The more I see this article posted, the more disappointed I feel. As a birth doula who has started and directed both hospital based, and private birth and postpartum doula programs, with 16 years of experience, over 900 births attended, and 20 some odd years as a massage therapist and holistic healthcare professional, I have to say this is not one of my favorite doula articles. I am not thrilled about hearing doulas compared with the doorman or Amazon prime. I am also not happy with the way they describe a father who is completely detached from his wife and her labor,” His wife, her contractions now 10 minutes apart, was almost an afterthought”. His lack of knowledge about what hospital they are even birthing at, and preferred focus on what type of luxury car service they should employ is not only obnoxious and self- involved, but ignorant and offensive. I believe couples should take responsibility for their body, their baby, their labor and birth. They should research and educate themselves, and practice techniques so that when labor begins they know how to cope, and dad knows how to support his laboring wife. The presence of a doula should enhance the partner’s ability to take an active role in the birth, and to participate at his chosen comfort level. A doula does not push aside or replace the laboring mother’s partner. Believing someone else, be it doula, CNM, OB, or RN, can take care of mom, and take away the challenges and pain, only sets moms up for a very difficult and frightening birth. Burying your head in the sand and thinking birth is just a simple physical activity that the doctors can handle, and you need not prepare for or be involved in, is utter folly. The person who wrote this article sounds like she has no experience with, or understanding of doulas or of birth. We are not the new fad “that is taking over where Lamaze left off”.
The article also states that for most doulas, their doula work is a second job, calling it “the new waitressing”. This implies, part time, on the side, just something to do for a bit of extra cash or to fill some hours and kill some time, just a hobby, which carries the added connotation of a job that is not deserving of a living wage. For many of us this is our only job, and one that requires a great deal of education, knowledge, experience, and skill in many areas. Doula services are not like a convenient and trendy concierge service, simply a luxury or extravagance for the wealthy.
When people focus on the cost of doula services with no understanding of what it takes to run a doula business, the necessary education, cost of supplies, or the hours on call, at births, away from families, and missing significant family events, I take issue with this too. How many professions do you know of where you are required to be on call 24/7, leave for the hospital at the drop of hat, no matter where you are or what you are doing, and then go without sleep and little food for anywhere from 12 hours to 4 days? How many jobs require you to work holidays, weekends, birthdays, anniversaries, day shift and night shift, and in between take numerous calls, go on appointments too, do research for clients as well, and participate in continuing education efforts as well? And how many professions do you know of where people feel that because the person performing the job does it from the heart, that should be gratification enough, and so they should not have to pay much for the service? Doula work is a job like every other job, and although we do this work because we love and care deeply for women and families, it does not negate the fact that we too need to pay mortgage, utilities, buy food, and afford to care for our family? Doulas work hard and deserve to be compensated for their work just like every other profession. The article mentions that there are various ways to pay for doula services, but perhaps it should not be up to individual doulas to ensure affordable doula care for all women. Perhaps hospitals, social services, and other family centered and non-profit organizations should pitch in to obtain grants, and to start doula programs that are offered to all birthing women, regardless of ability to pay. Maybe doulas should become part of the healthcare team at your CNM or OB office, or your chosen hospital, with the cost of their service included in the full fee for birth. Maybe it is not actually the doula who should be expected to work for low wages, but rather institutions that can better afford it, and would in fact, profit from offering the added service to expectant parents.
This article also does not take into account the fact that birth has become a much more medicalized, and for profit business, and defensive medicine to protect against litigation, and choices to minimize risk and cost are often employed, rather than research based decisions. Women entering into pregnancy, labor, and birth for the first time need an advocate who can help to educate and support them toward navigating this medical system, and assist them in gathering information so they can take part in, and make informed decisions, that are best for themselves and their baby, and not simply the institutions, who are not there in the future to deal with the fall out when defensive medicine decisions are made, or births go wrong. We also have one of the highest maternal mortality rate in the world, and a lot of this is due to continued overmedicalization of birth, high cesarean and induction rates, and not enough use of midwives for normal, uncomplicated births. Making your way through this system can be daunting, and carries a great deal of weight and importance for an expectant mother as she transitions from the life of a single woman, to that of a mother, responsible for the life of another human being. This medical system does not take into account the needs of this enormous transition, wrongly thinking it can be separated from the birth, nor do they consider the emotional and psychosocial aspects of pregnancy, labor and births, or how these needs must be met in labor in order for birth to progress normally, gently, and peacefully. A doula brings these things to the birth, and supports laboring mothers and fathers in ways that the medical system has forgotten are of utmost importance.
