“From a nursing standpoint, too many crossed a line and interfered with my job,� said Sarah Baxter, a registered nurse and director of labor and delivery at Reston.

And how many times has she needlessly interfered with a delivery?

I'm glad you posted about this, Miriam. I posted about the article this weekend, and Paul responded directly in the comments on LGM. I was surprised to see her there, and, truthfully, didn't really feel like her comments addressed my complaints, other than to say that some people have bad experiences with doulas too. Here's the link: http://lefarkins.blogspot.com/2008/03/times-as-propaganda-machine.html

So there should be no negative stories ever about doulas?

Seems to me that all the story does is show that doulas can be just as arrogant and controlling as the stereotype around here of the patriarchal doctor.

Why do some people continue to insist that all "natural" providers are automatically competent and empowering? The story serves as a useful corrective for the simplistic and destructive "alternative providers = good, doctors = bad" attitude around some circles.

Perhaps someday, we may even stop shaming women who choose to get an epidural. (I'm not holding my breath on that one though.)

Apologies for the double post but...

What is more shocking and infuriating than the initial story, is the doula quoted in the middle, who views "natural" childbirth as a political agenda, and cares more about her own agenda than she cares about the patients.

"I choose to work with women who are striving for a natural birth because that’s where my passion and training lies."

Imagine a doctor or pharmacist turning away people wanting the Pill because their "passion and training" lies with abstinence.

For these doulas, childbirth isn't about the mother. It is about the doula.

WOW that link fucked up my computer bigtime. I had to turn it off and on 3 times before it started to act normally. Guess someone'll just have to paraphrase it for me.

Actually, never mind, I'm not having children.

Imagine a doctor or pharmacist turning away people wanting the Pill because their "passion and training" lies with abstinence.

Uh. Yeah. Imagine that.

ForbiddenComma, with Miriam now a permanent part of Feministing, you might have to get used to seeing pro-midwife and pro-doula posts on a regular basis. I don't understand why you take these posts so personally. It is a simple fact that midwives have less representation in our culture through mass media than the conventional medical community. It is much easier for someone to read an unfavorable article about a doctor and compare that to their firsthand experience and come out with the understanding that not all doctors (or even most) are the way the article depicts them. With midwives and doulas, the only exposure some people have are articles like this one, so it disadvantages them quite a bit more than the so-called anti-medical establishment that you feel so attacked by.

I love my OB-GYN. LOVE her. But being such a woman-positive doctor, she would want me to be well-informed about all my options, and that includes finding out about midwives. And not giving all my attention to urban legends about midwives who cause pregnant women's uteri to burst and die.

If you want people to trust doctors, the best thing you can do is to become a good doctor. I'm sure that you're going to be a great one. But all the ranting about how Miriam and others are sooooo biased isn't helping your case.

This is kind of off topic, but related...

How does one become a doula? I am really interested in learning more, and perhaps becoming one. Can anyone point me in the right derection?

"'I choose to work with women who are striving for a natural birth because that’s where my passion and training lies.'

"Imagine a doctor or pharmacist turning away people wanting the Pill because their 'passion and training' lies with abstinence."

Passion is one thing, training another. If she doesn't have the training for medicated childbirth, isn't it better for her to say so than to let a patient think she does have that training until it's too late?

ForbiddenComma, with Miriam now a permanent part of Feministing, you might have to get used to seeing pro-midwife and pro-doula posts on a regular basis. I don't understand why you take these posts so personally. It is a simple fact that midwives have less representation in our culture through mass media than the conventional medical community.

But implicit or explicit in many of these pro-midwife, pro-doula etc. posts is a slam of the medical profession, as if pursuing alternative medicine suddenly makes one pro-woman and pursuing an M.D. automatically makes you one with the patriarchy.

If you didn't like my "exploding uterus" story, understand that it was merely there to contrast all the "evil OB" anecdotes that invariably follow one of Miriam's posts. The medical establishment is full of problems, but that doesn't mean that alternative providers fart rainbows.

Passion is one thing, training another. If she doesn't have the training for medicated childbirth, isn't it better for her to say so than to let a patient think she does have that training until it's too late?

Nobody is asking her to actually perform the epidural. But refusing to even allow her patients to receive an epidural from another provider (via shaming, dismissing them, whatever) does not exactly reek of empowerment. Hence my comparison to those wonderful pharmacists who refuse to fill birth control prescriptions.

