I believe that every woman should give birth where and with whom she chooses. But why do so many women make decisions based on misinformation and lies? It can be hard to believe that so much of obstetrical practice is wrong, but according to the research that I have done, and the experiences I have had, I believe this to be the case. The medical system pays lip service to the idea of “evidence-based practice” and “informed consent”, and yet so many of the standard procedures carried out run *contrary* to the most current evidence. Perhaps most disturbingly, informed consent is frequently violated during a typical hospital birth. Why do women put up with this?
Despite the fact that the media portrays childbirth as an illness, despite the fact that birth, in film & television, is depicted as horrifying and grotesque, despite the fact that our economy is based on disconnection and perceived lack, despite the fact that misogyny is alive and well…despite all of this, I still don’t understand why there aren’t more women who refuse to participate in the birth experience offered by their local hospital.
In the past two weeks, I have been witness to the private testimony of three women who experienced hospital birth with doulas, and who spoke of the sadness and anger and frustration they felt, when their babies’ umbilical cords were cut immediately after birth, despite their specific instructions that the cord be left to pulse after the baby’s emergence. The immediate cutting of the cord was, of course, but ONE of the many transgressions these women experienced during the birth process, but the issue of cord severance illustrates the utter and complete lack of respect that is so fundamental to the process of standard birth. Of course the *evidence* shows that delayed cord clamping is safer and healthier than the immediate cutting of the cord, and that delayed cord clamping offers protection and immunity to baby, as well as increased bonding opportunities for the baby and mother. Nonetheless, doctors and nurses in New Brunswick hospitals (and throughout North America) continue to insist on severing the cord within seconds of the baby being born. When the cord is cut directly *against* the specific wishes of the mother, this constitutes a grave violation of the rights of both mother and child, and yet this issue is rarely, if ever, brought up in official critiques of hospital protocol. Where were the doulas, and why weren’t they advocating for their clients’ rights? Because they know damned well that if they spoke up, they’d be kicked out of that birth room so fast, their heads would spin.
I hate to say that the rise in popularity of doulas has done absolutely nothing to alter the status quo of hospital birth, but this seems to me to be true. In the past 10 or so years, the popularity of doulas has risen dramatically. And so has the rate of C-section and interventions in general. Am I suggesting correlation or causation? Absolutely not. Do I think that doulas are well-meaning, amazingly hard-working women who are truly passionate about women and birth and are trying to make a positive difference? Yes yes yes. But sadly, I don’t think they’re going to get anywhere. Because hospital birth is the collision of female power and patriarchy, and we aren’t going to change anything by behaving ourselves or adopting the approach of our oppressors. (No, this isn’t hyperbole. I really believe it).
The doula can however, be held up as a saviour if the woman escapes a c-section. (“Thank goodness I had a doula! She made the stress-testing, pit-drip, epidural, and coached pushing a breeze!”). The doula can also be effectively scapegoated if the woman does end up being cut–blame the doula. But let’s face it: it is almost enshrined in the constitution of doula-hood, that doulas aren’t actually supposed to “do” anything, or to take on any responsibility, or to argue with the professionals, etc. Doulas are there to provide calm, steady support. To speak softly. I have heard it suggested that some women do hire doulas in lieu of educating themselves on the subject of pregnancy and birth. Maybe they do. I suppose we are all missing mothers and grandmothers who can reassure us that birth is easy, normal, real. Nonetheless, I increasingly view the doula phenomenon as a sideshow to the circus of hospital birth. I know so many many women who have dutifully paid their $800 for the privilege of having a doula hold her hand as she is wheeled into OR after “failing to progress” after 10 hours of “labour” while wearing the green gown in a sterile hospital room with electronic foetal monitors strapped to her abdomen under fluorescent lights. Cyborg birth.
Women are smart. Women are granted equal rights under the law in North America. Why then, whenever I am witness to a conversation about a woman’s hospital birth experience, do I inevitably–without exception, in my experience–hear the language of powerlessness, servitude, dependency, and subordination. “My doctor ‘allowed’ me to ‘go to’ 42 weeks.” “The OB ‘let’ me push for another hour.” “I wanted a homebirth, but my husband wouldn’t ‘allow’ it.”
When I talk about birth, I am conscious, always, of how my language frames me in my experience. I give birth. No one delivers me. I don’t need deliverance. I am never in “labour”. I experience the birth process. I have never had a contraction in my life. I move through sensations. There are no stages. There is me, and my baby, and our experience that I own, 100%. No one will ever grant me permission to live in my body, or to bring my children into the world. I will not allow my body to be colonized or occupied by the institution, especially not at the height of my power. Why do so many women allow this? Why.
