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Andrea's Diary
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The "doula" crazeAnother Americanism is threatening to undermine the movement towards humanized birth - this time it is the “doula” phenomenon. This movement, begun in the 1990's, has now become another money-making venture and introduced a whole new level of health professional to the labouring woman’s bedside. Its origins lie in the medicalised way of birth in the US, where women are routinely confined to bed during labour with IVs and monitors strapped on, cared for by obstetric nurses who check the technology and assist the doctor, who will invariably be there to manage the birth. The father may be present, but other support people have been discouraged or banned form attending. Midwives, as we know them in the UK, Australia and Europe, are not employed in hospitals who rely instead on the obstetric nurse (handmaiden to the doctor). It is a very medical, caregiver centred, institutionalised setting for birth. Enter the doula. Her role is to “mother the mother” as their advertising states. She offers physical and support, emotional understanding and practical hands-on comfort, as needed. She has been hired by he parents during the pregnancy and will have visited with them a few times to “get to know them”. She stays for the labour and does some post-natal follow up. She will be well paid for these services, and thus has a vested interest in promoting the need for her services. In the US there are several organisations that offer “doula training”. They appeal to women who have had babies, love birth, have a need to help others and who don’t want to undertake more formal education to become midwives or nurses. The work is attractive - you get the warm glow of being able to help, you get to hold newborns and it can be fitted in around your family commitments, while adding to the family’s finances. To be effective, the doula needs to be able to answer a pregnant woman’s questions and interact with caregivers, hence the need for some training in the basics of birth. They are bit like nannies, only this time the baby is not yet born. With their usual flair for self promotion, the Americans are now exporting their practices again onto an unsuspecting public around the world. I have heard of doula training programs in Australia and have had intending doulas in my workshops. Their intentions may be noble and high minded, but what are the messages they are sending to our population? That our midwives are not able to provide this kind of care? That women in Australia have no-one who could help them during birth? That buying services (and the obligations that come from such a contract) is better than relying on friends and family to fulfil these traditional roles? What is also needed is the re-education of obstetric nurses to take on the philosophy and model of care enshrined in midwifery. This is particularly important is those areas where midwives are scarce and births are medicalised. In developing countries where no midwifery exists in hospitals, the need to encourage birth companions is very necessary, but let’s not see these people as needing special training. Let’s first just open the labour wards to the family and friends of the labouring woman. If we only allow a trained doula to be present, then we have medicalised social support and once again robbed women of their right to a humanised birth within the family circle. Birth is certainly women’s business, and a spare pair of hands (often a woman’s) has been encouraged here for many years. Let’s not add another layer of “health professionals” into our already institutionalised birth system. Posted by andrea at September 06, 2002 09:32 AM Thanks for this article Andrea. You have put my sense of unease about the concept of doulas into words.The idea seems good in theory but making women feel they need doulas to get appropriate childbirth experiences goes against empowering women which is what doulas say they are trying to acheive. Posted by: Pip Wynn Owen on September 6, 2002 02:35 PM Dear Andrea I have just read your article "The Doula Craze" and would like to address a few of the points that you have made. I (along with my friend)offer my services as a doula and as you can imagine, am deeply concerned at some of the statements you have made. In my reply, I can only speak for myself, as I am not precisely aware of how other doulas operate. First of all, you mentioned that doulas are well paid. Maybe some are, I don't know. The service fee that we charge barely covers the petrol, time,as well as postage, printouts, massage oils, books, birthball etc that our clients have access to throughout pregnancy, birth and postnatally. We pretty much do it for the love of it - because for some people there IS a need. Which brings me to my next point. You stated "...but what are the messages they are sending to our population? That our midwives are not able to provide this kind of care? That women in Australia have no-one who could help them during the birth?" Doulas are sending no messages. It is a fact that for most people in the current health system that continuity of care with a midwife in the hospital is extremely hard to come by. This is not the fault of the midwives - it is the way the system is structured. So the answer is no, most hospital midwives cannot provide this kind of care. It would be fantastic if they could, and I'm sure eventually we will get there, with the advent of NMAP etc, and all other birth groups, midwives and consumers working so hard to achieve this end. Until then, we will continue to offer our services as another option, for those women/couples who require a more personalised service. As far as the help of friends and family are concerned, you are right. Most women are blessed with family and good friends who may easily fill the role a doula plays. Unfortunately there is increasingly a proportion of the population that lacks this social support (for a myriad of reasons) and this is where a doula may be able to provide help. I need to also point out that doulas provide information on natural methods of childbirth,pain relief etc, thus exposing some women to ideas that may not have been offered in other circumstances. Doulas in Australia (in my neck of the woods, at