The “Can do no Right” Doula Blues

by MotherWit | Aug 10, 2010 | Uncategorized

We have talked about the phenomenon of “doulas behaving badly”. I have brought up a few things about doula work to try to help us be understood a little better by medical professionals. Now I wanna sing the blues. The truth is, more often than not, doulas who behave conscientiously still get their share of berating. It’s true that those who behave badly can create or exacerbate prejudice for our work, but the reality remains that sometimes we’re hated on sight simply because of who we are. Our very presence does tend to evoke thoughts of “Are you here to challenge my authority?” in some caregivers. But instead of asking questions or trying to come to a place of understanding, what can happen are knee jerk reactions. Personal attacks, even. I have beseeched doulas to do their part in playing nice and have explained the nature of our work so caregivers will hopefully feel a bit more at ease with us. This doesn’t mean I expect overnight changes. I would like to take the opportunity to vent a little of my sadness. Here are my blues:

If I try to respect a hospital staff member’s job by getting out of his/her way, I can be asked huffily, “Why aren’t you helping me?” If I jump in and try to help (change bedding, soiled gowns, etc.) I am often criticized for not doing it properly, or told altogether to not interfere.

I have been told, “I know what I’m doing!” when I tell a resident who has just arrived on shift and who is about to take the mother off the monitor for an hour, that the reason she is still on the monitor is because of the fact she’s been having unusual bleeding during labour and the last resident said she was supposed to stay on it for a while (I’m just relaying information). Taking this as a strong message to just keep my mouth shut and not assume to inform anyone, I have with the same client been told by another staff member, “If you KNOW she has unusual bleeding, why were you going to let me take her off the monitor? I have visited 6 patients in 15 minutes…if you KNOW the drill, speak up!” Sigh.

When I’ve removed a bloody pad from the bathroom floor so as to keep the environment clean, I have been told, “You can’t move that! I need to measure the blood loss!” When the next time the situation has arisen and I have left it there for the nurse to assess, I have been told, “Why would you leave that there?! It gets germs all over the place! I thought you liked to keep the environment clean? Isn’t that a doula’s job? Jeesh!”

When I have placed a towel under a standing, nude, extremely actively labouring lady to protect the floor from slippery amniotic fluid, it has been yelled at me, “she’s going to trip on that towel..it’s a hazard!” When I have not placed that towel down, I am yelled at, “What are you thinking not putting a towel under her? Don’t you know that amniotic fluid on the floor is a hazard?!”

When I have been buzzing for someone in a busy hospital to help a 1 hour postpartum lady up to the bathroom to have a much needed pee, I can be asked with scathing indignation, “why wouldn’t you just bring her yourself? Isn’t your job to tend to her?” And, when I have taken the initiative and just brought the full bladdered lady to the bathroom myself, I have been been told, “You can’t take her to the bathroom! What if she faints? I’m responsible!”

If I have shown as much respect for boundaries as possible and asked first before doing anything, I have been advised to stop pestering, to take initiative, and just DO what needs to be done (barring anything considered medical). When I have taken the initiative, I have been told to do nothing without permission.

A doula can be a scapegoat for staff members’ frustrations. When things are busy, we can be damned if we do, and damned if we don’t. Sometimes it feels like I can just do no right. If that’s the way you feel sometimes, my doula friends, let the attitude roll off you like water. Don’t take it personally. Sense the tone, and do what you think will cause the least tension. If you’re wrong, you can rest assured you at least respected your scope of practice, respected your client, and did your best to respect the staff.

I personally have some boundaries I don’t cross, even when asked. I will not “just put the lady on the monitor for me..I have another lady about to deliver and don’t have time.” I will not start “coaching” and counting during the second stage of labour, unless this is what the mother wants. If a staff member wants to assume I’m lazy or don’t know what I’m doing because I don’t engage in the Purple Pushing Circus, that’s fine. I will not “make” my client stop vocalizing and “get control of herself” even if the whole room is scowling at ME because of my clients’ “antics”. If she is releasing tension by using her voice and is obviously progressing beautifully, there is no need to change anything. I will continue to just be quietly present if that is what the feel of the labour dictates, not worrying about the whispered comments I hear, “why isn’t she DOING anything, like telling her to breathe or anything? Why did they hire her?” I will not be over solicitous to a client to please onlooking staff members by performing sacral counter pressure, spraying lavender, applying cool cloths and asking endless “are you okay?” kinds of questions when I know it’s going to get on this particular client’s nerves. I will also not answer, for example, if my client is going to take postpartum Synto by IV or injection, as this is not a call a doula should ever be asked to make. Yet we’re asked to speak for our non-communicative clients all the time. I will communicate preferences the client has discussed with me, but I will never speak for her concerning a split second medical decision!

