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.