Doulas struggle with issues like the fact that the vast majority of committed and caring health professionals are not able to provide safe and effective care within the system. Their practice is constrained by policies and procedures which are often not based on best evidence, but on a complex formula which balances the risk of a successful lawsuit and consequent payout should something go wrong with that policy. This is damage limitation and not evidence based best practice. Add to that the situation where learning time for those professionals is limited and stops the professionals from keeping up with best evidence and new research. Hospital policy usually has the insurers best interests at the core, and not the best interests of the woman or her baby. That makes it VERY difficult for staff because they are torn between following the rules their employer lays down and doing what they know gives a woman the best chance of a good birth and healthy baby.
Add to that the fact that most maternity units are overstretched and understaffed. Midwives will typically be caring for two or three women at a time, all women they have not met before, and so building a supportive long-term relationship is just impossible. A doula, on the other hand, has the time to meet with a woman enough before the birth for them to trust each other and for both to know what the woman really wants from her birth experience. A healthy baby is a very important outcome, but certainly not the only measure of a birth which leaves a mum feeling ready for the challenges of parenthood!
Consider the difference with an independent midwife, or with the model so successfully demonstrated by the Albany Practice… A woman discovers she is pregnant and she goes to see a midwife, and the midwife (with her back-up) cares for that woman throughout her pregnancy, through her birth and for some time afterwards, even if there is a need for medical help, the same midwife is there to help the woman understand what is happening, what is on offer and help her make decisions. The woman feels safe and supported and trusts her midwife. Compare that with the more common situation, a woman does a positive pregnancy test, she goes to her GP who ‘confirms’ her pregnancy and refers her to a midwife and to a consultant. The woman then sees a variety of midwives for health checks and a medic who is a specialist in things going wrong, but has no real need to see a woman for whom everything is OK. She sees several different people and her care becomes focused only on the medical aspects, forgetting or minimizing the emotional ones. She then goes into labour and regardless of whether she goes to hospital or stays at home, she meets, usually for the first time, the midwife who will guide and support her through an intensely emotional, vulnerable, physically demanding, private experience. It is asking a huge amount of that midwife to expect her to know this woman’s wants and needs from the outset, so the discussions are had, medical checks are done and that stress makes labour more difficult, longer and more painful. The presence of a doula does not create conflict here, it preserves the woman’s labour!
Good, supportive and caring midwives know that the situation they work in is not serving women and their babies well. Those midwives welcome a doula with open arms. The presence of a doula means they don’t have to worry that the woman and her partner (who probably has no more birth experience than the mother) will lack knowledgeable emotional support when the midwife needs to be elsewhere. The doula is not bound to keep endless notes which take time to write and take away face to face care time. The doula can advocate for the woman and thus help preserve the hormonal and psycholocical state of easy labour. The doula can support the woman when she makes a decision which does not follow the lawyer-prescribed policy, and believe me, a midwife who knows that the policy was not right for this woman thinks that is a huge bonus. I could go on and on, and I probably will in another article, but I hope you get the picture.
Then, we have the defensive practitioner, the one who is bogged down and jaded by the system. They are generally the ones who want to do their job and go home, they don’t want to learn more than they have to and they are not keeping up with current research. They generally care too, but are at the end of their reserves. Sometimes they like doulas because that takes the pressure off, some times they feel challenged that someone else has more to offer the birth than they do and they are aware that things are not right in their job. They want policy followed to the letter because that makes the paperwork easy and the system feel safe for them. They are kind in their words but their actions pressure women into changing their minds. In these situations the doula must be supportive of the midwife too, and nurture her a little also (so long as that adds to the situation for mum and does not take care or focus from her) because it is clear she is not nurtured by her job.
Then we get the group who are arrogant and not really understanding of mammalian birth. This is the group who are experts in medical care but not in nurturing or supporting birth. These professionals are almost invariably intolerant of doulas and frequently rude to them. This is the most challenging situation, and the one that doulas need to rant about. Managing these situations so that the woman’s needs and wishes are respected is a tough job. These professionals hate doulas because they stand for the woman’s right to be a part of the care and to make decisions. This is a small group, but as they old adage says, it only takes one bad apple to sour a barrel.
I hope that helps. Women need an advocate, sometimes they get that in their midwife, she becomes a trusted friend and ally, but how can you have confidence that will happen if you have no idea which of the 40+ midwives on the rota is going to be the one who turns up to your birth?
Doulas rarely hate doctors and midwives, they frequently hate the system. Doctors and midwives frequently feel threatened by doulas… Whilst that is the case women will continue to need a doula to protect their birth space.