And yes, sometimes I do get eyeballs rolled at me when I gently say, “I’m sorry, but I can’t speak for my client.” Just like I get eyeballs rolled at me when I offer important information about my client that was not asked by the staff, because I’m not supposed to “speak for” her (ex. “Mrs. P had a double mastectomy 4 years ago..she has asked me to communicate that she wishes not to be asked if she will be breastfeeding”).

I just continue to smile and be kind, trying not to get caught up in the criticisms and comments. When my clients hold their babies in their arms with huge smiles on their faces and tears in their eyes, shining with gratitude for everyone in the room having been there for them how they needed them to be, this is all the “reward” for my efforts I need. I have surrendered the need to please everyone on a hospital staff and invest huge efforts in having them like me and approve of my work. You can’t please everyone. I serve my clients, and am confident I do nothing inappropriate to endanger them. I respect all boundaries to the best of my abilities, and do my best to reduce tension. And yes, it does burn sometimes. I do so much work to be the most diplomatic and conscientious person in the room (as do the vast majority of doulas), though there is not as much pressure on caregivers to do so at all, thus FAR more occurences of challenging medical staff behaviour than actual bad doula behaviour (such as non emergency episiotomies done without explanation or consent, or the undermining of a woman’s desire to have a natural birth “you think it hurts now? It only gets worse. Are you SURE you don’t want your epidural now? Anesthesia is on the floor.” or, upon vaginal examination the incredibly insensitive “hmmmm, it’s pretty tight in there…I HOPE this goes the way you want, but, hmmmm.I don’t know…how tall are you and what’s your shoe size?”) I know these actions and comments are not intended to hurt, and most likely they are intended to spare a woman from perceived potential harm or disappointment if things don’t work out the way she wanted. In fact, though, the tone of these comments is disempowering, and women need to stop being infantalized. A doula knows that a lady is more apt to be able to handle an honest trouble that arises, but will be far more disappointed if she felt not believed in from the start with these misguided attempts to “protect” her heart from getting its hopes up. This paternalistic type of protection so often creates self fulfilling prophesy through the oxytocin killing stress it introduces into the room.

If I am at a birth and someone takes me aside and says, “why aren’t you letting this mother get an epidural? Can’t you see she’s suffering enough? Why would you be so cruel as to encourage her to keep going with her labour when clearly she is in agony? Have you been feeding her garbage about how epidurals are bad?” I just smile and explain that an epidural is a mother’s choice, not ours to make for her, and that she will most certainly have our support if she asks for one. When I’m with a woman who TRULY wants an epidural, there’s not much I could say to stand in her way from getting it, even if that’s something I WANTED to control. It’s pretty crazy, really, when you think about it: at the same time as being thought of as puppet masters who have omnipotent powers to pull all the strings and have all control over a woman’s attitude, sounds, movements, breathing, requests, bodily functions and choices, we are often not thought of as smart enough to even hold a vomit bowl competently. I am reasonably well known and familiar in the hospitals I go to, and have the reputation of being a respectful doula. But if I run into a staff member I don’t know, enough times that it ends up being quite hurtful, I feel like I’m guilty until proven innocent. This is why I apprentice my trainees: so they can become a little acclimatized to the environment before their dreams of going off into the hospital and building bridges and making friends are dashed at the first harsh comment or judgement. It is good for them to know that this is a challenge that will remain with them perhaps even after 17 years of good practice.

Someone needs to make a decision. Is it our “power over our clients” and our seeming omnipotence that is perceived as dangerous, or is it our stupidity and ineptitude that endangers, as we are, after all, just a bunch of hippie moms? Do you really think we could magically stop a woman from demanding an epidural she really wants one? Do you really think our clients are so malleable and uninformed that they’ll put all their clinical decisions into the hands of a DOULA? We just translate the information that’s said in a more nurturing way and open the doors for more questions and options. Why is it seemingly believed that when clients speak up for themselves it’s because we doulas are playing ventriloquist in the corner, in a voodoo like way using our labouring ladies to promote our agendas and personal beliefs? If we ask questions that any well informed consumer of maternity care may ask (ie: what are the benefits vs. the risks of her taking Synto at this point? Is it possible an epidural in this case could slow down/speed up labour?), it’s because we have been asked by our clients to do so to help them gather as much information as they can about their care. In labour, they are busy trying to have their babies, and may not be in a logical state to pose these questions, the answers to which they most likely already know, as most of them read a lot, but aren’t in the headspace to think about unless things are presented plainly.

