost 20 years, I also became a better parent and a better partner and a better human and had a better relationship with myself.

Beautiful.  And I feel like your program is one of the first in the fertility space.  There are a lot more fertility doula trainings, but you were early on seeing that important need.

Yeah, I mean, anybody here listening – how you got pregnant impacts how you feel about your pregnancy, which impacts how you experience your parenting journey.  I mean, we know – recently, you had somebody coming on talking about their IVF journey and the risks of postpartum depression.  We see this.  We can’t break up, which is why in our training, every person leaves certified as a fertility, birth, and postpartum doula because it is one journey.  It’s not like you can just look at any one part of it in a vacuum.  So that’s something that we’re really proud of to have that.  We also were the first to remove gendered language of the training organizations.  We were the first to adopt an anti-racist, anti-oppression policy.  And we are the first and only to include therapy for all of our students and alumni so that we send healed healers out into the world rather than folks who have their traumas activated or just reliving it in a cycle with their clients.

Changing the system, and not only the work as a doula, but training future doulas to better support families.  I do feel like – I’ve been a doula over 10 years, and certainly, there’s so much more awareness about birth doulas.  Postpartum doula interest is rising, and awareness is becoming more common.  I felt like people knew about postpartum doulas in urban cities like New York and Chicago, but in Grand Rapids, Michigan, I had to do so much education in the past.

Yeah, I bet.

It is exciting that doulas are getting a lot of national publicity and the field is growing with more and more people.  I’m sure you’re seeing through your training program that people want to consider doulas as a profession.

Actually, the market research is very promising.  I look at it as promising because it means lots of folks are interested in becoming doulas, which I love because I want to train really amazing, grounded, healed doulas.  But it also – I get really excited that it’s expected to double over the next ten years, the market.  But more importantly – I mean, I love that I’ll have students, but my main focus is to have the field of reproductive health protected and have it be a place of safety and joy rather than a place of survival and trauma and the goal of just surviving.  I’m very excited to see how many families are reaching out to inquire about doula support, especially postpartum, which is on the rise.  Anybody that loves squishy babies, there’s definitely a need for you to go out and help parents.  It is really exciting to see how many more families are inquiring about doula services, as well as how many more states are really increasing their awareness and insurance programs for doulas.  As a field for both people who want to work as doulas as well as families who want doula care, it’s looking really, really great.  I’m excited.

I am, as well.  And Medicaid has expanded for birth doula support in many states, including Michigan this past year.  That certainly makes a difference.  And then programs like Carrot Fertility covering both birth and postpartum has been a real breakthrough.

Yeah, there are some good things on the horizon.  Check out what’s available locally.  There’s also lots of doulas who have really cool programs that they support under-resourced families.  So if you are a low or no income family, you should check out your local doulas and see what they have, what kind of programs.  We have a program, as well, where we have scholarships, so if anybody’s interested in becoming a doula who’s under-resourced, you can head over to bebomia.com/scholarships, and you can find out all about that.  We don’t want any barriers to folks accessing doula care or becoming doulas.

Love it.  So Bianca, for our listeners who are not familiar with doula support, whether it’s birth doulas, postpartum doulas, share with us a bit about how doulas can transform your pregnancy, birth, and postnatal journey.