least) receive no special treatment in the hospital scenario above any other family member or friend. Our mother to mother style of relating is a far cry from the medicalised social support and as for "robbing women of their right to a humanised birth within the family circle", we serve to make some women aware of that a medicalised birth need not be the only option (even though it is offered to the majority of birthing women). I agree that special training is not necessary to be a good support person - although I have attended one of your workshops, Andrea and found it extremely beneficial. I am also interested in doing the Childbirth Education course and possibly in the future the Bachelor of Midwifery as my passion for natural birth extends far beyond the so called "Doula Craze". I will leave it there for now. The time used writing this reply should have been utilised in planning for Homebirth Awareness Week, writing letters to politicians for birth reform and putting out the Hunter Homebirth Support newsletter. Please remember that we are all striving for similar goals - empowered women/couples having enjoyable pregnancies, satisfying births, great "babymoons", no matter what our training/occupation is. With kind regards Karen Arthur Posted by: Karen Arthur on September 6, 2002 03:50 PM I agree with what Pip said, and not only that.... if women do have a good supportive friend or sister to be their support birth person, they won't ever need to "employ" a professional to perform that role. That is in case they want a person of their own to be present at the birth, apart from the baby's father. Posted by: Jaqueline Marwick on September 6, 2002 06:28 PM Dear Andrea… Just to add my two cents worth to the doula debate…I agree with your position on the potential here to add another “layer of health professional” to our already over medicalised maternity service. I too have great concerns about the potential for hospital administrators to recognize the value of the doula to the birthing woman (and more for their bottom line)…in preference to employing more midwives….HOWEVER…having said all of that….I strongly support the work of doula’s to offer support for pregnant and birthing women….as Karen Arthur argues so well…our current system doesn’t allow midwives to provide the continuous one-to-one support that doulas can provide….(roll on NMAP!!)….Doula’s can never detract from that much needed support of family and friends….any doula worth her ‘pinch of salt’ would embrace the circle and sanctity of family to enhance her work ‘with woman’….. I see the very argument used here against the “doula craze” …could also be employed to that of lactation consultants….childbirth educators (with all due respect Andrea) parenting educators etc.. The proliferation of all these ‘professionals’ has only served to create layer upon layer of ‘professional’ who all seem to have assumed such knowledge that was once considered to be midwifery knowledge and women’s innate “ways of knowing”…….only to be slowly eroded away with the medicalisation of pregnancy and birth and the advancement of all these so called ‘experts’. In an ideal world…the professional doula…CBE’s and LC’s, parenting educators etc etc…..would all be redundant. Women would live and birth locally within their own communities with the local midwife/wise woman in attendance…All this education and support…would be done informally as part of the woman’s preparation for birth…a community responsibly…integrated throughout her life informed from life experiences….all normalizing the work of labour, birth and motherhood….Sadly however…as we all know to well….this is very much a romantic notion….as in today’s society….birth like death has been removed from our homes…our communities. We tend not to live by the seat of our pants anymore…or follow our instincts or intuition…we live quite removed from Mother Nature and all her splendors…. Our family dynamics are different….the nuclear family has shrunk and in some circumstances been totally reoriented…our extended family (mothers.. grandmothers…sisters… aunts etc..) is diminishing…so our ‘mother/wise woman’ role models are now few…Therefore women have little experience with pregnancy, birthing, breastfeeding and parenting…through the lived experiences of others…It isn’t until they find themselves doing it, with no real guides or role models for advice/counsel or support, that they seek out more formal avenues for information support and advice…hence the proliferation of the “doula craze” that you describe… At this point in time… doulas are offering women…what contemporary midwifery in this country cannot…a continuous supportive presence during their labour and birth. As I see it, this is far from “moves to undermine the humanizing of birth”…woman have taken steps to humanize the experience for themselves and to devalue the doula in her supporting role as “mothering the mother” ….is to devalue woman’s right to choice…when in our highly medicalised techno birthing world…choice is very limited…. I see that professional doulas will continue to grow in popularity in the absence of a strong and autonomous midwifery profession. In countries where there is a strong autonomous midwifery profession…. where midwives can offer that one-to one continuity of carer….professional doula’s are very few….To turn the tide midwives need to make a conscious shift in their thinking about their willingness and ability to provide midwifery led care….until they do I believe that doula’s will only continue to grow in popularity….as midwives continued alliance with the medicalisation of birthing….only continues to serve ‘the system’…not the women in their care…. Yours in midwifery, Bachelor of Midwifery Student Posted by: Tina Pettigrew on September 6, 2002 11:24 PM I decided to post my ozmid reply here too. I don't think any doula would place herself in the birthing room at the Doula services do provide support to women who are removed from their I personally do not know of any wealthy doulas. I do know people who earn a At this point I just want to offer some info on the obstetric nurse versus
Posted by: Marilyn Kleidon on September 9, 2002 11:26 AM
