Debunking the Difficult Doula

Debunking the Difficult Doula

I have just finished reading ‘And the Doula Makes Four’, an article on doulas and lactation consultants in last week’s New York Times. The article certainly does not paint a pretty picture of either vocation.

In any field there is a range of professionals and an equally wide range of beliefs and practices to which they adhere. Yes, there are some doulas who will not work with women who intend to use drugs. And there are others (myself included) who just want the mother to have the best birth experience possible, however SHE wants. Just as some doctors do not believe in natural birth, some doulas do not believe in medicated birth. Hopefully, the mother-to-be will select a doula whose philosophy is aligned with her own just as she would choose a doctor who will aid her delivery with respect to her preferences.

The examples given in the article of combative relationships between doulas and hospital staff seemed to be based on those doulas acting outside of the appropriate realm of a certified labor support doula. In my experience as a doula, I feel I go out of my way to stay friendly with the hospital staff. I think that most of my colleagues do, as well. The doula is hired to provide emotional and physical support as well as to be an advocate for the parents – not to be a source of tension and stress. A doula can, often times, help to avoid unnecessary routine interventions, but it is clearly against the DONA (Doula Organization of North America) guidelines to offer medical advice or to perform clinical or medical tasks. My personal practice is to offer my clients the best of my knowledge and inform them of the pros and cons of the options which are presented to them, as well as additional options, but never to make a decision for them. In fact, if I suspect that not all of the information is being offered openly and clearly explained, I will encourage the parents to ask for more details. And of course, I refer back to my “three questions”: Is the mother ok? Is the baby ok? May we have more time?

It is unfortunate that some doulas are causing strife for the parents and the hospital staff, establishing a negative stereotype of the “pushy doula”, especially as there have been numerous studies and research proving that the presence of a labor support doula helps to lower cesarean sections and routine intervention as well as adds to the mother’s satisfaction of her birth experience.

To date I have attended about 60 births, and only once was a doctor outwardly hostile to me. With this one exception, I got the sense that they welcomed my presence, as long as I didn’t try to impose on their practice. The nursing staff often seems relieved when I arrive. They are usually overburdened by the number of patients to care for, and my being there helps free them of some of the non-medical work. Furthermore, I find that my observations of and relationships with doctors and nurses have nurtured my practice as a doula. I have actually learned many useful techniques and ideas from watching and listening and learning from their experience.

For those on the fence about hiring a doula, I hope that Ms. Paul’s article has not made you decide against one. Please consider the encouraging stories as well, and look at all of the supportive research demonstrating the potential positive effects of having a labor support doula present. And please, PLEASE, PLEASE: Interview your doula and your doctor to make sure that you are assembling the best, most supportive team to possible for YOUR birth experience.

Here are some more research sources supporting the presence of continuous labor support:

Continuous Support for Women During Childbirth, new Cochrane Review through the Childbirth Connection (Formerly Maternity Center Association), July 2003

Listening to Mothers: Report of the First National U.S. Survey of Women’s Childbearing Experiences,Childbirth Connection
(Formerly Maternity Center Association), October 24, 2002

Caregiver Support for Women During Childbirth: Does the Presence of a Labor-Support Person Affect Maternal-Child Outcomes?, American Family Physician, October 1, 2002

Lying in, Canadian Medical Association Journal, September 17, 2002

Care of Women in U.S. Hospitals, 2000, Agency for Healthcare Research and Quality
, October 2002

  • Caitlin
    Posted at 14:54h, 11 March

    Deb – I wanted to follow-up your point about finding a midwife or doctor who shares your philosophy. As you have touched upon in a previous post about home birth, I think the third ingredient is finding the right birthing environment. Those of us in the NYC area are lucky to have a variety of options and I waned to share my first-hand experience touring the labor and delivery wards of St. Luke’s-Roosevelt, since it is very doula friendly.

    The early evening tour at St. Lukes begins with some juice, crackers, cheese and cookies in a lecture room. A staff member of the Parent / Family Education Programs reviews the different birthing options (regular labor and delivery and the Birthing Center), education classes, the registration process, and statistics regarding number of births per day, epidural and c-section rates – while fielding questions from the audience. When someone asked about doula support, our guide indicated that the hospital was very supportive of doula-assisted labor and encouraged women to consider it (“if anyone is interested, I have a list in my office”). After touring a labor and delivery room, the Birthing Center and a postpartum room, a dozen or so woman and their partners swarmed the guide’s office to collect more information about doulas.

  • Ellyn
    Posted at 11:19h, 06 May

    Hi Deb,

    I just wanted to add that we had the greatest birth experience with you as my doula. Its 4 1/2 years later, and I will always be greatful that you were there with us – supportive, relaxing! and helpful to all of us through the whole process. I can’t believe you have now been through 60 births. What a lucky group of families we are.


  • Deb
    Posted at 13:33h, 06 May

    Hey Ellyn

    So good to hear from you! It was truly my pleasure to be part of your birth. I can’t believe that Abigail is 4 1/2 years old! I remember so much of your birth with such clarity and detail. It was only my third birth, so it was very much a learning experience for me.

    Thank you so much for trusting and offering a rookie doula the opportunity to be part of your birth story.

    Be well,


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