And if we’re so stupid and inept, not jumping in to do all the stuff everyone knows doulas are “supposed” to be doing every moment, like double hip squeezing until the cows come home, or doling out ice chips, and asking “dumb” questions of our clients like, “are you comfortable pushing on your back like this? Is this the position you want to be in?” why on earth are we sometimes asked to put a mom on a monitor or handed a bowl of warm water and stack of compresses and told, “just tell us when you see the head.” I’m not kidding, I have been asked to do these things. I’m often asked how dilated my client is when I show up to the hospital! I’m a doula so I DON’T have to assume this type of responsibility, thank you very much.

Let’s just debunk these misperceptions altogether. I am neither omnipotent nor stupid. I’m a doula, and my work is important. Klaus and Kennel and many others have done studies on the amazing reduction in unnecessary medical interventions, better overall infant/maternal health, and greater satisfaction with birth and breastfeeding, that doula care can provide. So evidence states that IN FACT good doulas (not those few doulas actually behaving badly) are the opposite of dangerous. And I have to say, IN FACT, most of us ARE good doulas. Just as most medical caregivers are good. Prejudice and/or misunderstanding from some medical caregivers that can turn anything we say and do into an outrage because our very presence “threatens” status quo in the hospital is as likely to be a reality as an actual bad doula behaviour. “No matter what you do, somebody always ‘knew’ you would”.

Perhaps this fear of us having the potential to make everything SNAFU in the hospital maternity ward is not actually a testament to our dangerous, witchy natures, but simply a fundamental resistance to the uncharted waters of that unfamiliar, radical thing our clients often want and we support called normal physiological birth! That’s right, no bells and whistles like nifty beds, prophylactic cuts for postpartum healing enjoyment, constant monitoring, restricted food and drink intake, imposed positions, prescribed pushing formulas, silly jokes right after the baby comes out instead of reverent silence…and yes, they want it in the hospital because they appreciate the potential for swift and skilled intervention…when necessary. They want to have their cake and eat it too, and why not?

Putting doulas in their places because they’ve been perceived as being uppity, or sabotaging us by telling us one day something we do is wrong and then the next day the opposite thing we do is wrong too doesn’t hurt doulas (permanently, anyway..we’re used to it, and have thick skins), but the birthing women themselves. The birthing room is no place for a pissing contest.

Within 24 Hours: A Snippet of Doula Life

by MotherWit | Aug 5, 2010 | Uncategorized

Within 24 hours I travelled from Niagara Falls to Montreal, listening to music which reawakened an old and overwhelming desire to learn to play guitar like a man. There is nothing like being a passenger and immersing oneself into music, mind, and scenery, only interrupted by sporadic fights in the back seats by 3 bored kids and Tim Horton’s pit stops.

I attended two beautiful births (even though still technically on vacation). How can one say, “I’m still off call” when one is called by a lovely labouring woman, the powerful craving for the sanctity of the birthing room (what one can salvage of sanctity in a hospital, anyway) infusing one’s blood? And since that one went quickly and I still had energy, why not just tend to the next equally beautiful and sacred labouring woman, who, thank God, birthed quickly and smoothly too?

I watched an episode each of True Blood and Hung(between babies). I admit to an HBO addiction. I don’t watch any other tv, but I do love my Louisianna vampire and awkward girl pimp dramas.

After the next birth, I ran into my nurse friend Jodi, and both of us swaying in the hallway with exhaustion (me from working, her from being kept up all night by a 2 year old), we passionately created an outline for a doula-training-for-new-nurses. The date is confirmed, and I couldn’t be more excited. The energy sizzled and flowed in those few minutes in a way that made us resonate with a huge YES in terms of the training’s content and intention, after a year of musing and wondering and not being sure how to most delicately but authentically approach it. Inspiration vibrated through those hallways, punctuated by labour sounds and the buzz of a busy hospital staff, and we tapped it and created something special.

