“In a very disjointed healthcare infrastructure, the doula is seen as this clothespin to bring all of it together.”
– Chanel Porchia-Albert
Interview with Chanel Porchia-Albert
Chanel is founder and executive director of Ancient Song, a reproductive health and advocacy organization that provides resources and full-spectrum doula services to women of color and marginalized communities in New York and New Jersey. She’s a respected leader on the topic of birth justice and promotes a model of maternity care that relieves the burden on families.
What is something you wish people knew about community doulas and the work that you do?
I’d like people to understand the role of the community-based doula as extensions of creating community care frameworks for women, birthing people, and families — what it means to be within a community. Community-based doulas plays a role of being that extender because they usually live in that community and/or work in the community or both.
They’re not just coming from a perspective of supporting someone as an external provider coming into a situation and then wanting to analyze a situation and give feedback. They incorporate their lived experiences as a community member to inform the ways in which they interact with individuals who are pregnant and parenting because they themselves may also be parents.
What does it mean for them to build a framework that is culturally congruent or culturally humble? Understanding that the lived experiences of individuals are very different, although they may be within the same ecosystem. Understanding that there’s no one-size-fits-all approach to care and that they can’t be the sole individual driving that.
So they work in partnership with other community-based organizations to help shape what it means for someone to be centered in their bodily autonomy and enroll as a human being who is giving birth.
What are some of the things that are trending or new about doulas and their role in advancing birth justice and health equity?
The overarching trend around the name “doula” is the fact that we live in a very disjointed healthcare infrastructure and the doula is being seen as this clothespin to bring all of it together –when in actuality it’s a bigger problem.
Within any community, from a historical perspective, doulas have always existed. We’ve always had individuals within our respective communities.
When someone was pregnant, they would bring food or check in or offer resources, offer practical knowledge and information based on their lived experiences. The popularity of the term doula has become something of a trend.
But the term is only trending now because of the fact that we live in a fragmented society. Individuals experience community in a very fragmented way. New Jersey is a unique ecosystem. It’s broken up into sections — rural, central, northern.
The more northern you are, the more urban you are. Even though you may be urban adjacent. When you’re central, you’re in the middle and people don’t really know what to do with you. When you are in the south, you often are totally forgotten. And so then you find yourself in maternity care deserts.
What are the barriers to success for community doulas and their family clients?
New Jersey very fragmented. The supports that need to be in place to center someone within their birthing experience or their episode of pregnancy is fractured because everybody’s trying to do something everywhere and no one’s really having a conversation on what does it mean to do that for everyone.
Maternal health, in general, doesn’t work for anybody. Black, white, I don’t care who you are, it doesn’t work for anyone. But then when you start to get into particular groups, then you see further disenfranchisement. When you start to bring in gender, when you start to bring in language, immigration status, folks who are unhoused, all these different things, these social factors as well as health factors, you have a doula who’s trying to fix an infrastructure that historically hasn’t centered these groups.
The overarching question we have to ask ourselves is, “How has New Jersey traditionally centered women and birthing people and parents as a whole?” Then, “What is the doula expected to be able to actually do?” Is it to just stay in a space and hold someone’s hand and say, “you got this” and to connect you with some resources.”
Or will we elevate such other structural problems as a lack of healthcare providers, a lack of a willingness to want to move away from frameworks that traditionally haven’t worked, an infrastructure is monopolized by consortiums that historically haven’t centered those who are most disenfranchised where they reside.
A doula may have the best of intentions. They are going into a space, “They’re saying, “This is what your rights are, you can do this, you can do that.” But if we’re not also teaching providers what that means when they walk into that space, then we’re setting up individuals to fail.
If we don’t reframe the ways we drive care and we stay to one practice and saying that’s the standard for all, then we’re doing a great disservice to New Jerseyans, because there is no one-size-fits-all approach to care.
Then my question is, “How are we meeting people where they are, not where we expect them to be?” And then asking folks, “Well, what does support look like for you?” Understanding it’s intrinsically going to look different based on who you ask. How are we looking at New Jersey’s ecosystem and removing silos?
People have to be bold and do what needs to be done for families.
If you see a problem, the only way to answer the problem is by shifting the ways in which you are working every single day. You can’t keep approaching a problem the same way over and over again and expect a different result. And New Jersey is stuck on that same pattern.
Are there places where you see change happening?
There are pockets of people and organizations, community-based organizations that are really trying to affirm and center their communities in amazing ways. But those are also the same pockets of individuals and community organizations that have struggled in maintaining financial sustainability. They aren’t heard legislatively or they are labeled difficult. In short, no, there isn’t any systemic change happening.
What are the best solutions for improving both the access to doula care and success for community doulas?
There are tools that could be used that already exist. Maternal mortality review committees should include more community representation, not just doctors. Ensure that doulas and those with lived experiences and community members and your aunties and grandmas as well as police officers and teachers, and anyone who comes in contact with someone who is pregnant, is involved in those processes.
