EBB 306 – Culturally Sensitive Doula Training with Divya Deswal and Neha Misra of the Doula Collective in India

Learn more about The Doula Collective here: https://thedoulacollective.in/

Dr. Rebecca Dekker – 00:00:00: 

Hi, everyone. On today’s podcast, we’re going to talk with Divya Deswal, founder of The Doula Collective© in India, and Neha Misra, a member of The Doula Collective©, about how to support families during the transformational time of pregnancy and birth. Welcome to the Evidence Based Birth® Podcast. My name is Rebecca Dekker, and I’m a nurse with my PhD and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details. Hi everyone, my name is Rebecca Dekker, pronouns she/her, and I’ll be your host for today’s episode. I wanna give you a heads up that in this episode, we will be talking about birth trauma.  

And now I’d like to introduce our honored guests. Divya Deswal, pronouns she/her, has been a birth worker since 20 years and has mastered the art of working with expectant families through reproductive and parenting journeys. Divya is a doula trainer with The Doula Collective©, leading culturally sensitive, trauma-informed doula training in India, while also serving as a mentor of the Association of Pre and Perinatal Psychology and Health in the USA. Neha Misra, pronouns she/her, is a certified Lamaze childbirth educator, certified doula, doula trainer, active mama, prenatal fitness trainer, and an Evidence Based Birth® professional member. Throughout the journey of becoming a parent herself, Neha realized that she wanted to extend her support to expecting parents so they can approach birth with confidence and have a fulfilling, empowering, and positive birth experience. Together, Divya and Neha are passionate about supporting birth workers, and they’re actively involved in birthing communities across India, specifically through The Doula Collective©, which is a unique doula training program and sisterhood of doulas from across India. Divya founded The Doula Collective© India, a culturally sensitive, trauma-informed, holistic doula training and mentorship program, and Neha helps run the training program and the community that now has more than 45 doulas across India. I’m so thrilled that both Divya and Neha are here. Welcome, both of you, to the Evidence Based Birth® Podcast. 

 

Neha Misra – 00:02:21:  

We are thrilled to be here, too. 

Divya Deswal – 00:02:24: 

Thank you, Rebecca. We are delighted to be here as well. 

Dr. Rebecca Dekker – 00:02:26: 

So Divya and Neha, you work with this amazing doula collective in India, and we were connected through Sara Ailshire, who is our Evidence Based Birth® research fellow this year, working closely with me. And she has had so many amazing things to say about your doula training program that she took part in. Could you talk to me a little bit about how you put together The Doula Collective© and the mission to serve parents and birth practitioners in India? 

Divya Deswal – 00:02:54: 

So it started with a dream, and the dream was to support women. And then I found myself really alone. And when I first started working, not that I find that the training, I was left to do everything like a checklist on my own, but also there was nobody to talk to. And culturally, we have a very strong culture around birth, which means we have traditions of prenatal and postpartum. And I was exposed to all of that living and growing up here. In fact, in every household, we had a room where women would go and give birth and then they would spend their postpartum period there. And then suddenly I found that while I wanted to do what we had done traditionally, I found myself very alone. So the first thing that struck me was that how could you offer support to somebody if you haven’t felt it yourself? And that was the seed from which The Doula Collective© was born, that I wanted to have a program where everybody supported everybody else. We had an embodying experience of feeling supported, and then we would go out and offer that. And that’s where it started. When I was working, we found that we had many midwives who had come from the West, and they were struggling to offer good care because they couldn’t match the cultural part to it. So we decided that we needed something that spoke of our culture since we had a very strong culture on birth. And I had a wonderful mentor, Janet Chawla, who was working with the indigenous midwives. So I got bits and pieces from different parts of the country, which showed us how rich it was anyways. And then finally, when I became a trauma therapist, I realized that it all began in and around birth with pre and perinatal psychology. From that, the training grew. But the idea of the ethos of sisterhood came from the fact that you cannot give what you don’t know or don’t have. And I found that birth workers were really isolated with tiny checklists. Can I attend your class? Can I observe a birth? Can I do this? But there was no real support. And so The Doula Collective©, the word came from that, that together. We will grow. 

Dr. Rebecca Dekker – 00:05:09: 

And when did you start The Doula Collective© then? 

Divya Deswal – 00:05:11: 

So without, under the banner of The Doula Collective©, I started about 10 years ago when people from DONA, CAPPA would come with their checklist. Can I come to your childbirth class? Can I come and attend a birth with you? And then I put it all down together in a year-long program in 2018. 