I took a bus home, and fell into a short, but deep slumber for a few hours after saying “hi” to the kids.

I woke up to 4 new requests for my services, glad for my team of MotherWitties to take on these lovely ladies, as I am already booked for all the dates for those requests. It is an amazing thing to have abundance doing something I so love to do. Something I need to do. I count my blessings.

I awoke to my healthy, amazing children, and am waiting for my husband to come home so we can restock our empty, post vacation ‘fridge, and hope to watch a movie tonight before tackling a huge day tomorrow of catching up on administrative work.

A doula never knows what her day is going to be like when she wakes up. It is a rich and good life. There are days in which my life sounds like something out of the strangest of Tom Waits songs, days I end up doing things I would never have imagined in a million years I’d be called upon to do. The rhythm is always spicy, and boredom is never an option.

This Doula Don’t Drive

by MotherWit | Jul 29, 2010 | Uncategorized

Yes, you heard me correctly. I am a non-driving birth professional. I live outside of the city centre, I have four kids, I attend over 60 births per year, meaning TONS of pre/postnatal meetings which I conduct at other people’s homes…and I confess I don’t drive a car.

People ask me why. It is not that I am opposed to driving. I am grateful my husband drives, so we can take vacations, get around my suburban part of town, and have a vehicle handy. So I do have access to lifts when necessary. But the reason I don’t drive is simply because a) I just haven’t gotten around to learning (I have been mothering five year old and under kids for over 18 years now, not to mention constantly building skills and a business), and b) I don’t think I was made to be a driver. If you’ve ever seen the movie Up, you know how the dog Doug has conversations that, though otherwise normal, ar interspersed every two seconds with him getting completely sidetracked, uttering, “SQUIRREL!” as something catches the attention of his peripheral vision? Well, that would be me. “Mom! I need a Kleenex!”….all attention going to the kleenex getting, road and wheel temporarily but completely forgotton….

So I live without the skill. To be honest, it’s not so bad. Even if I did drive, I think at 3am I would still take a cab to a birth to avoid having to park in a dark, creepy, expensive hospital parking lot, worrying that I was missing important things up in the labour ward. Montreal has pretty decent public transport, and to be honest, my time on the Metro and bus is really the only opportunity I get to read quietly. I have a terrible sense of direction, so not getting lost frequently is a nice side effect of not driving. Plus, owning and maintaining a second car is more expensive than my cab use. Not to mention, if you live in Montreal, you know the fact that driving a car would really not save me time, as finding parking here requires you leave home 45 minutes earlier than you would if you didn’t have to troll for spaces with single minded focus and ferociousness.

I think I would like to learn, but not for work purposes. Rather, I would like to take road trips with my husband without leaving all the driving to him. Perhaps when the kids are older and there are fewer distractions….

In the immortal words of Melanie, “I ride my bike, I rollerskate, don’t drive no car…I don’t go too fast, but I go pretty far. For someone who don’t drive, I’ve been all around the world. Some people say I do alright for a girl.”

Back From the MotherWit Doula Training!

by MotherWit | Jul 26, 2010 | Uncategorized

Hello everyone! It has been a MONTH since my last blog! Seriously, I know, it is so not like me to not write for that long. But I have been on an epic summer journey.

A few weeks before the MotherWit Doula Training Intensive, which was from July 18th to the 23rd in Morin Heights, Quebec, I decided to bunker down and get working on the training manual. In the format I taught before, I didn’t give out notes. I truly never felt very comfortable with that, so I decided to make sure all the salient points were available for students to look at and revisit, as well as ensure they had a comprehensive outline and checklist of all certification requirements.

It was not easy throwing together something that ended up being nearly 200 pages in very little time 🙂 And truly, it could have been so much more. But that’s for a future book. I decided to focus all my writing energy on the manual, so I apologize to any eager lurkers who felt deprived 🙂 Of course, there were many intense, crazy births to attend as well, some of them way out of the realm of the hoped for, some of them just fantastic. Women first, manuals second. Sadly, husband and children were 3rd for awhile. But we are restoring balance now that the training is finished.