I can only speak from my personal birth experience...but man, I wish I'd had a doula. I was so intimidated by the midwife that I agreed to have pitocin, even though I was only an hour after my water broke and still had PLENTY of time to labor naturally before it was a concern. After it was administered, the nurse said "hang on to your hat, honey, you may want to rethink that epidural" and BAM hard, fast, painful contractions with no space to recover. I did not have the epi, I did accept IV drugs, the birth went great, my son is beautiful...but I heard the nurses laughing that this midwife liked all the women under her charge to be done delivering before her shift was over, and that she must have stock in pitocin or something. I felt completely manipulated.
I wish there'd been someone there for me to help me make that decision, or at least to be someone I could bounce ideas off of. Instead I was bullied into taking drugs I didn't want.

Women who seek out doulas tend to prefer as natural a childbirth experience as possible. Doulas tend to prefer to help women achieve as natural a childbirth experience as possible. It's not that complicated; it actually works pretty well. For both women who choose doulas and doulas who help women the goal is to make a choice they see as preferable possible. I don't see what the problem is with that.

I'm sure there are doulas out there who aren't particularly interested in helping women make informed choices and achieve the birth experience they feel is best for them (and supporting them if they change their minds about what's best for them). But the women I know who have had doulas present during delivery, even at very medicalized deliveries, have had overwhelmingly positive experiences in which the doula was a tremendous support and advocate for their wishes. So I wouldn't be so quick to write that off.

Nobody is asking her to actually perform the epidural. But refusing to even allow her patients to receive an epidural from another provider (via shaming, dismissing them, whatever) does not exactly reek of empowerment. Hence my comparison to those wonderful pharmacists who refuse to fill birth control prescriptions.

I don't think the pharmacist comparison is a valid one. This doula is up-front about her preferences, and she turns clients away when they tell her they're seeking medicated childbirth. As a massage therapist, I do the same kind of thing. I prefer to work with clients who are seeking long-term healthy lifestyle changes. If someone comes to me wanting sports massage, I refer them to another therapist who specializes in that area. This doula takes the exact same approach and refers those clients to other doulas. Should every health care provider be forced to take on every client who seeks them out?

Furthermore, since we have no idea what this doula's approach is when one of her clients ends up requesting an epidural, I don't think it's fair to accuse her of "shaming" or "dismissing" anyone.

from the DONA website:

"Doulas specialize in non-medical skills and do not perform clinical tasks, such as vaginal exams or fetal heart rate monitoring. Doulas do not diagnose medical conditions, offer second opinions, or give medical advice. Most importantly, doulas do not make decisions for their clients; they do not project their own values and goals onto the laboring woman."

Just a thought here.

Part of the problem doctors and nurses have with doulas -- or a lot of other alternative medicines -- is that they have little evidence of real effectiveness. That's why we do double blind trials for drugs.

Accupressure? SHow me it works on someone who doesn't believe in it and doesn't know that's what they are getting. Then you have me. Before that happens, you have all the credibility of faith healing. It isn't fair. But think of all the medicines you take for granted that keep birthing mothers alive in hundreds of situations where they used to die. With doulas in attendance, or midwives, I might add.

Think of it: 100 years ago living through childbirth was a chancy proposition. Now it isn't. Doulas can't help you one whit if there are the slightest complications. They just can't.

Does everything OBGYNs do turn to gold? No. But a woman is a lot more likely to live with one of them in the room than a doula, if anything goes wrong.

I get on about this because of my own personal experience -- my mother would have been stone dead if my sister had been born 20 years earlier. Alternative, "traditional" medicine had no part in saving her life.

Maybe the reason hospitals aren't welcoming is that doulas haven't proven their worth in serious situations. And the burden is on them to prove themselves in this situation. Again., it's not fair. But that's how it is.

I think a lot of what gets done in a hospital can be done at home-- there's no reason for being any more invasive than necessary.

But point me to a national organization that checks out people who say they are doulas and I'll shut up. There doesn't seem to be one that even ensures minimal standards. So I can say "I'm a doula" and go out and treat women right now. That's scary, not empowering.

I am in agreement with forbiddencomma and jess. I would have more trust in doulas if some of miriam's posts and alot of the commenters did not start the traditional-medicine-is-an-evil-part-of-the-patriarchy meme...

