Doulas – Still Fighting For Our Place In Birth

As I find myself coming home from an hospital birth, I reflect on the occurrences of the day. I think back to how grateful I am to have witnessed a new life come into this world and how privileged I am to witness women at their very uttermost power. However, with every hospital birth I walk into, I prepare myself for the battle which is the maternity system that I constantly walk into and the power shift that awaits me.

This power shift is something that I always think I get used to, but the hierarchy of birth is something very real and transparent each time. As a Doula working in the hospital settings for many years now, I have had to build a thick skin to deal with the usual downplay of the service I provide.  Even though I know and remind myself that what I do is essential to women and families.

I know this first hand, not only have I been doing this for a long time but I myself chose to have a Doula as birth support for myself and my husband as we welcomed my second and third daughters earthside. My Doula provided me with support that was invaluable to me in so many ways. My Doula provided me with the educational, emotional, mental and physical support I so desperately needed (especially after my first birth in the hospital system) to be able to have the most empowering and positive experiences and because of her I am doing what I am today. She also educated me in ways I didn’t get from my medical care givers and that was something that truly opened my eyes and was my first glimpse of how the system works.

So why is it that a Doula who spends the most time with the parents in the perinatal period, to know the wants and needs of the couple she is supporting, provides them with a wealth of information as well as emotional, physical and mental support gets classified to the bottom of the food chain in terms of value and appreciation from most in maternity care? Doulas are also usually the only ones outside of her partner, that have in depth knowledge of the woman’s emotional needs, any background history or trauma that might trigger the mother in birth or underlying issues that could potentially obstruct her labour as a result of her mental or emotional state. This vast knowledge and the understanding that we hold reverence for in birth is something that care providers usually dismiss for just what is happening in the physical body, right at that moment.  But as Doulas we engage with families to know them well and we are aware that what lies beneath the surface is crucial to a positive outcome.

At the most recent birth I came back from, I asked some questions on behalf of the parents so that they were able to make informed decisions.  Typically, the midwife didn’t like me being curious and inquisitive so she raised her finger to ‘shush’ me into silence. Again, belittled for what I know is not right. She was giving the parents I was supporting false information and trying to coerce them into a procedure they didn’t need. I do consistent ample continued education to know that and yet ‘I am just a Doula’ after all is what I was so blatantly told. Know your place here is was what she was saying to me with her actions. This isn’t the first time this has happened and I’m sure not the last.

I have the utmost respect for care givers, I work alongside them really well in caring for women but I know that they are only human and they have policies to adhere to, their own clinical history in caring for women and also their own philosophies and ethos when it comes to how they practice. I may not have gone to medical school and sat through countless hours of anatomy and physiology, read through hours of text books and writing assignments.  But I have been present for hundreds of physiological births, done years of training and continually educate myself so that I am providing my clients with evidence-based care and also guiding them to seek more information from reputable sources.

The expectation to be ‘shushed’ into silence is already there for me in some way when I enter the hospital doors. It was very apparent especially through Covid when I had to fight tooth and nail to be considered an essential part of the women’s health care team and be let in to support my clients, some hospitals were respectful of that but it was a fight. But I will not bow down because I am an essential part of a women’s health care team and there is ample evidence to prove that.

Having a Doula present at your birth can increase your chances of having a physiological birth and a shorter labour. It also decreases your chance of having pain medication, a negative experience and a caesarean and your baby is less likely to have complications at birth and need to be admitted to the neonatal intensive care unit. There have also been some studies that show when a Doula is present working as a team alongside the father/partner they are more likely to have a positive experience as well. This is even more evident when there is an induction with a Doula and a partner present supporting the mama and how it reduces the caesarean rate. So how can we look at all this profound evidence and say we aren’t essential to the healthcare team?

There is a famous quote by Dr John Kennell the founder of DONA which is one of the most well-known and reputable Doula training programs. In his quote he said “If a doula were a drug, it would be unethical not to use it.” Such a simple and yet powerful quote that summarises the benefit that a Doula can bring into the birth space. So why is it that Doulas aren’t yet seen for the value we offer?

As I got back home after many hours at a birth, I debrief my day with my husband who is by now very well versed in Doula chatter and I go to unwind and then check my social media to see a post by a very well-known and reputable home birth midwife that I once admired post about a suggestion that read ‘Doulas, but for on-call midwives who need life support. The midwife would go to the woman and the Doula goes to the Midwifes house to replace her there. It’s like indirect Doula-ing’ I was actually really taken aback and had to read the post several times and the caption that accompanied it which basically suggested that because I am already on call for mamas as a birth Doula then I might as well add a service to my already busy on call life to service the midwife with her family and her household needs so she can go do the ‘important’ work of being with woman. To say that I was deeply offended by this would’ve been an understatement. There were mixed comments on this post, some from Doulas and Midwives welcoming the idea however there were also some very rightly so upset Doulas feeling like myself very devalued.  Yet this midwife proceeded to tell those that felt devalued as to soul search as to why this is triggering them and they should self-reflect with that.

I want to twist this idea back on its head and change the scene a bit. Imagine a highly respected Obstetrician would put out a post saying midwives are already on call for clients then it wouldn’t hurt if he/she said OB could suggest an added service for them to babysit essentially and take care of light housework for them so that they could do the ‘important’ work. How valued and supportive would midwives then feel?

So, I am in no way saying that all our professions are created equal but in the birthing space we each contribute and add value in our own individual ways within our own scope of practice.  This is where I didn’t expect a home birth midwife especially to come out and suggest such a thing when they greatly know the impact Doulas provide and how important and crucial that emotional, mental, and physical support is and the educational knowledge that we give our clients in the prenatal period, in birth and postpartum and how that can enhance on the positive experience the woman has.

As Doulas I want this as a reminder to know your worth. I personally did not come into this work as a hobby and as something that I’ll give a go at and see where it takes me. This has been my professional career for 11 years now and I have invested hard work, dedication, investment in continued education and time away from my family to a profession that I love and have a lot of passion for.  Doulas deserve to be respected in the hospital setting by care givers for what we bring into the birth space in supporting the families that we do.  We certainly do not deserve to be treated as lesser than and even more so by home birth midwives. At the end of the day the hierarchy should not exist but it does because of posts and statements like that and those made to Doulas every day to burn their flame to put them in their place. Midwives are the first to know that this hierarchy only creates division and so they should not be doing it to others. We should all be working on a common ground and that is to support families to have the most positive experience as we all bring our own unique gifts onto the table to enable them to do so and if we work together, we can do that and do great things.

Photo Credit to: Kaila Sky Photography

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