Sunday’s article in the NY Times Fashion & Style section (again, why do women’s issues always get shelved in this section?!?) presents some bad press for doulas. The title, “And the Doula Makes Four” already implies the three’s a crowd mentality that doesn’t bode well if we think about the hospital delivery room.
The piece goes on to share the story of one mother who was less than pleased with her doula:
Then labor began — and went on and on — and Ms. Myers’s opinion took a nose dive. Though the doctor recommended that Ms. Myers receive intravenous fluids to hydrate her, the doula, eager to avoid medical intervention, insisted that Ms. Myers ignore the suggestion, causing her contractions to spike. When she ultimately chose an epidural, her doula walked out. “She was so set on my having a natural birth, she offended me, she offended the nursing staff, she offended my O.B.,” Ms. Myers said.
These types of stories are disappointing to see, especially in the mainstream media. Doulas get so little press (how many people have never even heard of one?) but of course stories like these are what makes the news. As I’ve talked about a lot on this blog, I don’t support doulas who do not support women’s choices. In my opinion, a doula who pushes a woman to do something she is not comfortable with is not doing a good job supporting that woman. There is a fine line between pushing someone and giving them options or encouraging them to try different things.
That said, I also think there may be some important facts missing from this piece. There is much more to be said here, and this article really does present a one-sided view of the issue. Things that the piece missed:
1) The perspective of the doula. In many of these cases with doulas in the hospital setting, the doula is put into a really difficult position for a number of reasons. First, medical staff (nurses and doctors) can be really hostile at times, even when the birthing mother advocates for the presence of the doula. The staff can feel threatened by the doulas presence, treat her with disrespect and make their disapproval of her presence clear to everyone involved. Also many of the techniques that a doula encourages are outside the scope of OB practice–things like massage, acupressure and visualization can be things that doctors and nurses don’t believe in, creating more animosity.
2) Most doulas work from the preferences and desires of the birthing mother. The parents may design a birth plan or at least outline the kind of techniques and strategies they want to try during their birth ahead of time. It is these preferences which guide most doula’s practice. Often things happen during a birth that change these preferences, but also frequently the hospital staff and their influence on the mother can change these as well. It is a very difficult balance to strike.
3) Being a doula in the hospital is hard. I say this one from experience. The hospital environment is far from welcoming, and when you have opinions and philosophies (as well as experiences) about what birth should look like, it’s really difficult to stand by and watch that be violated. As a doula you have practically zero control over what is done and what happens in that delivery room, and many times you are the only party involved who is specifically focused on the emotional needs of the birthing mother.
4) Not every doula is right for every woman. Just like not every doctor is right for every woman, not every doula is a good fit for every woman. It is best when the doula and birthing mother realize that ahead of time so a better match can be found. Things like philosophy about birth and medical intervention are important to discuss ahead of time.
I think the bottom line in all of this is that the increase in doula presence at births is ultimately being driven by the women giving birth. Modern OB practice is going to have to adjust to accomodate the needs of birthing women, who are not going to stand idly by and accept a 1 in 3 c-section rate.
Radical Doula 
Hi Miriam,
I can see how a doctor would be opposed to having a doula involved in a delivery.
Doctors typically want as few people in the room as possible. When everyone is well-behaved and the delivery goes smoothly, people aren’t a problem. However, when things don’t go smoothly, every additional person in the room adds risk to the mother.
Also, since doulas are not medically trained, the doctor has no idea what the doula will advocate. If the doula pushes for a medically unwise option, the doctor is put in a tough spot.
While some doulas do a great job of advocating for the best interests of the patient, the doctors definitely have some reason to be wary of their involvement. One solution may be a closer association between medical personnel and any doulas in the area, so the two sides have a greater understanding of where the other side is coming from once the delivery is taking place.
Is a lactation consultant considered a type of doula, or what? The article seemed to imply that was so, without distinguishing the two functions. (Or are they not separate functions?)
i think you are absolutely right. it’s disheartening to hear that the only mainstream press on experiences with doulas is negative. the points you listed are all considerations that anybody needs to take while reading this article, and unfortunately, most people wont.
i do wonder, however, about the validity of this particular doula exiting in a huff. admittingly, doulas have it rough, and it’s a very delicate balance in the birthing room with so many opinions flying. also, with being on such an intense emotional level with the mother, i would imagine it difficult to withhold interjections of influence, as well as the frustration of your client not taking your advice. there is just a very fine line between insistence and offending the mother by storming out.
again, it sucks that this particular incident just had to be reported, though i don’t necessarily question that it happened.
What I found conspicuously absent was an explanation of why a doula in a hospital setting has become necessary. One person referred to her doula as “ideological”, when her ideology is just one drop in the bucket compared to the gaping maw of the medical machine. I think a good definition of stifling ideology can be summed up in two word definitions: lay down ; fetal monitor ; pit drip ; be quiet.
Which is why I do not act as a doula for hospital births. It’s hard to stand there and bite your tongue while the doctors and nurses lie to the mothers, threaten them, and bully them into being well behaved patients. When they realize that you are there to support the mother and not stare dewy-eyed in wonder at the doctor’s power they get pissed and want you out.