I'm currently considering becoming a doula, and from what I have learned so far, doulas don't "treat" patients. They're there as an advocate FOR the mother, to help and support and encourage her. They're not there to save her life or perform any medical procedure. They're there to be a voice for the mother when she is vulnerable in labor, and to make sure the mother's, not the doula's, desires get met as much as possible. They also suggest breathing techniques and positions, and can help the mother move around the way the mother wants to. It's not about saying doctors are bad; no one's saying replace ob/gyns with doulas, but if doulas help mothers feel better, this helps mothers birth better, and there is a role for doulas in the hospital labor and delivery room. They also frequently attend home births because they are still the only person who is supposed to be totally focused on the mother and attend to her varied non-medical needs, like bringing her water, food, massaging her, giving her encouragement, etc, since the midwife is focused on the medical aspect and the partner is having his or her own experience that needs to be respected too. This demonstrates that the doula movement is not about anti-western medicine sentiments or beliefs, but about the fact that laboring women and their partners and families have many different types of needs and doulas can help to meet some of the non-medical ones.
There was a study done by Kaiser that found less epidural use and a more favorable perception of their birth in women who were provided a doula. A link to this study is here:
http://www.greenjournal.org/cgi/content/abstract/93/3/422

Thanks Icha for that interesting information. I think Jess summed up my position very well since I would categories myself as very pro-science. However perhaps the doula profession has been tarred by the alternative medicine brush in my mind a bit too much. It sounds like the sort of thing I want my partner to do but I can see merit in the idea of having someone professional take on that role.

Categorise is of course what I mean not categories, sorry.

"I'm currently considering becoming a doula, and from what I have learned so far, doulas don't 'treat' patients. They're there as an advocate FOR the mother, to help and support and encourage her."

OK, I got it now, thanks! :)

As for a doula not wanting to be a patient advocate at medicated births, maybe that's just another degree of specialization? It seems to be just one step further than wanting to be a doula instead of a patient advocate for patients who are doing something else instead of giving birth...

Icha--

one question. Is there anything or anyone to stop you from just declaring yourself a doula, walking out and offering your services, with no oversight whatever? If the answer is no, then we have a serious problem.

Even non medical professionals have to prove they have some knowledge of the subject at hand. I got my first responder card which at least proved I took the course, but it has long since expired and I would never, ever, claim that I knew what I was doing in a bad situation.

I understand that doulas aren't treating patients per se, but minus any kind of checking system where you have to show that you know something I have to treat it as new-age fuzzy thinking, I am sorry.

Doulas are not evil, but the best-meaning people in the world don't magically get knowledge because they care about women.

I'd be a heck of a lot more comfortable if someone who says they are a doula can show me some evidence that they have at least minimal knowledge of something.

The doulas mentioned in the article acted in unprofessional ways, yes. The purpose of a doula is to act as an advocate for a woman who wants a more natural birth. They are great if a woman wants to have a natural birth in a hospital, which is an environment that is not necessarily designed for a natural childbirth. Ideally, a woman and her doula will discuss all the possibilities before labor begins so that there does not come a point when the doula and the mother disagree.

There are people who have horror stories about every single profession--I could, with minimal journalistic exertion, write a fluff piece about the horrors of florists, trash collectors, housepainters, or gas station cashiers. That is the nature of life--you won't like, agree with, or work well with everyone you come across. Saying that the fact that some doulas don't work well with some women means that all doulas are bad is a flawed conclusion.

I wonder if the people who are gung-ho for hospital births, and the medical model of childbearing have read the statistics about birth in America. We're not doing so well compared to other industrialized nations in terms of both infant and maternal mortality. It's not fair to compare the United States to third world countries--our infant and maternal mortality rates are a lot better because of antibiotics and sterile procedures, not because of Pitocin drips and Cesarean sections. Once you compare the United States to industrialized nations, you'll see that we're not very high on the list, despite our heavy reliance on medical measures.

Medical procedures and drugs are not 100% safe. Many of them lead to further problems which must be treated with another procedure or another drug. Citing an anecdote about one life purportedly saved by modern medicine doesn't negate the dangers of applying medical interventions when they aren't needed.

To raise another point, with no intention of distracting from the main discussion:

I was actually very bothered by the first line of the article: "LIKE any other conscientious, organic-fruit-buying expectant mother, Pamela Myers knew what she wanted from her childbirth experience. "

Not every conscientous person who buys organic fruit wants a doula. Likewise, not everyone who considers a more natural birth is necessarily an "Earth Mother"-type. This sentence needlessly stereotypes women and, to me, belittles those who choose a doula, making it seem as if they are all flower power post-Hippies.

Maybe I'm being petty, but a large part of the fear/rejection of doulas comes from unfair stereotypes of them and those who employ them.

Ok, back to the real issues...

Hi there everyone--

A couple of thoughts. And thanks to everyone for their interest and thoughts on this.

1)To clarify not ALL doulas would turn a woman away if she wanted to have an epidural (or other intervention) during her birth. I would say from my experience, MOST doulas would not. The problem with the article is that it uses a few stories and tries to generalize them.

