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Denise Foreman cringes when she thinks about the doula she used to be.

Like many women, Foreman, 36, became a doula because she wanted to help mothers have empowering birth experiences without being pressured into unnecessary medical interventions. And like many doulas, Foreman was soon strapped for cash, unable to find enough clients who were willing to pay her a living wage — or who even knew what a doula was.

Doulas provide nonmedical physical and emotional support before, during, and right after childbirth with the goal of helping mothers advocate for themselves. The profession isn’t regulated: Unlike nurses and midwives, anyone, even someone who has never been to a birth before, can technically call themselves a doula, which comes from the Greek word for “women’s servant.” There are a few dozen private certification organizations that train professional doulas, and nearly all believe doula care should be accessible to everyone, even if that means working for free or low cost when that’s all an expecting mother can afford.

By 2014, Foreman was a certified doula, but she wasn’t making any money. Her first birth — which she attended for free, because her trainer said she needed the experience — lasted 28 hours. All women deserve doulas, Foreman’s trainer told her, and it was their job to provide. But how was Foreman supposed to provide for her family?

Everything changed when she discovered a private Facebook group called “The Business of Being a Doula,” or “BOBAD.” Most doula websites are decorated with watercolors of earthy women cradling their bellies or flowers that look like vaginas. BOBAD, which has over 10,000 members, features a peppy career woman fist-pumping in front of her computer. The group’s members were unusual, too. They didn’t think every woman deserved a doula. Instead, they considered doula support a luxury — one that ideally came with a premium price tag.

Denise Foreman Megan Mack for BuzzFeed News

At first, Foreman thought BOBAD was “kind of scary,” she said. Group members accuse volunteer doulas of “devaluing” the profession, calling them selfish “oxytocin vampires” for soaking up secondhand vibes at the expense of their colleagues’ paychecks (women release oxytocin, called the “love hormone,” during labor). “Sure hope that birth high is worth taking the food out of my children’s mouths,” an angry doula once wrote about a competitor advertising free services. Posts about whether doulas are a “necessity” draw hundreds of impassioned comments. “Everyone deserves a doula is a catchy phrase,” one doula recently wrote, “but so is ‘show me the money.’”

Foreman stuck around, because, she said, the women “were obviously successful, and I wanted that too.” She soon learned that the group was run by ProDoula, a new, for-profit doula certification agency. The mandate to “charge your worth” was coming straight from ProDoula’s charismatic commander in chief: Randy “Rock N’ Roll Doula” Patterson.

Patterson, 49, has breast-length black curls and elaborate tattoo sleeves on both arms. She’s disarmingly effusive, unless she’s talking about the people who’ve crossed her, of whom there are many — her critics compare her to Donald Trump. ProDoula’s attackers need to take a deeper look within, Patterson said in a recent interview at the company’s headquarters in Peekskill, a cute Westchester County town an hour’s drive from New York City.

“If you’re not successful, it’s because of you,” Patterson said. She wore a leopard-print top and black mesh spike heels as she held court in her purple-walled office, which is decorated with posters of rock bands, goth-chic candelabras, and a mounted unicorn head. A diamond-shaped award Patterson received at ProDoula’s first conference in 2015 sits on her glass desk: “You withstood pressure and remain strong, beautiful, brilliant.” She won it for standing up to ProDoula’s haters.

ProDoula is only three-and-a-half years old, but its co-founders — Patterson and her longtime business partner, Debbie Aglietti — say it’s the fastest-growing doula certification company in the country. It’s also the most controversial. While other leading organizations prioritize the needs of mothers, ProDoula also focuses on the needs of doulas, helping them turn “their passion into a paycheck,” through business-centered trainings and support. Patterson and Aglietti say they’ve earned six-figure incomes working in the doula industry. If they can do it, why can’t you?

ProDoula’s hardline stance has divided the birth world like never before. Doulas have long said they could transform the nationwide birth industry if they could reach more of the nearly 4 million women who give birth each year — just 6% had a doula at their birth, according to one 2013 survey. Whether covered by Medicaid or private insurance, more money is spent on childbirth than any other type of hospital care, and Donald Trump’s vow to end Obamacare could make pregnancy even more of a financial nightmare. Decades of research shows doula support reduces the need for major and costly medical interventions such as epidurals, inductions, and cesareans. One 2013 study found that women at risk for adverse birth outcomes were less likely to have complications with a doula by their side, and in 2014, the American Congress of Obstetricians and Gynecologists acknowledged the doula as “one of the most effective tools” to improve birth.