Dr. Rebecca Dekker – 00:05:31: 

Yeah. Can you talk a little bit, that was one of the things that Sara said to me that sparked my interest was, you know, there were doula trainers from North America coming to India and trying to do these trainings, but not really understanding the culture or being part of the community. Can you talk about, a little bit about, like some of the stumbles or the barriers there and, you know, how different it is having your own collective, you know, founded and led by Indian women. 

Divya Deswal – 00:05:59: 

So typically a doula training is about 24 hours spread over three days. It could be four and six or eight into three. And I found that there was a lot of information to take in. That was the number one thing. Secondly, to be told what to do. Actually, when we spoke about how your client should speak to the doctor. Now, that is something that you could do in the West, that you make a birth plan, you go, you give it, and that’s it. But here, it’s a little bit different because you pick your doctor and they pick the hospital. Or where they go. So primarily, you have no say over the hospital, and your doctor’s gone. So you can’t just give them a birth plan and they say, oh, but you’re not a doctor. You don’t know anything. And that was creating so much conflict. Because the way we were wording our requests were also being met with a lot of resistance, defense, and even sometimes sarcasm. And that kind of left the woman like all alone. And one of the really early days, my experience was that when my client walked into the hospital and she was six centimeters dilated, the first thing the doctor said to her, oh, why didn’t you call me when it started? And her first words to her doctor in that birth were, I’m sorry. And that kind of hurt me for a very, very long time. So I just found that this idea that you’re a disempowered woman who’s got to go and ask for her demands, it’s not going to be met here. And I must say, after 20 years, we’ve made a little headway. Neha, would you want to kind of comment on that? 

Dr. Rebecca Dekker – 00:07:35: 

Yeah, Neha, how is your approach different than how are you working with doulas and parents to, you know, enter a system where the doctor has so much power and you still want families to have an empowering experience? 

Neha Misra – 00:07:49: 

So I think I’ll just add on to what Divya was saying. So I also, like many doulas, many women who wanted to be doulas in India, did not have access to an India-based doula training. And so we attended DONA, CAPPA, Childbirth International trainings that have happened either in India or outside. But like Divya said, and then we are trained as doulas, but then we’re struggling to work with the system because the system, first of all, doesn’t recognize doulas mostly. And, you know, there is this, between families and the medical systems, there’s a huge hierarchy that exists in the culture. No one believes, most Indian women wouldn’t want to even question their doctor. And so we found ourselves stuck there, having this theoretical knowledge and doula skills, but not knowing how to apply it. So which is where, for me personally, when I met Divya. And I was a new doula. I was in the middle of this trying to figure it out. I learned a lot through her and I interacting, spending time together, talking about births, talking about prenatal meetings and meetings with doctors and how we negotiated our way through it and little tricks that we can use. And I found that is what actually helped me the most to be able to apply my knowledge and my skills in a more practical and realistic sense. So which is when we realized that the training has to have that element in it. So the way the doula training, Doula Collective training is designed is that while there is like all other doula trainings, there is the theory and the doula skills. That is a very, that is one part of it. But the interactions in the group, discussions, activities. We meet and talk about birth stories and experiences that we had with clients, with doctors, really helps us then to understand what to do with this information. So it’s a very layered learning in that sense. And because it’s over a year, there is more time and a lot of interaction. We meet online every week for like a year through the training program. And then we also then meet locally in cities as well as have like, an annual doula retreat. So bringing in that interaction was a very important aspect of it. And to answer your question in terms of how we are operating in the system, we’re all just figuring it out. I mean, there are times when, you know, you’re, you go into a hospital and the doctor doesn’t look you in the eye because they do not recognize you. They’ve never heard the concept of a doula. And even if they have, they do not see the value of a doula. And they often look at doulas as an intruder in their space. So there is that hostility that we do experience sometimes. But there are also doctors who have worked with doulas and see how births go better. And they’re not sure why or how. And, and so, you know, kind of, we’re trying to negotiate our way through, through, through those care providers, I would say, do. Working in the system. 

Divya Deswal – 00:11:03: 

There’s another idea that I’d like to say here is like when we say empowering birds, the idea of power. Culturally, it’s different for women. And it doesn’t always have to be resistive or assertive or strong. It could also be resilient. Like, I might pick a couple of battles and not all of them. And then she might be fighting a battle with family who are on the doctor’s side. And the way she negotiates that and gets away is also power, Rebecca. It isn’t always a clear stand on power. And then she smiles in the end and says, well, you know, what was important for me, I got that. And I did it. And even that is power for us. So it’s not always one face of power. 