The article also does not consider those women who have experienced infant loss, still birth, past traumatic birth experiences, who have been victims of sexual assault, or who are facing serious pregnancy and potential birth complications. I have spent countless hours on the phone and sat with women who sobbed in my arms over the trauma of the former terrifying or intervention laden births they experienced in the past. I have spent months working with hundreds of women to help them process these births, not project them onto their upcoming birth, and to do everything in their power to overcome intense fear, and to prepare for a joyful birth ahead. I have done a great deal of work to help second and third time mothers to prepare for a VBAC, vaginal birth after having had a cesarean birth, often a first time cesarean that was not only disappointing, but frightening and emotionally damaging for the mother. As the head of the perinatal grief and loss program at one hospital where I also started a doula program, I held the hands of women who labored to deliver a baby who was no longer viable, who either died during labor, prior to labor, or who would only live for a few precious minutes or hours after birth, due to genetic anomalies, and life threatening complications and deformations. I put my whole heart and soul into creating a safe space where these precious families could labor and grieve as they needed to, kept them informed of what was happening, comforted them, employed pain management techniques, coordinated to work as part of their loving maternity care team with the medical staff, and even bathed, dressed, and photographed their baby after it died, so they could hold their precious child, and have a memento of his or her birth. After their birth and loss, I checked on them multiple times, helped them locate needed resources for counseling, support, and cremation or burial, and did all in my power to ensure that even in the midst of devastating loss, these precious parents knew without a doubt, that they had been greatly loved and supported through it all. I have worked with women of childbearing age, those of advanced maternal age, and supported children as young as twelve years old, helping the entire family, as the laboring mother clutched her teddy bear and did her best to bear up. I have supported prison inmates who were being treated like they were unworthy of love, and even drug addicted mothers who no one wanted to support. Making sure all these women, no matter their circumstances, knew they were worthy, precious, sacred, supported and loved, made a world of difference in the quality of their births, in their lives, and the lives of their children. I have supported women who were victims of incest, rape, and domestic violence who decided after their birth to get help, to leave their abusive partner, and even to get into drug treatment programs, and programs for unwed and single mothers. Doulas bring a necessary quality of love, acceptance, and support which this New York Times article seems oblivious of, and in so doing, they do much more than fill the position of latest trendy fad, or luxury service.
It is also a well known fact that low income mothers, and mothers of color receive less adequate and compassionate care than financially well off, white mothers and families. Pretending this type of racial disparity does not exist in medicine, when it so obviously exists in the entire rest of the world is foolish. Every mother and every child are precious, worthy, sacred, and deserving of compassionate, loving, and safe, research based care during her labor and birth. Many will not receive this care throughout pregnancy or birth if they do not have a doula advocate by their side. Low income women also face many challenges, from the moment of conception, that more financially well off mothers do not have to deal with, and having a doula who can assist, will help to ensure a more healthy pregnancy and better birth outcome. I dream of the day when all hospitals offer a supportive doula advocate to every mother, regardless of her social status, skin color, or ability to pay for the service. Doulas understand that once in labor, all of us are the same, each one a sacred vessel bringing forth a precious fruit, and all of us are deserving of love, kindness, support, and compassion during labor to do so. Indeed the presence of such loving support can make such a difference, it can change lives, I have seen it happen.
The medical model of birth likes to say that healthy mother and healthy baby is all that is important. We know that is false. We know that the quality of the mother’s birth experience is also very important, as a challenging, traumatic, or intervention laden birth can have a negative impact on her ability to bond with, breast feed, and care for her new baby, on the relationship with her husband/partner, and on the healthy birth of a new family. A doula can help the mother and father to gather research and information and become educated, offer support during pregnancy, help them to learn coping skills and pain management techniques, refer them to other needed birth related professionals, help steer the way through the maze of what they actually need to do to prepare for labor, keep the mother focused on joy and positives, and help her to not be overcome by fear or anxiety. She can assist in answering questions or if she cannot answer, she can steer the mother toward her medical caregiver, or other resource who can. A doula can help the expectant mother to get into the right frame of mind to look forward to reveling in the miracle of birth, and then support her all the way through her labor with various techniques to allow her to keep her labor progressing, her pain managed, and her focus in the present moment, rather than running ahead of herself into future imagined fearful scenarios that will negatively impact her labor. The doula is an advocate who can be a liaison between the couple and the medical staff, help to initiate discussions, ask questions, tell the couple questions they can ask, and suggest comfort measures that can be used at the right time. She supports the husband/ partner so that he can take part in the birth of his/ her baby in the manner they are most comfortable with, offers suggestions if the partner runs out of ideas, explains what is happening so they know that mother and baby are safe at all times, allows the partner to take breaks, encourages the couple as needed, and lets them know what stages they have passed through and what to expect ahead. Essentially the doula does her part to remove the cloud of unknowns looming over the head of first time parents, break through and help to dispel the weight of fear that our sensationalistic society likes to heap on expectant mothers, and encourages a belief in their ability to rise to, meet, and successfully overcome the challenges of labor, while remaining mindful of the miracle and the joys. The doula offers a loving support that allows them to focus on the beauty, power, and miracle of all the births happening simultaneously, that of baby, of mother, of father, of strengthened couple, and of new family, and helps them to relax and surrender to the process so the mother’s body can do what it knows how to do. She is there to help in a myriad ways to bring about a gentle, peaceful, joyful birth and loving welcome into the world for the precious new baby, and a shared exhilaration and sense of elated accomplishment and closeness for the couple, as they work together to dance their child into life. Imagine if all babies and new families were welcomed into life in such a fashion, the impact that it would have on society at large. Peaceful, lovingly supported birth equals a loving start in life for our precious children, and helps to create healthy, happy families. Healthy happy families contribute to bringing to fruition the peaceful, environmentally sustainable, socially just, and loving world we wish for all our children and grandchildren to grow up in. It would seem to me that if a doula can contribute to doing that for the couples she serves and supports, she is a far cry from simply a luxury fad, Amazon Prime, or the high rise apartment building doorman.
Allison Harris NCTMB,LMT,CD
Kairos Holistic Healing Arts Birth Support Services