Wednesday, September 14, 2005

Guests at the Birth, Part I

This past Sunday the New York Times printed a front page article about the increasing number of guests women are having with them during hospital births.

Just a generation after fathers had to beg or even sue for the right to be present, the door to the delivery room has swung wide open. Even the most traditional hospitals now allow multiple guests during labor, transforming birth from a private affair into one that requires a guest list. Like bridesmaids and pallbearers, the invitees are marked as an honored group of intimates.

These honored intimates are not usually doulas or other people trained to support the laboring mother. Indeed, many of them are there precisely because the birthing mother would like them to witness live birth for the first time.

Because women used to be heavily sedated during childbirth, even those who have borne their own children may be strangers to the process. Barbara Covell of Rockville Centre, N.Y., joked that she "went to sleep with the first labor pain and woke up in the beauty parlor." Decades later, her daughter "thought it was important for me to witness the birth of offspring - not my own offspring, because it was too late for that, but a grandchild."

The tone of the entire article was positive. To the degree it portrayed a negative element in the birth crowds, it was that they can interfere with the mother's need for privacy during the birth.

Compare this with the front page Wall Street Journal article on doulas which ran on January 19, 2004, "As 'Doulas' Enter Delivery Rooms, Conflicts Arise:"

There's a new work force entering obstetrics wards. They are often strangers to the staff and unrelated to the patients. They aren't licensed and aren't required to have any formal medical training. And they are sparking protests in the medical community.

The workers are called doulas.

This was the first time doulas were addressed in a national media outlet. It was shockingly negative and hurtful to all of us in the birth community.

You have two groups of individuals. The first is family, friends and co-workers of the birthing mother. The second is a professional labor assistant hired by the mother. Both are known to the mother and unknown to the hosptial. Both are invited by the birthing mother to be at the birth. Yet the article about the former group focuses on how they are welcomed, despite their capacity to complicate things, in the delivery room, while the article about the latter group focuses on how a small, disruptive subset is souring hospitals' reception of the group generally. Why the difference?

How about this hypothesis: A woman who invites her family and friends, who turns her birth into a social occasion of which she may or may not be the center, who worries about hurt feelings and relationship ettiquite is acting in a socially acceptable female way. We are supposed to subvert our wishes for others'. We are supposed to share ourselves, even our most sacred and intimate moments, with others. We are allowed to let others come help, or simply watch us. A story about us in this role -- and medical institutions' accomodation of our wishes -- is a patronizing one, a familiar one to write, an easy one to read.

However, the woman who selects a professional NOT ASSOCIATED WITH THE HOSPITAL to accompany her in labor, who wants an individual to help her advocate for her wishes, who recognizes she may defy hospital and cultural conventions and need some support doing so is decidedly not behaving as women should. To write about women acting in this way is socially uncomfortable. We are not supposed to listen to our inner wisdom, especially when it means establishing boundaries, whether with families or with hospital staff. We are not supposed to have our own expectations or wishes. This can only be bad. Bad for our culture, bad for medicine. The only way to tell this story is as one of conflict, and one in which women are punished for their bad choices.


Blogger Julie said...

:( Your analysis makes total sense, unfortunately.

8:20 AM  
Blogger Mrs. Coulter said...

I have heard through the mommy grapevine that Reston Hospital in VA has banned doulas entirely from the delivery room, though enforcement of the policy varies according to the opinion of the individual doctor. What a horrible thing!

9:34 AM  
Anonymous Anonymous said...

Full disclosure - my husband in an obstetrician and I haven't read the articles, just your blog entry.

Given that, I think you are reading way too much into these articles. You are comparing apples and oranges. Two different articles in two very different publications talking to two different groups of people with two different authors with different agendas.

That being said, my next point is my husband's attitude toward doulas is ambivalent, at best. And, it's not because he's one of these supposed medical jerks who thinks he's all-mighty. Rather, doulas annoy him because they often are promoting some dangerous theories and are often encouraging their patients to NOT listen to their physicians.

Birth is not a Kodak Moment. It is a violent, dangerous event that is thankfully no longer much of a danger to mothers and children. If a doula is interfering with the physician-patient relationship, you bet the hospital and/or doctor is going to kick them out. Because if the birth goes south, guess who gets sued? Not the doula, not the "guests" the mom invites in, but the doctors, nurses and hospital.

And, guess who cares enough about the mother and unborn child to risk annoying doulas and other third parties by kicking them out to ensure the safety of the person actually giving birth? Yes, the doctors, nurses and hospital staff. They are not kicking you out to be mean, they are kicking you out because you are getting in the way of patient care. And if those "guests" mom starts inviting start interfering too much, I guarantee you they'll be gone soon too.

Allowing any non-employee of a hospital into a procedure is a decision fraught with danger for the doctor, patient and hospital. Are you invited in to the operating room watch a loved one's cancer surgery? Are parents allowed into the operating rooms when their children are under the knife? Are you even allowed to stay in the ER room during a procedure (my husband and I were kicked out of the ER when my son's broken are was set and he's a doctor)? No to all. Third parties do not belong in an area where a medical procedure is being performed.

And, whether you like it or not, birth is a medical procedure for most women. Sure there are totally benign birth events. But there are also lots of potential dangers and you should be thankful 21st century medicine keeps you from dying or losing your baby.

