Common Ground | Issue 006 | The Doula's Mind
🌱 ROOT AND GROUND
I had to make an announcement to Sashá, my fiancée. I knew it would bring up some feelings, but I took a deep breath and said: "I don't think I want goats anymore."
She was shocked – appalled, even. Immediately, she went on about how we've always wanted goats, goat's milk, and goat cheese. Honestly, I still want those benefits, but after all my research, GOATS ARE REALLY HIGH MAINTENANCE.
I don't feel I have the physical capacity required, and I also don't think I can handle goats being escape artists and power chewers on everything. The truth is I'm the researcher in my relationship, and Sashá is the emotional decision-maker, usually with no research to follow. In my thoughts, all I can see is a goat chewing something expensive because I'm resting as my body needs, and Sashá may forget to lock one little thing, and now we have a $5,000+ repair on our hands. I can't do it.
Our equines may be next. We were thinking one mini horse and one full-size donkey, but I'm also considering a second full-size donkey. I looked into alpacas, but they can't handle the South’s heat. We still want a mini cow. Either way, at the end of this month we have seven more chicks arriving, and we're trusting the process on what comes next, but I can tell you IT WILL NOT BE NO DAMN GOATS.
Oh! We also bought two hoop houses to continue expanding our garden through the Fall and Winter. Can't wait until it's all set up. Now one thing I can't say no to is more plants. Sorry, Sashá.
🌿 THE PLANT ALLY · Solomon's Seal / Polygonatum spp. For the person who carries it all in their physical body.
In a shaded area, you'll find Solomon's Seal. At first glance, you may notice his leaves, but on closer inspection, you'll find white flowers that hang like lit bulbs from the center stem, top to bottom.
He is rooted in a long history of use in Native and Asian medicine for joint, skin, and digestive complaints. Today, he is most often called on to support joint health, tendons, ligaments, and cartilage recovery, especially after repetitive-stress injuries. He also moisturizes and soothes the internal body during respiratory illness and helps heal bruises, swelling, or skin irritation when applied topically.
I often recommend Solomon's Seal salve for chronic hand pain due to arthritis or overuse. To make one, infuse 1 cup of olive oil with dried, chopped Solomon's Seal root, strain the liquid, and gently melt it with 1 ounce of beeswax until combined. Pour the warm liquid into small tins to cool and solidify.
A note from your clinical herbalist-in-training: Solomon's Seal is contraindicated during pregnancy, breastfeeding, and upcoming surgeries. According to Traditional Chinese Medicine, this herb is contraindicated for people with spleen deficiency and dampness, or with coughs. Consult your care provider when in doubt.
đź’ˇ THE GROUND TRUTH
In 2018, I had a mental health collapse.
I was a full-time doula in San Diego. I was attending births constantly, holding families through joy and grief and everything in between, and I was running on empty in ways I didn't have language for yet. I wasn't sleeping. I wasn't processing. I was just going. Until I couldn't.
What I know now is that I was experiencing what the research calls secondary traumatic stress: the accumulation of exposure to other people's trauma, grief, and crisis over time. It is not the same as burnout, though they often arrive together. It is the body and mind absorbing what they have witnessed, with nowhere to put it.
This issue's Ground Work essay is about the doula's mind. About what we carry, what it costs, and what sustainability actually requires, not as a self-care talking point, but as a structural and economic argument. The mental health of birth workers is not separate from the funding crisis in this field. They are the same crisis.
đź“‹ THE PRACTICAL
For birth workers and doulas: I created "What Doulas and Doula Organizations Need from Funders" from my years in this work as a doula and trainer. It covers what sustainable funding for doula work actually looks like, how to make the ask, and what your budget should be able to hold. Free with a Ground Work membership. [Link]
For investors and capital allocators: I created Investing in Doula Sustainability from my experience on both sides of this work as a doula and as a capital allocator. It is a 15-page guide that covers the evidence base, the state Medicaid reimbursement landscape, the financial case, investment areas, and due diligence questions for funders ready to go deeper. Free with a Ground Work membership. [Link]
✨ THE ENERGETIC READ
Do you know your limits?
Whether physical, emotional, or relational, do you know where yours are? When you are asked to go beyond them, are you able to say so? Or do you go past them, hoping you can recover from the overexertion before anyone notices?
I know I can't handle goats at this point in my life. Have you thought about what you can or cannot handle at this point in yours?
These questions aren't meant to cause self-judgment or throw you into an existential crisis. They're meant to remind you that when we go past our limits, we send a message to our nervous system that we cannot trust ourselves to choose ourselves. To be in right relationship with others, we must first go beyond what we can hold. We unknowingly teach ourselves that our limits are the problem.
If this feels familiar, don't give yourself a hard time. Be curious. Think about where that belief came from and choose, intentionally, to start choosing yourself. It doesn't have to be big. Maybe you hang up with a friend when you're tired instead of being sleepy at work the next morning. Maybe you say no to an invitation when you'd rather spend that time differently. Start there. That is how you build the right relationship with yourself.
đź”— WHAT'S MOVING
Three things worth your attention this cycle:
UNH expands doulas — better outcomes or a margin play? UnitedHealth Group is adding doula services to its coverage model. This piece asks the harder question: is this an investment in outcomes or a cost-containment strategy dressed up in care language? https://www.theglobeandmail.com/investing/markets/stocks/HUM/pressreleases/799406/unh-expands-doulas-better-outcomes-or-margin-play-ahead/
ACA Marketplace premiums are going up in 2027; rate increases are coming across 276 insurers, and the distribution is uneven. Worth understanding where and why, as the landscape shifts for uninsured and underinsured birthing people. https://www.healthsystemtracker.org/brief/how-much-and-why-aca-marketplace-premiums-are-going-up-in-2027/
Pregnant patients on Medicaid are still struggling. A nationwide survey documents what many birth workers already know firsthand: access and coverage gaps and delays in care. The data is worth having when you're making the case for investment. https://stateline.org/2026/06/17/nationwide-survey-shows-ongoing-struggles-for-pregnant-patients-on-medicaid/
🤝 THE INTRODUCTION
When I was in the thick of my own mental health collapse in 2018, one of the things that made care possible was access to affordable therapy. I found it through Open Path Collective, a network of therapists who offer reduced-rate sessions to people in financial need.
I mention this not as a referral, exactly, but as testimony. Access to care changes the outcome. For doulas, for anyone doing this work, knowing where to find it matters.
Open Path is a real place to start. https://openpathcollective.org/
🕯️ THE DISCERNMENT
The work of caring for others is meaningful. It is also a form of exposure: to grief, to fear, to loss, to the most tender and frightening moments of another person's life. Over time, that exposure accumulates. It changes us. Sometimes it hardens something. Sometimes it cracks something open.
Mental health is not a side issue in this field. It is the field. The inner condition of the person holding space is the ground from which care is delivered. When that ground is depleted, everything grown on it is diminished.
This week's discernment is simple: what is one thing you are carrying right now that you have not had space to put down? You don't have to solve it. You don't have to share it. Just name it, even quietly, even only to yourself. Naming is the beginning of tending.
From the ground where care grows, Sabia
Ground Work publishes every Tuesday. The Ground Work essay and the Common Ground newsletter alternate each week, so something is always in your inbox. Subscribe and find the full archive at ground-work-1.ghost.io