Thursday, December 3, 2009

Unnecessary Doulas?

There was an interesting article on doulas in The Telegraph yesterday: Doulas jeopardise care?.

The crux of the article is that doulas could interfere with medical decision making in a negative way. But, to be fair to Dr Chakladar, the author of a piece in the British Medical Journal online, the popularity of doulas in the UK may be a result of the decline in one-to-one mudwifery care. He says it very well, so I'll just quote him:
"This trend may be a sad reflection of failures in the delivery of medical and midwifery care, a sticking plaster concealing greater problems. Availability of this commercial service indicates that current social structures do not support pregnant couples adequately; healthcare professionals may not be able to support their patients as they would like to.

"Are we no longer able to make common sense decisions without asking a hired friend?

"Traditionally, emotional support came from female relatives; more recently the modern father has stepped into this role. Partners, friends, and family—those who know the mother best—should provide this support.

"Sadly, this position cannot withstand chronic understaffing, shift work, midwifery care that is less than one to one, and European working time directives, making continuity of care impossible. Nor can it withstand single parenthood and increasingly detached nuclear families."

Here's my point of view. I wouldn't want a doula because I would prefer to have people I really know supporting me, not someone I had only met a few times. I had a home birth partly so I could guarantee one-to-one attention from a midwife, and partly to minimise the interference from doctors. I am very wary of obstetricians (who I imagine, very unrealistically, to be bloodthirsty butchers wielding forceps and calling for epidurals and c-sections at any opportunity). I am also fairly confident that if there was an emergency, my parter would properly represent my views to medical staff (and there was no stage during my labour when I was so out of it that I couldn't talk to the midwife anyway). Also, I'm tight. I'm not going to pay someone when I know most people manage without a doula (though I do wish I had a close female friend who I trusted enough to be present at a birth, as women have done for millenia).

But if I felt that my wishes would not be respected - perhaps if I was a teenage mum, or if my partner was not supportive - and if having a doula would help me feel more confident about giving birth, then where's the harm? One of my friends has felt 100% more confident about the upcoming birth of her second baby since she she has hired a doula.

There's one thing to remember though. Doulas aren't midwives. They offer moral support but not clinical expertise. We must not confuse the two things.


Lyndsey said...

As a doula-in-training, I found your post to be very interesting.

I think the first thing to mention is that a doula simply cannot "interfere with medical decision making in a negative way!"...they shouldn't be interfering with medical decision making at all. It is not our job to "tell" our clients what may or may not be best for them. It is my job to present as much educational material as I can to my client prior to her labor so that she and her partner might make the most educated decision possible regarding their birthing choices.

I think it was important to stress that doulas cannot give medical advice...we have NO medical training. It is up to our clients to make their own decisions...we can simply support those choices and provide valid resources for them to turn to when making those choices in the first place.

Now, with all that being said, I birthed my son with no doula over a ridiculously drawn out natural labor. My midwife did NOT provide the one on one care I had hoped for and my husband chose to sleep much of my early labor (which due to it being back labor did NOT seem either early or easy!). I felt very alone and very scared despite having educated myself, and I wish that I would have had a doula. Ideally, I agree that a close woman-friend or relative would be best, but doula's do have experience...some hundreds of births worth of experience. They will not be surprised to see you in any state, they will be able to remain calm no matter what turn your birth takes, and they will never leave your side. For my next birth, I do plan on having a doula...I feel like my husband was great support once things really got going, but that for me was only half the battle :-)I just thought it was interesting to hear the thoughts of someone who wouldn't choose a doula.

Michelle said...

Honestly, any doula worth her salt will tell you straight up that she's not medically trained and cannot make decisions for you. If she tells you otherwise, turn around and find another one.

Not all doulas are created equal, just like not all midwives are created equal, not all OB's are created equal and not all anesthesiologists are created equal. It sucks that this was his first experience with a doula and has coloured his perception of the profession as a whole.

Cave Mother said...

I tend to think that if having a doula is going to make it more likely that you have a good birth experience, then it's worth it. Some people thrive on the company of others, other people (like me) prefer to metaphorically crawl under a rock and deal with things themselves.

It is a little worrying that the doula in question allegedly interfered with the doctor's advice, but I am sure that most doulas are not like that. I mean, it takes a pretty special kind of person to do the job in the first place.

Lisa - edenwild said...

I wanted to have a doula for my first birth (actually, I wanted an unassisted birth, but was neither brave enough nor was it medically safe for me). Anyway, I told my husband I wanted a doula and he thought it was a waste of money (what does he know, he wasn't the one giving birth!!). He said "Isn't that the midwife's job?" and I said only if the midwife is one on one (which ours wasn't) and even then it depends on the midwife. Midwives are about delivering babies safely. Doulas are about supporting the mother.

My birth experience ending up being a nightmare. I had to deal with nurses telling me that having a healthy baby was all that mattered. I went through THREE midwives while I was there, none of which I had ever met before. But there was one moment, when I was in excruciating pain, that one of the midwives starting stroking me gently and saying gentle words to me.It was like my pain cut in half. I was so calm at that moment and really felt like I could do it. Then her shift ended.

A doula's shift doesn't end until some time after your baby is born. My mom was there, and did very little for me. My husband was there, but I kept getting annoyed with him. I originally wanted a friend to be there with me, until I took her to my birthing class and realized she would be of no use. I really, really, wish that I had had a doula and I am insisting next time. They may not be for everyone, but they can mean the difference between a good and bad birthing experience for others.

TopHat said...

I don't think I'll use a doula for any unassisted births. In my first birth, I was at transition when a friend came over and the birth stalled for 12 hours. I think I'm just a private birther.

However, if we ever feel like a UC would be a bad idea for whatever reason, I'd consider a doula for a hospital birth as long as I knew her very well.

Noble Savage said...

I think a trusted friend or family member is the best support but if a woman doesn't have someone she wholly trusts to support her throughout her birth then a doula is a great option. I was lucky enough to have a close friend present at my son's birth, along with my husband and midwife, and she was brilliant. She got me walking and my labor going strong when I just wanted to lie down, she kept cool cloths on my forehead in transition and held my hand while I pushed, telling me I could do it and getting me to yell louder through my contractions to relieve my anxiety. She was absolutely brilliant and I'm so glad she was there. But if I hadn't had her in my life, I would've gladly gone for a doula.

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