intensely trivial



My response to the Today Show’s segment on doulas

Till now, I have avoided posting about doula and birth stuff on here. There’s been a lot going on in other areas of my brain, and frankly, I don’t want to offend too many people, because, for some reason, strong opinions about birth pierce to the deepest emotional depths of many women. I, being afraid to hurt anyone or go lower in anyone’s estimation of me, chose for a time not to go there. However, I knew there would be a catalyst for talking about this stuff someday, and yesterday I got it.
The Today Show had a segment on doulas. If you missed it and want to see it, feel free to do a search for it online. Doulas everywhere were looking forward to the media attention. But, as so often happens with “media attention,” it presented an overall negative perspective on doulas. Earlier in the show, Matt Lauer led up to the segment with a question something like this: “Doulas: Are they safe?” (What?! I can see how a bad doula would lead to a woman’s making bad decisions for herself and her baby, but I think a much better question would be “Pitocin: Is it safe?” I could do a whole post on that, based on my research and my observation of its use at birth. You could ask the same question about OBs, nurses’ practices, forceps, cesareans, epidurals, and on and on. *Big breath* I’m going to have a hard time not going off on a huge, livid rant. Must. stay. on. topic.)
The segment had interviews with a doctor sitting on the show, a mother who had hired a doula, a doula, and an OB in a hospital room with a labor patient lying in bed on a monitor. Here were the positives, from a doula’s point of view:
1. The woman who had hired a doula twice was very happy with the doula’s contribution to the birth experience. You could see this mother glowing as she talked about her second birth, which took place at home and was obviously a very positive experience.
2. They had actually interviewed a doula.
3. The doctor speaking with Meredith Vieira didn’t lie about a doula’s role in the birth. She said it’s the doula’s role to emotionally support the woman, which is true, and that the doula doesn’t perform medical procedures, which is also true.
And on the other hand:
1. The doctor on the live show, while telling the facts, omitted mentioning any of the well documented benefits of using a doula. Her body language and facial expressions were clearly disapproving of doulas. She called doulas a luxury (which I can understand but have some arguments about, too), and she said unequivocally that doulas are not covered by insurance. Sorry, I know some people whose insurance covered their doula, and I could give you a list of insurance companies who have covered doulas. There needs to be some action to convince insurance companies to cover them.
Here in Manhattan, Kansas, it costs $350 to hire me to support you prenatally, during the entire birth, and postpartum. Do you know how much an epidural, a cesarean, or an extra day in the hospital costs? A whole lot more than that. If insurance companies looked at the documented benefits of doulas, they would be covering the costs of using them. It makes all the sense in the world.

(And while we’re on costs, I want to say that if you really want a doula to attend your birth, just ask. Most doulas I know are ideologically committed enough that we’re willing to do it for less, for barter, or even for free, if that’s what you need.)

2. The doula interviewed briefly ended up looking flaky and flighty. If you only show a doula with her massage oils, massage tool, and iPod, of course she’s going to come across as a flower child with her head in the clouds, and our society doesn’t give those kinds of people much of a break. I can tell you she had a whole lot more in her doula bag than those three things. No, she didn’t have a speculum or a doppler — that’s the doctor or nurse’s job. She probably uses her voice and her hands a whole lot more than she uses her oils and music. But just because the tools of a doula’s trade are alternative doesn’t mean they are ridiculous.
3. The OB in the hospital was proud of the fact that her hospital had banned doulas. Frankly, she exhibited a paternalistic attitude that to me seemed demeaning. She said the nurse’s and the doctor’s decisions take priority over the woman’s, and I have some serious problems with that. A patient has a right to refuse any kind of treatment (not that I think she necessarily should). Also, I have to tell you honestly that I have never been shown anything but respect, and, at the least, tolerance by doctors and nurses. Many ask me for advice in how to make patients comfortable (and I am not that experienced — they just ask — apparently they think they could learn something from me). I make a point of working *with* the doctor and the nurses. It doesn’t mean I agree with all they do, but I really think a doula with her head on straight knows that inflaming a birth situation is counterproductive to everyone, especially the mother.

Additionally, like many other doulas, I am certified by DONA International, and as part of that certification, I agree to adhere to DONA’s standards of practice for doulas. This includes *not* speaking for my client or making decisions for her. It also includes collaborating with medical personnel, not preempting them.

4. There were also negative messages about doulas because of the way the segment was filmed. For example, the narrator’s voice was saying, “It’s that role (as advocate) that can sometimes land a less-than-savvy doula in hot water with hospital medical personnel,” and the camera was showing a row of babies in bassinets, factory-style (against American Academy of Pediatrics recommendations, by the way), and landing on a shot of a baby’s foot with a bandaid on it — as though the doula’s involvement had resulted in a baby’s isolation in a plastic bassinet with a wounded foot. Um, no. That is hospital standard operating procedure, to stick the baby’s foot and put them in a plastic box; it’s not what a doula would advocate.
I realize I am a luxury of sorts, and increasingly so with the economic downturn. Babies will come out without my help, and mothers will survive, too. I’m a doula because I believe women should be given the space to make their own informed decisions about birth. I believe women’s bodies are wonderfully designed to give birth to babies. I believe women and babies should be treated with respect, and I want to stand with families so they are treated that way in this transformative experience. If you know me, you know I’m not going to try to create conflict in the birthing room. You know I want babies and mothers to be safe. I’m not in favor of craziness that endangers anyone.
The question Matt Lauer asked was “are doulas safe?” To answer that, we need to look at whether outcomes are better with or without doulas. If you’re the type of person to need scientific proof, let me leave you with some numbers published in the Journal of the American Medical Association (AMA). With no doula, the cesarean section rate for this particular study was 18%; with a doula, 8%. The number of births with the aid of forceps without a doula was 26.3%; with doula, 8.2%. Use of pitocin without a doula was 43.6%; with a doula, 17%. Use of epidurals without a doula was 55.3%; with a doula, 7.8%. Incidence of fever in the mother without a doula was 10.3%; with a doula, 1.4%. Number of sick newborns without a doula was 24%; with a doula, 10.4%. Studies have also shown superior outcomes with postpartum adjustment, improved breastfeeding rates and duration, and decreased incidence of postpartum depression. Are doulas safe? Maybe we should be asking a different question.

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Comments

  1. * carmen says:

    How to respond? So many thoughts…I’m thankful you wrote this post…I am thankful for your work as a doula…and I have a hearty appetite for thought-provoking, “main-stream challenging” discussions with you. 🙂

    Posted 8 years, 9 months ago
  2. * t'ilia says:

    Please send these comments to the Today Show! You have clearly and concisely illustrated the benefits of doulas AND demonstrated their bias. Actually, I think these comments should be forwarded to every licensed obstetrician in the US.

    Posted 8 years, 9 months ago
  3. * clbeyer says:

    Yes, I agree with t’ilia: let your response be heard!

    I spoke to a nurse who said she had attended the birth of one of your (unnamed) clients, and she told me how wonderful it was to have you there. She had never worked with a doula before, and she said it made such a difference!

    Posted 8 years, 9 months ago
  4. Great post! I will have to look up that interview now. 🙂

    Posted 8 years, 9 months ago
  5. * margarete says:

    One grandmother’s comment was: “[manhattandoula] rules at my daughter’s house!”

    Posted 8 years, 9 months ago
  6. * laura says:

    Amen, sister! You’re so awesome.

    Posted 8 years, 9 months ago


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