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I get a fair number of women who contact me to ask me if I would consider attending their hospital births as a doula. The following has been my response, of late:
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Dear Gentle Mother, Unfortunately, I don’t attend planned hospital births. I admit, it’s selfishness in large part. It is just too soul-destroying for me to see brilliant, healthy, smart women, who have spent lots of time researching the facts, and who are well-informed, go into the hospital with their birth plan, only to end up with trauma or surgery.
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The sad truth is that it really doesn’t seem to matter how much you know, or whether or not you have a great doula, or a team of great doulas: doctors have all the authority in the hospital, and at any time they can (and often do) override a mother’s wishes, and her consent, if they have decided, (even arbitrarily) that a state of emergency must be invoked.
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I have a huge amount of respect for doulas and the work they do, because they occupy a very difficult role: like mothers themselves, doulas have no authority whatsoever in a hospital setting, and for many doulas who are certified by one institution or another, their scope of practice specifically prohibits them from “advocating” on behalf of their clients. This is not to say that being a doula isn’t a very important job: bearing witness to what occurs in the hospital is important. Reminding a mother of her wishes when she is facing a barrage of pressures is important. Helping a mother process what was done to her in the hospital is very important. But this is not my job.
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Of course, if I am with a woman at home, and she determines that a hospital transfer is necessary, then I would certainly accompany her to the hospital. In that kind of situation, I would then become her “doula” for the remainder of her birth process in the hospital. But I simply know too much to be able to take on a planned hospital birth.
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In the past, when I have attended hospital births, I end up dealing with symptoms of PTSD myself, that can last for weeks, and which impacts my ability to mother my own kids, and to support my community. When I am present at a home birth, I have to deal with joy and euphoria that lasts for weeks, which similarly impacts my relationships and my outlook. There is no contest.
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Homebirth is a completely different scenario from hospital birth. The two are almost entirely unrelated, as far as experiences go. Simply leaving your home and stepping into the hospital environment is the first intervention, and as nice as this may sound, it really isn’t possible to have a home birth in the hospital. Doctors and nurses are totally unfamiliar with spontaneous, normal, physiological birth. They have literally never seen it. They are trained in medicalized, institutionalized birth, and even the mothers who are able to have unmedicated births, still, in may cases, have to fight with the staff from beginning to end, in order to “achieve” simply having their babies emerge from their vaginas.
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The hospital is the Caesarean Store, Epidurals R Us, Pitocin Place. You can show up at McDonalds with Anthony Bourdain in tow as your dining doula, and an explicit “gourmet meal-plan” in place. But I hope you wouldn’t be too surprised when they serve you the very best Big Mac they have on offer…and it’s still a feedlot junk-food hamburger.
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I know this may sound extreme, and I hope it’s not upsetting for you to read this, but I have to just give you the straight goods. I’ve seen it too many times, and it breaks my heart.
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The good news is that there are many wonderful doulas working in our area. And they’re a hell of a lot stronger than I am.
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Sincerely,
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Yo
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Yolanda,
While I understand your desire not to want to participate in a planned hospital birth where the mother wanted a home birth-like environment (as I don’t believe that could be achieved in a hospital, completely agree 100%), what about a planned hospital birth in which the mother wanted to have a C-section or was having one due to a medical condition such as preeclampsia?
Do you think in this situation that you just wouldn’t be the right doula for them? I know you have spoken before about a woman’s right to choose her birth based on informed decisions, and there are some women who happen to want a C-section just because they feel that is the birth that they want.
While I greatly respect your work and admire your values, I worry about things swinging in the opposite direction where a home birth would be forced on a woman and she had to fight for her right for a C-section. Now I know that this would be very unlikely, as the majority of people and the medical profession prefer hospital birth, however it scares me. I think that all decisions need to be left to the mother, who inherently knows what is best for her child and her birth. For a mother who simply knows she cannot relax unless she is in the hospital for her birth, surely It wouldn’t be beneficial to her or her baby for her to feel pressured into home birthing.
If we are to empower women, I feel that we need to empower them to choose a birth that might contradict our ideal birth plan, or belief that women need to birth at home. I certainly understand that you may want to encourage them to find a different midwife/doula in the case of a planned hospital birth, but I wonder what your feelings are in general about a woman who chooses a planned hospital birth and whether this is okay or should be discouraged?