What a good question!  So doula care comes down to supporting through the three pillars of physical, informational, and emotional support.  And so if you ask most doulas, they’d say they support birth or parenting or the trying to conceive journey.  But what I think is the best part of doula care is that it really allows parents to have that pause and to feel like they are making informed choices throughout their reproductive health journey.  And so unfortunately, what’s happening in our current system is there’s a real – this goal of risk management.  And so we have all these really wonderful obstetric tools that are there if we need to jump in and save somebody.  So I like to think of the medical system like a lifeguard, if it’s functioning properly.  If you were out swimming, in a crisis, the lifeguard would run into the water and help you.  But otherwise, they let you swim because you’re doing your thing.  And so these tools are available, but just like if every lifeguard jumped in and grabbed your arms and legs and tried to do the motion of swimming with you, we’re going to run into more issues than if they just let people swim and jump in if there’s a crisis.  And so we have these tools – so I don’t want anybody listening to think any one of the tools have any judgment associated to them.  All of the tools we have save birthers and they save babies and they’re wonderful.  What happens, though, is we have this practice-based care rather than evidence-based care, and so when we go into our hospitals or our birth centers, all the tools just come at us.  And typically, without consent because this belief is, if we use all these life-saving tools all the time, this will make it extra good.  It’s like when kids are like, well, if one piece of cake is great, I bet five is really great, and it’s not.  We’re actually seeing a decline in outcomes when we use all the tools, and it’s not recommended by ACOG or the SOGC, and those are the governing bodies for Canada and the US for obstetrics, or the World Health Organization.  Everyone is saying, doctors, stop doing this.  We need somebody in that room with clients saying, doctors, stop doing this, and literally, like, stopping it if the client is not being listened to.  So it’s really about protecting our clients, whether we’re doing an egg retrieval or we’re going in for an induction or we’re at home and trying to decide where baby should eat or where they would sleep or how they would eat.  You really want somebody there that’s going to help you navigate through the actual research around the topic you’re struggling with, as well as giving you the space to use your intuition because you do know what you want and you don’t want, even if you’re not sure why.  You have this leaning towards one of the options.  Your body does know.  We want parents to feel really empowered and to trust that they know how to make the right decision, and if they get to have that protected in birth, they have that reinforced, that they’re ready to be parents.  And they go into parenting feeling really empowered and knowing that they know what is best for their baby and their family, rather than having the complication of noise around them.

Exactly, yes.  And I feel like there’s so much importance in that preparation during pregnancy, whether it’s taking a childbirth class, understanding your options, getting resources from your doula, like a prenatal yoga class or a therapist.  Really feeling like birth isn’t just happening to you, like you have this education and support team behind you.

Oh, that exactly.  We really want birth to be happening through you and not to you.  I love when my clients at the end of the birth, no matter how it went – we’re also open to having that pivot, like, I really hope it’s going to look like this, but I’m prepared if it’s going to look like this or this or this.  And so even if they don’t get their first choice, my clients, like 95% of the time at the end are looking up at me like, this is exactly – like, this was right.  This felt great because they chose it and they felt really present and that they got to say no when something was a no, and they got to say yes when it was a yes.

And certainly a doula’s presence in that postnatal phase.  If they’re not seeing their provider for six weeks and they have questions, we have that follow-up visit, or sometimes depending on the doula, multiple visits and check-ins and just knowing that you have someone that you can reach out to if you’re struggling with feeding and need a lactation consultant.  Or if you need to know if your hormone fluctuations are normal, for example. 

Yeah.  I mean, your doula is really this combination best friend and walking Wikipedia in your pocket at all times.  Whatever your questions are, you have that support.  We’ve lost that experience of the village and those intergenerational relationships within families.  That’s been severed.  That’s been severed.  Thank you, patriarchy, for rearing your ugly head yet again.  We have to pivot and we have to create something that is going to create the best outcomes for families, working with what we’re working with.  And a doula can really fill a lot of those gaps that have been left by the shift of how we’re birthing in this really isolated way, and then we go home into the postpartum in a really isolated way.  And one of my favorite parts of postpartum doulas – I think it’s the particularly magic element of postpartum work is that there’s so much focus on the baby after the baby is born.  It’s all about the pregnant person during the pregnancy, and then it’s like they’re forgotten, and they really should be centered because if they are well and centered and nurtured and taken care of, they can do a really great job with the baby.  Between the combination of kind of being an afterthought or being an extreme afterthought, as well as the fact that everybody feels like they are entitled to comment or recommend once you have your baby, it creates this really interesting place of isolation and suffering for parents because they have to keep explaining that they’re not spoiling their baby or they’ve chosen to – whatever, keep the foreskin intact or they’re having the baby sleep in their bedroom or not in their bedroom.  Like, all the myriad of choices that parents get to make for their children, they’re always questioned and challenged.  And a postpartum doula might be the first person that that parent has been listened to with no judgment and they don’t have to defend their choices.  I know when I do postpartum work – I mean, I haven’t done it in a few years because I’m mostly teaching, but to just watch people stare at me, waiting to defend themselves.  They’ll be like, so I think I’m going to start just pumping, and I just don’t – I just don’t think it’s working, and, you know, I know that, like, if I pump, they’ll still get milk from my body – and they’re just going so fast.  And I stop, and I’m like, if you want to pump, that’s fine.  Do you need help cleaning your pump?  Do you know how to use it?  And to watch their shoulders drop of, like, I don’t have to defend myself, and this isn’t wrong.  I’m like, great.  Do you want to talk about why you’ve chosen pumping?  Tell me about it.  Otherwise, let’s get you set up and get you some more water and we’ll talk about what a pumping schedule can look like.  And to see that they’re like, you’re not going to make me explain myself or tell me why it’s bad.  And I’m like, are there any other changes you’re thinking about for feeding your baby?  Tell me about those.  And just watching, and they’re like, wait, what is happening?  Everybody has something to say about what I’m doing and if it’s the best thing and if I’m a good parent.  And a postpartum doula salt of the earth, like, just going in and letting new parents know that whatever they’ve chosen is perfect, and they don’t have to do that dance of defending why they’re parenting the way they are.