I cannot express how thrilled I am at how this training unfolded. As a critical Virgo, I see lots of areas I can tweak, refine, and perfect in my presentation, but overall, I think it was stellar! I feel like I found my truest teaching voice, brought out by such passionate women. The consistent amazingness of the women who were attracted to this intensive was more than I could ever have hoped for. Seriously, to get 20 people together and have them all be so great is not easy, but things went really smoothly. I took the time to interview everyone I could in person to make sure they were on board for this intensive form of training, not just so I could check them out, but so they could give me input concerning that they wanted to learn. Forging that connection in advance made things feel comfortable from the start, and having some familiarity made us all feel set to learn in an atmosphere of safety.

In a nutshell, our modern birth culture in the West is wounded. The role of the doula is crucial to bring healing and balance to this insanity. It is not the technology and medicines and experts which are wounding in and of themselves…in fact, the fact that we have this world available to us is a total blessing… it’s the fear based way in which things are sometimes applied, as when they serve more to interfere with than support a normal birth process. The fundamental belief that every birth is potentially disastrous and that every little variation from “average” results in a cascade of “prevention” and intervention, is actually often creating outcomes that are nowhere near as good as the places which just allow midwives or family doctors to deal with the normal births of healthy women. Of course, in these places there seems to be a very good relationship between midwives and obstetricians who honour each others’ roles. The same cannot be said everywhere.

The doula’s relationship to the medical community is an important component to the healing of this birth culture. We talked a lot about the reasons for medical fear, and how understanding, compassion, and working together is the way to reach the largest number of people, not by dividing and harbouring contempt. To have an easier life, I could be a doula who attends tons of home births of women who feel safe and empowered surrounding their birth experience…and trust me, hits of those kinds of births are AMAZING, soothing balm for me. But guess what? Most women don’t feel this way. Besides, I never asked for an easier life. Most women are afraid of the pain, afraid of not being in the hospital, but also afraid of the hospital itself. What do these women need? Support! Their babies need to be born into an environment of peace. Their partners need to be able to feel relaxed and free to do what they need to feel safe and supportive of their spouses. Hospitals can be pretty cold and impersonal sometimes, and our continual warm presence can neutralize fear, and lessen the potential of birth taking on a less than normal tone because of that fear. Since the most important aspect of our work occurs within hospitals, it behooves us to forge good relationships, otherwise our presence is far less effective.

In this doula training, we put no emphasis on “birth plans” (though we had a lot of discussion of how important it is to go over typical interventions and birth challenges in order to give clients the opportunity to process their thoughts and feelings about them, giving them more tools with which to make empowered choices for themselves), pain tolerance evaluations, postpartum depression assessments, purple pushing coaching, and all those things people think are typical of doula skills. Instead we focused on deep listening, space holding, coming to a place of true non-judgement, active non-violent communication, the journey of the baby through the pelvis and how we can support that process when it’s normal or not, and how to holistically nourish a woman so her body can come to a place of balance naturally whenever possible, always honouring Western Medicine’s role of providing the clinical care, either by doctors or midwives. The roles of doctors and midwives themselves are changing a lot. I work with doctors sometimes who admit to using intuition a lot in their practices, getting a feel of things from the emotional tone of their patients, catching babies in comfortable clothes other than scrubs, but providing great medical care, as well as see midwives wearing scrubs (even when working outside of the hospital),timing contractions on little timer gizmos, proud of the fact they are trained at par with family doctors, and using guided imagery and prayer to help a challenging birth progress. It’s an interesting world.

We talked about being comfortable with a woman’s (or man’s) emotional process, allowing expressions of tears or anger to be there without feeling the need to save them from those feelings, or to change those feelings. Sometimes things are just lousy, and admitting that without the need to make it pretty, while holding the space for the healing to come in its own time, is the only thing we can do. We talked about loving in spite of feeling powerless. We talked about moving through our own intense emotions so as not to bring our triggers in to the next birth. We learned that healing doesn’t always mean finding a cure.

We talked about the importance of our connectedness to love being a crucial component to labour support, our love extending not only to the moms, dads, and babies in our care, but to those hands and minds which provide the clinical care. Change doesn’t come about by loud, in-your-face “I’m right, you’re wrong” soapboxing, but by gently creating an environment that makes normal birth possible. In so doing, amazing hospital births can and do occur, and are witnessed with awe within the system we wish to create changes for the better for. We also talked about being honest with our clients about how difficult if can be to achieve a normal birth in a hospital, and how they need to learn the balance between going with the flow, and standing up fiercely for their needs/desires in ways to keep that flow of oxytocin going. We learned new paradigms surrounding labour progress, never once referring to a labour progress chart, except to warn of its potential to create more challenging outcomes.