Because that’s the community. And use that information that you gather from those review committees to inform legislative policy because the recommendations that come out of that are golden.
Hospitals need to not just incorporate implicit bias training, but set a standard for accountability. And that accountability needs to be connected to community advisory boards that meet monthly. As you’re serving community, they’re giving feedback in real time.
That information should be used in meaningful ways to inform the way in which care is actually given. Peoples’ needs change based on what’s going on in society, and we often overlook that. If there’s social unrest, that will affect how people are able to access healthcare. If there’s a migrant influx, that will affect how people access healthcare.
If there’s a pandemic, that also affects things. People take a very linear approach to care that’s not looking at the lived experiences of human beings as a whole. For me, it goes beyond race and ethnicity. It’s really just talking about the human condition and how we’re really starting to center folks.
Have you seen a good example of a true community-focused approach to maternal healthcare?
I was a part of the Maternal Mortality Review Committee in New York City, and it was just like that. There were folks from different disciplines who informed the way things were done. I run a hospital-based community doula program out of Queens Hospital, which I designed from top to bottom.. And the model is, we have a community advisory board.
The board informs the ways the program flows. We’re responsive to them based on the needs and what’s going on and the respective communities. Before we even went into the hospital, I said I needed to train every single person to understand the role of a doula, to be able to understand the lived experiences of individuals who would be coming into that space.
That included social workers, nurses, the person doing the intakes — anyone who came in contact with a patient had to be trained first before you could even say you want to recommend a doula to anyone. I teach medical residents how to incorporate a birth justice framework into the work they do, and then go on the floor and do real-time evaluations on how it plays out in real life.
The goal is not to put all of the burden on the patient. It should also be the responsibility of the institution as well as the providers.
We also have to be innovative. South Jersey is a maternity-care desert. Why aren’t we looking for an expansion in certified professional midwives as a viable resource for folks to be able to access equitable healthcare?
Why are we not looking at using spaces that are underutilized or not utilized at all and revamping them into spaces where people can get their healthcare, they can pick up a prescription, and maybe even pick up groceries at the same time. Community of Hope in Washington, DC is a birthing center that follows this model.
If you know there are certain limitations to access of people calling here, there, and everywhere, why aren’t we trying to create a concerted effort so people can access the things they need so they don’t have to be jumping all over the place? And then people don’t have to use the excuse, well, these people just don’t want to be helped.
It’s easy to point fingers and automatically make an assumption as to why someone may be not accessing healthcare services. But it’s another thing to truly ask them and shift the way in which you drive care. If you know people work and they can’t get off, well, why don’t you do stuff on the weekends or late at night?
If you make things practical, people can practically engage. But if you’re not doing that and you’re not willing to see past one’s own ego and position of privilege and power because we all have it in some kind of way, then nothing will ever change within the space.
What gives you hope?
I’m hopeful about the conversation. I’m very happy that the conversation around doulas and around maternal health and maternal mortality is being uplifted. It gives me hope because the conversation wasn’t happening at all for years or, if it was, it was used as a footnote.
But I also understand that when conversations happen, there’s more space for exploitation of available resources as well as to advance one’s own personal agenda. And so I’m hopeful about community-based doulas who show up every single day and do this work knowing that they are not necessarily seen or heard.
I’m hopeful about community-based organizations who struggle to get funding and to sustain themselves, but still have the willingness to provide services to their communities with what they have. I’m hopeful about our community allies and individuals within the community who are very intentional about centering the voices of everyone and do it in meaningful ways.
I’m hopeful in seeing the children who come into the world. I’m a mother of 6, so I have to stay hopeful. I have to stay hopeful for them because I want them to live in a world where they are seen as children of African descent, as children who are able to feel their voice is being heard, and they’re not being disenfranchised because of the perception of who someone thinks they are.
What do you do for self-care? How do you motivate yourself to do it all over again the next day?
That has come up 3 times this week, where somebody asked the same question. I tell folks that at the end of the day, when I see the individuals who I’ve helped and the impact that’s had on their lives, and I see the other children now that are grown that I’ve helped to come and see this world, or I have taught someone and now they provide services on a large scale and do things within their respective communities, that’s what it is.
There are times when I don’t want to do this anymore, this is too much. It isn’t supposed to be this hard to care for people. It doesn’t have to be that hard. And it’s the lack of willingness of individuals to step outside their own box and understand that we’re a larger community.
And that fear — because it’s fear, and I know it’s fear — is fear of something that’s different. It’s fear of perceptions of the unknown. It’s fear of change. People get very comfortable. They get into their routine, but nothing is for certain. The only things that are certain are life and death. And you learn that as a birth worker. And I get to see the intricacies of what it means, the honor and privilege to be in someone’s space when they’re having a baby.
It’s a privilege for someone to let you in such an intimate space. And I’ve served all kinds of people from all different walks of life, all different cultural backgrounds, religious backgrounds. And the one thing they all have in common is that they just want to live. They want to center their families. That’s it. And that just gives me hope at the end of the day.