I know that different women have different needs, and desires. I understand and appreciate that options are important. But there is so much wrong with the state of birth these days, and I just wish there was more honesty and integrity, overall. Sigh. Sorry if I sound so militant.
!!
Oh, Yolande. Yet again- your description of birth and the shallowness, lack, and violation of the hospital experience is right on the mark. I really appreciate your expression of these issues- I do not find them offensive in the least. They are revelatory.
I hospital doula-d once, for a few hours, and then my baby needed me at home home so I left. (In retrospect, it was silly of me to leave my baby thinking that she wouldn’t need me, but my family offered, and hours passed, and the unrealisticness of the situation caught up with me. Non-continuous support, boo. But I was relieved by a close friend of the mother’s, so I felt less bad.)
Anyway- during the time I was there, the nurse came in and out several times, eyes on the machine. She explains to the mother what she is experiencing, based on the squiggles she reads on the paper. Oh, you had a contraction. The doctor comes in later, inserts a speculum and performs a procedure that is much like a pap smear in order to ascertain whether or not there is amniotic fluid present in her vagina. An incredibly invasive procedure. The mother cries out in discomfort. “It’ll be over in just a moment.” And then it’s over. The doctor takes the sample away to be analysed, and minutes later returns to report that no amniotic fluid was present. Was the information gained worth the strife and total dispassionate violation?
That is so debatable. To me, it absolutely would not have been. I know that the risk of strep infection in a full term, healthy infant would be around 2 in a thousand without antibiotics, and with vigilant “diagnosis” in the first 12 hours, infections are treatable in up to 90% of cases, which leaves a small risk of death and a risk of disability if the infection is serious. Note that preterm babies are in a higher risk category, as well as prolonged membrane rupture labors. For me, the miniscule risk GBS would pose to my full term, healthy baby who is born within 24 hours-ish of my membranes rupturing is nil. I suppose that if I thought my membranes had released I would want to keep a mental tab on it, but I would also be aware that I’m healthy and my baby is full term, and things will likely be fine without being subjected to things being shoved up my vagina. (Which exponentially increases the risk of infection, paradoxically.)
My way of understanding it is this: If you are a woman in a normal laboring state and go to the hospital to have your baby, you are inevitably under the influence of the powers that be, under the influence of other’s doubts, words, pressures, disconnection, fear. You are not treated like the master of your experience.
I could go on and on.
I’ve heard it expressed this way, and as a disclaimer, it’s a rather unpleasant way of putting it- “a doula is like a condom at a rape”
As a doula you must tread a line between total agreeable subordination and uncomfortable/tense questioning and confrontation of the “experts”. In my short lived doula experience, every fiber of me objected to the distrust and normative violation of this mother, but it’s just not in my nature to fight. I suppose it would have been the doula thing to do to have asked the mother “are you okay with this? Do you want this to stop?” But her own audible protest (discomforted whimpering while the procedure took place), was obvious to me but I guess to no one else that this was just a total violation. No one knew. I want to say, not even the mother. I think that she felt what she was going through was necessary to her baby’s safety.
It’s that fear. Why do we let it rob us of every shred of empowerment we have as mothers? I can only speak for myself when I say that yes, birth is a thin veil between worlds, it’s ethereal nature lends to a lot of unknown territory. Yes, sometimes death is part of birth, for reasons we don’t always understand. Why do we feel the need to assign responsibility for it, when it happens? Death happens in the hospital, too. With a ceserean rate of nearly 30% at DECH, you’d better believe that there’s a corresponding increase in the risk of maternal death and compromised newborn transitioning. Risk. Another word that is so potent and heavy with the fear that it carries. No one wants to take a risk in birth- but we live in a day to day world that’s full of risks. Evidence based information is important- but the thing about the studies we derive our obstetric evidence from is that sometimes even they get skewed by bias and perceptions that are based in fear.
Instinct.
That’s what I feel we need to trust and return to when making decisions about where and with whom to birth.
By the way, I gave birth in a hospital. I do feel that change in mother consciousness is possible, and is, in fact, inevitable. How could the ecstatic, empowering nature of undisturbed birth remain a secret forever? I’m sure that it won’t. I’m so appreciative of mothers who are telling the truth about unadulterated birth as they have experienced it. Their voices are so inspiring and much needed. Thanks for yours, Yolande.