Just because women have been pushing out babies for thousands of years without the help of modern medicine doesn't mean it's the preferable method. I bet if you could bring any woman back from antiquity and ask if they could have one of these supposedly horrible cold, sterile hospital births they would jump at the chance. Just think - no pain, no dead mothers, no dead or deformed babies, no endless days of labor, no sterility due to birth complications.

Soooo, instead of complaining about a hospital or physician's decision to limit who may attend a birth, a decision I promise you is made in the best interest of the patient and unborn child, you should be thankful they let anyone but the husband/partner in at all. And, you should be thankful to live in the 21st century so you can complain about not having a positive "experience" at birth instead of complaining about how many children you've lost at birth.

5:23 PM  
Blogger bearing said...


"Birth is not a Kodak Moment. It is a violent, dangerous event..."

Spoken like someone who has to spend a lot of time listening to an obstetrician talk about his day. *shudder*

My two home births were anything but violent. The hospital environment, often, makes it so.

9:17 PM  
Anonymous Anonymous said...


"Violent and dangerous" are my words, not my husband's. He has never used those words to describe childbirth. I have. It was spoken by a woman who would have died even 50 years ago with both her pregnancies and births, not someone who is just listens to her husband. If not for hospitals and medicine I would be dead and my two sons would not be here.

You're one of the lucky ones. Not all of us are. And, I challenge you to read some literature about births throughout the ages. It is not pretty for most women.

Those of you who have "normal, vaginal" deliveries often have an undercurrent of self-righteousness that those of us who have complicated pregnancies/deliveries are quite tired of. Your "shudder" comment comes to mind. Open yours and be thankful, not patronizing.

3:54 PM  
Anonymous Anonymous said...

Good on you, Anonymous, well said.
Bearing, I'm glad your home births went well. Most hospital deliveries go well, too. But I've seen at least one woman post-home delivery with a retained placenta, blood pouring out of her, and a systolic blood pressure of 60. My anecdote no more proves that home birth is dangerous than yours prove that it isn't.

9:30 AM  
Blogger Dr. Deborah Serani said...

Your take on this article is very incisive and makes great sense to me. And I can see from the other comments, that others are with you too.


6:58 AM  
Anonymous Anonymous said...

Do not believe the “Doula Hype”!

At best these non-licensed, often under trained (sorry, 32 hours DONA approved course study doesn’t compare with 4 years of medical school, and countless years of practice), and over priced “assistants” can provide emotional, and some physical support on par with a partner, parent, or close friend during childbirth.

At worse, however, a Doula can be dangerously undereducated, biased, and a down right obstacle to the medical professionals working to keep mother, and baby safe and healthy during delivery. Case in point, during the birth of my first child, our doula not only took it upon herself ignore our birth plan and argue with my wife, and her doctor when after three hours of pushing labor it was determine episiotomy was necessary, but worst of all the doula turned off IV/blood pressure monitoring alarms when the nurses where not looking claiming:

“I just thought I was on a higher plane than the staff, and the noises were going to distract from the labor”.

This careless act of sheer selfish ignorance placed my wife and my child in danger during one our most vulnerable moments, and I suggest anyone thinking of employing a doula to first take the time to consider the ramifications of having non-medically trained personal actively participating your birth.

The fact remains doulas are hypothetical non-medical labor assistants, unfortunately too many doula’s misconstrue their role by making judgments, and expressing opinions about issues best left to a patient and their medical care provider… remember? Those people whose outcomes these decision actually affects.

It should be clear the danger an unregulated doula brings to childbirth, but sadly “doula hype” is growing more material everyday. This is in part due to the successes a competed, responsible, and ethical doula can achieve. However, anyone thinking of hiring a doula should remember, doulas are, as of yet, an unregulated, unlicensed industry with no standardized training, or legal oversight.

Think about it this way:

The person who cuts your hair has to have a license…why not someone helping in the birth of your child?

11:51 PM  
Anonymous Anonymous said...

To the one who said "It is a violent, dangerous event that is thankfully no longer much of a danger to mothers and children"

We were created to birth, otherwise, we wouldn't!! Birth is not violent, but it can be dangerous in certain circumstances. We, as women, were made to birth. It is too bad that you are not capable of seeing how amazing your body truly is. Yes, there are times that birth can be dangerous, and thank God for doctors who are trained to save lives. My first birth ended in a c/section. And yes, 50-100 years ago, I would have died and so would my baby. BUT fortunately for me, I had a great caregiver. That being said, was my body flawed, NO. Was it violent, only the c/section part.
I AM A DOULA. I have see many, many birth go completely naturally and with out a complication because that is what a women's body is designed to do. Baring no REAL medical emergency, women are very capable of birthing without drugs, or medical intervention. Doulas are hired to support mom, we are not responsible for her medical well being, and she knows this. She is hiring a doula to help make her birth experience better. We offer advise, but never tell a mom what to do. We can offer alternative to medical intervention (assuming baby and mom are both doing well) We are never in charge of the birth, that is mom and partners place. We offer help. Just like you would seek counsel from someone who knows cars before making a car purchase. You would seek advise from someone who knows natural alternatives to medical interventions before doing anything drastic.
Unfortunately, there are going to be doulas, like in all professions, there are going to be those who cross lines. Who have their own agendas and who aren't looking out for mothers best interest. This is a tragedy, though not all of us are like that. And to group us all like that, you be like grouping all blondes as stupid. This is unfair, and untrue. Before you have such a strong opinion about anything, do some factual research.
Thank you
A Doula

4:34 PM  

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