We learned about the importance of a sisterhood of doulas to support one another as we witness the trials, tribulations, and triumphs of the births that elate, and the births that crush. Together we keep our spirits strong and have supportive feedback for when we get ourselves caught up in counter-transference and can’t figure out why it’s so hard to support some clients with our hearts wide open. Within our own community we can practice the importance of solving conflicts before they flare up into passive aggressive outbursts.

We learned how to tend to ourselves, how to be careful about getting too caught up in Facebook Faceoffs, Crackberry addictions, and selling ourselves short. We role played some challenging situations, and learned how not to engage in arguments when we are clear with ourselves we are behaving appropriately, but are nonetheless projected upon by defensive caregivers. As well, we did some guided imagery to visit our own personal healers within.

We ate…A TON, everyone taking turns with meal preparation and clean-up, and apparently from all reports, drank a fair bit on off hours too! Thank you Nux Vomica! We laughed, cried, hugged, and let it all hang out (figuratively, and in some cases quite literally). We subermerged ourselves into birth and community, surrounded by Nature, nursing babies and toddlers, a fox and a deer who came to see what was going on, and supported by the fathers of the babies who protected our circle (and spared us from shrieking ourselves into obvlivion when we discovered a bat in one of the bedrooms). As girlie as it all was, we were grateful for the wonderful guys, and I especially thank my husband Mitchell, who held down the fort, kept me on track administratively (which, if you know me at all, can understand what a challenging and painful task that can be), and kept me abreast of hearth and home.

Thanks to my fellow MotherWitties Sesch, Millie, and Lewina for their lovely, supportive, experienced presence to provide extra guidance and anecdotes, and to Steph and Molly for holding the fort for our clients back home. It does take a villiage.

I thank all of my beautiful students, who wrote me a card filled with appreciation, and presented me with a stunning painting (by a local artist) of women, watching each other, and watching over. When you look carefully, you can see they have wings, which I’m sure all the MotherWit students have hiding somewhere on their persons too. It was an absolutely unexpected gift, and I am overwhelmed with gratitude, because really, it is so easy for me to sit there and yak for days about birth to anyone who will listen. This painting will grace the entryway of the hopefully soon-to-open MotherWit headquarters, and remind our clients of the awesome power women generate when they gather with a strong intention.

I want to give a very special “thanks” to Sue Appleton, who made the magic happen. She set her intention to make this training happen, had the space to make it happen in (blessings to her 93 year old grandmother, Mrs. Ekers), and the gumption to carry out those big plans with amazing courtesy and focus, stupendous hostess that she was. Given that she doesn’t even live in Quebec can make you appreciate even more the strength of this firecracker. New Brunswick is clearly blessed to have such a powerful doula in their midst, along with another amazing MotherWittie named Amanda who also lends her strength and beautiful heart to the women of the East Coast. A dream team if I ever met one!

In the beautiful family home Sue provided for our gathering, nestled in the hills of the Laurentians, the spirits of Grandmothers visited, overjoyed that we heeded their quiet whispering in our ears to gather in their honour, and to reclaim their art of stoking the gentle fires of motherwit within every birthing woman. And in so doing, we answer their prayers, contributing a little to the healing, one mama, papa, and babe at a time.

Announcements for upcoming MotherWit Intensives will be put up periodically on www.motherwit.ca If anyone in lands near or far is interested in hosting a MotherWit Doula Training Intensive, feel free to drop us a line.

You Can’t Take the Effect and Make it the Cause

by MotherWit | Jun 24, 2010 | Uncategorized

“You can’t take the effect and make it the cause,” is a saying I quite like, immortalized in a song by The White Stripes.

I have thought a lot lately about the prejudice that exists towards doulas in general. A friend and I were having a discussion with a nice lady who happens to be an OB nurse. I don’t want to make people think badly of her or anything, so please don’t be reactive…but while my friend and I were making points about some medical practices studies suggested warranted more research by parents-to-be before they made decisions about their care, she responded, “Well, you know everything, then. It must be written in stone because the doulas say so,” She at some point in the conversation claimed that if something wasn’t medically proven, it was not knowledge. Yeah, yeah, I know, but this isn’t the tangent I want to take now.