Thank you thank you, Sarah. Your description of being a doula in the hospital is chilling. Like you, I am not really able to *fight* the system, when faced with the system. I think I tend towards cynicism a little bit…I trained as a doula with Gloria in VAncouver, 12 years ago–one of her first doula classes. THe word “doula” was foreign to most people, and we thought we were on the cutting edge of a revolution…Ultimately, I’m probably not really the person to be talking about how to change hospital birth practices, because I really have rejected that entire model–the paradigm, to me, is really off, and “creating a kinder hospital birth experience” is really not something I could get behind. Even my own birth experiences, which are at home, and owned by me, I continuously question and analyze in terms of what I can pare down, and how I can guide my “team” (ha, Lee & kids) to support me in a less intrusive way (please don’t announce the baby’s sex, while I’m still on my hands and knees…etc.)…But you’re right, “change in mother consciousness is possible” because, as you say, you experienced this, and I guess I did too (my first birth was a miscarriage in the hospital when I was 19 years old, and that was that. No thanks).
Birth IS political, and unfortunately, highly partisan. I have been told by other birth attendants and doulas and midwives that the way I talk and write about birth is alienating to other women, and that I, and others, make the natural birth community look and sound like treehugging eco-freaks or something like that…Well gosh. I only looked once at the comments written in regards to Felix’s birth video on youtube. The contrasts were startling. Many beautiful loving words, and then the barrage of abuse from those who don’t understand, or who aren’t connected to their bodies, or who felt disgusted… So sad.
The shift in consciousness around birth necessitates a shift in consciousness around everything: the way we raise our children, the way we live, in general. This can be pretty scary, and it IS hard, for me anyway, to negotiate how to live in the world, yet not get caught up in the silliness or craziness.
I really do want to get together for tea with you! Maybe we could make a date? And could you please start a blog or something? The thought of all of your beautiful words getting lost in the ether of Facebook is so painful for me. Your writing is exquisite. Thanks again for your thoughts.
Yolande – this is an EXCELLENT article. Well done and thank you.
oh hi! It’s you! 🙂
Okay, now I need to thank you, Sarah, for your wonderful addendum to Yolande’s post! Lots to think about this morning, but I think that what is clear is that women need to be more educated about their biology and bodily functions & intrinsic power. Birth is THE most badass thing a mammal can do. It beats everything else. And we can shine and rage and laugh right through it, as my dear friend Yo has shown me first hand. Girls need to know, so that the community of birth-wise friends and family comes back into the picture for the young and trepidatious first-time mother. Knowledge is not power, knowledge is potential – but that’s a great start.
xo
Yolande,
You have summed up my feelings and beliefs EXACTLY!! In our city,we have a team of 7 dr’s that “deliver” (hate the term!) babies at the local hospital.For the mom’s who choose to go there to birth,they never know which one of the “team of seven” they will get to “help them give birth” or “deliver their baby” (shudder!) That kind of care is unacceptable in my opinion.Women do not need someone to be “in charge of them”.I know that I am perfectly intelligent and capable of being in charge of myself! Thanks for the great reminder! Your article is extremely well-written;thanks again my friend!
Hey Sandra! Nice to hear from you. I totally agree. It seems astonishing to me that women often can’t even expect, as a minimum, continuity of care from one person who follows them through their pregnancy. In fact, where I live, it is only in the past few years that the hospitals have transitioned…FROM a system of continuous care (one OB follows a woman throughout) to the random crapshoot, whomever-happens-to-be-around deal. Blows my mind. Take good care, and happy season (early, I know!) to you.
Thanks! Sharing on my page! Parents need to be the ones advocating for themselves, not doulas!
Thanks Crystal! Take good care.
Powerful post! I share your frustration and (perhaps?) skepticism over the doula movement.
I have asked myself the same questions and formulated my own evolving theory as to why women both choose and accept modern maternity care. Simply put, despite the propaganda, birthing women to not *need* doulas or midwives or support or witnesses or even “someone to ‘hold the space'” etc etc. What they need is what our culture has skillfully stolen or manipulated us into giving away “freely” – our health! Our sharp instinct; intuition strong; intelligent; wild and non fearful full spectrum holistic health.
Most pregnant women, heck most people, today are sick and suffering from a multitude of “maladies” and/or “syndromes” etc that they have been deceived into believing are normal, natural parts of the human experience. In the increasing majority conception, pregnancy, birth and breastfeeding have actually become the high risk problematic illnesses or syndromes they are perceived to be. I believe our eco system reflects that of our wombs, when we have no respect, care or understanding for one the other naturally suffers the same fate. The good news is there is hope and many people are learning, relearning and acting upon knowledge that we nearly lost altogether. Change is always possible.
Absolutely and completely agree, Michelle. Although I, myself, was born in the hospital, my mother otherwise had a very holistic and countercultural view of health. The idea that illness is a manifestation of emotional and psychological imbalance, and that we are responsible for our own state of health was a concept I grew up with. For this reason I think, it was somewhat obvious to me to question the way the majority of babies come into the world. You’re right, change is always possible, and we *all* possess the inherent universal wisdom, cellular level. Best to you, Yolande
I guess the question (not that I personally am asking) lies with your mother for the reasons she made the choices she did in spite of her countercultural life philosophy. I too was born in a hospital to a primarily mainstream mother and hearing the story of her (our) experience truly highlighted what I believe today. There seems to be two major components that often dictate the journey of our births, the first is the state of our parents holistic health (which in turn reflect the health of the environment we will reside in) and on the chosen environment for birth.
