Can you tell us about the beginning of CBI and why you decided to start it?
About 25 years ago, I was working as a birth doula and childbirth educator in Singapore, where I had recently moved to after living in the United Kingdom. I started to have a few clients who had given birth and they approached me asking if I would train them to provide the kind of support that I had provided for them during their pregnancy and birth. I started really informally, with monthly sessions where we would talk about all things pregnancy and birth-related. After each session, I would note down what we had talked about in a diary and after a couple of months started to notice the beginnings of a curriculum for training coming together.
At the same time, I was running an online group through a platform called Yahoo Groups. This was all pre-social media and the only way to communicate with birth and lactation professionals in other countries was through these groups where all communication was done through email. This was the only active group at the time for doulas from across the world to talk to others. The concept of a doula as a profession was very new – hardly anybody knew the term and there were very few options for formal training in the US, and no options outside the US. Through the discussions in the group, I noticed that doulas were frequently becoming frustrated – frustrated with the medical system that wasn’t respecting their client’s choices, and frustrated with their inability to change anything. I was watching doulas frequently feeling burnt out by what they saw happening to their clients, and also seeing new doulas who had completed a short workshop on becoming a doula and feeling completely unprepared. I had learned that one of the most important roles that a doula can have is to help a client learn how to communicate with their healthcare providers and to facilitate that communication in the birthing room. But new doulas were not learning how to teach communication, or to more effectively communicate themselves, and were not building any resilience skills for when they were at challenging births. This got me wondering if I could craft the training that I was doing face-to-face into a curriculum that could be done online.
One of the most important roles that a doula can have is to help a client learn how to communicate with their healthcare providers and to facilitate that communication in the birthing room
Online learning was a pretty new concept then. It was often criticized for not being as effective as face-to-face learning. But, I was studying my Bachelor of Nursing online (I was living in Singapore and studying through an Australian university) and knew it was achievable. It just needed the right kind of program. I also knew that, while there are some real advantages to learning face-to-face, it is really difficult to develop reflective and critical thinking skills in a weekend workshop, or to cover the depth and breadth of the topics that really help a doula do their job well.
So, CBI was born with our first students signing up in 2000. In those early days, it was just me sitting on the floor of my home office, photocopying manuals and binding each one manually, taking them to the post office and sending them off to new students. Over time, our students became graduates, and some of them then went on to become trainers. We adapted the course materials and updated them as we got feedback from students on what could make the course better. We added more courses (postpartum doula, childbirth educator, and lactation counselor).
Do you think the vision you had for CBI has been achieved?
From the very beginning, I wanted CBI to provide training that would support birth and lactation professionals in developing the skills and knowledge that would ensure they felt prepared and competent in supporting clients, and to teach their clients skills to ensure they felt prepared for their birth and parenting, that they knew their rights and were making decisions that were right for them. I certainly feel that the training programs we offer provide that. I also wanted birth and lactation professionals to determine for themselves the kind of businesses they wanted to run and to have the confidence to develop their business in a way that works for them. I wanted to see doulas being recognized for the skilled professionals that they are and welcomed into every birth as an essential team member.
I believe that training organizations have a vital role to play in improving birth for everyone by highlighting the impact of birth trauma and advocating for improvements in reproductive care
There have been huge changes in this area over the past 25 years where, not only are doulas seen as valuable members of the birthing team, but we are now seeing governments value doula support. Finally, I really wanted to see the birth environment change for the better, with fewer routine interventions, the elimination of non-evidence-based practices, and the birthing space to be one where every person is treated with kindness, compassion, respect and dignity. On this last one, unfortunately, we are still seeing practices that cause trauma to those giving birth and significant disparities in outcomes for marginalized and vulnerable groups. Intervention rates have increased without any corresponding improvement in maternal or infant morbidity and mortality. But, we are now having a dialogue about this and I am seeing a recognition that birth trauma often results from unnecessary interventions and the way a person is treated during their birth. I am hopeful that we will see some significant improvements in this in the next couple of years. I believe that training organizations have a vital role to play in improving birth for everyone by highlighting the impact of birth trauma and advocating for improvements in reproductive care.
You have now been providing training for the past 25 years. What’s next for CBI?
Ongoing improvement in our courses of course. Using technologies that help us to deliver quality courses and adapting our courses as technology improves. Introducing new courses – we will be launching a new Advanced Lactation Counselor course this year together with several professional development courses. Most importantly though is strengthening our role in advocacy and using our voice to highlight the problems in maternal and reproductive healthcare and calling for change.