Randy Patterson’s office decor Megan Mack for BuzzFeed News

For these reasons, doula organizations often encourage their members to volunteer, offer sliding-scale prices, and partner with community-based programs that subsidize doulas for low-income families. Increasingly, some lobby to have doula services covered by Medicaid and private insurance in hopes of a more comprehensive overhaul, cutting costs to patients and creating more steady jobs for doulas — one recent study found professional doula support could save nearly $1,000 a birth. That’s why ProDoula’s insistence that doula services are a luxury, not a necessity, unsettles so many: It clashes with the research the doula movement was built on.

But Patterson has a different perspective on how to make birth better, and it starts with doulas’ bank accounts. “People who have money change things,” she said. She believes targeting higher-income clients will turn the profession mainstream and prevent burnout. Female-dominated care work is historically underpaid and undervalued, and ProDoula wants to fix that by shattering stereotypes that doulas are crunchy home-birth hippies or radical activists who will work for free. Too many women “have a weird time asking for money” and don’t value themselves, Patterson said, which is why ProDoula preaches self-esteem as part of its business model.

“I care more about many of these women than any other fucking person on the planet,” Patterson said. “ProDoula is more than a certification organization. It’s everything I have ever stood for as a woman.”

Denise Foreman had to go on a payment plan to afford her first ProDoula training, which at the time cost $1,025 for two days of not only labor and postpartum classes but also, well, reprogramming.

“I was given the freedom to remove the weight of women’s birth outcomes from my shoulders,” she later wrote. “I was told that if I want something, I can have it.”

Eventually, with the help of ProDoula’s “Advanced Business Training,” Foreman launched her own doula agency, presiding over a team of ProDoula-trained doulas. Once, Foreman had charged $250 per birth, if she charged anything at all. Now, her agency raked in $1,200 per birth — much more than the local average — plus extra for longer labors and other services. Last year, Foreman moved her family from Issaquah, Washington, to become ProDoula’s executive coordinator of trainings, which is kind of like a cardinal moving to the Vatican to work alongside the pope. Sitting in ProDoula’s HQ, Foreman, who wore double buns in her brown hair and large heart-shaped hoop earrings, cried as she described her transformation. Patterson was right beside her, instructing her firmly but lovingly to “hold it together.”

Patterson (right) working with a client. Raymond Forbes

Thanks to women like Foreman, ProDoula says it made $1.25 million in 2016. The company has nine full-time employees, 15 paid trainers, and an array of pricey services available for purchase, from placenta encapsulation kits to one-on-one coaching packages. The company says it has processed more than 3,000 certifications across the US, Canada, and Europe since it started, with triple-digit growth percentages in its first two years and nearly 50% in 2016. Patterson and Aglietti co-own three doula agencies across the country and plan on opening two more in 2017.

Despite ProDoula’s success, many of its members say they feel like outsiders in their local doula communities. When Foreman made the crossover, other doulas called her “money-hungry,” she said. Her blog posts from that time sound like they were written by a political radical. “There is a #doularevolution happening. And I’m part of it,” she wrote. “Doulas are succeeding and the ones who balk, badmouth and shame are going to be left trapped in the subterranean bitumen, burned out and broke.”

But where ProDoulas see community, critics see a cultish crew of snake-oil salespeople. Patterson was once a star Mary Kay consultant, and she’s applied some of the cosmetic company’s marketing practices to ProDoula, leading to questions about whether its success benefits all women, or just those at the top.

“The doula movement was founded on the needs of the woman,” said Penny Simkin, the beloved 78-year-old co-founder of DONA International, which bills itself as the world’s oldest, largest, and most respected doula-certifying organization. ProDoula’s business strategy “will do nothing for improving birth in this country,” she said, “and only improve their pocketbooks.”

Women have been “doula-ing” for centuries, but it only became a profession in the 1980s, after hospitals’ cesarean and medical induction rates spiked. Amid growing concerns about the country’s unreasonably high maternal and fetal mortality rates, research found that continuous emotional, patient-centered support during labor resulted in better maternal and infant health. The most effective support, studies show, comes from specialists who aren’t family members, friends, or hospital employees. Enter the doula.

