I was pretty excited when I heard that doulas would be the focus of a Today Show segment. But, when I watched that segment - finally airing November 20, after being pre-empted two other times - I was disappointed.

While the mother in the story was clearly thrilled with her doula’s support, enough to hire her a second time for the birth of her youngest child, the medical response within the segment was misleading and the commentary by the Today Show medical consultant was contentious and chilly.

The doctor interviewed for the segment was an Obstetrician at a hospital that claims it has “banned” doulas for interfering with patient care, implying that doulas have caused fetal harm by fomenting dissent against medical staff and confusing mothers. The Today Show medical consultant implied that doulas without midwifery or nursing backgrounds are woefully underqualified to provide care, that doctors and even labour nurses should be consulted about hiring doulas and that the cost of doula care is a frivolous luxury.

Each of these assertions were misleading. Let’s looks at them individually.

1. Banning of doulas. This idea of banning support persons is odd. While it’s certainly true that the staff at a hospital can remove anyone who they feel is interfering with their ability to provide health care to their patients, a blanket ban on one type of support person does not put the hospital in a good position. They have basically stated that they want no impediment to their ability to control a mother in labour. While it is absolutely against a doula’s scope of practice to speak to the medical staff about what mothers do and do not want in labour and birth, it is within her scope of practice to remind mother that she has the right to question what is being done to her body. If a care practitioner proposes to do things to a mother without her consent, a doula may remind mothers to ask about what is happening and to participate actively in the decision making process. The vast majority of Obstetricians, nurses and midwives care deeply about about each individual mother’s needs and desires and take those into account when managing her labour and birth. But, just as there are rare “rogue” doulas who may operate outside of their scope of practice thereby tarnishing the reputations of the vast majority of doulas, there are medical staff who take advantage of a labouring mother’s suggestibility and lack of obstetric education to manipulate those mothers into making the birth process more convenient for the care giver. Luckily the “rogue” doula and the manipulative care provider are exceptions. Especially here in Hamilton, Ontario, doulas, nurses, midwives and obstetricians, along with mothers, partners and their families, operate as part of a multi-disciplinary maternity care team, each playing a specific role that supports the others while keeping the focus on helping mothers give birth in a positive and healthy environment.
2. Doulas interfering with patient care. All health care decisions should be made by the mother. If a doula attempts to influence the content of the decision or make decisions instead of the mother, she’s operating outside of her scope of practice. This may be because of her inexperience or her mistaken understanding of her role. What is common, however, is that a doula may help a mother consider the pros and cons of any health care decision, ensuring the mother has the information she requires to make her own informed decision. It’s never bad when a mother exercises her autonomy and participates in her own medical care. It may not always be convenient for the care provider and the care provider may not be used to working collaboratively with patients, but that does not mean that anyone is attempting to impede care or confuse mothers and somehow “foil” care providers. It is very simple for care providers to deal with a doula speaking out of turn, they can merely address the mother directly and ask her what her wishes are and then privately remind the doula that she’s operating outside the scope of her practice. I’m sure there are situations where less experienced nurses speak out of turn, too, and the entire practice of nursing is not denigrated for making birth less safe.
3. The adequacy of doula experience and education. Since doulas do not provide any clinical support whatsoever, since they do not analyse and interpret clinical information, it seems rather over the top that they should be expected to have the same kind of educational background as clinicians. We specialize in emotional and physical support prenatally, during labour, birth and the postpartum period. Because it is our professional realm, we gather a great deal of information about the childbearing year that we are able to vet, provide our clients and arm them with the tools to interpret the information for themselves. Because we have no clinical responsibilities, we are freed to accompany a woman and her family continuously through the course of her entire labor and delivery in a way that nurses, obstetricians and even midwives cannot in our modern health care system. This continuity of care also affords amazing learning opportunities for doulas as they can observe labor and birth from beginning to end with little or no interruptions. To suggest that a woman who massages backs, speaks soothingly, helps women change positions and reminds them to make informed health care decisions should require four years of full time advanced schooling is ingenuous. It is really a red herring argument designed to take the focus off of what’s really going on: doulas are filling a vital role in maternity care and the women that use them are overwhelmingly grateful for their support.
4. A doctor’s permission. Some doulas meet with health care providers before labor commences, usually accompanying a women to a prenatal appointment. This is not usual. Some women tell their doctors that they’ll be using a doula during labor and some do not. Some begin their search for a doula by asking their health care provider for recommendations of doulas they’ve worked with. The idea, however, that a woman should have permission or ‘run it by’ an OB or even a labor nurse, is odd. After all, it is the pregnant woman who assembles her birth team. It is her body and her baby that all of this support is centered on. Should she not be expected to be in control of all decisions regarding those things?
5. A doula is a costly luxury. While a doula does cost money, those who have hired doulas agree that the money was very well spent. In fact, I’ve been told a number of times that I’m worth far more than I currently charge! Other costs associated with having a child such as prenatal vitamins, strollers, play pens, exersaucers, disposable diapers and more could also be considered luxury costs associated with having a child: in no ways required to be a parent to a child, but they sure can make life easier and more pleasant. If finances are a problem for a woman’s family, there are many options. All doula organizations encourage their members to provide some manner of volunteer support to those who truly need it. Most doulas would be only too happy to set up payment schedules or consider bartering some or all of their fees. Women in Ontario who require volunteer doula support can contact info@doulacare.ca for assistance.

There was something glaringly obvious when viewing the Today Show segment: the birthing mother loved having doula support and the medical personnel were skeptical. Those who had everything to gain from a doula were, of course, supportive of their use. Those who perceived the doula invaded their territory did not speak positively of doulas.

The Today Show squandered a prime opportunity to share that the use of doulas can result in 50% less c-sections, 40% less pitocin use, 60% fewer requests for epidurals, 40% fewer forceps delivery and labors that are 25% shorter than women who do not have doulas. They also experience less postpartum mood disorders, breastfeed in greater numbers for longer than their peers and report greater satisfaction with their husbands and more confidence as mothers*. These good health outcomes are consistent across many studies.

This is powerful information that is not being given to women by their healthcare providers. If you were sick and your doctor knew how you could get better faster with less chance of surgery and invasive treatment, would expect them to tell you about it? Would you feel angry or duped if they deliberately withheld this information? Would you wonder what their motives were?

Would you be curious to talk to the woman who could help you have a healthier and more satisfying birth?

If you are in pregnant in the Hamilton, Ontario area email me, Leanne Palmerston, and let’s talk about the kind of birth you want to have

*These statistics appear in “A Doula Makes the Difference” by Nugent in Mothering Magazine, March-April 1998.

This story, Expecting Parents: What Is A Doula?, examining the positive benefits of having a doula, appears on the Today Show website.