Exactly.  It’s such a good description of the work that we do postpartum.  Even looking at moms’ groups and all of the judgement if somebody is posting a question, let alone family or friends giving advice.

It gets real – I don’t even go in parenting groups.  Sometimes I’m like, oh, I should see what parents are talking about when it comes to sleep because I’m on this nurtured sleep revolution where I’m really trying to talk about sleep in a different way, and I’ll stick my head in, and it is terrible in there.

It is.

It’s terrible.  People start with the most harmless question, and then by the end of it, how did we tie this back to these deep rooted valued and judgments when all they wanted to know is, is this car seat – I don’t know, do you like the color of my new car seat?  At the end, they’ve been told they’re a bad parent in 14 different ways.  Oh, man, it’s pretty wild.  But I mean, we do see really, really magical statistics around parents who have the opportunity to have doula support.  There’s actually pages and pages and pages of studies showing just the improvement in birth outcomes as well as in parenting outcomes around mental health, the ability to feed from their body if that’s what somebody’s choosing to do.  Like, there’s so many really great things.  And we actually, over 2020 – I don’t know if everyone remembers how wacky the world got.  And we actually had a really unique environment where we got to – you know, there was lots of areas of research that came out because when else have we ever had in modern history these really bizarre circumstances where the world was shut down and medical had shifted?  We have really great research from this.  And we had the opportunity to see what happens when care providers have no witnesses.  And yes, I’m using that language very intentionally.  What happens when doulas are not allowed in the birth space?  What happens if for a certain period of time when even partners or family members were not allowed in the birth space?  What happens when people went into those birthing suites with the doors closed and they were left alone with doctors?  And so we have this – I think they did it over 14 months, and the maternal and fetal outcomes were abhorrent.  And when we look at mortality, morbidity, and stillbirth and depression – it was so bad.  And so I found this fascinating.  I mean, I was devastated to see how many birthers for those 14 months had to experience birth in these ways and then go into their parenting journey after these extremely terrible – after the environment was so not conducive to joy and protection and empowerment.  But it was a huge wakeup call for folks that do want to protect birth and for parents.  So we’ve actually seen a huge rise of parents being like, oh, hell, no, when they’re going into their birth again, if they did have a birth or they heard about births over the pandemic.  So from this terrible experience, we are seeing this rise for people wanting doulas, for people demanding more from their hospitals, for the ability for – this was one of the major turning points for insurance being – there’s been a fast track for insurance policies in so many states.  Tricare stood up and listened and they’ve improved their care.  Everybody was like, oh, man, we actually can’t trust the medical system as far as reproductive healthcare.  So really great things came from this, but it was very stark.  The outcomes plummeted over that time, and it was purely because we didn’t have witnesses and protectors in the space.

