Strollerderby

OK, I agree the Today show was totally in appropriate. They really should have showed both sides.

However, it is true that a doula is a luxury for most women. At least with my insurance, a doula was not covered, and was very expensive. However, a C-section is covered. Until doulas are covered by insurance, they will remain a luxury for the few.

Also, I have a wonderful relationship with my OB, and I chose a hospital that was well known for its overall care of the mom and baby. I know not everyone has this kind of option, but I would recommend this.

I think your overall recommendation of "get a doula" is not feasible or necessary for everyone. Don't get me wrong, I'm sure they can be great. However, I did have a friend who hired a doula for the birth, and then my friend ended up being in so much pain she wanted an epidural. The doula got very angry, and actually left! I know this is just one story, and I am sure most doulas are not like this, but it is possible for them to insert their own opinion. It just goes to show that you need to be extremely picky in choosing an OB, a hospital, and a doula if that is what you want.

I just read the article you were referring to. She states that she gave birth in a hospital that is known for "active management", or speeding labor along. Another reason to research your hospital. Maybe I live in a bubble (San Francisco), but the hospital I was at had the opposite strategy. They really followed the birth plan, and would let you have a natural birth as long as you could take the pain.

I wonder why someone would choose a hospital like this, and then be angry that their birth was pushed along.

I agree that "buyer beware" has to apply to all aspects of birth.

Doulas can be expensive, that's true.  But one can always hire a doula in training, for free.  They're required to assist a certain number of births before becoming a full-fledged doula.

Also, gpgirl points out that one needs to interview several doulas ahead of time to flesh out their opinions.  I made sure my doulas understood my desire to have an unmedicated birth, if possible, but also to understand I had no desire to be a martyr.  There is a time and place for pain medication.

My OB told me she thought doulas were a waste of money.  I hired one anyway, and the birth went so well, the OB actually asked her for her card afterward and said she'd recommend her.  Originally, my OB scoffed at my idea of an unmedicated birth as well.  I think she was amazed I actually went through with it.  For my 2nd birth, I opted for a hospital midwife practice....they didn't question my desire for an unmedicated birth, and openly welcomed my doula.

When I hired my doula I made it clear to her that I was definitely planning to get an epidural at some point, but that I wanted to labor naturally for as long as possible.  I just didn't want to go through transition and pushing on my own.  Her job was to help me manage the pain until I got the epidural, and to be supportive to me in general.  

Everything went great until it was actually time for me to get the epidural.  I was 9.5 cm and had been laboring for over 24 hours - I needed a break!  Well at that point she started getting upset with me and giving me a guilt trip of all the nasty effects this was going to have on my daughter.  And she got my husband in on the act.  

They nearly talked me out of doing what I wanted, which was the exact opposite of my intention when I hired her.  So yeah, she was great in many ways, but I would never use her again.  Buyer beware, indeed.

I wrote a response to the horrible Today Show on air segment on my blog: www.hamiltondoula.com. It refutes the negative assertions made by the doctor and the consultant.

There has been a lot of publicity about doulas lately. The Oprah Winfrey show had Nicole Kidman on last week talking in glowing terms about her doula. Thursday, November 20th, the TODAY Show on NBC was positive in some ways and negative in others but at least it got the term "doula" out there to millions of viewers. The DONA office has been flooded with requests for info to become a doula and for info about how to find a doula. That is really good!

If you are going to respond locally to this message, you may be asked about some of the negative aspects of the TODAY Show piece. If we address them correctly, we can turn them around to be positive.

Doulas have been working in hospitals all over the US and, in fact, internationally for over 15 years with good success. They function as part of a team effort with the hospital staff and the woman's choice of caregivers to help the family have the best birth possible. There are always exceptions to the good people in any profession and unfortunately one hospital took that exception to ban doulas. But that is one hospital out of over 7,500 hospitals in the US.  

In DONA International's Code of Ethics and Standards of Practice, doulas pledge to treat the health care professionals that work with their clients with respect. When a nurse comes into the room to check on my client, I step to the other side of the bed and if there is any non-medical thing I can do to assist her and serve my client, I will be glad to do that. The doula helps the mother ask appropriate questions so that the mother can make the best choices possible for herself and her baby. The doula should never speak in place of the family.

