It’s easy as a doula to migrate towards the world of homebirths and birth center births. As doulas, we tend to love the serene, comfortable setting of a birth center birth. The birth is treated as a normal physiological process and not something to be medically managed. It’s a beautiful experience where the doula is accepted as part of the birth village without question.
Hospital births may not be the same experience. The beeping machines, the continuous monitor belts that are always seemingly tethers to a bed, I.v lines and nurses who are constantly in and out of the room typing charts into a computer. Absent are the dim lights and the aqua doula tubs. Women are told that contractions are to be feared and medications are available. Doctors are not necessarily fans of a birth village and definitely not fans of doulas who advocate for alternative options to standard hospital procedures, let alone informed consent for standard ob procedures.
It’s these births where doulas can make a difference. A true and definitive difference. Bridging the communication gap between a new nurse who is confused about the importance of skin to skin, let around nursing in the first hour after birth, or just a gentle smile and words of respect to a doctor who isn’t thrilled with your presence or your reminder that AROM is a procedure in which the patient deserves informed consent. It’s this doctor who may bring this experience into his next birth knowing you weren’t a hippie crazy doula. You were a rational, well educated, professional doula and part of the birth team, there to support her client, and hopefully make birth normal.
Even though, as doulas, we need a birth center birth to revive us after a few rounds of hospital advocacy births, our skills are challenged and grow the most in a hospital setting. We learn how to mediate and graciously offer alternative to standard practice. We gain the respect of doctors by showing them our knowledge of birth and also by showing them respect for their knowledge. We humble ourselves to realize although we are birth professionals and valid members of the birth team, we are not doctors, midwives or nurses. We are doulas. We make birth normal by serving and supporting our clients well in any setting.
I’m a doula. In 2007 when I became a doula, I usually had to begin a conversation with another person about what I do for a living with helping them pronounce the word, “Doula” and then go into a ten minute narrative explaining what exactly a doula does. The inevitable remark of, “Isn’t that what a friend would do?” or my favorite, “That’s what the nurses do, right?” would happen next along with a smile and nod. Now, fast forward a few years and in 2015, most expectant parents know what a doula is and are discussing if they feel they need one for their birth.
Doulas have slowly become accepted in most hospital and birth centers as a valid member of the birth support team. Even the doctors, who would rather not have to deviate from their comfortable work patterns and their own birth script and plan for their patients, have realized that their patients are choosing doula support and are expecting the doctors and nurses to be respectful of their choice.
Birth has changed. Our healthcare system and careproviders, for years, have dictated the script of labor and birth. With rigid time limits, invasive procedures and a culture of medical management, the modern birth didn’t shape up to be exactly as enlightened as one would have hoped. Continuous monitoring was introduced, epidurals replaced spinal blocks and forceps, mothers were allowed to walk around during labor instead of being in bed, but, still our c-section rates rose and our births were becoming more medically managed.
In 1999, women were signing up for inductions at 36 weeks and scheduling their surgeries to avoid stretchmarks with little regard to the effect of premature delivery or the risks of major surgery. We had changed and modernized birth, but we didn’t necessarily make it better. We definitely hadn’t made it appear, “normal”.
Doulas are helping expectant parents edit this script. Somewhere in the last decade, we have begun the process of wading through the managed care of pregnancy and birth and start to push back on the limits and rigid standards of what the medical community deems the textbook labor. Women are realizing that maybe technology and birth don’t exactly need to go hand in hand. Maybe, just being low tech is better.
As a doula, I feel my number one commitment to a family is not that they get the perfect birth, but that they get an informed and empowered birth. I help normalize the experience and not medicalize birth. I am not a doctor. I have no time limits on how long I will hold your hand, apply counterpressure to your back during a contraction or help position you to turn your baby to lessen your backpain.
Modern birth is shaped by computers and medical charting that needs to be completed every hour. The ticking and beeping of the fetal heart monitor and the contraction monitor as well as the endless questions regarding health background information and consent forms to be signed that can be the last thing a woman wants to do in the middle of labor. Modern birth is a doctor coming in every two to four hours just to do a vaginal exam, shake his head or nod depending on the assessment and then leave for the call room until pushing time. Although a family may have a wonderful bond with their doctor and love their hospital, the reality of the typical birth experience is much different than they anticipate. Modern birth is anything but normal.
Doulas keep the woman the center of the birth. We keep the family and the birth the focus. After attending over a hundred births, I have seen many birth scripts, not one has been the same as another. My goal is never to have a woman go without pain management or for her to treat her birth as the pinnacle experience of her life. My goal is to keep her birth normal. Normal. Not modern, not crunchy, not exceptional, just normal.
Birth is normal. I guide women through early labor so we don’t arrive at the hospital and end up on the “labor clock” too early. I assure them that bleeding is normal and if your water breaks, it isn’t an emergency. “You are safe, you are in labor, you are going to be a mother soon, and your body will work. You are normal.”
Preparing a mother for a normal birth is incredibly important. Knowing you can rest, eat, walk, shower and even sleep in early labor will decrease a chance of a c-section. Staying home until active labor is an amazing feat in the modern birth. Having a support person who can safely assess when to leave for the birthplace according to the mother’s plan, can shorten the stay at the birthplace and lower intervention.
Doulas often get the reputation of being defiant, anti-medical, anti-doctor type super feministic women who charge into the hospital with our patchouli and peanut balls just waiting to jump in front of a doctor with an amnio hook. That’s not my idea of a doula and it isn’t the doula that I am.
Once doulas begin to realize that we are there to create a normal birth and not an exceptional one, maybe we can better fit into the labor and delivery room with a doctor who is trying to represent himself as the super human baby catcher. Families are hiring doulas to have a guide through labor and to avoid unnecessary interventions in a modern birth full of ways to intervene. Doctors have become amazing surgeons who can safely deliver babies in distress. Midwives have become supported team mates in collaborative care of women in hospital settings. Now, it’s time for doulas to become the final piece of the support team. The one that guides the woman through the normalcy of labor and empowers her to make the choices in her labor that make her feel comfortable.
We are not being hired to create the ultimate birth experience. That job, I wouldn’t even want to take. Birth is unpredictable and doctors and midwives have an enormous responsibility to bring mother and baby through it healthy and happy. Doulas, well, we just get to to make it appear normal.