2) In response to Jess, the issue of research is actually a huge problem for maternity care in general, because they can't do studies on pregnant and birthing women for ethical reasons. So instead most of maternity science is based on trial and error and looking over data from what has already happened. It's a huge problem because OBs don't even know the effectiveness or risks involved with medicines frequently used in childbirth, and women have suffered from this in the past.(http://radicaldoula.com/2008/01/23/more-studies-to-scare-pregnant-women/)

3) Lastly, if you want information about how to become a doula, go to www.dona.org and find a training near you! I highly recommend it :)

Miriam

We had a doula with the birth of our second child. She was wonderful. While I set out to have a natural childbirth, I ended up needing a few interventions. Our doula recognized those interventions were necessary, and in fact, reassured me that it was the best thing for me and my baby at that moment.

My husband loved having a doula with us. We were left alone in the room for long periods during my labor. She was able to be back-up support for him, as much as me. She made a comment in our initial meetings about how we now expect fathers/partners to be a mother's birth coach, but it really puts a burden on them. Having her there, someone who has seen births and knows what's going on, took some of the pressure off of him, and allowed him to do what he does best - loving me.

The problem isn't that doulas advocate (ideally a good thing.) The problem is WHAT they advocate. And the other problem is also what they advise.

Doctors don't often like doulas, because they are insanely undertrained in comparison to the effect that they can have on the mother.

It's a catch-22: if the doula just agrees with the recommendations of the OB, then one might reasonably ask what their role is: perhaps just to provide comforta care? That's a useful role, to be sure, though rarely is that all a doula does.

But once the doula starts having an opinion on or disagreeing with the care providers (be they OBs, CNMs, or midwives) or once the doula starts advising the mother, you've got a problem. Because who the hell are they to have an opinion? It's a problems because doulas are very undertrained in that field, and are often possessed of beliefs which are simply false. If you want to be involved in the medical decision-making process, you should be (1) the patient, or (2) qualified. Doulas are neither.

kissmypineapple: There is a lot of debate about whether or not the home birth movement is good for women/feminist, or badfor women/nonfeminist.

It provides choice (good) but also tends to provide false information (bad). It provides freedom (good) but is riskier, often in a hidden manner (bad.) It empowers some women to reject drugs and certain medical procedures that they would otherwise feel obliged to take (good) but it shames women who freely choose to use them (bad) and so on.

None of the other posts on feministing demand strict adherence to their philosophy; do you have some reason to suggest that these posts should be different?

A few thoughts ... please keep in mind that the article and some of the comments got my doula-in-training-hackles up...

First off, I agree with Miriam's original post. It IS frustrating that a little known field got such unfair coverage as this article. There were no interviews with other doulas, women who had a positive experience with a doula, or doctors and OB nurses that support doulas (yes, they DO exist) or hospital based doula programs (yes, there are HOSPITALS that employ doulas!).

Secondly, a few of the commenters seem to think that doulas have or claim to have medical training. Unless they began their career in a medical field (there are many nurses who later become doulas), they don't. The doula's role is not medical. It is to provide continuous emotional and physical support throughout labor. This is important in hospital settings because nurses often change shifts, partners need naps, etc.

I've noticed a lot of language in the comments referring to "they," "these doulas," "they advocate," "they advise," and I am curious who has had first-hand experience with a doula in the labor room.

I agree with mathgoddess - there is no stereotype for moms who choose to have additional labor support. I also agree with Icha's post, and when I get home to my doula books, I will post info on some of the other studies.

First of all, I think a few too many people here are confusing doulas with midwives--educate yourself before you start making proclamations about what doulas do in the delivery room.

I don't know how many of you who are trash-talking doulas have been hospitalized recently, or had a loved one hospitalized, but as someone who has had a few too many trips to the hospital recently I'd like to point out that ANY patient-experience in a hospital requires an advocate this day and age. This isn't because hospitals are evil, or nurses are incompetant, or doctors are assholes, it's because nurses and nursing assitants and doctors are all extremely busy, overworked humans who aren't any more invested in you or your loved one than they are in the person one bed over. In their attempts to provide care for all their patients, sometimes they can overlook the needs and wants of the patient in front of them at the moment. As someone who went rushing off to find a nurse when my partner was crashing at 1 in the morning, I would never begrudge a patient an advocate. I recently had a friend of the family nearly bleed out after a really complicated delivery produced an infant that needed to be rushed off to the NICU and everyone was so focussed on saving the baby that they didn't realize that her bedsheets were soaked in blood. Having an advocate specifically there for the birth mother is absolutely a good thing--and we can't always expect that to be the partner. Unnecessary C-sections plummet dramatically when you have someone who can advocate for the mother and challenge the necessity of the procedure. I think a couple should absolutely bring up "what if a C-section" during the doula interview process to make sure that she won't obstruct one that's medically necessary, but again: Most doulas are there for the mother. They are going to advocate whatever will make her most comfortable, and that will sometimes involve explaining to her that the doctors need to perform a C-section.