Dr. Rebecca Dekker – 00:11:50: 

Right. It’s not about winning some big battle. Right. And I love how you talked about how you changed the training from three days or 24 hours to a year. Can you talk a little bit more about what goes into that? The training, how many doulas are doing the training each year? And what are some of the other things they’re learning with you? 

Divya Deswal – 00:12:14: 

What we did is that we picked up every topic that we wanted to talk of. And we used to do a live class. And then over the five years, we found that we were repeating ourselves far too many times. So we kind of made small videos that they could watch like a pre-read every week. And when they come in, we talk about key elements. Say, for example, we talk about birth in alternate positions. And then we have everybody get up and move and say, okay, would you need to have a birth like this? When would you think you would be? How would you bring it about? Or? So we bring in elements of practicality. And then some of them are still attending births or they are childhood educators or they’re yoga teachers and their clients are going to births. So they bring in their own experiences. And we found that this interactive, practical approach is quite interesting, not just for our students, but also for us. Because each time people bring in a different point of view. So that’s how we do it. And then we have 24 hours of training, actually. In our foundation course. But it’s over 24 weeks rather than three days. So we put in the same hours. And then we have a seminar, too, which is more about a mind-body connect. Even if the baby’s in the right position and you’ve done all the exercises and you’ve got a sympathetic doctor, what happens if the baby, if you are feeling fearful or you’re bringing up something? Or when is the time that we are offering this information? Because the mother’s brain is also changing. So we know that there are different times they’re receptive. What happens when the baby was in the right position but now is stuck at, say, mid-pelvis? So that’s our second seminar. And the third seminar, we totally talk about creating a field of safety. So we say that our support work or our doula work is a field phenomena. When we form that field of safety. Doctors feel it. They don’t know what it is because they’ve never felt it, but they know that it feels okay. And so that’s how we run the whole program. So it’s 24 weeks, then 14 weeks and 10 weeks. So it’s almost a year. And how many people attend I think Neha can answer that better? 

Neha Misra – 00:14:27: 

Yeah, no, I’m just saying that the curriculum is actually bringing together Divya’s learnings across different fields. So she’s been a doula, but she’s also a trauma therapist. She’s a somatic experiencing practitioner. She’s a craniosacral therapist and a pre and perinatal psychology mentor. So the curriculum is not just about supporting labor. It brings in a lot of these other aspects to it and which is why we say it’s layered because and the way I like to describe seminar one, two and three is that seminar one is the hands, the hands-on skills. Seminar two is the heart because we’re going a little deeper and looking at how the subconscious works and how that affects the way birth goes. And the third seminar is the soul because that’s really about trauma-informed care and not about the birth but about the experience of birth for the mother and baby. So that’s kind of the way the curriculum is designed. In terms of the numbers, like Divya said, the formal program started in 2018 and I had joined her first batch and the first batch was around five or six of us. And gradually that’s increased to maybe about seven or eight. One batch had 10, so we have about 45 doulas who are either graduates or completing their course. But I think that the important thing also is that the training program is just one part of The Doula Collective©. There is a lot that we are doing outside of the training program as community programs. So there is monthly webinars, which is continuous education. There is a movie club. So we put up a birth film every now and then, which we watch and then we review, bring in guests to speak to the community. We have a very wonderful, which we started about a year and a half back, a postpartum support group for mothers, which we offer as there’s no cost to it. So it’s a space, a weekly postpartum support meeting, a listening circle that we offer to our clients and anyone who wants to join, we have the retreat. So all of that is an equally important aspect of the training program, because that’s where multiple opportunities for us to come together and engage. 

Dr. Rebecca Dekker – 00:16:46: 

I love how you’re continuing to support the trainees then as they go out into the community and start working. And it seems like that would be really important to help prevent burnout from secondary trauma. And I love your discussion of the physical skills, the heart, and then the soul. And before we get started, Divya, you said the placenta print behind you, which you can see on the YouTube video, was from a difficult birth. So do you find that the difficult births are more related to the physical or to the fear or to the system? 

Divya Deswal – 00:17:21: 

I’d say all three. 

Dr. Rebecca Dekker – 00:17:23: 

All three. 