Please don’t demonize this woman, who is a good person…it happens that people get defensive about their positions. If you’ve worked one way for a long time, believing it’s the very best, safest, medically validated way, then it’s not fun to have a couple of hussies come along and rock your world with stuff seemingly plucked from the air.

The thing is, we DON’T pluck things out of the air.

Doulas have been around since the beginning of time, doing our warm-fuzzy bit for birthing women and new moms. But in the last few decades, this role has become far more political. Now we are also called upon to be advocates. As the doula profession grows stronger and stronger as more and more women request our services, we are becoming more scrutinzed, criticized, and even ridiculed by many medical professionals, despite most of our clients’ excellent outcomes, both clinical and experiential.

Consider this: our modern role developed BECAUSE loads of women weren’t enjoying their obstetric experiences. Women were coming away from delivery rooms feeling confused and traumatized about what went down. You’ve all heard about Twilight Sleep and all babies being yanked out with forceps. It was the women who said, “We need to figure out whether this debilitating treatment of us in birth is actually needed! Were we not born capable of figuring most of this out on our own like those women we hear about who squat in fields? What’s wrong with us that we need to be knocked out and cut and without our husbands?” And as the women looked for more gentleness in birth, their concerns being picked up and validated by compassionate medical people, they realized that in the throes of intense labour sensations, they may not have the power to communicate their worries, and were terrified of getting caught in a cascade of interventions they didn’t need or want.

Wonderful people, such as Klaus and Kennel, noticed how much better women felt about themselves and their birth experiences when they decided to take another woman with them into the birthing room. Even just the presence of another woman contributed great things to the birth experience, never mind a female who also knew how to provide great emotional support, communication of the mother’s needs (not decided for her BY the support person, but translated to the medical staff FOR her if the labouring woman couldn’t speak herself), and soothing comfort measures. These researchers took the time to conduct some well known and well documented studies which confirmed their observations. Lo and behold, the presence of a non-medical, nurturing woman in the birthing room drastically reduces the need for medical interventions, as well as the desire for pain relief from labour sensations.

I can kind of imagine how medical people, who have busted their humps to get through the gruelling hell that is medical school, becoming skilled at diagnosing complications and executing amazing feats to spare mothers and babies from death, might scratch their heads and go, “Say what?” when a friendly woman NOT in scrubs asks them, because the labouring couple are clearly very focused on the work of dealing with huge contractions, “if it’s not truly necessary to stay lying down, this lady would enjoy walking around to help soothe her labour pain. She would like to have a natural labour if this is how things work out, and being upright seems to help her a lot. Would this be okay with you?” If that doula/mother/partner team do all kinds of strange things together, like slow dance, everyone massaging and murmuring sweet nothings to the mom, who drapes herself in unfamiliar positions chanting oddities like “oooopen!” and even yelling out tension releasing expressions of pain that would fill the uninitiated with fear, you might feel extremely wary. If you as the doctor are simply not comfortable with these shenannigans, having learned a way of managing labour that you are secure with and within your knowledge base and experience keeps your patients safe, you might, if you’re not actually impressed by the birth unfolding naturally, feel odd. You may feel usurped. You may feel resentful that the couple seemed to respond emotionally far better to the person with the strange smelling back of doula tricks than to you, who is the one ensuring their safety, for Pete’s sake! You may feel downright angry that some chick with her essential oils and hippie talk of breathing away tension came into your delivery room and messed around with your sense of rightness, in your own place of work no less!

We get that. I think it would probably be quite a normal human reaction, considering the doctor is the one in the room who bears all the clinical responsibility. But the thing is, our strange ministrations to these women ALONG with excellent clinical care actually create more favourable outcomes, for doctors, mothers, babies, and partners (fathers or other mothers). Even if medical people want to look at doulas sideways, believing we are puppet masters who pull our clients’ strings to make them carry out our evil plots of undermining medical authority, it’s important to take a breath and get some perspective.