At first, medical professionals saw doulas as activist interlopers. But in 1992, a group of doctors and maternal health experts launched the nonprofit now called DONA International. DONA’s stated vision was and is “a doula for every woman who wants one,” but it also aimed to professionalize the industry with trainings and a code of conduct for doulas.

Doulas who train through DONA meet with pregnant women to create a birth plan, regardless of whether the client wants an “all-natural” delivery or a speedy epidural. During labor, the doula acts as a negotiator, helping to make sure the plan is followed without stepping on the medical team’s toes if complications arise. They check in after the birth to make sure everything’s going okay (there are also postpartum doulas who focus solely on post-birth care).

Thanks in part to our on-demand economy, doulas are now more popular than ever. But although 2016 may have been “the year of the doula,” it’s also a time of crisis for the unregulated industry. There are conflicts between those who believe doulas should support their clients autonomously, and those who want doulas to collaborate with the medical system. There are doulas who want to be subsidized by Medicaid defending their reputations against “renegade outlaw” doulas who oversee illegal home births. There’s tension between self-declared radical doulas who serve marginalized communities and trendy “celebrity doulas” who cater to the “wellness”-obsessed elite. (“You know what a doula is? A white hippie witch that blows quinoa into your pussy,” comedian Ali Wong recently quipped on her Netflix special.)

There is one thing most doulas do have in common: They don’t make much money.

A doula lucky enough to sign three labor contracts a month at $800 each — the average national fee for an experienced, certified labor doula, according to one analysis — won’t even net $30,000 a year, without accounting for expenses like training fees, advertising, and child care.

“I care more about many of these women than any other fucking person on the planet.”

Yet most doula certification organizations shrug off the business side. Melissa Harley, DONA’s PR director, said one survey found only half the doulas who train with them plan on being full-time professionals, which is why they have some “business-themed offerings” but don’t focus on finances. “We believe that doulas can be empowered to make their decisions for their own individual practices,” she said.

But ProDoulas claim that trainers at DONA and other organizations often dissuade and even shame those who want to make a living.

“When expectation is set that doulas will do free or low-cost births, then people expect to get a doula for free or low cost,” said Catie Mehl, a ProDoula trainer in Ohio. When she loses a client to someone who charges less, “I’m like, I can’t feed my family now today,” Mehl said. “That’s personal.”

Mehl used to be a DONA trainer, but wasn’t making enough money to pay the bills, she said. She nearly quit doula-ing completely. Instead, she joined ProDoula.

It’s difficult to find a ProDoula who hasn’t been personally inspired by Patterson.

“She just turned this bright light on me,” said Leanne Palmerston, a ProDoula trainer in Hamilton, Ontario.

Randy Patterson with ProDoula partner Debbie Aglietti Megan Mack for BuzzFeed News

Patterson “knows exactly how to raise someone up and give them the inspiration to do amazing, huge things,” Palmerston said. “My dreams before were real small, like, I’d like to make enough money that maybe there’s an extra $1,000 in my budget every month, and she was like, ‘Lady, you can go buy yourself a house, a car, create a retirement for yourself, start multiple agencies. You can dream the whole world and hire other people to do the work for you.’ I was like, ‘Holy shit, I didn’t know I could dream that big.’ That’s what Randy gives us.”

Even Patterson’s life story is made-for-TV inspirational. Patterson’s parents were artsy junkies in Monroe, New York, who loved her but left her “a fucked-up kid with no self-esteem.” A high school dropout who was briefly homeless, Patterson claims she had no aspirations beyond being a good wife and mother to her two daughters.

Then, a mother at Patterson’s kids’ school helped her get an assistant job at her local hospital’s birth center. Patterson had no medical experience, but she was a natural who loved helping women in labor feel confident. It was an easy transition to independent doula work. Patterson ran her own business before partnering with Debbie Aglietti to start an agency called Northeast Doulas (Patterson calls Aglietti the “Greenwich, Connecticut” to her “Greenwich Village” because Aglietti prefers tasteful pearls to leopard print.)

The Radiant Project / YouTube / Via

Many doulas have personal or political motivations, but not Patterson. “I didn’t come into this industry to avenge my own bad birth experience,” she said. Northeast Doulas pioneered many of the contentious tactics ProDoula is known for, such as the “12-hour” contract, which means when a client’s labor goes beyond 12 hours, the doula gets paid extra for every additional hour. Northeast Doulas also prioritized postpartum care, which can involve everything from cooking to cleaning to pep talks. Traditionally, doulas checked in with their clients after birth to ensure they knew how to take care of themselves — not to score hundreds of hours of work for an average of $30–50 per hour.