Divya Deswal – 00:17:24:  

So, of course, we have a lifestyle, but though people are very conscious that they go for prenatal yoga, but it’s what they do in the rest of their day also matters. And then there are two aspects to the mind. One is just the pure fear of labor and birth, how it has begun, the pain, is the baby okay? It’s a precious baby. But also the burden of expectation of achieving natural birth. That’s a huge roadblock. Like people think that they’re like a good management, don’t mean they’ve lined up a good doctor, a doula, a waterbirth, et cetera. Now things are gonna happen, but they’re gonna happen through you. And very little, I find that when people concentrate so much on planning it out, they’re actually escaping the reality that’s gonna come into my body. And that can be, this placenta represents that. 

Dr. Rebecca Dekker – 00:18:11: 

So the perfectionism can be a stumbling block. 

Divya Deswal – 00:18:16: 

Yes. And then, of course, the system. So I’ve had the good fortune of actually being in Delhi, which is not the most friendly state to be in for birth, but I’ve made some excellent network with hospitals, doctors, and most of my clients do get or used to get, or anybody who works now in Delhi, if they go to these doctors and there’s a panel of them, they do get most of their birth plan saying, okay, yeah, that’s not a problem. That’s not a problem. That’s not a problem. But it’s their own expectations or performance. Can I say that? The anxiety of performance and achieving that, that also holds women back. But we don’t acknowledge that. 

Dr. Rebecca Dekker – 00:18:59: 

Neha, what stumbling blocks or barriers are you still seeing? 

Neha Misra – 00:19:03: 

So definitely, I would say being able to walk into a hospital or labor room is a big stumbling block. So like Divya said, over the years, we have built, you know, a comfortable, respectful relationship with some care providers wherever we’ve worked for long. But those are few because most don’t know. And like I said, it’s a slightly hostile environment for doulas. So for a lot of facilities, doulas are just not allowed. And so that’s definitely a big barrier. I would say that’s one of the biggest because mothers are looking for support. They may not know the word doula and they’re just learning about it in India. But mothers are looking for someone to support them. But they also quite tend to be more compliant with the doctor and the system. So if there isn’t a collaboration between the support team and the system, then that becomes a big challenge for sure. 

Dr. Rebecca Dekker – 00:20:02: 

So what are the visitor restrictions then? 

Neha Misra – 00:20:05:  

So usually, I mean, the standard protocol is one support person and that should be the choice of the mother. But in some hospitals, if they know you’re a doula, they may not allow you because you’re not a family member. So a family member is allowed and not a professional support person that’s there in some places. But I mean, there is no, every city is different. Every facility is different. Smaller hospitals are actually more supportive. They don’t have rigid protocols, but large corporate hospitals have more rigid protocols. So there is a lot. And I think mainly the fact that unlike in the West, the concept of a childbirth educator and doula is a little more popular. And doctors do understand the benefits of a good birth class and, you know, having labor support. That isn’t really so in India yet. In small pockets, yes, but largely it is the doctor who is the care provider and they do not see the value of anyone else playing a role to support the family. 

Dr. Rebecca Dekker – 00:21:09: 

And I’ve seen that here in the U.S., too, not always to that extent, but 10 years ago when I had started doing this work, I still saw people say, and still today, you know, why do you need to take a birth class? You have a doctor. That kind of… you know. You don’t need to know anything because I’ll take care of you. 

Neha Misra – 00:21:29:  

Which is why I think we believe strongly that the change will be driven by families, by women seeking support. So most of us work as independent doulas and work directly with families. And change there is slower. But that’s the way we believe rather than we haven’t really had any sort of effort to reach out directly to doctors as a community. We’ve spoken about it a few times, but it’s not something that we’re as drawn to as working with families today. 

Divya Deswal – 00:22:03: 

India is not just one India. So there is a large population of this country who actually don’t even go to a doctor. They don’t need a birth class. They don’t need a doctor. They’re just tuned with their bodies. They don’t have a choice to be out of tune with their bodies. Of course, there are other issues, but… do we really need a… a class. The answer can vary from person to person. 

Dr. Rebecca Dekker – 00:22:30: 

Right. From culture to culture, depending on how much knowledge they carry.  

Divya Deswal – 00:22:35: 

Yes.  

Dr. Rebecca Dekker – 00:22:36:  

So what are some of the basic statistics of India? Like, is home birth legal or are they trying to discourage it? And what are some of the other data you’ve been collecting about your doula work and other trends across India? 