Thanks so much for this blog, as it has taught me so much about home birth! I am weighing it as an option for my future birth. 🙂
Libby
Hi Libby,
Thanks so much for your comment! I do, absolutely, believe that women should make whatever choices they feel comfortable with. But this doesn’t mean that I have an obligation to facilitate those choices, myself, personally. I have mixed feelings about elective c-section, because I feel quite strongly that doctors should not be doing harm, or performing unnecessary (harmful) surgeries. Because medicalized birth, and surgical birth have become normalized in our culture, it is inevitable that some women will choose this kind of birth, and ultimately, that is their prerogative. But I also feel quite confident that the vast majority of women, *if* they are given accurate and truthful information about many of the interventions that are presented as benign “options” (for example, that c-section increases risks to both mother and baby, that c-section is very painful, recovery time long and arduous, that c-section could increase the risk of disease for their babies later in life, etc etc,) that most women would not choose this route. Some will, and that’s fine. I’m not a doctor or a midwife, but I do work with birthing women, and I have my own stringent code of ethics that prohibits me from doing anything that would cause harm. So far, it has worked well for me to be 100% transparent with my clients about the nature of the service I provide. During initial meetings, I make it clear that if mothers are looking for someone who is going to use a doppler on their babies, or give them vaginal exams during the birth process, or artificially rupture their membranes–all practices which I think are dangerous and unnecessary, it’s clear that I’m not the right support-person for them. I’m not in the business of empowering women to do anything. One of the benefits of writing this blog, and about being so vocal about my beliefs and convictions, is that women who desire a birth that involves a lot of interference, simply don’t get in touch with me. I really don’t do any convincing, or discouraging of birth choices at all. I just do what I do 🙂 Take good care, and thanks for getting in touch! –Yolande
I am also a doula who no longer attends planned hospital births and I don’t consider it selfish. After many years of attending hospital births, I just know that this is not a good fit for me and that I will not be able to serve the woman in the way that she deserves. I refer those women to other doulas who are more than happy to attend hospital births. Not selfish, self-knowing.
Thank you Lo. I have received a lot of negative backlash from this article (which kind of astounds me). Thanks for getting it, and for taking the time to write!
I feel ya.
Not to be negative or trying to take away from what you are trying to promote, as far as home birthing goes. I would like to say that you are categorizing ALL hospitals and staff under one umbrella. Saying that every hospital birth will end in emergency and intervention and that NO doc or nurse has every seen spontaneous birth is down right WRONG. You are basically telling women that they can be educated and ready for birth with a plan, but that it will be destroyed once they enter the hospital. You promote yourself as an advocate for women and birth, why would you not assist them in the hospital so they CAN have the birth they want?
I live in Miramichi, NB and have been a doula to many women for 8 years. ALL in the hospital. I have never (knock on wood) had a traumatizing experience. They have all been beautiful and glorious. Please stop trying to scare women away from the hospital, a hospital birth can be just as amazing as a home birth. Our staff here is incredible and they let mom labor they way she wants and they do whatever they can to allow for the mom to follow her birth plan. I do understand that all hospitals are different, of course. But, as a Doula, a mom and a woman, I support ALL birth.
Hi Mandi, thanks very much for your comment. I’m afraid that I didn’t do a very good job, in my article, of getting my point across. First of all, I’m not trying to promote anything. I honestly couldn’t care less about the choices that other women make–and as I have said *billions* of times before (including in the article in question), I absolutely support the right that every woman has, to make whatever birth choice she wants, from elective c-section, to birthing in the middle of an open field. But that doesn’t mean it is my duty or my obligation to work directly with every woman. I have never claimed, or written, that every hospital birth will end in emergency and intervention–although of course, every hospital birth involves interventions of some sort or another (even the presence of another person could be interpreted as an intervention). What I *am* basically telling women, is that they can be educated and ready for birth with a plan, but that they can never be sure that their birth plan will be respected in the hospital, because hospitals are designed hierarchies. You can argue this all you want, but I think the scores of women who call and write to me every week, with stories of obstetrical abuse might take issue with a denial of this general reality. Again, I am not promoting anything, I’m simply speaking the truth that I have seen and experienced. I will not assist women during planned hospital births, because I find hospital birth traumatizing, and because there are wonderful doulas like yourself, for women to choose instead. To be honest, I am shocked and delighted that in 8 years you have never had a traumatizing experience. I hope the same is true for the women you serve. It sounds like the Miramichi hospital is a rare gem. For me, any hospital environment is very triggering; witnessing a woman receive a vaginal exam is traumatizing; witnessing a woman’s baby being exposed to doppler and ultrasound waves is traumatizing; witnessing a woman’s abdomen being fitted with electronic foetal monitors is traumatizing. Etc. The hospital environment is not where I belong–not as a birthing woman, or as a birth-worker. I’m not sure why this would be a problem for anyone, but alas, it seems to be. In any case, I commend you, again, for the important work you’re doing. Thanks again for getting in touch.