Unique Perspectives of a Doula
Doulas have a unique perspective because we are one of the only birth workers who attend births in a wide variety of settings: local hospitals, birth centers, and home births. Most doctors, midwives, and nurses only attend births in the hospital or birth center where they are employed. And many home birth midwives do not attend births in the hospital.
So, doulas have this wild (and yes it is wild) experience of entering birth environments where “normal” and “safe” drastically depend on the location of the birth.
How has this impacted the births I’ve attended?
Well, one good example is this: Near my home, there is a local hospital that allows water birth. At this hospital water birth is considered not only a safe option, but a good option for low-risk moms who do not want an epidural. The medical staff at this hospital openly recommend water birth to mothers.
In the same hospital system, there is another hospital that barely “allows” women out of bed during labor. At this hospital, I’ll support a client with a similar health history as another client who just had a water birth a few miles away, but I will have to advocate for this mom to just be able to get out of bed.
And the list goes on and on and on.
Some hospitals will never perform AROM before a 6-centimeter dilation, which is the recommendation. Meanwhile, other hospitals will often rupture mothers membranes at 2 centimeters.
And then there are home births, which come with radically different rules. Cervical checks? Only if moms want them. Birth on a timeline? No way! Placing limitations on movements? Never. Continuous fetal monitoring? Not even an option.
So what has all this taught me?
One important thing I’ve learned is that protocols that are considered safe are more of a cultural norm within a birth setting, rather than an accurate reflection of what is safe. This is partially true in different hospital settings. Each hospital encompasses its own culture with its own rules around birth. Each one also has its particular ideas around what is normal, and especially around what is considered safe. The lack of consistency across hospitals and birth settings is truly mind boggling.
You talk to any doula who works full-time, and it can almost break you.
One day I’m walking the halls with my low-risk client who is getting intermittent monitoring, and the next day at a different hospital I have a doctor looking at me sideways when I suggest we go for a walk in the hallways. It’s hard to know exactly what to do with all this.
I always come back to ACOG’s recommendations, as well as the Lamaze 6 Healthy Birth Practices. Those are my gold standards for what is “safe” and “normal” for birth.
The most important decision you could make in pregnancy is the doctor/midwife and birth setting you choose. Your options will change dramatically from one place to another, from one practice to another.
A lot of pregnant moms want to believe they have the willpower to do whatever they want in labor, despite what the hospital norms may be or what their care team may suggest. However, this is difficult – close to impossible. When medical staff tell you the things you desire (for example, changing positions or extending your pregnancy past your due date) are unsafe for you or your baby, it is hard to go against their suggestions.
We don’t want labor to feel like a fight! We don’t want a laboring mom to be on the defensive. The goal is for women to be laboring with a team whom they trust and whom they have good conversations with.
It is rarely too late to change doctors or midwives. I do suggest you make this decision earlier in pregnancy, as opposed to later in pregnancy. Yet, even if you hit 36 weeks and realize your provider is not a good fit for you, there is usually still time to change doctors.
Many people don’t explore this option because they believe that all doctors and midwives are created equally and that the system is broken. “Why try to get a provider who listens to you?” This is absolutely untrue. There are incredible doctors and midwives out there who will help you feel seen, heard, and safe.
What are the keys for effective communication?
Like I have stated earlier, the foundation is impeccable listening skills. What does it take to be a good listener?
The skill to be a good listener starts with dropping your agenda. Dropping the idea that you must provide a useful response or that you must know everything.
Most people just need to be heard. They already know the answer to their problem, they just want someone to talk it out with. Someone to validate their feelings.
Another key of effective communication is reflecting back what the person has already shared. This allows them to feel well listened to, and it gives them a chance to hear their words in another person’s voice.