Where do I start? Why is there such a tendency to drag to the stake people who recognise a lack of support in our community and seek to offer their support to others? And why is money such a big concern, after all, who pays you for your services, Andrea? I am a fledgling. And I would love nothing more than to learn how to give myself, my time and my support to connect with women who need it. I don't want to make any money from doing it. I just want to love life and share experiences. So I have begun a journey of self discovery which includes developing skills that will allow me to offer help to women, who want it, at various points on the road of motherhood. If you wanted to give me a label call me a Doula in training. But I don't want to stop once I'm a 'Doula'. For me it's about supporting and empowering women and helping in other areas, ie fascilitating change in the 'birthing industry', that might make these dreams a reality. So lets just start supporting each other. By all means share our concerns, which I thankyou Andrea for doing. But support, connect, support, and see what beautiful dreams we can nurture into this world. Sincerely Anna Posted by: Anna Rose on December 14, 2002 08:45 PM Wow, I didn't realize how we Americans are so despised. I do understand the frustration with the American model of birth. Please understand that the Doula is not an invention created by a money-hungry doctor who wants to rob midwives of their position, but rather of a Pediatrician (Klaus) and physical therapist (Simkin) who desire to see the outcomes of women's experiences as positive, no matter where they deliver. I have a video of Simkin at a home water birth, at a birth center, at a hospital, and also at a vaginal breech twin birth at a hospital. She does not overwhelm herself with the outcome of the birth as much as she wants to protect the memory of the woman's birth. The doula, in my opinion, is not there to replace anybody at all, but rather to be a facilitator who recognizes that how a woman is treated and how much control she has in the decisions she makes largely affects her long-term mental well-being. The doula is not the newest member of the obstetrical team, but rather the oldest. She does not take away from what the midwive does, but rather enhances it. I have seen the tranformation of two local hospitals, from being suspicious of the doula to appreciating her for the unique role that she plays. Our local homebirth midwifery school requires that the student take a doula course prior to graduating from the class. Posted by: Kelly Townsend on December 27, 2002 05:05 PM I am astounded at you labeling all Doulas so easily, perhaps your trying to turn a fast buck by going for such an outlandish view point? Rather than being highly paid for my services I balance paid work with voluntry work, I doula for women from Holloway Prison in England who would other wise have no one with them, I very much doubt these women look on me as a 'craze'. I also offer far more than 'some post-natal follow up' I visit most families for a number of hours a day for up to 6 weeks, a level of support that it would be impossible for the normal medicalised system to fill. I am training to be a voluntry breast feeding counsellor, this fits in very well with my role as a Doula and I suppose I am only doing that as a method of self promotion? I also get most of my post-natal work from a team of independant midwives, are they just passing the buck? I will agree that if we all had friends, family and midwives who could be there to support and nuture us at this time I would be out of a job (& happily) but look around you we live in a transient world, healthcare is not providing continuity of care, we don't have the support systems that we used to have and this is a role that if I can help a little filling..... Perhaps a little more research is needed before you make such sweeping statements? Posted by: Lesia on March 9, 2003 10:58 PM I am one of the training organisations providing certification for doulas. Not exported from the States but providing a service internationally after having lived and worked in New Zealand, Australia, the UK and now Singapore. As a childbirth educator (formally trained through the National Childbirth Trust) I experienced a great deal of frustration in teaching women about active birth concepts and then saw them overwhelmed by the "system" when they entered hospital. I chose doula work not out of some noble, high-minded intent, nor out of a desire to cuddle babies. I can't remember the last time I held a baby at a birth - that is, in my view, the realm only of the mother and father. I chose it to help women empower themselves. While it would be perfect if midwives, whether they are in Australia, the UK, America or Singapore, could provide one-on-one midwifery care and all have a strong belief in normal birth, that simply is not the reality in any of these countries. A hospital midwife cannot be with the mother in her home while she is in early labour. We are all aware of the women who go to hospital thinkig they are further along than they are, are then reluctant to leave the hospital and are subsequently overwhelmed by the cascade of intervention that ensues if their labour does not comform to a timeline of somebody elses making. Doulas are able to support a woman, and her partner, in the early hours of labour. Reassuring them of their strength and ability to birth normally. Once in hospital, how many centres actually have midwifery servcies that enable a midwife to focus only on the care of one woman at a time? The midwife is on a shift system in most cases and caring for several different women. She also has paperwork, coffee and meal breaks, and administrative responsibilities. Her focus is on the physical well being of the mother and baby, as well as the emotional wellbeing. Sometimes she is working together with an obstetrician and his/her preferences have an effect on the options made available to the mother. The midwife may have to follow hospital policies that may not be in line with how the mother would prefer to labour. The doula is independent. She is focused simply on the emotional and spiritual needs of the parents. She is able to ensure that the mother has all her choices and options presented to her and that she is truly able to make informed choices. Sadly, whilst the aim of the hospital staff is for every client to have all the information to give informed consent we all know this is not always the case. The