intensely trivial

The doula dilemma

It’s hard for me to believe I’ve been serving women at birth for five years now. I’ve witnessed the births of 60-some babies. About a month ago, I learned how to encapsulate placentas and am really excited to offer that to families. Then a midwifery apprenticeship came to me, which was like getting engaged! (It hasn’t started yet, but it’s a for-real act of providence.) And then last week I took a CAPPA training to become a childbirth educator. So I feel like I’ve glimpsed the gamut of birth work.
Meanwhile, though, at least for the next few months, I’m just a doula. As I continue to serve, mostly in the hospital, I see the doula role with different lenses. Serving is great. Doula work is sacred work and drudgery and blissful worship all at once. But I’ll be honest, a doula who cares passionately about women and babies and birth, all three, is in an untenable position, especially in the hospital. Today it happens to be ripping my heart in two. Doulas are expected to support women, partners, doctors, nurses, babies — everyone! — without having a personal opinion.
Here’s a sample situation. As you may know, I really care about leaving the umbilical cord alone till the baby has received all the blood that belongs to it. I now know a lot about that topic. Some of my clients see the sense in not clamping the cord immediately; they read research and find good articles to share with their doctors. They work hard to get the OB’s word that s/he won’t clamp the cord immediately. But immediately after the baby has been born, the doctor might flat-out lie to the mom: “The cord has stopped pulsating.” S/he will reach for the clamps and the scissors, and voila! Baby is separated from his placental transfusion, aren’t we efficient. The doula, meanwhile, has to bite her tongue, keep from grabbing the instruments out of the doctor’s hand, and not let the mom know that the baby just missed out on 30% of his blood volume, because that might make her question her doctor or her birth experience.
Or, in another variation on that scenario, the dad might not be at the birth. So out comes the baby, doctor catches, reaches for the clamps and scissors in one swift motion, clamps the cord, and then asks the doula, “Do you want to cut the cord?” The doula thinks, “Hell, no!” But it’s already been clamped, there’s no turning back, and the mom says, “Yes, go ahead!” So the doula is party to an amputation that she doesn’t believe in. And she has to smile, be all zen, and not make waves.
Not that I’ve ever been in those exact situations.
The doula might make waves by virtue of radically supporting families to have their own voice, but she can’t appear to have changed anything much at all or she has stepped out of her scope of practice. In fact, she really isn’t supposed to go about trying to change anything, even though the way things are currently is a human-rights failure.
So yeah. Basically, I care a lot about women and children. (And you know, I have found in my Bible reading this year so far that Jesus really cared about women and children, too, so I think I’m on the right track.) But I feel like my hands are tied most of the time. I’m enabling disempowerment.
And that is why at this moment I cannot sign anything to pledge my allegiance to the well-known doula or childbirth-educator organizations. And that is why I cannot be a doula forever, at least the way it is currently defined.


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  1. * Sandie Anderson says:

    You are growing as you learn! Yeah for your growing confidence and knowledge. You rock, Rachel.

    Posted 6 years, 3 months ago
  2. * Keely says:

    Loved seeing you yesterday at work, it was beautiful!! Also an eye opener as why it is safer for babies to be in the hospital for birth:)

    Posted 6 years, 3 months ago
  3. Keely — Yes, it was really fun to be at a birth with you — it’s been a long time!! I too was glad for that particular family to be in the hospital. All the midwives I know would have transferred in that case.

    Posted 6 years, 3 months ago

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