What is the role of a doula? Lately I’ve been considering it carefully. There are a couple of things precipitated this reflection. First was the lukewarm (at best) reaction of a friend of mine — a labor and delivery nurse — to the news that I was becoming a doula. I also recently witnessed and participated in email/online discussions on the matter. Finally, as I attended a “professionalism” training course for the doula volunteer program I’m joining, it all started to crystallize for me.
Why would a labor and delivery nurse dislike the idea of a doula? I know she is committed to helping moms have both a healthy baby and an excellent birth experience. She became an L&D nurse because she loves L&D! I think part of the problem is that many doulas see themselves as some kind of soldier. An advocate of natural birth, but to the extreme. Any intervention is considered some sort of a failure and a “bad birth.” Something to go back to the email list and deconstruct: “How could this have happened? Where did I go wrong?” I know doulas who will reject a client who who wants an epidural or an induction. Some doulas even feel it is appropriate to physically block medical personnel from their clients, unhook monitors, or take out IV’s in the name of letting nature take its course.
I don’t believe a doula is a “Birth Warrior,” in the sense that we are fighting to change the way birth is done around the world as we work with each individual client. As a doula, it is not my responsibility to make medical decisions for my client or to interfere with medical procedures she has consented to, no matter what I feel about that particular procedure. I can make sure she understands what a decision means and how it might affect her. I can educate her, and I can remind her of her goals. However, it is her responsibility to make her own decisions and interact with her doctor, midwife and nurse about those decisions. Once the decision is made, it is my job to support my client. I am not her voice, I am her support. It is just as paternalistic for me to tell my client that I know what the best decision is for her as it is for any doctor to do the same.
I would encourage any doula to read this article in the New York Times. Here is the meat of the story:
At first, Ms. Myers, now a 36-year-old mother of two in Glencoe, Ill., was thrilled with her doula, who doubled as a prenatal massage therapist. “She was earthy yet grounded, and really knowledgeable,” she said.
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.
Then “she urged my husband and me to take a shower to ease the pain,” Ms. Myers said. “I told her I didn’t want to, but she was adamant.”
Dripping wet, freezing and in bone-shattering pain, Ms. Myers said she seethed in silence. 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.
Do you think Ms. Myers wants to work with a doula again? How about her OB or her nurse? How do you think they treated the next client with a doula who came to them? What about the myriad of people who have read this article in the New York Times? The professional reputation of all of us has been damaged by this one overzealous woman, and it will probably take thousands of positive interactions to make up for the damage done. Not only that, but there are more doulas out there just like the one described here. I know them.
Activism has it’s place. I think that as doulas, we should be involved in birth activism — we need to focus on changing the laws in our areas to favor women and their access to birth choices. We need to build relationships with doctors so that they can see that we offer a valuable service and enable more women have access to doulas. If we witness our client being assaulted, we should call 911 at that moment and report it, or at the very least encourage our client to do so. These are the kinds of things that effect actual change. However, when it comes to medical decisions and care in one specific case, it is not our responsibility or within our scope of practice to make them for our clients. I believe if we focus on empowerment and education, we will be more successful in our attempts to expand access to the myriad of birth choices we want our clients to have, then when we speak with vitriol and act with superiority.