NRC and Nieuwsuur broadcasted a news item about doulas earlier this week which featured again in NOS this morning. In this news item it is suggested that doulas do not always respect the care providers’ role, occasionally interfere with medical decisions and even the utility of their role was questioned.
It makes me really sad to hear this very one-sided and partial news item. The mothers, central to this process of giving birth weren’t invited to share their perspective on the topic. Many midwives are extremely supportive and appreciative of the contribution of doulas in the birthing process and these testimonies didn’t appear here to offer a balanced view on the matter. In my personal and limited experience, I’ve been blessed to work alongside many open-minded midwives who made me feel very welcome. There was mutual respect and total clarity on roles.
A doula’s role is to support emotionally and physically the birthing woman and her partner. She offers non-judgmental support and represents the birthing woman. A doula doesn’t voice her own opinion or have her own agenda, she stands with her clients as best as she can and holds space for their process.
A doula supports a couple in preparing for birth. She invites the birthing woman to think about comfort measures and birth preferences, provides resources and research where asked for so that she can make informed decisions.
While there is never any guarantee that a woman can birth as she hopes, a doula does her best to support a woman in her wishes. She will encourage a woman and her partner to voice their preferences as long as there is space to do so but also not to be attached to them and flexible when adjustments are needed for health and safety reasons. Birth is completely unpredictable and sometimes quick medical interventions are definitely the wisest course of action. The job of a doula is certainly then not to get in the way but to continue to assist the birthing couple emotionally to the best of her ability however birth unfolds whatever the scenario. A doula also understands her limits and boundaries. While she may sometimes assist her client in voicing her preferences or asking for clarification to make an informed decision, her role is certainly not to interfere or give advice regarding medical decisions. Personally, this is one of the very first topics that was addressed in my doula training. I trained at Bia Doula Training and the boundaries of our role were made clear from the very beginning.
A doula does ensure that a birthing woman is heard and seen, that her preferences are respected where possible and when not, that she understands why and what is happening to her, that there is informed consent whenever an intervention or medical procedure is needed. These are all elements of a non-traumatic birth process and most care providers are sensitive to these.
A doula doesn’t interfere with the relationship between care providers and client. Her role is to create peace as much as possible in the birth environment, facilitate communication between all parties, so that her client can feel safe and supported.
I believe that the fact that a doula isn’t medically involved is actually central to her being able to provide the kind of support she does.
Being a reasonably fresh doula and non-Dutch with many expat clients, I wondered if it was my place to respond to this news item. Also, because it may just grow awareness for a flawed message in the first place. However, I respect women too much to stay silent. Staying silent is being complacent. My opinion may not have its place in a woman’s birth environment but I’d like to voice it here.
This news item doesn’t represent doulas role accurately. It feels like there is a misunderstanding about what we do. I do not deny that there may have been a few cases where doulas may have gone beyond their scope and the challenges this may have posed. However this is the exception not the rule. It isn’t fair to mention this and not the many success stories of doulas working harmoniously amongst care providers to serve a woman giving birth. It isn’t fair to doulas and most importantly it isn’t fair to the birthing woman, manipulating her with this misleading news.
In the last birth I attended and supported, the midwife mentioned shortly after the birth what a great team we had been all together : the birthing woman, her partner, her, me and she didn’t forget the baby, working hard to be born. It was inclusive and touching.
For me birth is about a woman in her most vulnerable hours feeling supported, heard, cared for, respected as she brings in new life into this world. This is a sacred space that is very sensitive in which a woman can feel safe to open up and give birth her baby or totally disempowered, almost cut off from her own process, depending on the way she is treated. And that feeling can change in the blink of an eye. This is not about power plays or ego but about serving a birthing couple in an essential life moment. Most midwifes, gynaecologists, nurses, doulas, partners work together to serve women in their own particular way with clear roles.
Birth is a space where a woman should be allowed to make her own choices as much as possible. This doesn’t necessarily mean having a doula by her side but if it is a woman’s wish to have this additional support than by all means this should be respected by care providers. The rising number of women giving birth with doulas by their side clearly Indicates that there is a need for this kind of continuous support which is seldom an option in traditional birth care. Midwives are absolutely able to fill this gap however the current care structure and system do not allow for this as it isn’t considered efficient or profitable. Midwives are sadly under increasing pressure with more clients and less means. This isn’t fair to them or to birthing couples. And this is where doulas step in. Continuous support is a necessity not a luxury.
On a more personal note, before becoming a doula myself, I hired a doula for the birth of my first daughter. I hesitated a lot before hiring her wondering if it was necessary, fearing it may harm our intimacy, et. In hindsight, just her presence and quiet reassurance was a gift I wish for every woman.
At one point I was 9cm dilated and it was time to transfer to what was referred to as the “delivery room”. The hospital staff was about to wheel my bed to the room when my doula softly suggested we walk there. I looked at her in disbelief in the midst of very intense contractions (“are you kidding me?”) and then I remember thinking “why the hell not, let’s try this”. Walking in the hospital corridor to the room where I would give birth to my little girl, supported by my partner on one side and my doula on the other, was the most empowering moment of this birth experience. I probably looked anything but glamourous from the outside but on the inside I felt like a warrior and was shining with pride. I am grateful my doula saw my strength and believed I could do it. Any woman deserves this unconditional support and trust in her process … if she wants it!