I'm often asked to explain what it is exactly that I do. To begin with, Birth Doulas provide emotional and physical support, as well as information for women during pregnancy, birth, and the early stages of postpartum.
No, we are not midwives.
No, we do not consider ourselves medical professionals;
and no, we don't tell our clients what to do, or make decisions for them.
So what do we do?
We do provide our mothers with up to date evidence based information.
We do support women throughout their pregnancies.
We do accompany women to their babies births, and hold their hand during the whole process.
And countless other things. We all come with our own skills, life experiences and most importantly, love, into our clients lives.
Don't get me wrong, I've definitely been in a delivery room many times when a doctor presented an intervention to a laboring mother, and the mother looked over at me and said "Is it safe? Do you think we should do it?" That's not a spot I like to be in. These types of questions leave Doulas in a very uncomfortable situation. On the one hand, we are there to support our clients in whatever decisions they make, and often provide them with Evidence Based Information. On the other hand, we can't make their decisions for them, and very rarely does a hospital's policy match what current research is telling us. This creates an awkward chasm between the doula and the medical profession. When my client asks, "Should I do this?" the doctor hears the mother asking a "less informed" individual what to do, and often feels threatened, or like we think we know better. It's not that at all though. Firstly there are many different ways to present information to clients, without saying outright in front of the medical professional that we disagree with their choice- and we very often agree with the call that they make! It's not because we think that doctors are evil, or that we dismiss the medical profession; it's completely the opposite! Because of the medical profession we are able to have extremely necessary research done, as well as life saving interventions for those women in harms way during labor... But... and heres the thing; there are a few reasons that doctors sometime do things we disagree with:
Firstly, just like in every profession, including my own, there are people who are highly skilled, and others who aren't. You can always get stuck with the bad end of the deal, no matter what you're doing; but aside from that, due to the high number of law suits surrounding the medical profession, many times, doctors would rather be safe than sorry; and that means they can't always pick the procedure, (or not do a procedure,) that would be best for each INDIVIDUAL mother. If a doctor decided to do a cesarean, and G-d forbid that baby didn't make it, they still look better in the end of it all for having tried, even if in reality that baby wouldn't have made it anyway. I highly respect the OBGYN's and nurse midwives I work with on a regular basis; but unfortunately in todays day and age, they need to be watching their own backs, and that's not their fault at all.
Another problem, especially in our Israeli hospitals is being overfull and understaffed. Israeli labor wards differ greatly from American labor wards. In many American hospitals, especially along the east coast, you find a nurse assigned to stay with each laboring woman, (until her shift is up, at least.) In Israeli hospitals, there aren't enough nurses to do this work, so a laboring couple is left to their own devices, aside from a few intermittent midwife visits, when they are placed in a delivery room. Doulas come in handy here. We are able to stay with the our clients from start to finish, depending on our policies, and don't switch out for a hospital shift change. Because of the surplus of birthing women, lack of staff, and beds, a doctor may be forced to put a time limit on each delivering mother. Although research may support just waiting, (except in an emergency situations,) doctors and midwives often administer Pitocin, cut an episiotomy, or use a vacuum to speed things along. (I am of course not referring to any situation where any of these interventions, or others are medically necessary, or save the lives of mother or baby. There is a time and place for everything.) They aren't to blame for most of these decisions, as the hospital policy puts them in an awkward position as well.
So where do we come in as Doulas?
Since there is so much pressure already placed on the laboring mother the moment she walks into triage, it's our responsibility to prepare them ahead of time for what is about to come, (or to direct them to an excellent Childbirth Educator,) and help them find clever ways to get the information they want out of the people they are talking to, without insulting them. Our work is to help a mother understand that she has the skill, right, and ability to make decisions for herself and her baby, and that's the first chance she has at being a parent. We wholeheartedly believe that a woman's experience of labor can strongly effect her ability to mother with confidence, and feel fulfilled in the postpartum period. We have gentle and encouraging ways of asking doctors and midwives if the intervention they are about to perform is medically necessary, or if it can wait a few moments.
One acronym I learned in my Childbirth Education training, but often use with my clients is reminding them to use their BRAIN.
B- What are the potential benefits of this procedure?
R- What are the potential Risks?
A- What are the possible alternatives?
I- What is my intuition telling me?
N- What happens if we do nothing?
We can help clients by kindly saying to the doctor, "Can you explain the potential benefits or risks of this procedure, please?" We are also able to help remind the couple what comfort measures they have learned in their CBE courses. I often take over massage from an exhausted partner, or remind a father of what he could be doing, instead of running around flustered. I've even been there just to create the space for the couple to have privacy by turning off the lights, closing the door, and putting on some relaxing music, that gives them the time to whisper to each other intimately. I also run errands for couples, bringing them fresh water, a croissant, or a treat to help keep up the energy.
Doulas are basically personal assistants for Pregnancy, Birth and the Postpartum period. In fact, I always wonder why we don't have Doulas for everything!
Who doesn't need the hand of a loving support person, the calming voice of a Doula? Who doesn't want to be told that they got this!
Who doesn't need a cheerleader to follow them through life?
As a Doula, I'm privileged to go through life building people up, and being a positive participant in the most exciting and intimate part of peoples live, and I wouldn't trade it for a thing!