My argument is that when a birth “goes well” according to our personal and societal standards, it is because women (mainly mothers) and in some cases men have consciously insured (or in the best circumstances have been culturally guided to insure) that both components were optimal (natural, biological, mammalian etc). However, when one (or both) of these two components (often our health) is systemically compromised or even eroded, fear justifiably enters the picture and compensations (hospitals, midwives, doulas, medicine etc) are appropriately necessary.
I hope this makes sense, it’s just what I have been contemplating when I continue to witness the landscape of disappointing and deficient “options” the modern birthing woman (is hopefully even aware of and) has accessible to her. Thanks for the thought provoking discussion and all the best to you and yours too 🙂
Your candid analysis is right on. I was a doula for a few years, and although I could not articulate what you have said here at the time, I think it was an underlying discomfort with the whole dynamic that contributed to my discontinuing doula practice (along with family needs).
Part of the continued escalating cesarean birth rate I believe is from consumers hiring a labor doulas, that is preventing the consumer “pregnant women” from a national uprising demanding change in hospital practices. Now they try to protect themselves instead of creating change as a consumer. Unlike years ago when there was a dramatic change in hosptail practices in the 1960′ and 70’s it came about from the consumer demanding it from all sides, and the general population denmead
Now women “hire a doula” to help themself !
Change is from the consumer demanding the change, not “birth advocates” but the women dissatisfied by the interventions.
^^ Sorry about the typing errors in my previous post 🙁
Here is a fascinating book written about this topic from sociologist Barbara Katz Rothman in her book “Laboring On” . It is definitely worth reading to understand the larger picture and problems with the the role of the doulas at births.
http://books.google.com/booksid=9PzYGOEoRFgC&q=266#v=snippet&q=266&f=false
Try this link to start reading on page 266
http://books.google.com/books?id=9PzYGOEoRFgC&printsec=frontcover&dq=On:+Birth+in+Transition+in+the+United+States&hl=en&sa=X&ei=fByyULfxMare0gGl2oDQDA&ved=0CDAQ6AEwAA
Thank you very much for your comments, Ruth. I will definitely check out the book by Barbara Rothman. Your perspective is interesting…I see so many women entering “the system” during their pregnancies, with a desire to have a “natural birth”, but who end up having their requests and rights trampled…while at the same time women seem to also want, or expect some kind of reassurance from the “professionals” in the form of testing and diagnostics, which of course, isn’t really possible (because birth is inherently messy and unscientific and unpredictable and inaccurate!). Sigh. I’m interested in the book. Thank you!
As a doula (who primarily attends hospital births) as well as an activist and community health worker, I agree with the general sentiment of this post. However, there are some major oversights and disconnections here. You’re pretty spot-on that doulas are not encouraged (and actively discouraged by their certifying organizations) to act as a verbal advocate or to intervene when abuses and violations of patient rights are occurring in the hospital setting. How do doulas overcome this lack of training or scope of practice and fill this role? What are the implications of doing so? Many would argue that this would result in less access to doula care (which, yes, does have positive impacts on individual births, however marginal compared to the need for an overhaul of the system).
Also, how many mothers go into their doula-client relationship with the misconception that their doula will be their “body guard”? That their wishes will be respected just because they hired a doula? If doulas moved into more of a role of personal advocate, would that make this perception on the part of the mother better or worse?
I honestly do not think that the “one-birth-at-a-time” approach that most doulas take is enough to change the system from the inside out. To expect it to, or critique it in this framework, is misled and near-sighted. I think doulas are an untapped resource of raw independent energy that could be used to put pressure on the system from the outside, but that will only happen when doulas begin to see themselves in this light, regard themselves as human rights activists and organize in this way. But unfortunately, so much of the time, we’re stuck serving privileged white middle class women who are more focused on their “wishes” in order to break even rather than reaching out to the families that need represented the most.
I agree with you that we’re not seeing enough change and that the current arrangement doesn’t reach far enough for it. But I hear a lot of doula-blaming and not very many offered solutions.
