A recent post on Facebook provoked a slew of comments that brought out the polar thoughts on the topic of doulas at Unassisted Births. I started the argument with: “Doulas attending UCs make me CRAZY!” That got ‘em going. Here, I share the most cogent of the discussion, with a few of my added interjections.
JT: So women who choose to UC don't deserve the support of a doula?
JT: Wow. That's messed up. Unassisted does not mean no outside support. It means no birth professional such as an OB or midwife. At least in the birth world I belong to.
NgM: What happens is doulas become the professional at UCs. They get asked questions about safety. They get asked if something is normal. They get asked if a transport should occur. Doulas are NOT just there as doulas; they become the professional. THAT is why a doula has no business at a UC.
DJ (who said it better than I did): A doula attending an unassisted birth may be considered "the most experienced and educated person in the room" and therefore the most liable. Philosophy and ideology aside, it just doesn't seem wise.
CU: I'm conflicted about this. Years ago, when I was a doula, one of my clients decided not to go to the birth center or hospital after 72 hours of PROM. After she said she would just do it at home if she had to, I consulted with colleagues and told her I would not be the only professional at the birth. The mother was PISSED and fired me. Do I think she deserved support? Of course. But it's not fair to be the only paid, trained person there--it's not fair to the doula. Better to ask a friend or a family member, rather than to hire a doula, IMO. By the way, I was flamed all over the (anonymous) internet for what I did--everyone responded saying that I abandoned her and was acting selfishly. Sigh.
DJ: Why can't I decide when to move my child to a booster seat? I know my child better than anyone.
NgM: I think any doula who goes into a UC situation is asking for trouble. She could end up in jail if anything untoward occurred, her being the most professional at hand an important legal point.
KJP: That may be correct NGM, but it's still of the utmost importance to protect the choices mothers/families have in regard to who they want at the birth and what kind of assistance, if any, they desire.
WB: But believe so strongly in the services they provide I women so they risk it!
DJ: Women who choose unassisted birth can choose nonprofessionals to be present with them. Since when does the need for emotional support trump the need for medical guidance? If you feel you need any professional in attendance, and not simply a family member, then what are you really thinking?
LS: I don't feel that it matters if it’s a friend or family member or random client. If they are planning a UC, you become liable. If something goes wrong, the doula present becomes the face of doulas everywhere, just as a midwife at a mw-attended home birth becomes the face for all of those tragedies when that goes awry. The situation could bring you under legal proceedings by local authorities seeing you as an unlicensed practitioner or the parents could decide you had a hand in the child's fate. Simply a bad place to be, IMHO. You stake the well being of your own family and finances on being the only birth professional present by contract.
AO: Doulas are not birth professionals and you seem to not really understand what a UC really is and the work, and the emotions that go into planning and having one, birth is not a medical event so why do I need medical assistance?
NgM: Doulas sign contracts. They are, indeed, birth professionals. I/We do understand what UCs are and the work that goes into them. YOU might not consider birth a medical event, but legally, it is.
GB: That may be true, but that is not up to you or anyone else to decide FOR anyone else.
AO: Doulas are support, not care providers.
NgM: That’s true, but doulas offer an enormous amount of information to women including options in birth and when things might need to be changed if stuff is going wrong. Doulas carry a lot of weight with responsibility and women put them in that position.
DJ: But being the only professional present gives the appearance of having some responsibility. At least that's the way the law sees it. Hence, you are at risk of "practicing medicine without a license." It doesn't matter what your intentions are. You can argue whether it should be that way, but that's just how it is.
TB: A doula decides for herself what is in her scope or not (or her certifying org decides for her if she is certified). If a doula is comfortable attending UC, clearly states in her contract AND to her client exactly what she does and does not do, then its really between her and her client. Just BC you don't want a doula at your UC doesn't mean it wrong, stupid, risky, etc for everyone else. As a doula I like to support my clients however and wherever they need it. I also don't just take anyone, and would be especially picky with UCs. I do not become a "medical professional" even if there is not one at the birth. My role is still the same, I still don't provide medical support.
NgM: A doula can have every intention of staying “non-medical,” but when the shit hits the fan and the mom starts asking questions, what’s the doula going to do? Say, “I don’t know,” when she does? Or is she going to help the woman save the baby’s life. We know that answer.
