Dispelling a Doula Myth
I agree with you, Batman. (Artist unknown.)
“I plan to get an epidural. Do we still need a doula?”
I get this question in meet and greets a lot. Some families reach out to doulas reluctantly, worried about any judgement towards their birth preferences. Some are wary of the importance of having a doula at all. In this article, I will dispel the myth of doulas being only for unmedicated physiological birth.
Doula Stereotypes
Not long ago, many people had in their minds an image of who a doula is and what they do. Maybe they pictured a “hippie” dressing white woman, wearing crystals, telling the birthing person to only focus on the positive and not call in unwanted interventions. Or they might have pictured a bossy, domineering doula, who hijacks the birth plan because of her own opinions and biases. Fortunately, there has recently been a big movement to reclaim what it means to be a doula and what doulas do. That movement has been trying to get false idea of a “good birth” (vaginal, unmedicated, spiritual, at home), and a “bad birth” (choosing medication, in the hospital) out of the collective’s mind. And for good reasons! Many people might miss out on the support of a doula on their team, thinking because of their preferences, they don’t need support. Or worse, they feel shamed, judged, or misunderstood.
Where We are Coming From
A lot of the emphasis of an unmedicated, physiological birth equating to a “good birth” is a heavy pendulum swing from the medical mistreatment and malpractice in maternity care over the last century and a half. We are coming from a place of being collectively traumatized, from the era of twilight sleep anesthesia, to the current climate of high cesarean birth rates.
It is not surprising that from this history, the “natural birth” movement was formed (I put “natural birth” in quotes, because what is hell is an “unnatural birth” then? How is giving birth to a human ever something other than natural?) This movement emphasized bringing birth to the home rather than to the hospital, into the hands of community-based midwives rather than OBs, and empowering families to take their decision making into their own hands. While arguably a lot of good has come from this movement (hello, accessible community based out of hospital care!), there have also been unfortunate repercussions of dividing birth into the “good” and the “bad” based on interventions and outcomes. We now have people walking away from their births feeling like they failed, just for utilizing an epidural or giving birth via cesarean. We have harmful messages coming from social media that there is only one way to give birth. And we have effectively created divisions between birthing people, separating them from each other and putting them into these made-up categories.
While the choice of having a spiritual birth or birthing at home without utilizing pain medication can be a positive one, I want to be clear that that does not mean it is the only right choice. Trauma can occur at any birth, at any time. There can be empowering births made possible by utilizing pain relief at the right time. There can be traumatic births from being denied pain relief, by oneself, one’s partner, or anyone on the birth team. The point here is, there is no good or bad way to give birth. And the doula’s role is to gently reinforce that, and tailor their support to a client’s specific desires and needs.
A Doula’s Role
A doula’s support does not waver or end if you choose to utilize any interventions that the hospital has to offer. Your doula does not put you into a box with judgement statements because of how you choose to give birth, or what happened at your birth. As mentioned above, a doula’s role is to support, educate, advocate, nurture, build confidence, and counsel. It is our never-ending work as doulas to leave our biases at the door. As I say to my clients who ask me what my philosophy of birth is, “when we’re working together, my philosophy is your philosophy.”
If you know you want to have an epidural, or utilize another pain relief option, a doula can support you to:
Educate you on what your options are, with evidence based resources,
Explain what to expect,
Walk you through the benefits and risks associated with each intervention,
Create a safe word to use in labor,
Help create a plan for when you want to utilize pain relief,
Support you in collaborating with your provider for the best care,
Advocate for you if your wishes are not being respected,
Navigate changes in preferences or plans on the fly, help ground and center through those changes,
Support you in staying active while you have an epidural (just because you will be on the bed doesn’t mean you have to be flat on your back! Spinning Babies is where it’s at with keeping the pelvis open and balanced while utilizing an epidural. Please note I do not share the same beliefs as the ones expressed in the linked article),
Support you in staying connected with your baby and your labor,
Offer guidance and suggestions for pushing with an epidural,
Offer relevant resources and tips for healing and baby feeding postpartum,
Process your birth story with you with a gentle, open, and listening presence.
Your Birth, Your Choice
At the end of the day, it is you and you alone as the birth-giver who gets to decide what you want, when you want it, and how you want it. While birth will always have it’s unexpected twists and turns, your team should be there holding you, supporting you, reflecting back what you want and helping to make it happen.
If you know you want to utilize the pain relief options the hospital has and are unsure about whether to hire a doula, keep these things in mind while interviewing:
Does this doula support all ways of giving birth?
How does this doula feel about epidurals, IV pain medication, nitrous oxide, cesarean birth?
Where did this doula train? Who is influencing how they practice?
What biases do they have?
What kind of language are they using? Are they supporting a narrative of “good” vs. “bad” birth?
While interviewing doulas, listen to your gut feeling, and take notice of how the doula responds to these questions. When you have made the best choice for you, you’ll know! You will feel grounded, calm, excited, empowered, informed, and in the center of your experience. Your doula will be your guide to exploring birth on your terms, and never anything other than that unwavering support.