doula is not some new fangled craze. She is not replacing the role of the partner, or the woman's family. She is a woman who can provide information, support and a deep sense of the normality of birth. She can reassure both mother and her partner when they are unsure if what they are experiencing is normal. She can remind them of the questions they can ask their caregiver. She can focus her energy on the mother and the mother's needs without the same level of emotional involvement of a family member. When questioning the benefits or not of a doula, I believe our results speak for themselves. In a country where the episiotomy rate is around 95%, the rate amongst our clients is 3%. The caesarean rate amongst our clients is 10% (national rates are about 25-40%)Breastfeeding rates at 6 months amongst our clients are 85%. The women I work with fel strng after their births, regardless of how their baby was born or how their labour progressed. They beleive they were informed and determined the choices that were best for them. They felt supported and cared for. Why does there have to be a debate about whether or not doulas need to exist? Does it really matter? If women want to have doulas to support them through their births, then surely this should be a service that is available to them. We could just as easily argue that there is no role for an independent childbirth educator since midwives also provide this role. Or even that there is no need for childbirth education at all since a woman's body knows how to birth, how to breathe, how to move. She certainly doesn't need education to learn that. I sincerely believe that a good doula can help a woman to empower herelf, realise her strength, and have the birth experience that she wishes to have. Lets support each other in our individual roles rather than create an internal battle that is never going to benefit the women we are working to help. Posted by: Nikki Macfarlane on May 3, 2003 12:00 AM I have read your comments about doula's and am facinated by the debate. As a doula I would challenge any one who is critical of the doula as a money making venture or as another proff disempowering women to source out women who have employed doulas at their birth and ask whether or not the doula is a valued member of the birth team. The debate ends there. This is what it is all about. As for money, I value my proffession and value my job as a doula. Traditional womens roles have been devalued for too long. Lets not go back there. Rachel. Posted by: Rachel Moran on May 12, 2003 10:43 AM Doulas are one of the biggest threats to independent midwifery, and here in Australia to gaining independent midwifery and having midwives recognised like they deserve to be. I come from New Zealand where Doulas are not known because independent midwives are common place, and provide continuity of care, woman have no need or want for anyone else. I am shocked at the situation here with Doulas. As woman with passion for childbirth we should all be doing our darndest to promote midwifery and fight tooth and nail for autonomy for midwives. I for one am a passionate midwifery student who will promote midwifery as an autonomous profession and fight against the "medical model" and establishment, and if that means doulas too so be it. You are not helping. Don't try and excuse yourselves by saying you are filling a gap. You need to get behind midwives and midwifery and push for midwives to be recognised, for education of the public about midwives and pf the current situation. Posted by: Kirsten on May 15, 2003 10:18 PM I agree with some of you. I don't believe Doula's should ask for money for their services. I do believe there is a need for doulas. I am due to start my post grad diploma in midwifery in six weeks, and have been a doula for four years. I find the view that "midwivwes rule supreme" and doulas should just shut up and go away just a varaiation on the old "obstetriceans rule supreme" let's let mothers decide what they want/need! Posted by: Sera Nichols on May 30, 2003 04:46 PM I agree with some of you. I don't believe Doula's should ask for money for their services. I do believe there is a need for doulas. I am due to start my post grad diploma in midwifery in six weeks, and have been a doula for four years. I find the view that "midwivwes rule supreme" and doulas should just shut up and go away just a varaiation on the old "obstetriceans rule supreme" let's let mothers decide what they want/need! Posted by: Sera Nichols on May 30, 2003 04:46 PM I agree with some of you. I don't believe Doula's should ask for money for their services. I do believe there is a need for doulas. I am due to start my post grad diploma in midwifery in six weeks, and have been a doula for four years. I find the view that "midwivwes rule supreme" and doulas should just shut up and go away just a varaiation on the old "obstetriceans rule supreme" let's let mothers decide what they want/need! Posted by: Sera Nichols on May 30, 2003 04:47 PM I agree with some of you. I don't believe Doula's should ask for money for their services. I do believe there is a need for doulas. I am due to start my post grad diploma in midwifery in six weeks, and have been a doula for four years. I find the view that "midwives rule supreme" and doulas should just shut up and go away just a varaiation on the old "obstetriceans rule supreme" let's let mothers decide what they want/need! Posted by: Sera Nichols on May 30, 2003 04:47 PM I agree with some of you. I don't believe Doula's should ask for money for their services. I do believe there is a need for doulas. I am due to start my post grad diploma in midwifery in six weeks, and have been a doula for four years. I find the view that "midwives rule supreme" and doulas should just shut up and go away just a varaiation on the old "obstetriceans rule supreme" let's let mothers decide what they want/need! Posted by: Sera Nichols on May 30, 2003 04:48 PM I agree with some of you. I don't believe Doula's should ask for money for their services. I do believe there is a need for doulas. I am due to start my post grad diploma in midwifery in six weeks, and have been a doula for four years. I find the view that "midwives rule supreme" and doulas should just shut up and go away just a varaiation on the old "obstetriceans rule supreme" let's let mothers