And yeah, there are assholes out there who become doulas for their own self-aggrandisement. But I've never been about dismissing a job because there are a few assholes out there: because I seriously doubt that the per-capita asshole rate four doulas is anywhere near than the per-capita asshole rate for any other profession.

"But once the doula starts having an opinion on or disagreeing with the care providers (be they OBs, CNMs, or midwives) or once the doula starts advising the mother, you've got a problem. Because who the hell are they to have an opinion?"

And that right there is why I won't take into consideration anything you have to say on the subject. Who the hell are they? They are people. Who have a right to be there if a mom-to-be wants them there. If I am the pregnant woman, and not medically trained, I too have a right to an opinion about my birth. I find this elitist attitude disgusting.

Again, lots of the anti-doula folks continue to ignore the stories that people have been sharing on these posts about their negative hospital experiences, about how they felt manipulated, about how they wish they could have changed things. There is a need for doulas and some women will prefer them over OB/GYNs whether you like it or not. And like Jessica F. says, how can some here continue to compare the US rates with third world countries?

Actually, we're fairly high on the lists of statistics that measure our OB ability and treatment. Which statistic are you proposing to use that suggests we are not doing well?

I really don't see how most doulas can't be compatible with doctors. Even if a woman decides to do whatever the doctor advises medically and gets an epidural perhaps, can't she still benefit from the doula's support and alternative ideas? Miriam mentioned massage and vizualization in her post. How can those be bad? If the woman thinks what the doula does helps, go for it. There doesn't have to be a conflict with what the doctor recommends. I don't know why we seem afraid of trying things other than or in addition to traditional medicine.

Also, being a doula sounds like a tiring job. Just wondering, how many births a doula is present for in a typical week.

Doulas can't help you one whit if there are the slightest complications. They just can't.

Well, that's OK, because that's not what they're there to do. I've been trained as a doula (never completed the fieldwork) and at no point are we supposed to be helping with medical treatment. That's what midwives, nurses, and doctors are for. Doulas are there to advocate for the mother's birth plan, to provide massage, to physically support her in a variety of birthing positions, to make sure she has the music, food, drinks, lip balm she wants, to walk with her if that's what the midwife wants, to take the hair out of her face, to generally make the mother's life easier during birth and to make birth as comfortable an experience for her as possible. Doulas are there so that there is somebody with the mother at all times during labor and so that she has somebody there who is looking at her face rather than her vulva. It is not a medical position.

Is there anything or anyone to stop you from just declaring yourself a doula, walking out and offering your services, with no oversight whatever? If the answer is no, then we have a serious problem.

We don't, actually. There is nothing to stop anybody from just hanging out a shingle declaring her/himself to be a therapist and counseling patients, but that doesn't mean that the entire practice of talk therapy is useless or that all therapists must be seen as harmful charlatans. It means that when you see a therapist you should go by reputable referrals and check into her/his credentials. If you choose to have a doula, make sure she is a member in good standing of either DONA or ALACE.

Miriam,

Is there a reason you prefer DONA to ALACE? I'm just curious.

kat's and Mighty Ponygirl's posts are good examples of why doulas can be valuable in the hospital setting. They can help ease anxieties of the mother and life-partner to have someone present, just for them, who has been through the process several times before. To the extent a doula tries to alter considered medical interventions, that would be improper and potentially dangerous. But it doesn't hurt to have another set of experienced eyes around. Fetal monitor machines sometimes run out of paper, sometimes an ob nurse forgets to check the strip, sometimes something is happening to the mom when the nurse or midwife of OB isn't present. Sometimes the mom gets worried when something happens which is normal and ordinary but doesn't seem so to the mom.

Part of the problem doctors and nurses have with doulas -- or a lot of other alternative medicines -- is that they have little evidence of real effectiveness.

And yet, this doesn't seem to have stopped them performing episiotomies, inducing and augmenting a huge proportion of labours, performing routine vaginal examinations in pregnancy and in labour, encouraging or coercing women onto their backs, engaging in coached pushing, and having a C section rate of over 30% and rising. Why single out doulas as the "non evidence based intervention"?

Part of the problem doctors and nurses have with doulas -- or a lot of other alternative medicines -- is that they have little evidence of real effectiveness.

And yet, this doesn't seem to have stopped them performing episiotomies, inducing and augmenting a huge proportion of labours, performing routine vaginal examinations in pregnancy and in labour, encouraging or coercing women onto their backs, engaging in coached pushing, and having a C section rate of over 30% and rising. Why single out doulas as the "non evidence based intervention"?

EG--

I don't have a particular reason to prefer DONA to ALACE, I am just less familiar with ALACE. I have heard good things about both groups though. There are other alternative certification groups out there as well.