Doulas are available to women with various economic means. There are many private practice doulas who work with clients who can afford to pay for their services. Many of these same doulas also take clients who cannot afford to pay their full fee at a reduced rate or may pass them on to another doula in the area that is charging less. There are also many volunteer programs or state run agencies that offer doula services for very little or free. In the press release info put out by DONA International for it's members, some of them mentioned. The vast majority of doulas are in this work because it is their "heart work" and they would likely do it for free if they did not have family obligations. But I want to make it clear that doulas are worth every penny they charge. It is up to each doula to decide if and what she charges.

DONA certified doulas have 50 or more hours of education behind them before they get certified. That includes the workshop, breastfeeding class, childbirth education class, reading and working with families. Then they have to document their work and write papers about their experience. It is not a simple process but it is a worthwhile process!

With this information and the PR pieces available to members on the DONA discussion board, we can spread the word about doulas even farther. I was interviewed by a local newspaper this morning on the recommendation of the head of the Labor and Delivery unit at a local hospital. This is an exciting time!!

If you are a postpartum doula, you can still use this info to suggest that there are both birth and postpartum doulas and you would be available to talk more about the concept of the postpartum doula!

To find the information I spoke of above, go to the Members Forum of the DONA Discussion Board, www.DONA.org.  If you are not yet a registered user of the Discussion Board, please give us a day or two to get you signed up.  If you are not yet a DONA member, you may want to join now.

Thanks for all you do to serve families. Let's get out there and grow the profession!

Why would I want another stranger at my child's birth? Especially if I wasn't planning on having a natural childbirth? My husband and family were there to support me. I don't need a stranger there for support who I have to pay.

And let's face it. How many doulas are pro epidurals? The only people I know who have doulas are trying to have a natural childbirth.

Also, I read the article you linked to. My child's birth was nothing like that. I had a c-section and it STILL was nothing like that. I was treated with respect and it was a great experience. I don't live in a particularly progressive town.

I get so sick of the anti-doctor stuff when it comes to childbirth.

Why would you use an OB or midwife you didn't trust to begin with?

I had both a doula and an epidural, and would do it again.  I was hoping for a natural childbirth but wasn't strongly committed to it, and when I decided to have an epidural my doula did just what I had asked her to do ahead of time - gently try to distract me, encourage me to wait 15 minutes, and when I still wanted an epidural she called the nurse in so they could call for it.  

Even after the epidural, having a doula was great.  The most important thing was that she slowed down and made sure I understood what was happening.  When the doctor was explaining what the new plan was, she would always ask me and made sure I understood what they were doing.  I am normally very good at being a good advocate for myself, but both my partner and I were too distracted by labor to be able to make sure that we had the information we needed and asked the questions we needed to.  Her presence also allowed my partner a chance to catch a nap for part of the labor.  

And after my son was born, I was way too tired to remember to ask for the placenta, which I did want to keep, but our doula spoke up for me.

I also had a great ob/midwife team, and didn't feel like there was any tension in the relationship between my doula and doctor.

anon, thanks for the post. I was going to ask if anyone had a positive experience  with a doula when they wanted an epidural and/or they still liked their OB.

Debbie Young, thanks for all that info! Is there any work being done to advocate for doulas being paid by insurance? I know you say you are available to women of all economic means. But there are some of us who probably make enough money to not qualify for this, but still have a hard time justifying the expense.

If doulas were to be paid by insurance, many more people would use them. If you could show that using a doula would lessen costly intervention, it should be worth it to medicaid/insurance.

@gpgirl - the problem is: the insurance companies are not interested in reducing obstetric costs and payouts or they would have long ago mobilized to support midwifery care and doulas.

Women's choices and desires in birth, whether for an unmedicated birth or  an epidural, should have no bearing on the doula.  A doula is there for support, not judgment.  I have supported women through scheduled cesareans, unmedicated births, fully medicated births and just about any birth you can imagine.    

You cannot plan birth, but you can stack the odds in your favor to have the best experience possible.  A good doula can be a strong asset in that light, regardless of what is desired or what occurs during one of the most amazing times in a woman's life.