Hi Stephanie. Thanks so much for your insightful comments. I have to be honest with you in saying that I think that the certification of doulas (and incidentally, midwives) is part of the problem. We have created a system in which the hospital institution reluctantly grants doulas the privilege of attending women, and yet the doulas are ultimately beholden to their certifying bodies rather than the women themselves. So I suppose that the implication, if a doula acts outside her “scope of practice” (sigh), by putting her foot down when it comes to an unwanted procedure, or by agreeing to attend a birth at home, would be that she would find herself out–out of the hospital, and out of a certificate. So where does that leave birthing women, and what the *heck* is the point of hiring a doula, if not as a personal advocate in the hospital during childbirth, when the last thing a woman can do, or wants to do, is have a big fight with an obstetrician (which, in my view, is inevitable, if you’re giving birth in the hospital, AND you don’t want unneccessary interventions, which is a bit of a conflict in and of itself, isn’t it?).
It seems to me that you’re suggesting that doulas are NOT personal advocates (beyond scope of practice), but that they should/could be acting as human rights advocates by putting pressure on the system from the outside…But doulas are not on the outside, they are on the inside! They’re on the inside of hospitals, and they’re on the inside of their own certification organizations which exist as businesses to make money–which means they are clearly not going to be training doulas to actually fight the system now, are they? Please don’t get me wrong. I don’t think there are devious people pulling strings in the back room. This isn’t a blatant conspiracy. But I do think the entire setup is questionable, and self-perpetuating, and that ultimately, it doesn’t serve women, families or babies.
You’re correct in pointing out that I really don’t see any solutions to the current situation, and I agree too, that I’m entirely misled in thinking that there is any real point to my critique…Because after years of witnessing what hospital birth does, and talking to women, and having babies myself, I don’t think it’s possible to have a normal birth or natural birth in the hospital. I certainly don’t blame doulas for this at all. But it does bother me that there is a continuing mythology that somehow in hiring a doula, women are going to have a better birth. In my world, a slightly lower statistical chance of having a c-section, does not a great birth make.
Doulas are still part of a paradigm that sees birth as a medical event, requiring management and help and policy and intervention. And this is just not where I’m coming from.
The more babies I have, and the more work I do to advocate for natural birth, the more convinced I am that the complications that arise during birth are *caused* by the environment, and procedures and technology and interventions offered by the hospital. And by the idea that women need help, support, witnesses and advocates.
But I really do appreciate your thoughts, and maybe things will change in time. Take good care, and good luck.
This is an interesting perspective. I would like to add that we do have solid evidence that having a doula present at a birth lowers the risk of C-section significantly. http://evidencebasedbirth.com/why-wouldnt-you-hire-a-doula/
However, if you take the U.S. as an example: only 3% of women in the U.S. who give birth have a doula. Although this percentage may have risen as you say, the overall percentage still so tiny that I doubt it could make any significant impact on the overall national C-section rate.
Researchers have shown that the main drivers of the C-section rate (in the U.S. at least) are practice patterns of physicians– specifically, artificial inductions of labor and refusal to offer VBACs. Artificial induction is carried out in an alarming 42% of first-time U.S. mothers (Laughon, Zhang et al. 2012), which doubles the risk of C-section (Zhang, Troendle et al. 2010). More than one-third of the inductions in first time-mothers (36%) are carried out for NO medical indication (Laughon, Zhang et al. 2012).
So although doulas are an important piece of the fight against non-evidence-based maternity care, one at a time their efforts are like a drop of water in the bucket when you look at the overwhelmingly high induction rates and stunningly low VBAC rates in our country.
However, if women– and doulas– joined together to raise awareness for these issues, maybe we could make a difference. So I believe there is hope, and that doulas will be integral in creating change.
Hi Rebecca, thank you so much for your comment.
I read your article, and I found it to be very interesting and informative. I’m really coming from a different perspective here, in that I have personally rejected the entire paradigm of the hospital birth experience. So my view of the benefits of hiring a doula is skewed by this, which I admit, is possibly unfair.
But the statistics you point to in your article are in some cases compelling. I suppose that a 28% decrease in the likelihood of having a c-section is significant. But again, for me, avoiding a c-section, or reducing the length of the birth process by an hour or two, or choosing not to have an epidural…this isn’t what birth is about, for me. Birth is emphatically not a medical event in my life, and I have come to view even the most mundane of standard elements of the hospital birth experience as interventions that can, and often do, upset the intense focus and concentration that is optimal during the birth process (the spectrum of interventions, in my view, ranges from getting in a car to drive somewhere, to being in contact with strangers, to fluorescent lighting, to being spoken to, to being told what to do, to internal exams, to c-section)
But of course I have to acknowledge that most women don’t feel the way I do about birth. So if we’re talking about “the system” what is the best way to create change? I suppose that more women could hire doulas. According to your statistics, this would probably help a little bit. But it seems to me that there has to be someone who is satisfied with the status quo. Because a 42% rate of induction for first time mothers is not only alarming, it is positively insane. Simply changing “policy”, right across the board, to “allow” women (yes, “allow” good gracious) to begin the birth process spontaneously up to 43 weeks, would put a stop to this level of induction. Easy easy easy easy.