I’m so thankful that doulas were considered essential in Michigan due to our governor, and most hospitals followed suit.  As long as a doula was certified, they were able to go through the process and support.  So I had very few clients that I wasn’t able to support during the early pandemic.

That’s amazing.  It was not great in Canada, the lockdowns, so I managed because I know the midwives really well.  I was doing homebirths and still allowed, but doulas weren’t even allowed to be present at homebirths.


Oh, it was, like, 18 months.  And there were some hospitals that literally no one could come to the hospital, and no one was allowed in for birth or postpartum.  I think especially in Ottawa, they had it for the longest, but I believe it was almost – don’t quote me on this, anybody, but I believe it was about 60 days where it was no contact, that people birthed alone, alone, and went to the postpartum floor alone, alone.  Like, nobody went into their rooms.

That is just – I mean, devastating overall, for the partner, for the doulas, for the nurses who are obviously overwhelmed when they don’t have doulas supporting in the hospitals.  Wow.

Yeah, it was bad.  There was a time where they actually got pretty dragged, but they weren’t even allowing folks to Facetime or Skype.  Oh, man.  I can’t believe the babies – like, I hope we do some really great community care for these parents, which can still happen even years later, just to really protect and reconnect and do some healing around that because these circumstances were just really not ideal for all these families to be growing and feeling really confident in their ability to parent and to trust themselves and know that they feel safe.  There’s a lot of aftercare that will need to be done for this.

I totally agree, and as you mentioned, the positive aspects of all of that is that we have some good research for the value and benefit to doula support and the need for support in general, partners being there and the importance they make.

Oh, for sure.  You know, birthing, you require the people that make you feel the most safe around you.  We need the environment that really lets that oxytocin flow.  That’s that love hormone.  And you want to just feel safe and relaxed and have that ability to let go and trust your body as much as you can in labor, and the conditions of a cold room with all the lights on and not your people that you love the most around you?  It’s not the best environment for you to feel really safe and relaxed and to let those hormones and those muscle groups do what they need to do.  We always say as doulas that we want people birthing in similar circumstances to how they would probably have sex.  No, I know not everybody likes a dark room, and some people are a little more interested in something zanier, but most people have a certain circumstance that involves privacy and intimacy and security and the ability to feel comfortable and vulnerable, and so we really want to try to recreate that as much as possible, even if you are birthing in the hospital.  We can do that with lighting and music and candles and different scents, if that appeals to you and your hospital says okay.  And then your people: people that keep you safe and they’re cheerleading and protecting you and creating this bubble of safety for you.

Yes.  So any final tips for our listeners, Bianca?

Well, if you are not sure about doula care, I would highly recommend checking out some of the research because some of the things that you might be the most worried about – like, you might be worried about an episiotomy, or you might be worried about if you’re going to be able to feed from your body or not, or worried about a postpartum mood disorder or a C-section or an operative birth or a belly birth, whatever term feels the best for you.  If any of these are your worries, doulas are the fixes for them.  And so you can check out some of the research there.  You can literally just Google “benefit of a doula” and there will be journal after journal after journal.  And if you are curious about becoming a birth worker, we’ve put together a page for you that you can check out at bebomia.com/ask.  And there’s a code there, too, if you want to find out more about our classes and services, and it’s ASK15, and you’ll get 15% off of everything.

Love it!  And you’re also on quite a few social media networks, if you’d like to share those, Bianca.

Yeah, sure.  You can find us at – you know, pick your channel, and it’s /bebomiainc.  And you can check us out.  Our TikTok is just growing, so it’s not the best place, but our Instagram is awesome, and we have lots happening over on Facebook and on YouTube, so you can hang out with us there in all of those places.

Love it.  Well, thank you so much for spending time with us today and sharing all of the great need items for both birth, postpartum, as well as fertility doulas.

Thank you so much for having me, Kristin.  I really love your podcast, and I love everything you guys are doing.

I feel the same way about you!  Thank you so much, Bianca.


Bebo Mia

Birth and postpartum support from Gold Coast Doulas

Becoming a Mother class