Neha Misra – 00:22:51:  

In terms of like India level data there is some basic data that the government surveys publish and home birth while that was the way everyone gave birth till just two generations back. Most of our grandparents were definitely largely born at home. It was almost, I think, 90% or so until two generations back. It’s drastically reduced because of a very, an effort by the government to institutionalize birth. And so home birth statistics now, if I’m not mistaken, are somewhere around 10% or so, but only in like rural areas where they do not have access to a hospital. In cities, we hardly hear of people giving birth at home. Maybe just people who chose to give birth at home because they did not want to go to a hospital, but very, very less. So it’s pretty much institutionalized. In terms of our statistics as doulas, there is actually nobody gathering that information. We have decided that we want to do that. So amongst all the doulas in The Doula Collective©, we have created like… a template where we will all punch in basic details of the births that we were at so that in a few years we will have some sizable data to work with. I mean, personally, I have been capturing my data, and I have to say I’ve been inspired by EBB because I’ve been following Evidence Based Birth® since I started as a birth worker. So I felt it’s good to always capture data and then I don’t know where it will be used. And that’s what we’re trying to do as a doula community. But there isn’t any data on doulas, on even childbirth educators. In fact, most of the evidence we use is also from Western global research, not India specifically. 

Dr. Rebecca Dekker – 00:24:43:  

I was thinking what you were saying earlier about India being so large and having so many regions, you know, with the… a population of 1.4 billion people, are you pretty sure, do you know how many doulas there are? I know you said you’ve trained about 45. Are we talking about like less than 100 for the whole country? 

Neha Misra – 00:25:02:  

Also, the word doula is a Western word. It’s a new word for India, but that doesn’t mean that women haven’t been doing that work. I think in communities, women have played that role of a doula, not knowing what it means. We have what are called as dais, which are traditional midwives. So they’re not medically, clinically trained midwives, but they are traditional midwives who I think basically play doula support. I mean, they support as doulas. So they’re not called doulas, but that doesn’t mean there are only 45 doulas in India. There are definitely many more. 

Dr. Rebecca Dekker – 00:25:40:  

Yeah, I think that’s really important to remember. But then also the institutionalization of birth, not allowing visitors, means that when the people in the communities who have traditionally done that role can’t accompany people during labor. 

Neha Misra – 00:25:55:  

They’re also actually looked down upon. 

Divya Deswal – 00:25:57:  

So there’s a cultural context to it. Women who did this work was dirty work, quote unquote, they call it that way. And so in a system of a hierarchy, they weren’t really high up there. And women learned from apprenticeship. They learned this work between mother-in-laws and daughter-in-laws or aunts and nieces, and they would just carry the tradition forward. So they’re actually called TBAs or traditional birth attendants or assistants. They’re not even called midwives. We call them indigenous midwives at times. And so do Indian women have support? Yes, they do, because the role is also played by family. So in large joint families, they used to have a room for childbearing, and there were many sister-in-laws and other people having babies. So traditionally, women would accompany other women, and there was a culture of massage, heating the body, all of that was there. There was no scientific basis on it. So like you’re saying, so therefore, it’s not illegal to have a home birth in India. It’s neither legal nor illegal. It just is. You’re having a baby and people are having babies everywhere. So it’s not illegal. In fact, when we fill up our forms for the name of the baby and to register the birth, we have a clear option of saying, was the baby born at home? So the government recognizes that babies are born at home. They’re trying to institutionalize birth because we have a high mortality rate. And that is because of anemia. That is because of malnutrition. That is because of sanitation. There’s so many reasons for it. Poverty. But it’s not illegal to have a baby at home or in the hospital or wherever else or tiny, what we call our maternity homes. You can have a baby anywhere you want. It’s not illegal. So it’s unlike the U.S. where you have to have it under the purview of the law to be attended by a caregiver. If you choose to have your baby without a caregiver, it’s not against the law. Because that’s how women have always given birth here. So that’s one of the aspects you must understand. But women in our area, when they decide to have a baby at home, They cannot do it because they don’t have a care provider. There is no midwife. Or trained midwife. And they have been educated enough to have fear of not having a care provider there. Whereas on the other side, the rural and the poverty stricken have always given birth with the dais. So they feel safe in that arrangement. So it’s really complex and like I said, nuanced to give birth in India. But it’s not illegal. And most of the data the government of India collects is only about mortality. We’re just trying to save people. We’re living at the edge of survival. So a birth experience is really not high on the list of what we want to give to the women. Let’s just save the women from dying and the babies from dying. And recently we passed a law that every woman is entitled to a companion. 

Dr. Rebecca Dekker – 00:28:53:  

So they can’t make them birth alone. 