AT: Wow. Selfish to want to have support without medical assistance. Nice to see why we can't get things changed in the birthing community. We're too busy worrying about whether everyone is doing everything just right by everyone else's rules.
ED: But a doula is NOT a medical professional. That's like saying the photographer would somehow be the "default authority" in court or something.
NgM: A photographer does not have training in birth. That is a ridiculous comparison.
AT: Frankly, a woman will ask a doula if something is wrong no matter what. Women look to doulas for many things when they're scared in labor. In which case, the mom probably shouldn't be UCing. Having no medical professionals there doesn't change the situation. If something happened while waiting for the midwife to arrive or on the way to the hospital, the doula would be at risk. Being at a home birth period is risky for the professionals, no?
DC: I have had a UC with a doula there. She was only there for emotional and physical support, not medical advice. I was not scared and I didn't ask her for medical advice, like someone here said all women do. It was wonderful and 100% complication free.
NgM: But, what if there had been complications? What if you had asked for advice? What if you were scared?
ASM: It's her uterus and her choice. And I stand as a (soon to be) fellow that supports her choice to birth as she feels right (TBA student). Until then, I take my risk at jail time for serving UC's as a doula. Because I serve women. And I accept risks for what is right for her. But that is my choice and mine alone. And I don't give a flip what anyways else says. Women deserve a choice.
CM: Hey, doulas shouldn't do something because they might be held liable or arrested...
Law = justice = truth = the right thing always, right?
We all have the obligation to do right by each other, support each other, love each other.
Fear driven care, whether midwifery, doula-ing, ObGYN practice is dangerous for women.
O: I really love your blog but this time have to respectfully disagree. Doula isn't a medical professional and doesn't 'attend' birth in that capacity. She is not intended to replace a medical professional but support the mum. Freebirth is a legal right and a woman's choice and contrary to popular belief - far from reckless. Some UC mums might want a doula and if they need one - they should be able to have one. There's nothing wrong with a doula at a freebirth.
NgM: Again, she might have every intention of attending in a non-medical capacity, but if complications arise during the birth, she will be thrust into a whole different scenario.
ES: Someone who puts "doula" in her name is the same as a mother or grandmother who has helped other mothers through their births in the past and brings support, wisdom, etc. they both have every right to attend a UC if the mother desires and if they cross the line into medical advisers then that is their own risk, but they should not be banned from all UCs simply because that risk exists.
NgM: Now that’s a clever comment.
AY: I've not taken on clients in my doula role if they want to UC. You can be prosecuted for acting as a midwife and if you are there even in your doula capacity and something goes wrong it's a huge risk to take that the CPS would understand the difference between doula and midwife etc. and not prosecute. For my own safety I wouldn't attend.
JL: I can put sparklemummy in my name and treat you like a sister but because I am a trained person if you we're choking I'd bang you on the back and do abdominal thrusts because I am also a nurse. If a traditional untrained midwife is there acting as doula and something goes wrong she will use her skills! And thus she will be in the shit. And so will you because she has no Ob backup no O2 and can't intubate.
NgM: Lastly, I think this poster speaks for many of us in this field, those who want to help, but are constrained by the fear or the law… or fear of the law. She says this eloquently.
SM: I have such mixed feelings about the matter and really don't think there is any good answer in place yet. On one hand, a doula is putting herself out on a limb legally by attending a UC, whether or not the mother has any intention of holding her responsible for problems. The state doesn't require the mother's consent to do that. If that was not the case, if there was some way to protect the doula, I would be completely in favor of a doula's choice to attend medically unassisted births.
On the other hand, when I had my third child and wanted to give birth in NY near family, having the baby with only a doula seemed like the best option at the time. All I expected from her was counterpressure to help with my back injury. My husband was NOT capable of that and nobody else lived close enough by to commit to it. As it turned out, my sister completely missed the birth.
If I was to have a fifth child, I don't know what I would do. And if I was to start working as a doula again, I still don't know. It's just complicated.
Lia Joy Rundle, a doula who is also a three-time UCing mom, wrote a great post entitled Doulas and Unassisted Births. I encourage you to read it.