Thursday, February 12, 2009


I had a response from Kathy, who had some questions about my perspective on doulas and when things were not cool.

Your comment about the doula overstepping her bounds made me curious -- would you sometime give some examples of this happening? Not that I'm doubting it happens, but just wondering what it looks like. On one of my email lists, I sometimes read stories written from the doulas' perspective, and I read how they view the birth (and many times the manipulation they see women undergo, to accept things they have clearly stated they did not want), so I'm looking for a balancing opinion -- from someone who likes it when women have doulas, because so many stories I read include birth attendants who most obviously did *not* like doulas in general, or at least that doula in particular.

I want to address the 'manipulation' first. That term bothers me a bit because I am not sure what you mean by it. There are times when I do have to make a recommendation for 'something' that I know the woman may not want. This usually involves exhausting all other options first, then trying 'whatever' to achieve a certain goal. This typically comes with an explanation of why I think we need to do 'something'. When it comes down to it - the doula is a support person. I am the one who bears ultimate responsibility for the outcome for both mother and child. It's a heavy burden.

I can't stress enough that I think doulas are very valuable members of the team. What I hate, and this has rarely been a problem, is a doula who gets in the way of the relationship I have established with the woman throughout her entire pregnancy. Part of that relationship is the building of trust. I would certainly hope that a woman trusts me enough to know that whatever recommendations I may make, are made with no ulterior motive (i.e. golf tee times, etc). If a woman can't trust me, then she sure shouldn't be seeing me!

So, I have had a doula who would start whispering in the woman's ear the minute i left the room. The gist of the conversation being that the woman didn't need 'whatever' I was suggesting. A family member told me later about it. I was not happy. That's sabotage. I don't have a problem if a doula wants to bring up other suggestions, or questions in an open conversation - that's totally great!

The only other negative experience I have had was with a doula who really didn't do squat for the woman, other than kinda hang out. That ticked me off as this doula was being paid for her services and I felt like my patient was not getting her money's worth.

All my other experiences have been very positive. I recommend doulas to women who express interest :) I view them as a member of the team, right along with dad, the nurse, myself, etc.

Thanks, as always, for your comments Kathy!!!!


Anonymous said...

I understand your point of view. Having read the doulas' points of view (being that knife-happy doctors intervene too much for their own convenience [an exaggeration for clarity]), I can see why some doulas may overstep their bounds, in the name of protecting a woman from unnecessary intervention.

When you have Consumer Reports reporting that high-tech measures are overused in healthy, low-risk women (inducing labor, epidural, c-section, arom, episiotomy, and EFM), and may lead to poorer results and certainly excess cost, it can perhaps skew the perspective of some doulas in thinking that *every* birth attendant is like that. Or at least, she may be unsure whether this particular doctor or midwife is going by the evidence or going by his/her personal convenience.

"Manipulation" -- I wasn't trying to bait you with the term, or get you between a rock and a hard place. Certainly I don't think that every time a woman ends up with something outside of her birth plan that she was the victim of manipulation; but I also certainly think that manipulation exists. I'll give you two examples.

1. Over-bearing dad, aloof during natural childbirth classes, during labor actively demeans his wife for attempting to give birth without drugs, and circumvents or directly opposes the doula's attempts to help her achieve that goal. At one point, he leaves the room and comes back with the doctor; the doula is escorted from the room by a nurse. When her husband and doctor come out of the room with the signed C-section consent form, the dad is jubilant, literally jumping up and down, announcing to his family on the phone that the baby will be born within an hour; and he's obviously glad that labor is going to be over -- little caring that his wife is going to be recovering from an unnecessary abdominal surgery (no maternal nor fetal indications). The doctor wouldn't look the doula in the eye, because he knew that he was guilty of joining with the husband in manipulating the mom into agreeing to an unnecessary C-section. When the doula goes back into the room, the mom is in tears.

2. Woman declines AROM, so doctor performs a very rough vaginal exam on her, "just to see how far along she is," and keeps his hand inside her claiming he can't tell exactly how far dilated she is, until she finally agrees to let him break her water.

I could probably go on, but that gives just a few instances of what I consider to be manipulation. Again, I don't think that every intervention used on women is unnecessary, nor that women agreeing to an intervention that they had previously declined is "evidence of manipulation" -- I'm not *that* hard-headed. :-)


Ciarin said...

Story one is absolutely scary!!!!! That dad ought to be forced to go through the same thing right along with his wife. I mean, it's one thing to find it difficult to watch your loved one be in pain - but c'mon - get your head out of your butt dude.

Story 2 is sad - it's a shame that some providers will 'punish' patients for not doing what they want.

Doulas need to remember that they are a relative late-comer to the relationship (in most cases). They should not assume a 'us against'them attitude with every provider - until you see evidence that that is the case!

Kelly said...

I am a Birth Doula. I am so glad to hear from your side on the birth, always. Mom's decisions are ultimately the one to be respected.

Kayce Pearson said...

I'm training to be a birth doula, and my sister-in-law had a doula in her old ward that would come up to her and treat her like crap because she was induced and had an epidural for her first baby.

A doula isn't there to take sides on issues. A doula is there to give the woman the labor she wants.

It makes me so sad to hear of terrible doulas out there that ruin things for other people that don't do the same thing.

And those two stories were so sad! It just breaks my heart.