The more doulas the better I would say!

And just to add to the discussion about advocates in hospitals in general, I definitely agree that they are necessary. My brother had an emergency appendectomy last year and I was TOTALLY his doula. Hospitals are not places where people are comforted by anything other than medications (which numb rather than make you feel good) and supporting him, rubbing his back and trying to help him feel good made all the difference. It's not just about childbirth.

(If you want to read more about that particular experience, go here: http://radicaldoula.com/2007/04/17/pleasurepain/)

Miriam

EG--

I don't have a particular reason to prefer DONA to ALACE, I am just less familiar with ALACE. I have heard good things about both groups though. There are other alternative certification groups out there as well.

The more doulas the better I would say!

And just to add to the discussion about advocates in hospitals in general, I definitely agree that they are necessary. My brother had an emergency appendectomy last year and I was TOTALLY his doula. Hospitals are not places where people are comforted by anything other than medications (which numb rather than make you feel good) and supporting him, rubbing his back and trying to help him feel good made all the difference. It's not just about childbirth.

(If you want to read more about that particular experience, go here: http://radicaldoula.com/2007/04/17/pleasurepain/)

Miriam

I think the comments on this site illustrate the problems with the article.

If the article was about the importance of finding a good dentist (or lawyer or whatever) you can work with and included some horror stories about bad dentists, it wouldn't be such a problem because most people know what a dentist is and what her job is and have been to a dentist (or optomitrist, or florist, or lawyer, or whatever well known profession).

Doulas are new in this world. People aren't clear on what their job is. If you get outside NYC, you probably won't meet many people who had a doula.* I'm sure that for many people reading this article, it was the first time they'd ever heard of doulas. In this context, such a one sided article is inappropriate.

I live in DC, which according to Pamela Paul's website is a center of doula activity, and I have lots of natural-birth type friends. None of them have used a doula. The only person I know who had the assistance of a doula lives in NYC, and had a great experience.

I'm one of those people who believe that an obstetrician should be nearby for any birth, just in case of sudden complications. I also think my sister could have used a doula at her birth. She isn't terribly assertive, and would rather accept being made uncomfortable than 'making a fuss'. She needed a c-section-in fact, she needed a c-section a good 10 hours before she got one, since it was glaringly obvious that the baby was too big to come out the usual way, and the labour just wasn't progressing. Despite having my parents, both doctors, with her (once the mean nurse went off-shift, and the other nurse let her have parents and husband in the room (rule was two people), it took that nurse to finally say to the OB 'this is ridiculous-she's exhausted, and this just isn't working-she needs a c-section'. I'd like to think that a doula would have more 'proactive' in asking the doctor questions like 'Is it even possible for the baby to be delivered vaginally?'

Because that's what doulas do-they make sure the doctor pays as much attention to the mother as the incipient baby. Doulas don't disagree with doctors, they back the woman up when she disagrees. I can see how an assertive patient or patient advocate would annoy some doctors, with the questions, and the asking 'why'. But if the patient lacks the medical literacy to ask why, someone needs to be there to do it for her.

I'm one of those people who believe that an obstetrician should be nearby for any birth, just in case of sudden complications. I also think my sister could have used a doula at her birth. She isn't terribly assertive, and would rather accept being made uncomfortable than 'making a fuss'. She needed a c-section-in fact, she needed a c-section a good 10 hours before she got one, since it was glaringly obvious that the baby was too big to come out the usual way, and the labour just wasn't progressing. Despite having my parents, both doctors, with her (once the mean nurse went off-shift, and the other nurse let her have parents and husband in the room (rule was two people), it took that nurse to finally say to the OB 'this is ridiculous-she's exhausted, and this just isn't working-she needs a c-section'. I'd like to think that a doula would have more 'proactive' in asking the doctor questions like 'Is it even possible for the baby to be delivered vaginally?'

Because that's what doulas do-they make sure the doctor pays as much attention to the mother as the incipient baby. Doulas don't disagree with doctors, they back the woman up when she disagrees. I can see how an assertive patient or patient advocate would annoy some doctors, with the questions, and the asking 'why'. But if the patient lacks the medical literacy to ask why, someone needs to be there to do it for her.

To me the weirdest thing about this article is that, as Miriam points out on her blog, it's in the Times' Fashion & Style section.

Re: not supporting women who decide to have various medical interventions, I'd agree that's problematic. I mean, a doula's job is to cater to the laboring woman's wants and needs, right? Well, pain medication is something that a laboring woman might want -- even if maybe she previously thought she didn't want it.

