January 12, 2016

Defending The Doula

A few nights ago, I was quietly lying in bed reading when I stumbled upon the article, “More Doulas Can Help Lower the Cost of Childbirth.  There’s Just One Problem,” by Elissa Strauss on Slate.com.  I was intrigued and excited that an article supporting the usage of a doula was in a main stream magazine.  And then I read the piece.

The article starts off stating the financial benefits of having a doula, which is a major decrease in cost of birth.  A new report from Choices in Childbirth and Childbirth Connection has explained “doula care decreases the likelihood of C-sections and epidurals, which would save public and private insurers a lot of cash. According to their estimates, the reduction of C-sections alone could save Medicaid at least $646 million and private insurers around $1.73 billion annually.”  These are HUGE numbers that can make an impact on medical costs.  Cesarean section, the most common operating room procedure in the country cost approximately 40% more then a vaginal birth. Choices in Childbirth and Childbirth Connection also suggest that Congress mandate doula services for Medicaid patients and encourages private insurers to reimburse for doula cost.1  This is as far as the article goes in supporting the usage of a doula.

Ms. Strauss seems to have formed a very narrow opinion on the value of continuous labor support.  She appears to hold contention that doulas are not standardized, believes doulas only support natural childbirth and demonize the usage of epidurals and doulas have their own agenda.  If this is the public image doulas carry, it is vital to correct this misinformation so those that are considering seeking doula support do not miss the opportunity to have a valuable advocate.

Let’s start out with what a doula is, and what her boundaries and responsibilities are.  Labor support doulas are  women who are trained to offer physical, emotional and informational support.  Her role is to unbiasedly support the wishes and desires of the laboring mothering and help bring to fruition the mother’s vision of her birth.  The doula does not perform medical examinations or give medical advise.  However, the doula can offer evidence based material so the mother can make an educated decision.  The doula does NOT make decisions for the mother.  It is extremely important for the doula to respect the mother’s birth intentions regardless of her own birth preferences.

Do many doulas believe in natural birth?  Yes, in general, I would say so.    Most people involved in the birth world, doulas, midwives and other holistic practitioners, subscribe to the idea that pregnancy and birth is a natural, physiological process that should be inherently trusted. But that is not in anyway a reflection of how they perceive those who use pain medication.  As a doula, I have had clients that plan to take an epidural once in active labor.  I have also had clients who planned to go without medication, but realized it was best for them to get rest and relax before pushing.  When teaching prenatal yoga classes, prenatal yoga teacher training and childbirth education, I am extremely careful not to demonize the usage of pain medication.  I offer the pros and cons to the epidurals and leave it for the mother to make her own decision.

For those who seek the support of a doula, it is often because they desire to birth naturally or reduce their chance for unnecessary interventions. Likely these women are birthing in a hospital with the traditional medical model, which emphasizes the pathological potential to pregnancy and birth.  Having the continuous support of someone who can help navigate the hospital system and offer different assistance then their partners, is appealing to many women.

As for the lack of standardization, Ms. Strauss is correct about this.  There are several organizations who certify doulas.  Having been certified and recertified several times through DONA (Doulas Of North America), I can tell you first hand this organization takes the certification process and the criteria to use the DONA name very seriously.  Not everyone may choose to become certified, but it is up to the individual mother and partner to agree to work with an uncertified doula.  Ultimately, it is up to the couple to meet and interview the different doulas to find the best match.

Sadly, it appears the author’s bias against natural childbirth and those who seek it or support it, outweighs the importance of  lowering medical costs and decreasing our countries staggering cesarean section rate.  It appears Ms. Strauss is advocating more for her personal agenda then the greater good of pregnant and birthing women.


  1. Slate.com

The Cost of Having a Baby

Childbirth Connection

Very special thank you to Carmen Oates, Doula for the beautiful picture!




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