Discussion of the Role of Doulas in the Childbirth Process

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What is a Doula? Discussing the boundaries between Doulas and doctors during pregnancy and childbirth.

Doulas – non-medical birth support

The definition and job description of a doula is: a non-medical person who assists a woman before during and after childbirth.  She also assists in parenting of children, taking care of a newborn at home. She provides emotional and physical support. If this was all Doulas provided for pregnant patients then they would be welcomed in delivery rooms by OBGYN physicians.

Let’s look at the training of Doulas compared to the training of your OBGYN.  Doulas do not need any college, and only need to pass a written test after 6 months of “reading”.  Their recertification is also just reading and of course the check must clear for the training.  There is no standardized licensing or supervisory body to regulate the practice of Doulas.

MD and DO OBGYNs must be at the very top of their high school and college class, and they must take physics, calculus, organic chemistry and get an A in all of those classes.  Medical OBGYNs go to 4 years of college, 4 years of medical school, and 4 years of residency seeing patients and delivering babies for over 10,000 hours of experience in residency.  They are not just the smartest students but determined to be the best.  By the time residency has been completed they are at least 29 years old and they have seen every situation, good and bad that can happen in the Labor and Delivery suite.  In contrast Doulas’ education pamphlets pitch the fact that anyone who can read can become a Doula! The name doula comes from the Greek word for servant, but that is not what my OB-GYN partners have experienced in the delivery room.   So why do OBs often enter a battleground with a Doula, when they enter L&D to delivery their patient?

I believe that the woman who chooses to be a Doula, with no real education or medical training is someone who wants to be a medical specialist but who doesn’t want to do the work.  They step outside their roles as servants to the patient to try to direct traffic in the delivery room and they often tell doctors and nurses what to do.  The worst part of this is not just that they hijack the people who ARE experts but they don’t know what they don’t know—like what happens  if there is a postpartum hemorrhage, or a shoulder dystocia (baby’s head is out and the body won’t follow),  cephalopelvic disproportion (the baby bigger than the pelvis) where the baby is too big, or what happens if you don’t’ cut an episiotomy when there is a very big baby.  Doulas, don’t know what can happen if doctors don’t use their extensive training and decision making at the proper time, so often Doulas engage in arguments with the doctor in which they try to stop an immediately important intervention that can save the baby’s brain.  This impediment and invasion of an outside person arguing with the doctor or nurse in charge does not end well.  If the doctor backs off then something bad will happen and they are still liable.  If they argue with a non-medical person who is blocking their care, then they are not thinking clearly and the delivering woman’s body becomes a battleground.  

The typical situation goes like this.  I enter a room of a patient who is laboring and the Doula is sitting close to the bed and even before I greet my patient, she is telling me that my patient who I have cared for over the last 7 months doesn’t want any intervention during her delivery process. She speaks for the patient and tells me  the patient will be refusing episiotomies, Kobayashi vacuum assisted deliveries, and especially C-sections.   Instead of being a support for the natural labor process, they are an obstruction to timely care.  Just like in an ER, the L&D is a lifesaving unit that intervenes only when there is life or brain health of the baby at stake.  Doulas who I have come in contact with delay adequate care by speaking instead of the patient and making the delivery room a battleground between well-trained professionals and an untrained, ill equipped lay persons.  Here is what I mean.

When doulas began entering the delivery room, I gave it a try with one of my very insecure patients whose husband did not want to join us during the delivery.  I thought that this was a perfect fit for a Doula—however my first Doula experience changed my mind.   First, as I entered the delivery room to check my patient, who I had been seeing for 7 months in the office, I was verbally attacked by the Doula.  She said, “I am here to see that you don’t cut an episiotomy, or use forceps or do a C-section!  That is what MY patient wants!” Well, I was speechless at first because the days of arrogant paternalism were long gone at that time and I’m a female too, so what was the problem?   What did my patient need protecting from?  This incident was 20 years ago and at that time I had already practiced 10 years and delivered babies for 14 years—over a thousand babies or more– but I found myself confronting a non-college educated, non-medical woman who thought she knew a lot more than she did. Her diatribe went on.  I had to ask her to leave just to talk to my patient.  I reassured her that I would let her labor without anesthesia if she wanted that, and to abide by her wishes if they were in fact hers, but I would not listen to a Doula tell me how to practice medicine!  She was agreeable when the Doula was not in the room, but was quiet when she re-entered.

The end point was that the doula refused an episiotomy for my patient, and because of the time wasted in the ensuing discussion the baby was delivered without episiotomy, but with severe tears ripping her bottom from stem to stern. It took over and hour to stitch her up and even longer to heal than if I had cut a simple episiotomy.

It required security to remove this out of control doula from my delivery room. However awful this birth experience was I allowed another doula into the room down the line and had an equally unpleasant experience, however  my patient’s care was not compromised because I had that doula removed from the room before the delivery.  This is not me vs doulas, it is the medical community vs untrained, over-zealous, people who have an overabundance of arrogance and control over a laboring woman—not for the benefit of the patients  healthy delivery, but for the power surge that is experienced by the doula…..

Long before I retired from delivering babies, I told my patients ahead of time that doulas were not welcome during the delivery, so I avoided further conflict.  Now that I have investigated their qualifications, I believe they should have standards that limit them to Lamaze breathing and support, not medical management.   Laborer beware!

This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author, with Brett Newcomb, MA., LPC.,Family Counselor, Presenter and Author. www.BioBalanceHealth.com.