Yesterday's NYTimes had an article on doula support (in the Sunday Styles section) that was a wee bit controversial; check it out at New York Times Doula Support. The article had me all in a tizzy, but it's not that I disagree with some of the content. The article gives the stories of families who do not have great experiences seeking support from doulas and lactation consultants. In one example, a doula tries to force her steadfast belief in natural childbirth upon a family in the labor and delivery room and ends up walking out on them when they choose an epidural, and then another family where a lactation consultant encourages a mom to get her preemies off of tube-fed formula (recommended by the neonatologist) and onto intravenous nourishment until breastmilk became an option. The article also sites examples of hospitals that have banned doulas because they were interfering with the medical staff.
Eeek. Doulas have worked so hard over the past few decades to professionalize and develop standards to prevent exactly these problems. But. Well. The article is not entirely wrong, it's just a little too one-sided. Childbirth often draws really opinionated, orthodox individuals -- ranging from the field of obstetrics to, yes, the Natural Childbirth Nazi doula or childbirth educator (Bradley Method gets awarded this prize more than most approaches). While it is usually an arrogant OB that outrages me when my clients tell me stories, sometimes it is definitely the Childbirth Educator who told my client that her gestational diabetes didn't exist and she should ignore the suggested medical and nutritional treatments. Or my friend whose doula thought she was a midwife and tried to do a vaginal exam (but, err, couldn't find the cervix). Or my two friends whose doulas didn't show up for them when they needed them (one decided to sleep through the night and called to check in when my friend was getting pitocin administered; the other doula asked if my friend minded if she took a quick nap just as she was starting to transition).
Despite these stories, I jumped at attending a doula training here in San Diego. And it was amazing. This DONA-approved training, simply put, rocked. Taught by a Penny Simkin-trained doula and childbirth educator, the training leaned toward as-natural-as-possible childbirth as yielding the best outcomes for mom and baby. However, the assumption was that our future clients would be laboring in hospitals, and that relationships with the medical staff were key. The training reinforced that our role as doulas was to support the family as they labored toward their best birth scenario. And for some families that might mean various interventions. Penny Simkin describes a doula's role as protecting women's memories of birth; it's not about forcing an unmedicated birth any more than forcing interventions. It's about making sure women and their families have a positive experience of the birth and have a good shot at materializing their own birth plan.
On the lastday of my training, each of us doulas-to-be took a little survey asking us various questions about how we felt about different birthing scenarios. We scored our answers and all found ourselves categorized in one of three camps: ProBaby; ProMom; or ProNaturalChildbirth. Our trainer wanted us to be really in touch with our own biases and intentions as we set out on this path. We serve nobody if we walk into a birth with our own intentions unclear; this is not our own birth we are attending and we need our own agenda off the table.
The article does give a nod to Doulas of North America which provides some sort of standardization and certification. Though, as the article points out, technically, anybody can be a doula and this certification is not actually required. But I think there are a few interesting bits about certification that the article could have highlighted. In order to become certified by DONA, you need to successfully complete trainings and then you must attend three births and have successful evaluations filled out by the mom, nurses and doctors for each birth. From the very beginning, each doula understands her role in relationship to medical staff. DONA sees the medical staff as important partners in the birth experience and gives them a say in whether each new doula passes muster.
In the article, Falls Church, VA doula Mary Beth Harris referred moms-to-be to other doulas because these women knew they wanted to use epidurals; this is exactly the level of conversation that families need to have when they are interviewing doulas. If there is any scenario in which you envision yourself using pain medications or various interventions, a really orthodox natural childbirth doula is probably not the best choice for you. And please do note my use of the plural when discussing interviewing doulas. You want to do your homework ahead of time, and then talk to lots of doulas on the phone and then invite three of the potential best fits into your home for an in-person discussion. Remember, inviting somebody into your birth is really an intimate thing, and you want to see how you respond with them in your personal, home space. A lot of pregnancy books have various questionnaires you can use when interviewing a doula, but here's a good list from the DONA website, as well as some more info on using professional, well trained labor support from Childbirth Connection.