It's hardly surprising that some women change their minds on that when they're actually going through childbirth, is it? So it seems to me that a person who takes on the job of catering to a laboring woman's wants and needs should be prepared to support that woman's choice in that moment.

My impression is that most doulas would support that choice, though (? -- not that I know a million doulas or anything...)

I'm a New Yorker from the midwest, and anecdotally speaking, I agree that most people outside the city haven't heard of doulas. The New York Times, however, is a newspaper that is notorious for catering to a very specific audience. Educated, liberal New Yorkers. (They've never stopped others from reading their paper, obviously, but they've also never stopped catering to educated, liberal New Yorkers. Why start with this specific article??)

Demographically speaking, I've gotta assume that this is the very audience that is most likely to have had some experience or familiarity with doulas. If the NYT ran a piece that said, "Hey everybody, check out this awesome new idea! These people are DOULAS. Sit down and we'll draw you some pictures of what doulas look like!" their target readership would be offended.

Instead of running that story, they ran a story that said, "Hey, you know those doulas you're all familiar with? Yeah, well, they're not all created equal."

And to me, that was really helpful. My sister's pregnant right now, and I suggested she seek out a doula. After this story, I'll now suggest some follow-up questions for her that I'd have never thought of before.

I think Isabella has a great point. Before I started reading this site, I had never even heard of doulas and can someone tell me, how do you even pronounce that? Dooola? Do-ah-la? Do-uh-la? Dway-la? Dwey-ya?

Anyways, as someone who hates being sick and makes sure that everyone in the general vicinity knows exactly how unhappy I am, I can see the benefits of someone to run interference and - in my case - keep someone from slipping me a mickey, since I hate being unconscious in unfamiliar areas even more than I hate being sick. When I had oral surgery, my friend had to promise to stay in the room before I would allow them to stick me with the needle full of sleepy-juice.

My only issues with doulas are essentially the same that Sailorman brought up. They do have an agenda, and can interfere with procedures in ways that can needlessly harm people. They're not trained medical professionals, and while some women may feel comfortable with a cheerleader/lip-balm-applier/back-rubber, they are simply that.

My other big issue is this knee-jerk nonsense that modern medicine is OMGevil and that we need to go back to the good old days (you know, the ones where women died in childbirth way more often). I'm not at all comfortable with the blind embrace of pseudoscience in the name of "empowerment".

For what it's worth, I just had some surgery (a tubal ligation)this Tuesday.(Recovering pretty well, thanks.) The evil patriarchal conspiracy that was in effect there? My GYN was an incredible feminist woman. My doctor who referred me? Same. The entire OR staff was all female, very supportive, explanatory through every bt I was awake for (and ran what I wasn't by me first).

Only lousy doulas allow whatever "agenda" they have to override the mother's agenda. And if the mother's agenda is one that doctors disagree with, why shouldn't she have an advocate? There are lousy exemplars of every profession--I had a couple lousy professors when I was an undergrad; that says nothing about the overall value of the professoriate. It means, hey, sometimes people suck at their jobs. Try to avoid those people.

They're not trained medical professionals

Again, they do not pretend to be. So there's no problem. No decent doula goes around telling her clients that she is a medical professional who can deliver babies. In fact, if I recall my training properly, it is considered highly unethical for a doula to agree to assist at a birth that isn't being overseen by a midwife or a doctor. So...what's the problem?

The fact is that a mother's partner is not a trained medical professional who might disagree with doctors and interfere with procedures and who brings an agenda to the process--but nobody's saying that partners shouldn't be part of the process. Nobody has a doula forced upon them, so what is the problem here?

My other big issue is this knee-jerk nonsense that modern medicine is OMGevil

I'm starting to feel that this is a strawfeminist. Could you please find me an example? I have yet to meet a professional doula who objects to modern medicine overall, and as a pro-doula pro-midwife person myself for myself, I have no intention whatsoever of giving up my asthma inhalers or my anti-depressants or the doctors who oversee my care for those illnesses. Do you know many doulas who eschew modern medicine altogether?

My mother is a doula. These are the types of births she participates in:

-Home births
-Hospital births
-Medicated births
-Unmedicated births
-Vaginal births
-Emergency C-section births
-Births where the mother thought she wanted to go natural, but decided to have an epidural
-Births where the mother thought she wanted medication, but didn't get it (either because she changed her mind, or because there wasn't time, or because there was a medical reason to deny it).

She DOES have an agenda. Her agenda is to help the mother have a positive, affirmative, comfortable birthing experience. She is an advocate for the mothers, and she gets to know them (and their likes and dislikes and their ideas on how childbirth should go) far better than the medical professionals can. She can do this because it is her JOB. If the mother wants (or thinks she wants) meditative techniques, breathing techniques, or hypnobirth, my mother practices with her one-on-one BEFORE delivery, until the mother is comfortable with the technique and they feel they have a working relationship.