“The message previously was: Work yourself out of a job,” Patterson said. “My message is: Well, that’s fucking retarded.”

Still, the women felt so loyal to DONA, their certification organization, that they offered to share their business model for free. DONA wasn’t interested, according to Patterson. The duo started consulting instead and were so successful that they decided to launch their own doula certification organization — ProDoula — in August 2013.

From the start, ProDoula targeted pragmatic doulas ill-disposed to what one woman called “all that woo woo, drum circle, doula heart stuff.” Doulas complained that other organizations didn’t teach them how to make money, so ProDoula included business lessons and offered advanced marketing courses. Doulas said other groups judged mothers, so ProDoula billed itself as apolitical. (In the words of one ProDoula: “client got an epidural, circumcised, formula fed, sleep trained? So what!”) Doulas were upset other organizations took months to certify them, so ProDoula promised speedy certification and around-the-clock support, including on Facebook.

“I was like, ‘Holy shit, I didn’t know I could dream that big.’ That’s what Randy gives us.”

The two Facebook groups ProDoula runs, BOBAD and “So You Think You Can Doula,” can be brutal: Members are banned if they don’t follow a long list of rules, such as if they write “Kumbaya, sister-hood, doula spirit posts,” or talk “negatively about us as a group, or as individuals, in another forum.” The drama is good for business. There are just 2,000 ProDoula members, but there are over 10,000 people in ProDoula’s Facebook groups, providing ProDoula with a huge pool of potential disciples. After vicious arguments, Patterson once wrote, “the ProDoula phones and emails light up like you can’t imagine” as new doulas “decide who to align with and where the future of their doula career can go.”

Many women said they spent years hiding their competitive side before finding ProDoula. In these groups, however, they’re free to be fierce. Although ProDoula doesn’t advocate lying, newcomers are told by other group members that they can charge as much as doulas with decades of experience, even if that means faking it until they make it. (“I used to tell people that our most popular service was overnights before I’d ever sold a single overnight shift,” one woman advised.) Doulas discuss their “target markets” (think upper-middle-class professionals instead of teen mothers) and how to attract them with expensively designed, search engine–optimized websites. There are even threads about brushing off new doulas seeking mentorship: “My future competition isn’t going to pick my brain for details on practical and business advice, have access to my clients, and have me pave the way for free,” one doula wrote.

Randy Patterson’s ribbon collection. Megan Mack for BuzzFeed News

Online, doulas also hash out ProDoula’s argument that volunteer doula work is selfish, not selfless, and whether —as ProDoula instructs — it’s disempowering to suggest that a woman can’t have a positive birth experience without a doula. Once doulas depoliticize the profession, they can lose the guilt and start dreaming big. Patterson has compared purchasing doula services to owning a Lexus; another doula recently said doula care is a desire akin to “manicures and vacations, massages and fancy dinners.” They insist they are like any other service provider. “Do you think plumbers sit around fretting over the problem of people needing plumbing help who cannot afford it?” one recently asked.

This sales-based perspective has led critics to compare ProDoula to controversial multilevel or “direct sales” marketing companies. In fact, ProDoula is heavily influenced by one such company: Mary Kay Cosmetics, the billion-dollar business that has been called a “pink pyramid scheme.”

ProDoula’s attempt at “redefining the meaning of doula care fits their profit motive but completely ignores the research on which the doula movement was founded 20 years ago,” said Sheri Deveney, a former member of DONA’s board of directors. “Doulas should be seen as professionals,” she said, “but they also need to be part of the solution to fix birth. If you are here to get rich, that is in direct conflict with your mandate and purpose as a doula.”

Patterson disputes accusations that Mary Kay only benefits higher-ups. When she was a Mary Kay salesperson, she said, she invested just $100, then made six figures her first year and won one of the company’s famed pink Cadillacs.

Mary Kay taught Patterson the importance of motivational leadership. That’s why ProDoula holds conferences — the next one is called #SpeakYourTruth2017 — and hands out ribbons and awards so doulas can show off their achievements. But Patterson was also “fascinated” by Mary Kay’s marketing plan, and there are more than a few similarities.