But what would happen then? So much less control, so much less standardization, and so much less money coming into the system. I’m sure I do sound like a conspiracy theorist, but what other conclusions can one draw, when, as you point out in your blog, the *evidence* does not support current practice.
Thanks again for your thoughts. Take good care.
Thank you for your gut wrenchingly honest insight into hospital doula work. I am struggling with my job as a hospital employed “labor support specialist.” I had worked as a independent doula for 18 years and thought I could make this transition to the hospital. I am finding myself wondering if I am even worse than a bystander (and more like a co-conspirator) to the assaults in the birth rooms. I can relate to Sarah’s comment about the condom at a rape. AAAAHHHHH. I struggle because I believe all women should have a doula. Women birthing in the hospital need the doula the most because they will be most vulnerable to having their rights trampled or abused. The doula most likely can’t prevent the unnecessary and harmful interventions and violations but she will witness them -and that in and of itself is affirming to the mama.
I agree with you, Nancy, and I also agree that at the very least, having someone witness the experience with love and care is important. Thank you for your comment, and for the good work that you do.
Doulas like to say ‘One women at a time” but are we really healing womankind, or our earth, only if you have money and purchasing a buffer and education to make a broken system work for you. I don’t believe women should “need” a buffer to go into a hospital and have the type of birth they want. There is no other dept in a hosptial you need this level of outside advocacy and education to not have unnecessary interventions thrust upon. I find this Outrageous. Without preparation for the few who use doula or specialized CBE to learn those women get what they need privately from the system. I guess what intrigues me is maybe if women did not have this buffer instead these same women hiring doulas would speak up to the system to demand better care in a hosptail, instead they hire a doula to help them navigate to get what they want ~ a hosp should be serving all laboring womens needs to give birth normally. The training for OB’s needs to change. OB’s eduction about “Normal” has gotten twisted, it has gotten mixed up with only happening at homebirths which most OB’s deem unsafe without them looking at their own interventions as “unsafe practices”. That is not ok for a society, we should be able to walk into a hospital and give birth unfettered..
I think doulas are good if you get one for the right reason, and get the right woman. They won’t magically make your hospital birth natural or not stressful. They are NEVER a replacement for educating and advocating for yourself.
That being said, I plan on having one if I have another child, though I do plan on a home birth. My husband is not good at the touchy-feely, massage, birthy stuff. It just isn’t his nature. He is a natural birth supporter, and he was physically present at the birth of our son, but if I want any of those other support methods, I will need to hire someone.
If you are able to have a spouse, friend, or family member present who is educated, able and willing to preform in that role, there is no need to have a doula. If you are the type of women who wants to birth without being touched, you don’t need one.
So, the bottom line is, doulas are great if you want them for the right reasons. They are a waste if you want one to do your job for you!
I absolutely agree, Elizabeth. My post probably really complicated the issue, unnecessarily. Thank you for your succinct summary! Best to you.
This is not my experience at all. My doula had a marked impact on the quality of my hospital birth.
Of all the reasons I could outline, here’s the most important one: when I hit a wall, when I thought I could take no more, I declared over and over that, “I can’t do this.” Everyone in that room: my husband, my mother, my MIL all knew I could do it but would I believe them when they told me so? Nope. They’re biased. But when my doula, a relative stranger, told me I was strong enough, I believed her because she was impartial. And because of that I avoided an epidural and a c-section despite laboring for 24 hours with Pit and Mag sulfate.
I had gestational hypertension and was induced at 37 wks with Cervadil, Foleys and finally Pit. I gave birth at a baby friendly hospital with a midwife so things like rooming-in, eating and drinking, laboring in water, delayed cord clamping and no circ were all routine. I didn’t need my doula to put up a fight for me.
But because of my complications, I was stuck to the hospital bed–exactly what i didn’t want. But my doula helped me shift in bed during labor and because she knew that hospital, she knew how to change the bed so I could still labor in different positions. She set up a pull bar, brought the birthing ball into the bed, got me on all fours and when she saw my baby’s heart suddenly decell, she quickly flipped me back over. My midwife had several other births going on that night-she couldn’t have helped me labor that way. Even if I had known just what to do, I was too out of it in the Mag to do it.
Without my doula, my complications would have sent me straight to the operating table. You’re right, women are smart. I didn’t hire a doula to advocate for me or as a replacement for childbirth education. I hired a doula to be a coach. One that had no emotional ties to me and wouldn’t fall apart even if I or my family did. If all had gone well, she would have just cheered me on and suggested new strategies. If things didn’t go well, I knew she’d be the passionless voice of reason, taking time to explain things, finding alternative ways to help me reach my goals and supporting my husband when my pain became so intense it had him in tears.