She is not a medical professional (although she WAS an OB LPN, before she changed focus), and she does not pretend to be.

She is also a post-partum doula, which is a major part of her work. After the delivery, when the woman is released from the hospital, she comes to her house and does *whatever it takes* to assist her. This is especially vital for women who have had C-sections, because they typically are not able to care for themselves and their child(ren) independently for several days.

She will do dishes, do the laundry, cook food, change dressings, care for older children while Momma bonds with the newborn, care for the newborn while Momma naps, etc.

She ALSO (for women who need it, typically first-time moms) acts as a lactation consultant and parenting instructor, teaching new moms (and/or dads) how to diaper, bathe, and care for their new baby.

This is a critical role that had historically been held by members of the extended family - but not all new parents have access to a familial support system anymore.

Oh, and she works on a sliding scale, and donates a percentage of her time *for free* to single, low-income mothers.

I honestly don't understand the doula-hating, or why people feel that doulas (or even midwives) are incompatible with Western medicine.

EG, what I'm saying is that a doula, unlike a partner, is in theory supposed to be somewhat educated. A partner can say that they're not comfortable with this or that, but a doula is in an advisory/advocacy position which can, as is illustrated in the article, come into conflict with the wishes of the mother or doctors.

And as far as the claim of "strawfeminist" goes, the idea of doulas itself (along with the whole "natural childbirth" movement) is part of what looks an awful lot like an anti-science backlash. It seems to me like a conflation of modern medicine with this terrible, detached, unpleasant patriarchal monolith. Which I would say is doing a major disservice to the feminist doctors out there. While I know no doulas personally who object to all forms of modern medicine, I do see the perception that adding non-scientific professionals' opinions is a good and necessary thing for an "empowering" birth as a bith a a knee-jerk anti-medicine move.

Which, I suppose, goes along as a response to Mighty Ponygirl's comment that "I'd like to point out that ANY patient-experience in a hospital requires an advocate this day and age.". I call bullshit on that. Maybe I just happened to be really, really lucky in my very small, very overworked, very understaffed, rural, legendarily anti-choice province, but I doubt it.

(Please excuse any typos, I am still recovering.)

Becca,
I agree with your statement that part of the doula movement, like the home birth and midwife movement, has an anti-medicine element.

But the need for a knowledgeable advocate in a hospital setting is often quite real. I discovered that when my father had multiple weeks in and out of a hospital following a stroke. My sister in law is a registered nurse and she caught a lot of things that were being done wrong or not being done at all because of short staffing on nurses. I didn't have a clue because I don't have that training.

While I know no doulas personally who object to all forms of modern medicine, I do see the perception that adding non-scientific professionals' opinions is a good and necessary thing for an "empowering" birth as a bith a a knee-jerk anti-medicine move.

That's simply not true. You really can't imagine any other reason for wanting an advocate who has been at and participated in many births before, who is not emotionally invested and so can keep a level head, who is committed to representing my desires to be present during birth than knee-jerk anti-medicine sentiment? In that case, you really need to do some more research into why women hire doulas and what doulas do before you make such a sweeping statement. The idea that a woman in extremity couldn't possibly want some experienced support during a difficult, stressful, and painful time is really that foreign to you?

Maybe I just happened to be really, really lucky in my very small, very overworked, very understaffed, rural, legendarily anti-choice province, but I doubt it.

I think you are very lucky. I've met an overwhelming number of people who have had dreadful experiences and wished for an advocate, even in planned procedures. Social workers provide this kind of advocacy as well. Why are you so unwilling to believe that other women have not had your positive experiences?

a doula is in an advisory/advocacy position which can, as is illustrated in the article, come into conflict with the wishes of the mother or doctors.

YES. And THAT is exactly why Miriam is objecting to this article. This article profiles some extremely lousy cases with some doulas who did bad jobs, and you are extrapolating from that to say that they are representative of normal doula-patient-medical professional interaction. THAT IS EXACTLY THE PROBLEM.

I find it interesting at how up-in-arms people can get when bad doulas or widwives are presented as the norm. Especially since many of the same people are quite willing to trade horror stories with bad doctors, and then condemn the entire medical profession as a result.

I'm as sensitive to anti-doctor sentiment as some are to anti-midwife sentiment. And there have been some ridiculous examples of both around here. Which may be why any criticism is perceived as an attack, by both sides. WHen there really shouldn't be any sides at all.

I agree I don't think this was a very balanced article.

Forbidden Coma: I did get an epidural and no one has ever said a negative word to me about it and I run in circles where natural childbirth is the norm.