“Do you think plumbers sit around fretting over the problem of people needing plumbing help who cannot afford it?”

For example, ProDoula markets itself primarily through word-of-mouth referrals. “Training liaisons” (ProDoula will send a trainer to you, anywhere in the world, if you get enough people to show up) pester their communities just as Mary Kay salespeople do. ProDoulas are advised to “warm chat” prospective clients, a tried-and-true Mary Kay tactic for talking to strangers. New doulas are encouraged to invest in the services ProDoula sells, along with website design (through Patterson’s husband’s company) and social media consulting (through Patterson’s daughter).

ProDoula’s agency model — in which owners contract out labor and postpartum work to teams of doulas — also raises eyebrows. The agencies aren’t owned or operated by ProDoula, although Patterson and Aglietti do co-own two in Baltimore and Chicago and plan on opening more next year. But the dozens of ProDoula-affiliated agency owners around the country often buy ProDoula’s business consulting beforehand, hire ProDoula-trained doulas, and offer ProDoula-approved services.

“We are very much a business, we are not a volunteer program,” Patterson explained to a group of Seattle doulas last year, a recording of which was obtained by BuzzFeed News. “Each doula that takes our training is our client. We want them to be successful. We have a vested interest in their success. If they are successful, they’re going to continue to pay their membership. If they’re really successful, they might consider the agency model.”

It’s easy to spot a ProDoula-run website. While other doulas dub themselves “Gentle Journeys” or “Seeds of Life,” ProDoula agencies have localized, google-able names. They promise to attend to their clients’ every need, but don’t list prices. Some doula agencies don’t even list their doulas, like Doulas of Chicago, which is co-run by Patterson and Aglietti. The other owner, Ariel Swift, describes herself as an “executive assistant for all things birth and parenting.” Her target market is “Type-A business executives,” she said, which is why her website asks prospective buyers to “indulge” and her Instagram account showcases Calvin Klein underwear and expensive ceramics.

“In Chicago, we have hundreds of doulas, and everyone is talking about oils and reiki and unmedicated births,” Swift said. “We talk about doulas in a totally different way.”

When Swift blogs about ProDoula, she sounds more like a revolutionary than a business executive. “Too many doulas who have found ProDoula have felt the sting of a betrayal that comes from broken systems and promises,” she wrote in one post about loyalty, acknowledging that others think ProDoulas have “drank the Kool-Aid.”

But for ProDoulas, “there is no Kool-Aid,” she recently posted on Facebook. “It’s our fucking water.”

Dozens of doulas across the country told BuzzFeed News that ProDoula had transformed their lives by teaching them how to make money — in some cases, tens of thousands of dollars more — rather than lose it.

“ProDoula changed my life,” said Florida doula Staci Plonsky. “I own a sustainable business now. My family is supportive of my work because it benefits them, instead of draining them. I love what I do because I don’t have pressure to fight the system. I change the system by treating clients and their providers with respect, by acting with honor and dignity. I look at myself as a business owner and doula, not a stay-at-home mom who sometimes goes to births.”

Other doulas, however, said ProDoula’s promise that anyone who works hard can succeed is not as advertised. Patterson said that ProDoula doesn’t guarantee success, just a business model: “We offer an opportunity,” she said. But some women said the purportedly tight-knit community turned on them when they struggled.

Virginia doula Liz Pelletier said she was “very hard-core ProDoula” in the beginning. Patterson’s motivational messaging drew her in.

“I really felt like she just absolutely loved doulas and wanted what was best for us, each and every one of us,” Pelletier said. “It was like being brainwashed.”

On Facebook, ProDoulas swap tips with each other on how to afford the company’s services, suggesting others take out loans, charge credit cards, and even sell plasma. Pelletier said she spent her $2,000 tax return on what she now calls “worthless crap,” from an expensive web host service ProDoulas suggested to ProDoula’s own labor training and advanced business course. The latter was “just a pep talk,” Pelletier said, “where they try to sell you on a bunch of stuff.”

ProDoula tells doulas to ignore local doula collectives — why fraternize with the competition? — in favor of staking out a competitive advantage. But the mothers in Pelletier’s community found doulas through word of mouth, she said, not by googling, and they weren’t interested in paying premium fees for a new doula like Pelletier. After a midwife advised her to lower her prices and take out her 12-hour contract language, she started getting more inquiries, she said.