Doulas do NOT attempt to assume medical care of a client (decent, run of the mill doulas don’t, anyway). It may seem like it to a doctor or nurse if a mom is being yelled at to get angry and PUSH while we’re smiling at her silently, not joining that enthusiastic cheering squad. It might irk nurses to hear us say, “your body is amazing! It knows how to birth that baby. You know how to do this.” Please know this is not a covert attempt to undermine anyone’s medical authority, but to execute the wishes of the mother, made known to us in advance. She has spent her pregnancy reading up, figuring out how she wants things in her birthing environment if things go reasonably normally, and discussing those things with us. We open their eyes to other possibilities they may not have learned in their hospital based childbirth education classes, yes, but if a mom is not interested in something, we don’t go there. If our clients have different ideas from what is typically done in a hospital, it is our job to lead them to resources that will help them make decisions about their care…we don’t tell them what to do, we make sure they’ve informed themselves from several different sources, so as to better make choices for themselves from an empowered place. We absolutely encourage them to discuss their wishes with their caregivers. Then we support what they want. If their ideas are not sympatico with typical hospital protocols, it is important for medical people not to assume their patients are weak minded, malleable creatures whose minds were warped by the likes of doulas. Patients need more credit than that. In fact, that’s probably why we’re here, because even up to the latter part of the last century, birth practices were still pretty barbaric in many ways..and women became fed up.

We are not accusing the medical system of being barbaric now, or ignorant as to how to deal with perfectly normal births (though you may find that some women who feel victimized and traumatized by their births and treatment would vehemently disagree). But it is important to understand that the modern doula profession was born from the effect of medical practices that made women feel disempowered.

You can’t take this effect, and make us the cause. Good doulas are emphatically not the cause of patients seeking empowerment, looking to birth on their own terms, even if those terms make medical staff feel uncomfortable. Media jokes about doulas a lot. We get many snide remarks from some hospital staff members, like “The DOULA told her to lift her leg while lying on her side, yeah, like THAT’S going to get a first baby out!” Or “There’s a DOULA here…I guess now we’re going to have to speak in dulcet tones.” Or, one of the ones that hurts most, is, “Honey, you don’t HAVE to suffer with labour pain! Just because your doula told you epidurals are bad doesn’t mean she’s right. She can’t know that because she’s not a medical professional.” It hurts because we wouldn’t say, “epidurals are bad,” and we would never keep a mom from an epidural if that was her wish. It may not be realized by staff that mothers tell us in advance of labour that they’d like to avoid an epidural, and we have ways of communicating with each other so we’ll know when she’s serious about changing her mind. While the staff may think their ire is aimed at us, in reality, comments like these completely disrespect their patient’s wishes, based upon gathering information and making choices for herself that make her feel safe and happy. To take the effect of a mother’s choices (to hire a doula to help her birth naturally) and to make us the cause (of her “suffering” in labour), is not acceptable, or logical. Many birthing women here are told, “if you want to birth in that position, you should have given birth at home!” and this is cruel. Do you know how many women in Montreal want to birth at home and cannot because of the unavailability of midwifery care? Some of our clients want to birth in hospital, on their own terms, and some feel stuck with medical care they wish they didn’t have to have. Don’t point fingers at doulas for those women feeling uncomfortable with the hospital institution.

We’re often treated as if we just waltzed into the hospital, having attached ourselves to an unsuspecting couple, just to wreak havoc in the obstetric ward. In reality, we are sought out, requested, paid for, turned to for emotional support and bouncing ideas off, and at the end the relationship are very often told, “we couldn’t have had this experience without you.” This does not mean our clients were not grateful for their medical care. It just means they are so glad they got that saline lock instead of an IV with a pole so they could be mobile (which often is not offered…it’s asked for by us or our clients), or that when everyone was telling them they should have an epidural, our voice illuminated the possibility of getting to the end on their own steam. The medical procedures that occur with a woman who wanted a natural birth are usually secondary in a new mother’s experience to how she felt she was treated.

I try hard in my doula career to come into the birthing room as clear as possible every time, letting go of past traumas and challenges. I try to always let bygones be bygones, and stay focused on the task at hand to help the woman I’m with according to HER needs. If a doctor or nurse has in the past been burned by bad doula behaviour, I would appreciate not having that effect turn me into the cause of this particular patient’s “non-compliance”. I do not take past TERRIBLE things I may have seen and hate the medical system for it. My gratitude for Medicine to diagnose and intervene with complications is profound, and the bad behaviour of some of its practitioners will not kill my respect for it nor the women who choose this institution within which to give birth.

The truth is that doulas and medical practitioners working together represent to most women in our North American birth culture the best of both worlds for their birth experience. It behooves us to foster respect and compassion for each other.

If you’d like a little entertainment, check out the actual song I’m referring to, just for fun!

“Effect and Cause” The White Stripes