I had to write an essay on this topic for my DONA certification packet. I haven't written a real essay since 1998. I am also physically incapable of keeping the word count to 1000. I welcome constructive feedback on the structure, clarity and content of this essay. I think there are a few awkward paragraphs...
Please pass it on and share your thoughts!
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Throughout
all of human history, women have helped women through the process of giving
birth. When birth migrated from a
home-based, women-centered activity into the medical world of doctors and
hospitals, this critical element was lost.
As women put their births in to the hands of the doctors, pregnancy and
birth turned from a sacred rite of passage, guided and supported by midwives
and female friends and relatives, into a condition to be assessed, managed and
treated. Somewhere along the way, the
only acceptable goal in this setting became a healthy mother and baby,
regardless of what the woman had to go through to get it. While many hospitals and obstetricians today a
least give lip service to the idea of a mother-friendly birth, the fact is that
most women who wish to define for themselves what constitutes a satisfying
birth experience must fight through miles of red tape and protocol to be
“allowed” to labor as they choose and give birth in the way that feels right to
them. Introducing a doula into this
scenario brings back a little bit of the human element that was lost in the
transition from home to hospital.
A
doula is a non-medical, trained birth professional whose primary responsibility
is to the woman giving birth. The doula
knows the woman, her birth preferences and her partner. They work as a team to help the mother give
birth to her baby in the way that feels best to her. A doula is not there to speak for her client,
but rather remind the client when the course of events is veering away from her
birth preferences and to support the client in getting the information she
needs to make an informed decision. At
its most basic, the role of a doula is to provide emotional and physical
support for the laboring mother so that she can have a “safe and satisfying childbirth as the woman defines it”. That last part is key - “As the woman defines
it”. A doula must not project onto her
client her own desires, fears or “birth baggage”. Birth is the mother’s journey. The doula’s role is to follow the mother’s
lead and gently remind her of the path she had wished to follow.
Over
the last few decades, there have been many studies that show the benefits of
providing women with continual labor support.
The largest systematic review of continuous labor support studies
(published in 2011), found that introducing a doula into the birthing room
dramatically lowered the instances of obstetric interventions, including
cesarean sections, the use of Pitocin, and the use pain medications. Besides these medical benefits, mothers who
have a doula present throughout their birth are also less like to view their
birth experiences in a negative light, regardless of the outcome. When a woman feels heard, honored and
supported during her birth she can own the decisions that are made and deal
with them from a place of empowerment instead of helplessness. It almost doesn’t matter what the decisions
turn out to be, as long as the woman can make them with her own voice and under
her own power. Women who have satisfying
birth experiences are less likely to suffer from postpartum depression which can
disrupt mother-baby bonding and deeply distress the entire family. The benefits of having a doula go well beyond
the birth itself.
Doulas
provide physical, emotional and informational support during the birthing
process. When a doula is present, the
mother and her partner have someone there that they know is unequivocally on
their side. The birthing family knows
they have an advocate who has no conflict of interest. A doula is not tied into the often competing
demands of the patient’s true best interests and hospital protocol. A doula is a witness to their process, a
shoulder to lean on and a gentle guiding hand to help the mother find her
voice. She helps the mother find ways to
deal with her pressure waves by applying comfort measures, assures her that
things are going well, tells her that she is doing a good job, helps the
partner to participate at his comfort or her level, and finds natural ways to
get labor moving past a plateau. A doula
reminds the family when things are veering away from their desired birth and
gives them the confidence to speak up when they have questions or concerns
about the care they are receiving.
Partners may feel less stressed to have a trained and knowledgeable
birth professional present who is not the care provider. Because a doula is not a family member or
close friend, she is not tied in emotionally with what is happening during a
birth. She cares deeply and works
tirelessly to help her client have the birth she desires, but she can see
things objectively because she has no personal stake in the outcome. She can provide needed assurance and guidance
to a partner who may be distressed to see his or her loved one in pain. She can also take the pressure off of a
partner who is reluctant to participate actively in the birth by allowing the
partner to engage with the birthing woman at his or her own comfort level. A doula provides informational support
prenatally and during the early postpartum period to help ensure the family is
as prepared as they can be for the demands of labor, birth and caring for a
newborn.
A
DONA certified doula has a responsibility to follow the Code of Ethics and
Standards of Practice set by DONA International. She also must not overstep the scope of a
doula’s practice by providing medical advice or interfering with the
relationship between the mother and her care provider. Helping a mother find her voice does not mean
speaking for her. A doula also must be
committed to providing her clients with the services she has promised. This includes securing a back-up doula in the
event that she cannot attend her client’s birth for unforeseen reasons, and
providing a client or potential client with referrals to other doulas if she is
unable to serve as the woman’s doula.
When I had my first child 4 years ago, I had never even
heard of a doula. I did not have one at
my first birth. In retrospect I know a
trained doula could have potentially shortened my 50+ hour labor and reassured
my very nervous husband that everything was okay. To some, having a doula may seem like a fad
or another way to have a “trendy” birth.
In reality, the resurgence of the doula is a return to our roots as
human beings. In ancient times, women always
protected each other in that sacred space between pregnancy and motherhood. The transformation between “woman” and
“mother” was a rite of passage to be honored and celebrated. Women have always supported, guided,
encouraged and upheld the birthing women in their communities. As the modern world has caused families to
scatter and allowed women to have babies later in life, the natural childbirth
support system of made up mothers, sisters, aunts, friends has also scattered
or been lost altogether. The doula fills
this ancient, sacred role.
