When I meet a doula, whether she has been one for a long time or just beginning, invariably, I hear the phrase, “I really want to see a home birth.” The next thing that comes out of her mouth is often, “Can I go to a birth with you? I’ll be quiet.” Or something to that effect. Having been a doula for many years before ever attending a homebirth, I totally understand the desire. Especially when the births she sees, one after another, are the typical, energy-suck, lack of empowerment type.
While some homebirth clients will hire a doula, in my experience, they are few and far between. If she brings a doula along on the birth trip, I really enjoy it. I’ve often said there’s enough work to go around for how many hands are there (laundry, food prep, tending to kids, etc.). The doula is able to do loving support in a way the client needs from that woman. It doesn’t mean I sit back and don’t do any labor support, but the doula definitely has her own place on the birth “team” (if you will).
One of biggest joys for women birthing at home is they get to choose who’s going to be there. Great thought goes into who they invite and who they do not. It can be excruciating when a family member or friend wants to attend, but the mom knows it will hamper her birth. When she says no, there’re always reverberations, but they usually get ironed out before the birth occurs. So, you can understand why it seems quite impractical for a midwife to ask her client if an on-looker can attend –just so she can see a homebirth. Hospital births foster voyeurism; homebirths foster intimacy.
I’ve had doulas tell me they were sick of/burnt-out from hospital births and all they wanted to do now is homebirth doula work. In my world, that would mean the doula isn’t going to be very busy. 99% of women birth in hospitals; 1% birth at home and most of those do not hire a doula. Women in homebirths are very supported without a doula, whereas women in the hospital need as much support and love as possible. I understand how defeating it can be to watch birth after birth managed to hell and woman after woman have their birth plans flushed down the toilet, but even if all the doula does is be with the woman as a witness to the travesty, she has given the mother a great gift.
On July 1, 2010, Nicole Murray wrote “Doulas and Unassisted Births” in her blog Zipadee Doula. While I know that my writing about UCs is/can be controversial, I’m choosing to address this post for three reasons. One: there are doulas considering attending UCs Two: there are mothers considering a UC and deserve another viewpoint besides the rose-colored glasses view typically offered and Three: healthy, civilized discussion is always beneficial. Let’s try and keep it civilized, eh?
(UC stands for Unassisted Childbirth. Not sure why the initials haven’t changed to UB, for Unassisted Birth; always wondered that.)
Because I know of many doulas’ desire to attend homebirths, I find this entire piece a justification for/an excuse for doulas to be with women as they have their babies at home. It’s a clever way to be invited where they might not otherwise be when the mom has a midwife.
Or might this be a backlash from doulas being pushed/shoved out of the labor room?
Nicole mentions the semantics of when a person can call the birth a UC. On-going conversation about what constitutes a UC includes: is it a UC if the dad is there? kids? grandma? and now, add a doula into the mix. I can’t help but wonder if the definition of UC is expanding because more people are invited to the birth. Seems anyone and everyone can be there… except a midwife. Isn’t this odd to anyone?
“A doula is not providing any medical care.” Hmmm. Nicole, neither does a midwife. Midwives provide midwifery care. In most of the licensed states, midwifery care is legally defined as separate from medical care. This is an important distinction; not only in semantics, but that the midwifery model of care is enormously different from the medical model of care.
“Having that trust and relationship with another person can be a great thing at a UC, when often you are left alone to fend for yourself.”
This line in particular annoyed me. “…left alone to fend for yourself”? Isn’t that the purpose of a UC? To be alone? Fending for herself makes it sound like she is being refused care, that there weren’t midwifery options for her (and I totally know that is the case for some women), not that she chose to give birth solitarily. That sentence colors the entire piece, drawing the woman as victim (of circumstance? of society? of a healthcare community?)… that others turned their back on her, therefore she is left to suffer on her own. This phrase also creates the illusion that she is Doula the Giving/Sacrificing/Supporting… that, otherwise, the woman would be bereft of any goodness to her birth. As cranky as UCers get about a midwife’s arrogance, doesn’t it seem odd not to comment about a doula creating a space at your births?
Nicole goes on to say, “After birth, she (the doula) can help clean up, make sure every one has what they need and help with settling in. She can be a person to look to for resources, advice and postpartum support. Having a doula on your side can ease the worries about not having anyone to turn to postpartum, because you are afraid of what they will think of your decisions. Women should not have to be afraid after their births, because they have no outside support.”
Can I just say, this is simply baffling. Seriously.
According to this piece, a doula fulfills all the roles a midwife does, except she is left without the safety net of a doppler and other potentially life-saving equipment. I mean, really?
What kind of alternate universe makes having the safety net the negative?
Let’s look at this in the bright light. Doulas are hired. They’re outsiders. They know birth, usually pretty/very well. They make suggestions to the mom about positioning, making sure she eats and drinks enough, helps with the partner’s comfort, cleans up after the birth, helps with breastfeeding, makes sure mom and family are comfortable before leaving, goes to the hospital with mom in an emergent situation, knows how to contact emergency services and becomes an intimate part of the family dynamic as it relates to the birth.
If a judge heard a doula describing the above actions, supposedly only “supportive” as they are, that sounds an awful lot like practicing midwifery –without a license. Is a doula willing to go to jail in order to “support” a UCer? It seems unlikely now, but it seems the doula-at-UC is a new-ish phenomenon. What happens if you are the test case?
I encourage doulas to look closely at women’s motivation to bring them into their birth circles, but not a midwife. What are her expectations? Why does she want you and not a midwife? Looking from here, it’s a razor thin line between having a doula and a midwife at a birth.
Nicole ends her post with, “Isn’t it a bit hypocritical to say that you support women, yet only if they do it ‘the right way’? If you feel uncomfortable with someone else’s birth choices, you can still give them the respect that they deserve as a person.”
This, as most know, is where I struggle. As a very pro-choice midwife who talks about women having the right to a cesarean-by-choice, it makes me grit my teeth to think women have the right to UC –and that I might actually have to support them in their choices. It is hypocritical. It is. I have to feel it is cognitive dissonance at play. Cognitive dissonance is the experience of knowing what is right, yet doing the contrary. Knowing the risks, yet smoking anyway. Drunk driving. UCing. (Had to throw that one in there.) But, my own cognitive dissonance comes from knowing women have the right to their own choices, their right to self-determination, yet not giving acceptance/appreciation/the space for women to do just that. I think this is a topic all on its own, though, so I’ll let it percolate even more than it has been the past couple of years… write about it when the words/feelings find their light.
Back to doulas. I love and appreciate doulas tremendously. Heck, I still doula myself. But, I think we all need to step back, take a second and consider the changing role the doula might be making in our birth world. Is doula as midwife what we really want?