Divya Deswal – 00:28:56:  

They don’t give birth alone. So we recognize that women giving birth alone is more afraid or it’s difficult outcomes, a companion. But what we’ve done is that we’ve taken the letter of the law, that one companion. They say at least one companion means more than one because that was tradition. But now hospitals are putting a blanket no to more than one. So the women are saying, do I need my mother there? Do I get somebody who knows what they’re doing? Do I get my husband there? Depending on where they’re at, they want that one person, but that one person cannot do all the roles.  

Dr. Rebecca Dekker – 00:29:29:  

Right.  

Divya Deswal – 00:28:30:  

So that’s a bit of a confusion as well. 

Dr. Rebecca Dekker – 00:29:33:  

And who are most people, what is the trend to who you choose as your companion for the one person you get? 

Divya Deswal – 00:29:39:  

For most urban people, it’s their husband. They want their husbands there. Even if they’re terrified. And that’s when education really helps because it allows the man to ask the questions, know what they need to do, et cetera. Some women, more traditional outlook, would say, I want my mother there. Some would say, I don’t want my mother there because she’s going to make me afraid. 

Neha Misra – 00:30:02:  

There are also a lot of women who still labor alone because in a lot of hospitals, while they may be allowed, the companion may not be encouraged to be there. So a lot of women do labor alone. And so it’s only in cities where there’s more awareness and, you know, people want their partners inside that it’s changing, but it’s not quite there. There are a few other pieces of information that are captured now, which is the c-section rates. And that’s been good to look at because you do clearly see it rising and definitely rising much faster in urban private hospitals. So when, I mean, I feel that’s a good benchmark to look at when we’re looking at doula data. How do our births compare with the general urban private hospital births, at least in terms of c-section, because that’s the one thing that’s being captured. And they do also capture breastfeeding rates, initiation of breastfeeding, continued breastfeeding. So that’s another thing to look at because breastfeeding rates also have reduced. And especially in India, India’s had only exclusive breastfeeding for the longest time until the formula did come in and then it changed. 

Dr. Rebecca Dekker – 00:31:18:  

I’m thinking back to what you said earlier about just some of the ways you practice in a culturally-informed, trauma-informed way. What are some other strategies or practices you use as doulas to help your clients achieve, you know, a healthier, more positive pregnancy and birth. 

Divya Deswal – 00:31:39:  

So one of the things that we do is we do family meetings because family is usually not just the husband, but they could be a mother-in-law, they could be a mother. And like Neha said, it’s only in the last two generations that we started to go into hospitals. Like my mother was born at home, but I was born in a hospital and she was in a hospital all alone. So there is a bit of a fear in the parents of the parents-to-be, which is the grandparents, the child. And so one of the things we do is that we do speak to families and we make time to say, okay, I know that we’re all invested in this baby. Tell us what your concerns are. And we also encourage to bring in tradition and decode the science and then say, okay, you know, this is great and this is how it translates. So when we meet that older generation where they are and we appreciate, you know, tradition, not all of it, but some pieces which are valuable, we appreciate it and we bring it to the next generation. We kind of win them over. 

Neha Misra – 00:32:46:  

In fact, I find it really fascinating how a lot of the good birth practices that are evidence-based now from the studies talk about it are there in traditional practices. And, you know, the Lamaze healthy birth practices are our default followed. Labor starting on its own, movement in labor, birthing in the position of your choice, having companions, other women with you in birthing, keeping the baby with you. No one needs to tell you culturally that these things are required. So kind of, I think in the manner in which we offer information helps. So you’re bringing in what research and science is explaining now, but what you’re saying is this is no different from what seems to be right to you. So then it makes more sense. It’s not an external idea that’s coming in and telling you to change what you need to do. It’s actually just taking you back to what you instinctively already know is right for you. And how women in your… family have been birthing for years. So the moment that connection is made, that information makes a lot more sense. And I think like Divya said earlier, you know, the other very important aspect is the sensitivity that… a lot of Indian women… find safety in just kind of not shaking things up too much and going with the flow. So working individually with each client to see where they are at on that. There are some who are, you know, ready to take it all on, whether it’s family or the doctor. And there are many who may choose not to, but if they know what they’re choosing, then they’re more comfortable with their choices. So that kind of individualization of support. Is something that we find is really important. 