What is ridiculous about the NYT article is the idea that *doulas* are the professionals at hospital births who force women to make choices for which they are not entirely on board. What about OBs? Women in hospitals are routinely pushed to induce, get an epidural, etc. The number of doulas and the amount of intervention they impose on laboring women is, to my mind, a non-issue compared to the number of OBs and the much more intensive and powerful interventions they impose on laboring women.
I also take issue with Andrew’s comment about people being “well-behaved” in the delivery room. What does it mean to be “well-behaved”? When is a woman in labor “well-behaved”? When she follows her doctor’s orders? Her doula’s? Her own instincts? When is a doula well-behaved–when she tries to stand up for her clients’ wishes? When she submits to an OB or RN?
There is a need for doulas in our culture right now because birth is not being respected as a natural process. Unfortunately, doulas are often put into difficult or impossible situations in which they have to compromise their own values and beliefs about birth, their clients’ desires, and hospital or OB policy. These various factors often clash.
(By the way, I also found the snarky tone of the NYT about “organic-buying” moms to be unnecessary. Why be snide about trying to help the earth?)
Lactation consultants are very different than doulas, with a different role in the labor and delivery as well as a completely different certification process.
In my experience, doulas are usually brought into the hospital setting by mothers, and lactation consultants actually work for the hospital (sometimes they are nurses as well). They get a very different training than doulas do, and it is a completely separate issue from labor support.
I’m not sure why they got conflated in this article either, Jenny.
Another important point that this article totally missed: some hospitals have doulas on staff, or doula programs that are funded by the hospital. Obviously some OBs think it’s an important service.
Right on, Miriam! I was horrified at this article — it was not just frustrating to read as a women’s health advocate, it was also incredibly bad journalism. Have you written a response?
Thanks Zippy. I haven’t written anything beyond the blogosphere. Truthfully I’m a little intimidated by the NYTimes and wouldn’t know where to start. But rest assured there are a lot of people writing responses from the doula/birth activist world.
Until OB’s stop slicing up and medicating women who are perfectly capabale of natural birth this conflice is going to continue if not get worse. Some alternatives are needed. It is a problem to have so many attendees at birth with different levels of skills and opinions – the women will suffer even more in the end. We need places of natural birth for women who want it – and OB’s and hospitals for women who want and need that. Until there are alternatives women will keep having to go to the hospital with all the attendees they need to fight the system ie: have nature present in a clinical enviroment surrounded by surgeons. How can this work ?
Until OB’s stop slicing and medicating women who are perfectly capabale of natural birth this conflict is going to continue if not get worse. Some alternatives are needed. It is a problem to have so many attendees at birth with different levels of skills and opinions – the women will suffer even more in the end. We need places of natural birth for women who want it – and OB’s and hospitals for women who want and need that. Until there are alternatives women will keep having to go to the hospital with all the attendees they need to fight the system ie: have nature present in a clinical enviroment surrounded by surgeons. How can this work ?
Arielle:
To clarify my comment, by “well-behaved”, I mean following the standard norms for public behavior. I do not mean disagreeing with the doctor. I mean yelling, throwing things, not moving out of the way when requested, physically interfering with the doctor (excluding when the doctor is clearly violating the mother’s stated wishes), etc. The majority of doctors wish no one other than the partner (and sometimes the parter too) were in the room. Every extra person makes things more crowded, complicated, and stressful.
I do NOT think this is the way the typical doula acts. However, plenty of other people do, and it’s one reason doctors are wary of letting any extra people in.
Thanks!
I am utterly shocked at the responses here. I could post a lengthy reply here, but I won’t. Just know this — most women enter the hospital knowing exactly what they want. Women aren’t stupid. I knew that I wanted IV fluids, as well as phenergan and an epidural. I was asked during my births in 2003 and 2008 (at two different hospitals, 200 miles apart) if that was what I really wanted, if I wanted to wait.
Just because birth can be non-medicated doesn’t mean that it has to be. I wanted a medicated birth. And, should I get pregnant again, I will be asking for the epidural to be on tap when I waddle through the hospital doors. That does not make me less of a woman than someone who chooses a more painful path. It does not make the miracle of the birth of my children any less miraculous than one born at home or to a granola mom.
That is the issue here — not where or how one delivers. The issue is that members of what I call the Nature Nazi movement have a bad habit of looking down their noses at women who choose a different path to deliver their children. I have been around many, many medical professionals and many, many nature nazis. And the nazis are the ones with chips on their shoulders, giving out false information, and using scare tactics to get birth out of a hospital setting. For that reason, I side with the medical professionals. And, in my opinion, the dark side of this doula hype is pretty much hidden under the molly-sunshine image that is touted by pregnancy magazines and books. Kudos to the NY Times for printing this story.
Pam, I can understand the distaste you hold for more militant Natural Childbirth advocates, fundamentalism in any form is counterproductive and women have the right to make the choice for themselves. However, there are two sides to every story, and the majority of women only know one side and choose accordingly. You might want to look at the real numbers and statistics, such the proportion of women who go into medicated/induced labors and end up having C-sections, serious complications, post-partum depression and neo-natal problems and compared to the rate of these issues in women who choose and manage to have natural labor.
The cause and effect pattern is pretty clear when you look at the studies and this is why many doulas have a hard time allowing the mother to increase her risk significantly of a negative outcome.
That being said, the job of the doula is to respect the wishes of the mother and to try and make the labor and delivery as positive an experience as made possible by the circumstances.