People sometimes assume that doulas only support home births, which simply is not true. The majority of the births I support are in hospitals. Here are some things to think about if you would like the support of a doula during your hospital birth.
When old friends and new acquaintances find out that I am a doula, one of the first questions they ask is, “Do you deliver babies in people’s homes?” I’m always filled with a mix of feelings when responding to this question. Firstly, doulas are not medical professionals, so we don’t catch or deliver babies.1 We attend births to comfort, support and amplify the voice and wishes of the birthing person. We are contracted by the birth family, not the state or any national licensing organization.2 This gives us the unique position to hold the space required to tailor the birthing experience to the families we serve.
In using the word tailor, I mean this: doulas do not stand to lose our jobs by failing to uphold hospital policies and procedures.3 We can push back without fear of repercussions, if we see our birth family’s voices being ignored, or if things are being done without the birth person’s consent. 4 We stand as witnesses to what is happening in the labor and delivery room. I cannot in good conscience state that hospital policies and procedures are created to protect the patients first. Though they are executed and prove harmless for some, those left to the margins can actually be harmed by them. Further, due to systemic racism, biases of those who are licensed to provide care for non-white birthing people, if left unchecked, have caused harm and death at a disparaging rate.
For this reason, I would like to state for the record, that doulas are absolutely NOT strictly hired for home births. To date, I have not attended a home birth. In fact, I feel specifically called to attend births in hospitals for the purpose of closing the mother5 an infant mortality disparity experienced by my people.6 If the birthing person wants to exercise any amount of autonomy in their birth experience, I might argue that the place a doula is needed most is in the hospital, whether the birthing person is considered high risk or not.7
I am saddened by the disparaging notion that doulas only work in homes and for people who want to have an unmedicated birth. This is simply not true. In fact, most of my on-site training has been learning about all of the interventions that exist at different hospitals, so that I can let my clients know what their options might be when it’s time to deliver. I’ve supported unmedicated births, inductions, births that have turned into both joyous and semi-emergency cesareans, as well as the planned cesarean of my youngest aunt.
Harkening back to the question I am most frequently asked, I think this query points in several directions. The tone with which the question is asked, and the comma-huh-question mark that sometimes trails at the end, to me, indicates that the allure of an unmedicated birth is palpably attractive but the desire to have access to state-of-the art healthcare is also forcefully present, even if we are hoping to God that we don’t need it.
Fear can play a big role while in labor, and knowing that trained surgeons and monitoring devices are on hand, can mitigate fear for some people. When it comes to deciding where one will give birth, it’s not always the birthing person’s voice that is the loudest. If I told either of my grandmothers that I wanted to give birth at home, that statement would be swiftly followed by a barrage of questions, that could add stress to my birthing experience. Many people are in the same boat as me, and would rather avoid having to have that dialogue with each of their relatives.
I am here to say, doulas support those that want to give birth in a medical setting.8 I support you and think you have the right to try for whatever experience you desire with medical support nearby. Hiring a doula is a means by which to stand in your power with support. You do not have to do this thing all alone. A doula will help prepare you to make your own informed decisions with dignity.
It’s not lost on me that many have had horrible experiences with medical professionals. I have heard stories of malpractice and microaggressions. Some folks are actually terrified to return to the hospital site where harm was done, but have no choice because they are considered to be high risk, or because their insurance limits their options.
In the hospital, a doula can be a helpful companion, because our purpose is clear. We are not present to uphold hospital policies.9 We are present to ensure that the birthing person feels cared for. Feeling cared for looks different for everyone, but baseline non-negotiables are that they are truly seen by all who enter the room, that their correct name and pronouns are used, that their questions are heard and answered, and that their physical body is made to feel as relaxed as possible through positioning, comfort in labor techniques, movement, and appropriate nourishment. Doulas bear witness to what is going on in the hospital, and our copious time-stamped notes are helpful to both the families we support and sometimes the nurses, lactation specialists, and doctors.
The picture I am trying to paint here is one that places another person on your side, no matter where you decide to give birth. Your doula is attentive to only you, and you deserve to be supported during this most vulnerable and joyous ceremony of birth!
Footnotes
- This statement is written with the understanding that people can and do give birth without the help of medical professionals.
- Though most birth workers go through an initial training, and continuous educational workshops, I also see this work as ancestral and spiritual.
- When doing this work, I chose to assume good intentions, but also understand that policy is not law, thus, we are entitled to ask questions of those who are providing care to us.
- In 2010, my sister-in-law went into labor, and after a few hours, was asked if she “wanted a little something for the pain.” Before she could answer, the nurse on duty was injecting a clear substance into her IV. This is an example of non consent.
- Studies I have seen label the birthing person as a mother. I have kept the language here so that those who wish to research the topic can. Transgender birthing people face harmful issues in finding competent care and should be noted here as well.
- Black families. It is important to point out, Pacific Islander families experience similar birth disparities as Black families in America.
- When valid, categorization of a birthing person as high risk can bring with it, a strong sense of loss of agency. Combat this by finding out as much information about the condition, while exhausting all possible outcomes so we have some idea of our options and preferences before entering the birth space.
- When working with clients who want an unmedicated birth experience, I will use affirming language to reflect that, and often only bring up pain medication during our pre-birth visits. I find It keeps us focused on our objective. Some folks prefer to deliver at a birthing center, where there is no option of an epidural, but where clear procedures for a transfer to a hospital do exist, should the need arise.
- I speak with my clients about how they move through situations where an authoritative figure has a viewpoint that is contrary to theirs, and what level of dissent or push-back are they comfortable with expressing when they are in pain? This way, if illegitimate policies are used as an excuse to take away their autonomy, the client has a method by which to move through that roadblock.
Birthwork is Community Care 