Doulas are invaluable in all types of births and while they don’t take the place of educating oneself, they can make the hospital a safer place for women to give birth.
Thank you so much for your comment, Liz. I am sincerely glad to hear that you got the birth you wanted, and that your doula was a help to you. I know that many women don’t feel that “doulas are invaluable in all types of birth”, and I continue to speak with many women who feel very frustrated with their own experiences with doulas in the hospital, but again, I am glad you got what you needed. Take good care, and happy season!
YES!!! EXACTLY!!! Thank you!!
My partner and I rant about this so often! It’s time to make change!
Good to hear you’re working for change, and glad this post resonated with you. I think sometimes controversy can bring awareness to issues, which can lead to change. Take good care!
My mother gave birth to me, her first, in hospital when she was 20. I am reminded of her many rants about the whole experience – ”they wouldnt even let me have a hot water bottle for my back…thats all i needed for pain relief but they said they couldnt because I might burn myself!” and ”I said absolutely no no no to pain medication, I didnt want anything and they knew that, but when you came out you were so woozy I knew they had given me something and when I asked them straight off they hesitently said they had gaven me a shot without my knowing or consent…it was totally against consent and they wouldnt have said ANYTHING if I hadnt noticed the evidence.”
Since then my mother has had 3 homebirths, and I have been there for all. I have seen what can go wrong (cord wrapped around neck 3 times and my sister didnt breath for 8 minutes and was limp and grey) even when there are 2 private ‘holistic’ midwives there (they forgot to fill the air canisters so they had no oxygen to give my grey lifeless sister, and my mothers placenta had to be manually removed and they were very very clumsy during the procedure causing my mother absolute agony). And I have also seen the most amazing homebirths (a midwife was there but very much taking a back seat) where my mother completely owned her experience and there was no testing and monitoring and all that.
I’m 24 and I havnt given birth yet… I like to think I am more knowledgeable then most my age as I have seen my 3 sisters births….but I really dont know where I stand in regards to unassisted birthing. Does your confidence come from successfully birthing 5 children, and the knowledge that you know what your body is capable of? For me it is hard to imagine that my body is capable of all that it takes to successfully birth a child…
I definately want children, and sooner rather then later what I am sure of is that I would not give birth in hospital unless there was a SERIOUS complication… that is something inspired by seeing my mothers births. However unassisted is a whole other ball game. That takes such confidence in your own body, and I would say such assurity that everything is going to be ok! Isnt birth dangerous? In my head it is, and if something were to come up that was going to potentially effect the health of my child and myself I would be at that hospital faster then you could say ‘naturalhomebirth’. Maybe thats just because I have never been in this position myself….or that I just dont trust my body like you do…
Xx Bex
Hi Yo! I love reading your perspective on birth. I live in the US in a semi-rural area. I work in one of the local hospitals as a nurse assistant [in the emergency dept], so i see every day just how much the system needs to change. I have been very interested in learning all that i can about birthing, so when the time comes for me, I am better prepared, and just more educated about not only my options, but how the system at the hospital works and what I can do to have the ideal birth for me.
Sadly there are not many options for me when my time comes. I can birth at the hospital where i work (my insurance with the hospital will cover about 70% of the cost to birth there)… or I can birth at the new local birthing center (my insurance will cover at most 40% because the birthing center is not “in network” with my insurance coverage — if it covers the cost at all.) I am still researching my options for birthing at home. I am not sure with the state laws whether or not I could have a midwife attend my birth at home…? still looking into that… I would feel more comfortable for my first birth to have a midwife on hand, but would prefer to have a hands off approach……
A close friend of mine just had her second babe two weeks ago (both babies were born in a hospital) and she was very unhappy with her experience there. The more friends that I have (who are having babies) the more unhappy they are with how their births have gone. All but one of them have birthed in the hospital.
I hate how skewed this system is. I hate that if I go to the hospital i HAVE to have an IV placed. That I HAVE to labor and push on my back. That I HAVE to go along with everything that the doctor recommends… this whole way of thinking (that a medicated, hospital birth what-the-doc-says-is-law, unquestioning, uneducated…. ) is sickening.