“I look at myself as a business owner and doula, not a stay at home mom who sometimes goes to births.”

When she started looking for advice from other doula organizations, word got back to ProDoula, and Pelletier was swiftly banned from BOBAD. “I went to bed crying, wondering, What did I do wrong?” she said. A year and a half later, she’s still “trying to get back from all the debt I’ve created from going the ProDoula route.”

Another doula, on the West Coast, estimated that she spent more than $20,000 building her agency based on ProDoula’s advice. She said at least $12,000 went straight to ProDoula and Patterson’s husband’s web design company.

“Every penny was a waste,” said the doula, who didn’t want to be named because she’s still trying to regrow her business. “I feel like I wasted two years of my life.”

She provided BuzzFeed News with several receipts for business consults, conferences, and copywriting. One invoice for website design and brand development totaled nearly $5,000. But the new website didn’t draw more clients. Instead, she said, ProDoula’s businesslike approach actually put off the parents in her area.

The doula said her family had to sell their house in part to pay off her ProDoula-incurred debt.

ProDoula “never promised me I was going to be rich overnight,” she said. “They made it clear it would take a lot of work and effort. But I put all of my money and all of my energy into the services they offered, and it was just not how it was presented to be.”

Some women who did do well with ProDoula said they felt pressure to use cutthroat methods to succeed. And since ProDoulas attract clients — and ProDoula attracts doulas — by billing themselves as the industry’s top professionals, even those who try to stay out of the way can become a target.

Last August, an experienced Virginia midwife named Tammi McKinley chuckled to herself as she posted a Facebook status: “You haven’t lived until you’ve reached into your purse for your car keys and pulled out a bagged placenta instead.”

Not everyone thought it was funny. Unbeknownst to McKinley, ProDoulas across the country had been waging a war on “unsafe” placenta handling for over a year. It’s not illegal to encapsulate a placenta, the increasingly trendy practice where mothers ingest them in pill form, outside of a client’s home. But ProDoula sells its “Placenta Prep” course with $525 trainings and $475 kits — and ProDoulas advertise encapsulation services, which also cost hundreds of dollars — by claiming that’s the only safe way to do it.

Shortly after McKinley posted her status, local ProDoulas swooped in to scold her, one commenting on Facebook that she was “disgusting, dangerous, and completely unprofessional.” McKinley explained that she had permission to freeze the placenta for teaching purposes. Nevertheless, the status was shared widely. Soon, an agency run by ProDoulas in California left McKinley a damning review on her Google business page, warning people not to seek her “incredibly reckless” services because she “boasts on social media about improper handling of placentas,” putting mothers and babies at risk. McKinley threatened legal action before the conflict was resolved.

“Although there was probably a better route for me to speak my truth, I believe strongly in safe placenta encapsulation and handling,” the California ProDoula told BuzzFeed News.

After what McKinley dubbed #Placentagate2016, she received messages from other doulas thanking her for standing up to ProDoula, she said.

“They think it’s their way or the highway,” McKinley said.

Facebook fights over placentas might sound ridiculous, but doulas need stellar reputations to get client referrals and to network with care providers. Nearly two dozen women nationwide told BuzzFeed News that ProDoula caused havoc in their birthing communities. Often, they said, it wasn’t worth fighting back.

In July 2015, Seattle doula Emily Fontes received a Facebook message from a woman who said she was an Ohio doula named Gwen Rodriguez. Fontes, who also offers business and marketing courses for birth professionals, was a vocal critic of ProDoula, and Rodriguez told Fontes she was “overwhelmed and saddened” by the company, writing that she had “no idea grown women behaved this way.” The two women exchanged hundreds of messages before Fontes found out Rodriguez was actually a false persona created by a ProDoula who then fed the information to Patterson. She later admitted in a blog post that Fontes wasn’t the only doula she had tricked.

“Is the doula profession going to eat itself alive from the inside out or are we ready to step forward in unity?”

Fontes posted their chat transcripts on her website, along with a summary of the situation. After BuzzFeed News asked ProDoula for comment this fall, the company emailed Fontes’ website host and ordered them to remove her post. Fontes complied, fearing her business’s entire server might be erased forever if she challenged them.