Divya Deswal – 00:34:33:  

And I also wanted to add, with care providers, I find that doctors are really they’re gods with a small “g,” I think. So as a practice, I would go and meet them. I would introduce myself, give them a bit of an ego boost. Just say, and then my wording would be something like that, saying that I’m so happy to come and meet you because ultimately I want to support you to give this woman a good birth. So now I’m supporting the doctor’s vision as well. And that’s where they say, then I clearly say that I’m a doula. I will not be doing anything medical. We will be deferring to you. I’ll be here to hold a hand. You know, when they’re less anxious, things go better. And most doctors agree with that. So that was also one of the ways of bridging. And making a relationship. And then, of course, during the course of the birth, they do see the difference in a woman when she’s more in her body, she’s less stressed, they’re asking the doctor less questions, nobody’s hassled, then they’ll come back and talk to you again and say, yeah, you know, I think that’s great. You know, we can work together. And that’s how I make bridges with doctors. 

Dr. Rebecca Dekker – 00:35:47:  

Divya, I know you have a really wonderful presence and I can see you having that confidence to go talk with doctors. How do you even get that first meeting though, where you can introduce yourself and say what you do and give them your little speech? 

Divya Deswal – 00:36:03:  

20 years ago, I went from doctor to doctor and I was shown the door saying, what do you know, I’m a doctor. And then I did meet a really good doctor. And I had just come back from the US and we wanted to do a waterbirth. And then, you know, I kind of held her hand and developed a relationship. But it’s also a society that says, oh, if you’ve done it, I want to do it too. So that kind of brought me a little bit of a, let’s say, good publicity. And then the confidence came. But believe me, 20 years ago, I’m a civil engineer who had a child and decided that, oh, nobody should be alone at birth. And then got pushed around from one big hospital to the other till I found that one good doctor. And that was the starting point. But I think that if you have passion and that you’ve put your heart and soul, confidence is a byproduct. 

Dr. Rebecca Dekker – 00:36:56:  

Neha, what about you? How have you built bridges with medical providers? 

Neha Misra – 00:37:00:  

I think that I also did try that, which is when I tried to reach out directly to a doctor to meet them, but I realized soon that wasn’t working. What always worked is when I met the doctor with my client. So if my client has developed a good relationship with their care provider, and they are then keen to introduce this other person who is part of the team, then it works very differently. So I always encourage my clients to, of course, you do need to do like a selection of who you want to go with. But once you choose your care provider, you have to work towards developing that mutually respectful relationship. And when you have that, at the end of the day, they’re human beings too. And in that kind of a warm relationship, bringing in this other person who’s here to help us, you know, to have the kind of birth that I want to have, changes the dynamics of that meeting. And then they’re not seeing you as someone who’s an outsider, but they’re seeing you as part of the existing relationship that they have with their client. 

Dr. Rebecca Dekker – 00:38:04:  

So. Going to a prenatal client with you is how you got that face-to-face time with doctors. 

Divya Deswal – 00:38:12:  

The two things we realized about doctors is the first one is that they themselves are quite traumatized. The medical system is quite traumatized, so they deserve kindness. Because we’re all at the edge of like, our defenses are really up. So that’s really the big thing. And the second thing I believe is my vision for the Collective is that if I’ve already made in-roads. Then nobody has to reinvent the wheel. So we do take mentees, those who are still studying, with us to meet the doctors we already have relationships with. So it kind of has that building block effect. 

Neha Misra – 00:38:51:  

I learned this skill by just accompanying Divya for prenatal meetings. And now we believe that that’s what we need to pass on to our other doulas. So typically we invite one more trainee doula to join us for prenatal meetings. But birth, it doesn’t always work because you can’t have people standing and watching, as we know. But at least for prenatal meetings, you know, witnessing that interaction, you gradually learn these subtle skills of how to find your way in. And I would say that these subtle skills are equally as important in the hospital when you’re operating with nurses and duty doctors. So one is, of course, the main consultant care provider. But then in the hospital, there will be other duty doctors, there will be nurses. And kind of having like this comfort with them is another trick. And I feel that if you see them as human beings, and you kind of, address them by their name, and you introduce yourself, and you have a little bit of a chat or a cup of coffee with them, suddenly they’re like open and they drop their guard because now they’re not seeing you as a threat, but they see you as an ally. And those are the ways we… and it doesn’t always work. Sometimes it works. Sometimes it backfires. And just figure it out on the job. 

Dr. Rebecca Dekker – 00:40:08:  

And that’s the importance then of the weekly meetings you’re having with your Doula Collective, right? So that you can talk about the difficult scenarios. Yeah. 

Divya Deswal – 00:40:19:  

Absolutely. 

Dr. Rebecca Dekker – 00:40:21:  

Is there anything else you want our listeners to know, to learn from you today? Speaking to newer doulas or to expecting parents. 