decide what they want/need! Posted by: Sera Nichols on May 30, 2003 04:48 PM I agree with some of you. I don't believe Doula's should ask for money for their services. I do believe there is a need for doulas. I am due to start my post grad diploma in midwifery in six weeks, and have been a doula for four years. I find the view that "midwives rule supreme" and doulas should just shut up and go away just a varaiation on the old "obstetriceans rule supreme" let's let mothers decide what they want/need! Posted by: Sera Nichols on May 30, 2003 04:48 PM I agree with some of you. I don't believe Doula's should ask for money for their services. I do believe there is a need for doulas. I am due to start my post grad diploma in midwifery in six weeks, and have been a doula for four years. I find the view that "midwives rule supreme" and doulas should just shut up and go away just a varaiation on the old "obstetriceans rule supreme" let's let mothers decide what they want/need! Posted by: Sera Nichols on May 30, 2003 04:48 PM I agree with some of you. I don't believe Doula's should ask for money for their services. I do believe there is a need for doulas. I am due to start my post grad diploma in midwifery in six weeks, and have been a doula for four years. I find the view that "midwives rule supreme" and doulas should just shut up and go away just a varaiation on the old "obstetriceans rule supreme" let's let mothers decide what they want/need! Posted by: Sera Nichols on May 30, 2003 04:48 PM I agree with some of you. I don't believe Doula's should ask for money for their services. I do believe there is a need for doulas. I am due to start my post grad diploma in midwifery in six weeks, and have been a doula for four years. I find the view that "midwives rule supreme" and doulas should just shut up and go away just a varaiation on the old "obstetriceans rule supreme" let's let mothers decide what they want/need! Posted by: Sera Nichols on May 30, 2003 04:49 PM I agree with some of you. I don't believe Doula's should ask for money for their services. I do believe there is a need for doulas. I am due to start my post grad diploma in midwifery in six weeks, and have been a doula for four years. I find the view that "midwives rule supreme" and doulas should just shut up and go away just a varaiation on the old "obstetriceans rule supreme" let's let mothers decide what they want/need! Posted by: Sera Nichols on May 30, 2003 04:49 PM I agree with some of you. I don't believe Doula's should ask for money for their services. I do believe there is a need for doulas. I am due to start my post grad diploma in midwifery in six weeks, and have been a doula for four years. I find the view that "midwives rule supreme" and doulas should just shut up and go away just a varaiation on the old "obstetriceans rule supreme" let's let mothers decide what they want/need! Posted by: Sera Nichols on May 30, 2003 04:49 PM I agree with some of you. I don't believe Doula's should ask for money for their services. I do believe there is a need for doulas. I am due to start my post grad diploma in midwifery in six weeks, and have been a doula for four years. I find the view that "midwives rule supreme" and doulas should just shut up and go away just a varaiation on the old "obstetriceans rule supreme" let's let mothers decide what they want/need! Posted by: Sera Nichols on May 30, 2003 04:49 PM I am puzzled and disappointed by the negative attitudes towards doulas here. I am an Aussie now living in British Columbia Canada and a doula. Unlike NZ/AUS, midwives & doulas here work together in advancing the cause of women and baby friendly maternity care. Posted by: Amber on May 30, 2003 06:32 PM First of all, I would like to say that no forces anyone to have a Doula... One is free to have or not have a service. Doulas do not perform the duties of a midwife. Nor do they replace family members, unless family members, by tradition, necessity, or because there are none cannot help with the birth. Douals help with home and hospital births. One arrages with a Doula how much, how little, and what the Doula will do. Doulas can coach. They can help with the functional things such as answering the door and getting clean bedclothes. They can do prenatal care, and postnatal home-care, assisting in the first few days or weeks so mothers can sleep when they need to. I assisted during the birth of a friend's baby, in the capacity of a Doula. They were from Kosovo, and English was limited. In their culture, the husband does not attend the birth, and hospitals there do not allow families attend, so they were unsure of their role. During the labour, the father and I comforted her and coached. I got her water and cold cloths. I took her to the bathroom. I massaged her legs while the massaged her back. I did not interfere with what she wished to do. Nor did I interfere with the nurses or other staff. I did only as much as she was comfortable with, and left as quickly as possible after the baby had been born. This year, when my friend's English had imroved, she told me how much my help had meant to her and how grateful she was. It was nice to know this, but I didn't need the thanks. To be able to help when help was needed was all that mattered to me. And, in case you wondered. There was no payment asked for, nor expected. Posted by: Anneke on June 18, 2003 02:19 AM I am not surprised that a topic regarding birth is so emotive but I am surprised that there are such nasty and negative points of view. I am a young mum (an Aussie now living in Canada) who had midwives attend and support me at the birth of my two children. Midwives work independanly with hospital priveledges here and are responsible for care usually starting when a mum is 8 weeks pregnant to 6-weeks postpartum and all in between.I cannot think of a profession more in need of advocates than midwifery (in Canada and abroad) and plan to pursue a career as a midwife when my children are older and I can go back to university (here in Ontario there is a 4 year direct entry midwifery degree)I am training to become a doula at the moment - not for the money or any other reason but to pass on the support and care I received at my birth to other women. Many women, either through misinformation (believing that you have to have a homebirth and cannot have drugs) or