Burning Questions #1: Do Doulas Have Specific Ideas About How Birth Should Go?

I'm so thrilled that a week after asking for your Burning Questions about birth, breastfeeding, and bodies, I've already got several questions in the queue. Thank you, and keep 'em coming!

Today's question comes from my fellow Swedish Institute graduate and New York City/New Paltz-based massage therapist Eowyn Levene who says:

Love your Burning Questions idea for the blog, by the way! For some reason, a lot of people ask me doula questions. A big one is whether doulas have specific ideas of how a birth should go, or whether they are always ‘non-interventionist.’
— Eowyn Levene, LMT
Do Doulas Have Specific Ideas About How Birth Should Go?

What a fantastic question! Thank you, Eowyn!

(One thing I suppose I should point out right from the get-go here is that I can ultimately only speak for myself as a doula, though I do know a lot of doulas very well and we discuss our philosophies of birth, attitudes as practitioners, and style of support often, so I've got lots of information to work from.)

A lot of people have the idea that doulas believe that there is one right way to give birth for everyone, and that the right way includes very few medical interventions. In my background as a toLabor certified doula, my focus is on providing evidence-based information to help you make your own decisions about what is best for you, your baby, and your family - and when it comes to many of the things you could make decisions about in your birth, the evidence strongly suggests that fewer interventions lead to better birth outcomes. But when it comes down to it, I'm not your medical care provider, I'm not your partner, and I'm not YOU - so the choices aren't up to me, and my job is to support you in getting what you need.

In my three years of practice, I have supported births at home and in the hospital, for clients choosing to give birth without an epidural, for clients knowing that they want to use an epidural from the beginning, and for clients who changed their minds about epidurals (in both directions!) in the midst of labor. I have supported clients whose labors began spontaneously, clients who chose to have an induction of labor, and clients whose labors were augmented with pitocin. I have supported clients switching care providers, and clients who chose to stay with care providers they didn't love. I've worked with couples to achieve a VBAC (vaginal birth after cesarean) and with couples who have chosen to have a repeat cesarean birth. I've sat with clients in the labor room as they made the tough decision to consent to a cesarean birth when they had been planning to labor without pain medication and have a vaginal birth. So for myself, the answer to the question "do doulas have a specific idea of how birth should go and are they always non-interventionist" is, unequivocally, NO. 

At least, I don't have a specific idea of how any one birth should go.

As a doula, my interest and involvement in birth is largely focused on providing one-on-one preparation and labor support. But my involvement also extends to collaboration with the larger community of birth professionals paying attention to the routine care provided and made available to birthing families in our country. I think overall in the US, medical interventions (such as routine continuous fetal monitoring and routine IV hydration, among others) are routinely applied without evidence that they are beneficial, and thus over used without regard to individual circumstances or needs. So when it comes to birth as an abstract, maybe it IS fair to say that doulas are in support of "low interventions," or that we have specific ideas of what should be possible or available in maternity care -- but I think this is a long way from saying that doulas believe there is a specific way that birth should go. 

It occurs to me that if someone is wondering if doulas have a specific idea of how a birth should go, what they may be trying to get at is "Can I have the support of a doula if I want to _____?"  Fill in the blank with: 

  • Have an epidural?
  • Give birth in a hospital?
  • Go in for an induction?
  • Plan a repeat cesarean?

The simple answer is YES, you can have the support of a doula if you are choosing any of those things. Now, some doulas may specialize in working in specific circumstances (for example, one of my mentors primarily attends homebirths, so she will refer most potential clients planning a hospital birth to other doulas). But I think it's fair to say that in most cases, doulas will support whatever decisions you are making for your birth, and will be honored to provide exemplary emotional and physical support during your labor and birth. 

Of course, I would encourage anyone planning to give birth to do your research and learn all you can about various interventions and choices during labor and birth. But making decisions for your birth is not just about following the research. It's also about taking that research to your care provider and discussing the research in light of their clinical experience and YOUR values as the patient in their care. So with your values, needs, and desires, you make the best decisions you can for your family, and your doula provides physical and emotional support with no agenda other than supporting your desires.

I hope this answers your question, Eowyn, and helps you answer this question when it comes up with other people! If you, like Eowyn, are someone who might find themselves in the position of referring clients or friends to doulas in your area, it helps to know a bit about some of your local doulas and be clear about what sorts of boundaries they may have on supporting clients' birth preferences. But overall I want to assure you that doulas are here to support you no matter how, where, or with whom you choose to give birth!