I would like to add that I have not yet met a doula who was not willing to work with women who could not afford the service.  This includes newer doulas looking for more experience (and don't turn up your nose at newbies - they can be fantastic doulas!) or seasoned doulas who have attended hundred of births.

One cannot make a blanket statement that ALL women NEED a doula, but it's true that a doula can be quite wonderful for many birthing women and their partners.  Scientific evidence backs that up, as does the majority of feedback from those who have had one.

Debbie Young's comments above are correct. Many doula's will work for a sliding scale fee. Also, you can modify your service requirements. Most doula's provide after birth visits and you can scale those back. I was lucky in that my doula happened to be a friend of mine. I couldn't necessarily afford a doula, but I felt that I couldn't afford NOT to have one either. I birthed in Berkeley, CA and even there in the middle of the "natural birth bubble" I felt having an advocate there for me and my baby was of utmost important and I wouldn't change the process or the outcome for anything and I'd make the same decision again-- even though we are even poorer now (ha ha)!!

Some hospitals have volunteer doula programs as well. It's worth researching to find out which hospitals provide this service and/or getting your hospital to start the program. My cousin did it (volunteered to doula) and loved it!

gpgirl, You do indeed live in a bubble. Why would a woman choose active management? Active management is the norm. Unless you live in an urban area, you are very lucky to even have a choice of hospitals. And when you do, you are most likely choosing between 2 or 3 active management hospitals.

Docs like c-sections and inductions so that they can be sure they'll make it to their social and recreational events, and sometimes for somewhat less insidious reasons like the doc's need for some shut-eye. The better question is; "Why did they choose to become OB's?"

Ellen your question about why docs like c-sections - there is another point of view, which I'm not sure I agree or disagree with, but is something to consider.  This reason came up in a coversation with hospital staff.  The reason?  Liability Insurance.  During labor, if anything appears to be wrong with mom or baby, a c-section is a proactive way for a doctor to manage the birth to avoid problems with liability issues.  Now here's the kicker - the differing opinions between what is considered 'something wrong'.  Doctors vary in experience and expertise.  Just like in any profession, a novice or conservative doctor may be more inclined to do c-sections for a variety of reasons because they may view them as safer in a particular circumstance vs. a more experienced doctor, in the same circumstance, may be more comfortable allowing his patient to explore other options first, before turning to surgery.

Oh yes, and by the way, I'm chiming in as a volunteer doula.  My main client base is derived from referrals from a local pregnancy crisis center.  I offer my services for no charge to those clients that agree to commit to prenatal and parenting classes prior to their delivery.  We are out there!  

I had a Doula. And I had an epidural (I waited as long as I thought I could and then I gave up... my contractions were literally off the charts on the monitor from the time we got there, and I waited 6 hours from my arrival at the hospital). She was my pre-natal massage therapist, a very grounded and grounding influence, yet also full of life and positive excitement. When my husband and I first met with her to talk Doula, he honestly didn't understand why I wanted one. He thought it unnecessary, but he went with it. I do believe that some part of his agreement can be attributed to his desire to keep the crazy pregnant lady happy and maybe less crazy. He was honest with her during that interview when he said he found it "a little weird."

During my labor she massaged my back, head and feet when I was tense and stressed, talked my husband through some of the stressful moments, and led me through a guided meditation once the epidural kicked in and I was able to relax. Most importantly, she gave my husband a break when he needed one and took quite a bit of pressure off of him. He didn't feel like he was the only one who could comfort me, and he was able to ask his own questions and deal with his own fears instead of pushing them aside to reassure me. She also walked back and forth from the labor room to the waiting room to keep the nervous grandparents up-to-date.

As for being in the way, the birth of my daughter involved no less than 6 people, not including myself or the baby. We had my husband, the doctor, the nurse, a resident, a student nurse, and the doula. There was a veritable crowd in the room staring at my vagina. I didn't mind, honestly, I was asked if the student and resident could stay and I thought that there was no harm in helping to educate the future health care providers. Through this crowd, my Doula and my husband were the voices by my ears, telling me how great I was doing and coaching me along. Was she in the way? Well, if she were, I doubt my OB would have let the swarm of non-essential people attend the birth.

For all of his misgivings, once we were comfortably in the recovery room, my husband looked at me and said that the doula was "worth every penny." I agree.