availability (I would recommend calling the local midwife as soon as the test comes back positive! - my midwife office always had a waiting list)or being higher risk, do not have access to personal midwifery care. As a doula I will not be trying to take over from the midwife (a doula doesn't do any clinical tasks - she solely concentrates on supporting and caring for the labouring mother) and a good doula helps the family present by making suggestions and helping the family support the labouring mother. I hope to gain a lot of insight that I can take when I am able to undertake the midwifery degree. I am becoming a doula as a stepping stone - but maybe I will also find my niche as a doula. As others have said - no one forces a mother to choose a doula (whereas many women feel, in hind sight, forced to endure uneccessary interventions during birth because they didn't have the information or an advocate to help them get the information that would have prevented that intervention). I hope that many of the women here that have been extremely negative about doulas and what they do will educate themselves to the limits and scope of what a doula does - a doula is not trying to be a substitute for the midwife, nurse, husband or family. She is there to support the mother to have the most positive experience that she can, which involves working with everyone that is present in the labour room. Posted by: Robyn on July 10, 2003 08:25 AM I am have been post-partum doula in Seattle, WA USA for the last five years and happened on this discussion as I was searching the web to learn a little bit about the Australian Birth community. I will be visiting for three weeks in and around Brisbane. I was somewhat surprised at the negative tone of the original comments about the "doula craze" because my experience of being a doula and knowing birth doulas and midwives and how they intersect is very different from what was presented. I have chosen not to be a birth doula at this time because I have a child at home and can't work the hours needed to attend births and the transition time after the birth is where I am able to be most helpful. My friends ,who are birth doulas, do not do the same jobs as midwives and are not considered to be in competition. Our society IS over-medicalized and many women cannot bring themselves to trust the experience of birth outside of a hospital. This is very unfortunate, but a birth doula can often soften the impact of a hospital birth and can be a useful member of the birth team. A doula is not mandatory but many women are glad to have the option if family members are not able to be present. Many of my postpartum clients are older mothers (40+) and their own mothers are not always available due to age or other family commitments. Rather than being pushed out by a doula, many family members pay for the service as a gift when they cannot be there. Many of the hospitals in my area have midwives on staff. Birth doulas are independent and are an option that the client can ad if they chose to do so. Many of the previous commentators illuminate what doulas do in the way of additional support. Some doulas continue after the birth and provide much needed companionship and service to the new family especially with breastfeeding which is jeopardized in this country by lack of education and the availability of formula. Midwives cannot be there on a day to day basis and the old fashioned "Baby-nurse" is no longer available. The work of a doula is too intimate to be solely a money making venture. We find that it is a "calling" as much as a "career".Many midwives refer their clients to a postpartum doulas if they are concerned about Postpartum Depression because doulas can help the mother with her recovery and aid her in learning how to get adequate sleep while adjusting to a newborn. I don't know of any doulas who might be considerd remotely rich from their work. The hours are very difficult to schedule. The unknown nature of birth means that one is almost always on call. In Seattle, the doula education takes place at the midwifery school and we all work to support the work of each profession and to support women to retain their power and to have access to out- of- the- hospital birth options. Posted by: Susan MacPherson on August 3, 2003 05:30 PM Interesting. Posted by: term life insurance on October 7, 2003 06:14 PM I have had my 4 babies at home with midwifery care and have also worked as a GP (family MD) at homebirths with both doulas and midwives. As well as this, some of my best friends are midwives and doulas, many of whom work together. I see that Andrea is concerned that widespread use of doulas in Australia will take power, attention and/or money from midwives, who are in a difficult position at present- almost entirely unable to work as true midwives or offer continuity of care. This is a sad situation and, with many others, I am putting energy and support into the National Maternity Action Plan, which is promoting one on one midwifery care for all Australian women. However, I don't agree that doulas and midwives are in competition or detracting from each others roles, especially at the present time. I observe that many women here who have true calling to be 'with women' at birth are not happy with the midwifery training and/or work and that doula training is actually closer to the heart of midwifery than 'medwifery' is in Australia, at present. I trust that this will change with the growing direct entry courses- but there is still the problem of the scarcity of real midwifery work (and support for this)- at least until we have NMAP care. I support Andrea in the excellent work that she does to support hospital midwives in true midwifery. If all midwives could work like this, the need for doulas would be lower. But until we have NMAP-style one-on-one care with a midwife for all women who want it (and most women do want this, once they know about it- 70% or more in New Zealand) women will be seeking this personalised and contunuous relationship, and doulas are perfect for this role.
