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Monday, January 3, 2011

Do you need a doula?

When most people think of labor support, they conjure up images from movies and sitcoms: the idea of nervous dads and meddling mothers-in-law, in a scenario of total chaos where everyone freaks out so much they pay little attention to the laboring mother. I've talked to a few people who, if they even know what a doula is, think they're a waste of money and would never hire one, because they have their husband, after all. This is really quite unfortunate.

I'm not downplaying or underestimating dad's role as labor coach. Some dads are terrific - rocks of strength and support for their laboring partner. Some are not - quivering, uneasy blobs of jelly who hit the floor the moment the first real contraction hits. And some are on the fence - they want to support their partner in labor, but often fall prey to the hospital staff who sometimes use fear and scare tactics to get mom to comply.

This is where a good doula comes in. Perhaps not just to support mom, but both parents in labor.

A few days ago a most disturbing blog entry was posted on My OB Said What?!?. A mom was going over her birth plan with the OB, and requested no pain medication. The OB responded, "That's okay, we'll just get your husband to sign the release and give you an epidural anyway."

I can't think of anything more repulsive.

I'm not even going to join the "at least they were honest" crowd, because regardless of whether it's a bad joke or not, it's downright despicable. And clearly it's obvious that this doctor willingly uses dad as a pawn to manipulate the mother into things that she doesn't want and might not even need.

Some OB's, in discussing birth plans or other details with the female patient, will completely overlook mom and make eye contact with dad instead. As if he's her overseer; her boss, her daddy, if you will. This is why it's so important for both parents to be on the same page about birth wishes. And if they're not - if dad is on the fence - I strongly recommend a doula, who will help both mom and dad in the process.

This is another reason why it might not be a good idea to have dad, or another family member, as labor coach: they love you, they don't want you to suffer or be in pain. If dad, or mother-in-law, or whoever, is quavering even a little bit, that fear comes out and someone will tap into it: whether it's an overbearing nurse or a doctor who just wants to get it over with and move on to someone else. Having a neutral third party there, if doctors and nurses are unsupportive or blase about mom's birth plans, is essential.

I also recommend hiring a doula if you you have no labor support. Mothers whose partners are deployed, or where family is far away, could greatly benefit from having a doula. Think of all the inductions that take place simply because mom is waiting for parents, grandparents, sisters, etc. to roll into town. Just because of this perceived lack of support, mom now puts herself at greater risk of cesarean section and a whole host of other potential complications, and for what? I often think that if women and their loved ones knew what an induction entails, and the complications that could - and often do - arise from them, they would never want you to go through all that just for their sake.

If you desire a natural, normal birth like the woman mentioned above - with no induction unless absolutely necessary, no Pitocin and no epidural - then hiring a doula is probably the best thing you can do. While there's definitely no shame in asking for drugs if you need them, you should not buy into the illogical farce that you absolutely need drugs to get through labor, because you might not. It's the doula's job to remind you of that, much to the chagrin of the OB. While some hospitals are completely supportive of natural birth, many are not, and those women who truly want that experience might find it hard to combat aggressive nursing staff or the idea that they are stupid, uneducated or ill-informed because they recognize the risks of pain meds and want to forego it if they can.

Mothers who are attempting a VBAC or twin vaginal delivery would likely benefit from having a doula as well, mainly because women in these situations are finding increased pressure to perform a cesarean because the medical establishment sees these scenarios are increasingly seen by the medical establishment as "dangerous" or impossible

Another group of women who could benefit tremendously from a having a doula are teen mothers. There is already so much negativity and bias towards young mothers while they're pregnant that it often makes it very difficult for them to find support while in labor. Their youth, coupled with the possibility of being completely uninformed about the birth process, as well as their rights and choices in childbirth, can make it a disastrous situation that no doubt ends with more primary c-sections. Not to mention it further embeds a very abnormal view of birth in their minds, which is hard to erase or change.

Yesterday I had a wonderful conversation with a friend whom I am going to lobby hard for this year to become a doula. She has been the labor support person at almost all the births of her grandchildren, and attended nearly two dozen births while working as a crisis teen pregnancy counselor. She told me one interesting story of a young mother who was in active labor, and the nurse wanted to give her Pitocin.

ML showed up at the birth and the nurse demanded to know who she was. Nurse Ratched then told her that the patient needed to be put on Pitocin, and ML demanded to know why. "What do you know about Pitocin?" the nurse asked defensively. In other words, How much can I get away with telling you before you'll realize I'm giving you a load of crap?

The nurse explained that they needed to free up more beds on the L&D floor, to which ML replied, "This girl is already in active labor. Go speed up somebody else's contractions."

As far as ML is concerned, I think she'd make a great doula. She is compassionate, caring, and yet outspoken. Even if you don't know the ins and outs of something like a doctor or nurse would, just asking questions - "Why do I need to do this?" - makes a world of difference. And if they can't give you a good answer, chances are you don't need whatever they're selling.

ML affirmed my opinion that teen mothers - who are already in a position of vulnerability - are often the scapegoat of frustrated care providers who are out to "teach them a lesson" because they got pregnant so young. No one needs that care and support more than someone who is not that far out of childhood herself.

Studies have shown that doulas can actually decrease the rate of epidural use and cesareans (although they most certainly can attend you if you do have a cesarean). Although I kept an open mind about pain relief when I had my VBAC, my doula was - literally - a focal point for me while in labor. She talked me through it, was supportive and focused on me, and I focused on her. It was literally like having an extra person there to guide my husband in his support for me, too, so that the care and attention he paid me was more productive and meaningful. (In other words, he didn't look at the monitor and say, "Looks like another contraction is coming!" like he did during my first labor, God bless him.) Following the doula's lead can encourage other family members who might be present not to contribute to the general freak-out factor when they see how things can progress normally, without such a sense of urgency.

Unfortunately, some doctor practices forbid the use of a doula, which in a strange way I find sort of comforting. Not only does it tell you that perhaps your control-freak doctor might not be the right fit for you, but it effectively admits that the doula can be a symbol of peace and calm, yet power all at the same time. Because of her neutral advocacy, she is there to remind you that yes, you can do this! and provide mother-focused care that the OB might not, which means you just might get the birth you want and deserve.

More recommended reading:
Doulas of North America (DONA)
Statistics on doulas and how they can help in labor
He Ain't Creepy: He's My Doula


Dana K said...

My husband was recently asked by a friend & dad-to-be for his biggest piece of advice. My husband immediately responded, "hire a doula." Our doula was a wonderful help for HIM during a very long labor. It was a wonderful experience.

Anonymous said...

doulas are AWESOME! soo very glad i had one with baby #1, will be using one again for baby #2.