Divya Deswal – 00:40:31:  

I want to talk to other doulas. There are two things very clearly. One is that women’s energies are different than men energies, I truly believe. Women are more collaborated in nature. In our culture, we say purusha, which is male energy, and prakriti, which is feminine energy, but it’s also a literal translation of nature herself, so it’s a little bit wild. But it’s kind of energetic where purusha is more mass, more stable, more straight path. So feminine energies don’t pass down like a hierarchy or like a, you know, from generations in a lineage, but it moves from woman to woman. And typically my mentor’s daughter, I was the doula for my mentor’s daughter. And I just asked her, I said, why is she coming to me? I mean, she has you as a mother. And she says, that’s not how women’s energies will pass. They will go from women to women. So I gave it to you and now you’re offering it to my daughter. And then it so happened that Neha mentored my daughter. So that’s one of the things I want to tell everybody, that while the world model may be competitive or career-oriented, women’s energies are collaborative in nature. The more you share, the stronger you grow as a collective. So that’s the one thing I want to tell others. And I also say that we have a community which is not restricted to just the students of Doula Collective. Our community is open for everybody. So we’re willing to host people who want to share their knowledge and invite people who want to come and be a part of our community activities. So those are the two things I wanted to say to doula sisters. And since Neha’s working actively with expecting mothers, I’m going to leave that for her to say. 

Dr. Rebecca Dekker – 00:42:21:  

And Divya, how can people find The Doula Collective©, other doulas or people who want to train? How can they find you and get connected? 

Divya Deswal – 00:42:29:  

We have a website. We have a website. It’s called thedoulacollective, one word, dot IN. 

Dr. Rebecca Dekker – 00:42:35:  

Okay. 

Divya Deswal – 00:42:36:  

And we have an Instagram page. 

Dr. Rebecca Dekker – 00:42:39:  

Awesome. We’ll share that in the show notes. 

Neha Misra – 00:42:41:  

Both of us deeply and strongly believe that this sisterhood is really important amongst birth workers because we do see a lot of people trying to do something. But when you’re working in isolation and you’re working in silos, it becomes really hard. So, you know, finding ways in which we can come together. When we come together, we realize there’s no competition between each other. There are enough people having babies and there is a lot to be done. So it’s not like they’re going to take away each other’s work. But actually, together, we’re able to be much more impactful. And how to collaborate is something we are figuring out as we go along. But the intention is very, very strong. And, you know, it’s not just about the skills and the training, but the community aspect of it is really, really important. And that’s how we’ll be able to reach out to more people through this collaboration. 

Dr. Rebecca Dekker – 00:43:39:  

Well, Neha and Divya, thank you so much for coming on the podcast and sharing your wisdom with other doulas and parents and birth workers from around the world. We appreciate all the work you’re doing. And I want to encourage everyone to go to the doulacollective.in, check out their work. You can also follow them on Instagram, same username, thedoulacollective.in on Instagram. And we just appreciate you coming here and taking time in your evening, my morning, from opposite sides of the world. And I appreciate you both. 

Divya Deswal – 00:44:12:  

We do appreciate the work you’ve been doing. You’re a great inspiration. We’re absolutely thrilled to be here. It’s like one of those moments for us for sure. 

Neha Misra – 00:44:21:  

And I have to mention thanks to Sara was part of our community is part of our community and the training and it was so wonderful learning from her and including her uh in our sisterhood and now she works with Evidence Based Birth® and we were so thrilled to hear that so uh definitely thanks to her too. 

Dr. Rebecca Dekker – 00:44:42:  

Yes. And she has talked many times about you both and the work that the whole Collective is doing. And it’s just so impressive and exciting. To see the impact you’re making on families and birth workers there. 

Neha Misra – 00:44:55:  

Thank you so much. Having your acknowledgement means a lot to us. 

Divya Deswal – 00:44:59:  

Yes, indeed. Thank you so much. 

Dr. Rebecca Dekker – 00:45:03:  

Today’s podcast was brought to you by the Signature Articles at Evidence Based Birth®. Did you know that we have more than 20 peer-reviewed articles summarizing the evidence on childbirth topics available for free at evidencebasedbirth.com. It takes six to nine months on average for our research team to write an article from start to finish. And we then make those articles freely available to the public on our blog. Check out our topics ranging from advanced maternal age to circumcision, due dates, big babies, pitocin, vitamin K, and more. Our mission is to get research evidence on childbirth into the hands of families and communities around the world. Just go to evidencebasedbirth.com, click on blog, and click on the filter to look at just the EBB signature articles.