Looking from the woman's perspective, I see doulas as offerring a great service, especially for women having babies in hospitals (tho I've worked with excellent doulas at home too). Personally I would not have a baby in hospital without an advocate- even as a GP with a medical husband- beacuse I don't want to be tied up with arguing with the system- nor for my husband. I would choose between a midwife- if one was available, but there are very few here- and a doula, based on who I liked better for this role. I believe that it would be a very rare relative or friend who could fulfil this role- which I see as protecting and advocating for the woman- because the hospital system is so difficult to challenge- they can be very nice or very difficult to their clients, as we all know. Finally, I encourage all you doulas, doing a great job, to value what you do- charge what you are worth, if you can! We tend to undervalue women's work - this applies to midwives also- but if the woman and her baby have a better experience of birth because of your presence, you have given them the gift a lifetime! Blessings Posted by: Sarah J Buckley on October 22, 2003 01:52 PM I had my baby just under 4 months ago and was assisted by my husband, best girlfriend, 2 midwives (in shifts) and a doula. The first midwife we had was fantastic, she'd just transferred from the Birth Centre but she had finished her shift just when things started to go pear shaped. My husband was heavily emotionally involved (as well as extremely tired as we were at day 3 of an induction with about 2 hrs sleep in the previous 3 days), my girlfriend had a 3 month old who she had had to leave me to take care of and feed and the first midwife's shift had ended an hour previously so who was able to be there with me in totality - my doula. The second midwife was lovely but there was no time to establish any trusting relationship with her. Without my Doula to manage the space for me I would have had an extremely negative birth experience. It was MY choice to have one and I'm glad I did! Posted by: Ren on December 1, 2003 09:36 PM I am shocked by what I have just read. I had a disappointing first birth experience. I wont go into it but the process of healing lead me to discover a passion for birth & women I did not know was there. I live in queensland more specifically Townsville. I did not had my daughter here. Anyway I went about trying to find a way into midwifery. Qld doesn't yet offer a direct entry course. My only option is to become a doula and hope to get enough credit to do the course when it is available. In the mean time there are not any independent midwifes up here. I cant get a home birth for my next baby. But I can help some women to have a beter excperience. I agree that midwives are the way to go. But it is not always possible. I wish it was. Posted by: Philippa Scott on December 4, 2003 11:10 PM Idealistic simplification of the issue. Not every woman has sisters, aunts, friends or a mother who is willing and/or available to attend her birth, for many and varied reasons. I would suggest that to force upon me, my mother and aunt as birth companions, would be sheer torture even worse than the most scalpel-happy obstetrician, but that is neither here nor there. From personal experience, fathers do not always make great birth companions, and even if they are they should not be expected to 'shoulder the burden' all by themselves, considering how long labour can take. Some doulas practice on a pro bono basis. But I would willingly pay money for a woman who had experienced birth herself, (she does not necessarily have to have had any pseudo-training for this purpose) to support me during my next birth. In no way should this detract from the midwife's role. A doula does not and would not deliver a baby, so I can see absolutely no conflict of interest there. Perhaps midwives are feeling threatened just as obstetricians feel threatened by midwives? Turf wars always seem so petty to the consumers on the outside. But in what situation can a woman obtain midwives who are available to support her and only her throughout her entire labour? Certainly not in any hospital and there does not appear to be enough independent midwives to go around. Perhaps Ms Robertson is referring to Utopia, where there are no critical shortages of health practitioners (providing multiple midwives per birthing woman) and all individuals feel positively about birth (therefore making satisfactory birth companions). Certainly to campaign for these things is a noble cause, but the doula need not be the scapegoat for decades of mismanagement (for want of a better term) of issues of pregnancy and birth. Naturally in the end the only people who really lose out, are mothers and babies. Posted by: Kelsey Andrews on December 6, 2003 10:49 PM After further reading I must concur with Andrea's sentiment. The focus should be on midwives. I don't think the doulas are to blame, though; but I do think that it's more midwives we need, not more doulas. Thanks Andrea for bringing up this topic in the first place, because it's easy to be led to believe that doulas are a necessary part of birth in the 'enlightened' 21st century. Posted by: Kelsey Andrews on December 13, 2003 01:55 AM I had no idea there was any element of rivalry between midwives and doulas. In 2001 I achieved a successful VBAC but with no thanks to the indifferent midwife I was assigned. The only comments made by her were negative and un-productive and left me with much doubt about my ability to birth at all. Although my husband and mother were present, neither of them could give me what I needed - constant encouragement and reassurance - and my labour was filled with terror and regret at ever attempting a natural birth. I realised the absolute importance of a trusted birth partner so I had my sister present for the birth of my babygirl born Aug 03. It was her unfaltering support combined with a positive mindset that gave me a beautiful drug-free water birth. Knowing what incredible impact a good birth partner makes has inspired me to train as a doula once my baby is old enough. I do not plan to charge for my services. I know from first hand experience that some midwives fall well short of providing the support that is required for a labouring woman. Their attitude alone can make or break what is either the most empowering or traumatic event a woman can experience. I make no apologies for wanting to assist other women in achieving a beautiful birth. 