There are women that I work with — nurses, nurse assistants, and even some of the nurse practitioners and physicians — who are, in my mind, so naive about birth. They are horrified that when my husband and I get pregnant, we don’t want to find out the sex of our babe, that I am not keen on jumping on the bandwagon of lets-have-our-baby-in-the-hospital, that I don’t want a medicated birth, that I DO want to have my baby at home…
I have seriously considered going to school to become a nurse midwife. For the longest time, that is the only job that I have ever wanted to do. The more I learn about the US system (and Canada as well) the more I am encouraged to, yes! become a midwife and help start the CHANGE that this system so needs! I may only be one person, but there are many likeminded women out there who are just too timid to question the system up front. My parents raised me to question [everything] and to do my homework. I am astounded that so few women research how our bodies work, pregnancy, and birth… that they go like the proverbial lambs to slaughter, climbing up onto the OR table to have a “necessary” c-section which was “the ONLY thing that saved my baby (because I had an induction and didnt meet the standardized and unrealistic expectations of having my baby by the time the doctor when home for dinner that evening).”
WOMEN — do your research. Know the effects that drugs (pitocin and pain meds during birth) have on your baby and your body. The longer these drugs are used, the longer c-sections and complications arising from inductions will continue to plague our babies and our bodies.
Sorry I have rambled on and on, [steps down off of “soap box”] the more I learn about how my body works — understanding little signs and symptoms of even having a period [am reading through the book Take Charge of Your Fertility] that women are not taught in school or by our mothers because we live in such a patriarchal world — the more I learn about birthing and just how beautiful and [normal] it can be, the more I am saddened at the state of things. I watched both of your birthing videos of sweet Felix on youtube. I loved every second of them.
Birth is beautiful. Birth is intense. Our bodies are MADE to give birth. We can do it! Birth is a normal bodily function, not some sickness to be medicated and treated. Birth was meant to be intense and painful. But the end-all result is so worth it.
I [own] my future birth. A pizza is delivered. My baby is not. I just wish more women could understand and own this knowledge too.
Keep preaching Yolande. We are out here, and we are listening. <3
I think you are missing a very big part of what a doula does. She is not just there to hold a mothers hand through the birth. She is also an educator to help the parents make the informed decisions for themselves and their babies. This is mostly for a hospital setting of course. In a homebirth setting advocacy and some of the educational role of a doula is changed. She is there more as a person to help keep the space of birth safe. Meaning that it is the best it can be for the mother and baby. I agree parents should stop givig the power to the providers and take it back for themselves because they have every right to make their own decisions for themselves and their baby. However I feel doulas are trying to make this possible. Unfortunatly doulas don’t tend to play dirty like the medicalized birth people do. We don’t use manipulation and we don’t use scare tacticts to get women to do what we want them to do. In this the battle is so very uphill. I must confess I am somewhat biased as I am a doula and obviously feel I offer a very valueable service. Another point I think you’re missing is having medical intervention isn’t the only marker for a positive birth experience. How a woman feels emotionally is the biggest marker for her having had a positive birth experience. This is also what I feel doulas bring to the table. Even when a doula can’t get the mom to say no to unecessary interventions she can help a woman feel empowered instead of defeated.
Thank you so much for your comment, Colleen. I think what I’m really getting from this rich discussion, is that there is such a diversity of opinions on the topic, and of experiences. I find that I hear equally from women who feel very much as I do, and also women who had wonderful hospital experiences with their doulas. I should also say that I think that the “markers for a positive birth experience” are entirely personal…I wish you and your family the very best, and a wonderful holiday season! Take good care.
I’m not sure it’s fair to blame doulas when a care provider cuts the cord, a mother has a c-section, or a woman has a dissatisfying birth experience. I also don’t think it’s fair to put the weight of the issues with maternity care on the very people who are bold enough to step into those settings day after day. I work as a doula, mostly in the hospital setting, and I will admit it’s an uphill battle every time. But I continue to go back because I don’t find that I’m as needed in the homebirth setting (despite homebirthing myself and often having an easier time doulaing there). We can’t speak for our clients, when we do nurses say “I want to hear the request or preference from the patient” and we’re not the patient. But I have reminded care providers of mom’s wishes as baby is being born only to watch the doctor cut the cord and separate mom and baby. My words fall on deaf ears. However, when that happens, I don’t blame myself. I could not continue to do what I do, and sometimes its downright heartbreaking, if I shouldered the guilt and responsibility when things don’t go according to plan. I am in agreement that things need to change, but as many have said, it needs to change at the level of education (both for those providing the care and those receiving it). It’s not our job to change hospital policy. It’s our job to support moms and to help them process whatever happens, good or bad, at their birth.
Thank you for your comment, Laurie. I absolutely do not “blame doulas” for any of the destructive, cruel and abusive hospital practices that are standard in North America, and I’m sorry that that was your interpretation of my post. I can imagine the challenges that you go through, working as a doula in an institutional setting. Your comment here really illustrates many of the reasons why I could never give birth at the hospital. Thank you for sharing your experience.
” I [own] my future birth. A pizza is delivered. My baby is not. I just wish more women could understand and own this knowledge too.
Keep preaching Yolande. We are out here, and we are listening. <3"
Hear, hear!!