At the time, Fontes wrote that she felt strongly about doulas making a living wage, but didn’t think “yelling at someone to charge more, ostracizing them,” or “accusing them of taking food off your table” gave them “the confidence or skills they need to increase their fees.”

“I think we are at a crossroads,” she wrote. “Is the doula profession going to eat itself alive from the inside out or are we ready to step forward in unity?”

Patterson said she doesn’t condone this type of behavior. The women who left negative reviews for McKinley’s business were acting like “assholes,” she said, and after Fontes was tricked, Patterson posted on Facebook that “ProDoula did not facilitate” the deceit. But Patterson doesn’t feel she can control the actions of individual ProDoulas. “If you are Catholic and rob a bank, did the Catholic Church rob a bank?” she asked.

Others wonder if Patterson fosters the fervor.

“A lot of these women have felt very marginalized in the past, so when they hear someone saying what they want to hear, they go a little crazy,” said Devon Clement, a former ProDoula trainer. “I’ve seen so many women whose lives were positively changed by ProDoula that I can’t speak negatively of it as an organization. But Randy wants it to be everyone’s religion.”

Kansas doula Sunny Schaffer described ProDoula as “literally like a church.” When she recently broke ties with the organization, it was like leaving an abusive relationship, she said.

“You have to be all in, or they get rid of you because they don’t want any dissent,” Schaffer said.

Patterson said critics like Schaffer chose to leave ProDoula and that she doesn’t see herself as occupying a position of power. But she doesn’t seem to mind playing the messiah. During one recorded business consult with a doula, she admitted she didn’t think all of her clients paid $250 an hour just for business advice.

They want to fucking be inspired,” she said on the recording, obtained by BuzzFeed News. “They’re depressed. They’re dark. They’re quiet in their lives and they want someone to breathe life into them. And I come and do that.”

On one of November’s last sunny afternoons, Chanel Porchia-Albert gave a tour of Ancient Song Doula Services (ASDS), the social justice–based doula collective she runs in Bed-Stuy, Brooklyn. Housed in a historic mansion once owned by New York’s first black OB/GYN, ASDS is everything ProDoula is not. It’s funded partially by grants, hosts conferences on topics like “decolonizing birth,” and never, ever turns clients away, even if they can only pay by bartering woodcrafts or vegetables.

Porchia-Albert, a former jewelry broker who hated corporate life, started ASDS in 2008 because she was concerned about barriers to health care for low-income women of color. The name comes from her own experiences, Porchia-Albert explained: “My partner and the people involved say while I was in labor I sang an ancient song.” Her husband looks after their five kids when she’s busy with ASDS. Most of the collective’s doulas have other jobs that pay the bills, but they wouldn’t have it any other way. Porchia-Albert doesn’t think much of ProDoula, but she doesn’t think much about them, either.

Chanel Porchia-Albert in the Ancient Song Doula Services Office Megan Mack for BuzzFeed News

“There’s a doula for everybody,” she said, cradling one of her babies amidst the dream catchers, crystals, and donated woodcarvings.

ProDoula isn’t the only doula organization brainstorming innovative ways to grow the industry. Alongside grant-funded community-based groups like ASDS, there are also organizations working to ensure Medicaid and private insurance coverage for doula care on a state and even national level. Many believe that’s the future — one that could guarantee a doula for every woman who wants one, while also making it possible for doulas to be seen as professionals, with paychecks to match.

But Patterson is opposed to third-party insurance for doulas. “I don’t want anybody determining how much money I make,” she said. She has her own grand plans, one of which is to work closely with hospitals to form “collaborative agreements” under which doulas agree to cooperate with medical staffers, not work against them. It’s a controversial practice that some say creates a conflict of interest between doulas and clients. For ProDoula, it’s one more way to professionalize, and market, its services. Patterson’s other goal is to champion the benefits of being a doula — a ProDoula doula — to more people than ever before, from professional women (and men) to empty-nester parents looking for a change.

“Where else can you take something that you’re passionate about, take a short training, work your ass off on the certification, and have a new career?” Patterson asked.

ProDoula will continue to sell itself to newcomers as the only way to make birth better without sacrificing the needs of doulas. But it’s too soon to say who ProDoula truly benefits — other than ProDoula.

“If you live in the United States of America, and you are not successful, you have to look at the decisions and the choices you’ve made,” Patterson said, sitting in her office amid her rock star posters and adoring employees. “We have to take some fucking accountability, don’t we?”

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