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Posted by: fp292003 on January 21, 2004 01:54 PM Thank you for your opinion on doulas, everyone is entitled to their own. Being a doula in Canada, I would have to state that we do not have an abundance of trained and qualified midwives in my area. For a population of approx. 350,000, we have one midwife. So as you can imagine, doulas are necessary. You may state that "whatever a doula can do, a family member can do". I tend to disagree. Although I would rather a woman in labour have a family or friend support her, than no one at all. I would beg to differ that a family member is the same as a trained and qualified doula. My personal training focused on pain measures for the mother. Emotional support for the whole family, and that includes involving any family member or friend that the mother wishes to have with her. I DO NOT exclude anyone. I also do not speak for my client. Before labour , I offer my client the pros and cons of many areas of labour, and then it is up to the family to decide their wishes. I am there to support the family through a most joyous time , and I am sure you would agree, a confusing and exhausting event for some. Posted by: Kimberly Hasson on April 5, 2004 01:47 AM m writing in response of "Doula Craze". I have to say I was slightly lost when I got to the "well paid" part. I am a pregnancy and birth assistant and I would not consider my time "well paid". I have said more then once that doula work is 90% community service and 10% income. I put in more hours with clients then either the provider or nurse who will be attending them. They receive approx. 6 hours of my time prenatally, the entire birth and 4 hours postpartum. When all equals out I make about 12 dollars an hour U.S. I don't drive a BMW or Jaguar, and I certainly don't make the three thousand dollars during my service to them that their obstetrician does. As a matter of fact, the OB spends approx. 1 hour 45 minutes with the client, all services combined. This includes the prenatal appointment, birth and postpartum, that equals out to just less then Two Thousand Dollars an hour. Yes the OB has overhead for his office and supplies, nursing staff etc. But the OB sees 15-20 women a day and does on average 30 births a month, I do 2. My clients are never forced into doula support although I highly encourage a female presence at their birth. Someone who is there to support the mother and partner only. Someone who does not work for the hospital does not have to follow policy and does not look to the facility for their next meal. This could surely be any friend or family member. I however after having 4 of my own children would never burden my husband solely with my physical and emotional support during birth. If he is going to assist me then I appreciate having someone there to assist him. I wonder, if women feel "forced" to hire a doula, what do they feel when expected to lie down for weekly vaginal exams starting at 34 weeks, or routine testing, or routine monitoring, routine IV, routine epidurals, routine cesareans. Do women not feel spiraled out of control when pregnant and birthing? Do they not feel as if they only way to do things is the establishments way and to do otherwise is against the rules? How many women think that when having a baby in a hospital the routine interventions are law? If over 80% of births in the U.S. are taking place in hospitals, and the induction rate is over 30% and the cesarean rate runs from 25-50%(depending on the geographic area) then you tell me what advocacy, education and support are worth. I say that for my clients, who chose to seek me out, who chose to hire me, who chose to have me by their side regardless of payment, for many were reduced or free from fee, I say my efforts were worth more then you or any other person could ever imagine, To Them. Being a doula isn't anywhere near big business, rather a valiant fight worldwide to dismantle the big business that hospitals, obstetricians and insurance companies have made birth into. You want to empower women. Tell them they have the choice to do what they want, when they want with their bodies and no one can take that away from them. They have the choice to choose. I get the opportunity to tell my clients this! Posted by: Chantel Haynes on April 5, 2004 06:04 AM How unfortunate to see midwifery now being pitted against such advocats of that fast dying craft. Yes, America is a capitalist nation, but that doesnt mean that doulas are "well paid". If I am so well paid, then why do I still live in an economically challenged area of Los Angeles California while, 3 miles away in the local hospital, an anesthesiologist is paid 3-4 times my fee to administer an epidural, a doctor is perfoming an unnecessary Cesarean surgery increasing their fee by a few thousand dollars, or a single mother is being told she has to be induced because her due date will be Monday and the doctor is going on vacation Wednesday, raising the hospital costs and subsequently insureance premiums? Not all Americans are money hungry... Posted by: Lauralynn Pearson on April 5, 2004 02:41 PM I have read all the comments with great interest. I have recently attended a 4 day doula course, with British Doulas in London. (which incidently is ran by Midwives and health professionals). I am starting a BTEC National full time course in Health in 2 weeks time. As part of my study, I have to do 400 hours of care work (my doula work will count for this). Once this course is completed I hope to begin the 3 year diploma in midwifery, as this is my long term goal. However, I thought it might be of interest to those 'against' the doula movement - that whilst attending the doula course there was a lady there who was a QUALIFIED MIDWIFE and had been for a couple of years; who felt that due to the 'politics' - as she called it - of midwifery, she wished to become a doula, and advised me against becoming a midwife! She said that often it was not unusual for her to be 'attending' to 9/10 labouring ladies at a time and therefore could not possibly give them the one to one care that they required and that she wanted to give. She whole heartedly enjoyed her job as a midwife, but felt that she would therefore get more satisfaction as a doula, knowing she has supported the mother in a one to one basis. Posted by: Teresa Reid on August 26, 2004 07:19 AM Post a comment |
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