Just read a very thoughtful response by Megan Davidson and Stephanie Schiavenato, Raising Roots Doula-http://www.raisingrootsdoula.com/publications/
5
long, long ago, in the 70s & 80s, when our two daughters were born, we took lamaze classes for many weeks in preparation for the day; as both the life partner and business partner of my wife, it seemed not only natural, but empowering for me, to share this rare moment together. it brought us all closer together and was a natural continuation of sharing everything as a couple. what is this new-sexist idea that a husband cannot be there to serve and support the emotional and practical needs of his life partner at this most critical time in the relationship's development? you need a doula? enjoy. but for living a full life, husbands, you need to open your hearts and minds to this central experience, for your wife and baby and, perhaps foremost, for your own enrichment. 30+ years later, divorced and remarried, i contemplate being by my wife's side at the birthing of our child, her first, my third; i wouldn't miss it for the world.
4
After reading all the comments and replies, I wondering if a better way to look at doula services isn't as childbirth assistance, but as mental health professionals. People see counselors, social workers, and all sorts of people who provide psychological support. And people see physical therapists who provide massage and help with non-pharmaceutical pain relief. A doula is a combination of these professionals. If you called your psychologist while you were in labor, and they provided support over the phone, no one would argue about insurance covering it. If while you were in labor, a physical therapist or accupressurist gave you massage therapy, no one would argue about insurance covering it. So recognize doulas for professionals they are, and start including their services as part of standard health services for the people who want them.
6
Paying my doula was one of the easiest checks I've ever written, even though my husband said "That's a lot of moula for a doula!"
I got through 48 hours of labor with only a first degree tear and no epidural. She gave me massages and reassurance and the nurses loved her. We skipped the Bradley classes and spent the money on having a labor expert right there with us during the experience. It was awesome. Ask around for recommendations and hire a doula if you can possible afford it.
I got through 48 hours of labor with only a first degree tear and no epidural. She gave me massages and reassurance and the nurses loved her. We skipped the Bradley classes and spent the money on having a labor expert right there with us during the experience. It was awesome. Ask around for recommendations and hire a doula if you can possible afford it.
4
Doulas fill the gaping hole left by results-centric medicine that needs to expand its view for the long-term health of babies and moms. The current focus is on a healthy delivered baby and, increasingly, on breastfeeding numbers. With this narrow focus, moms are treated merely as vessels and milk manufacturers. For example, after I was restricted access to food for 24 hours (you are only allowed jello and broth during labor) and then after undergoing one of the most physically demanding events of my life, I was starving. My husband had finally brought me back food (none was offered from the hospital). As I was biting into my first much-needed bite, a nurse walked in and plopped my baby in my arms, so I couldn't finish my second bite, because she was on her rounds and it was time to make me breastfeed - no regard for my physical state or needs. (hello, vessel and milk manufacturer) The hospital also had a new "room-in" policy designed to increase breastfeeding rates if the baby is always with mom. Never mind that lack of access to a nursery means that moms get no chance for restorative sleep before leaving the hospital. Doula's aren't just there for emotional needs -- they are able to help new moms manage the very basic, very necessary physical needs for recovery, as well.
3
Once doulas have established a body of knowledge, licensing exams, and certifications, then they can talk about insurance reimbursement. There will be too many inconsistencies in care without this being established. Anecdotally, doulas were not allowed in one major OB practice in my city after one doula openly challenged the OB when she wanted to do a CSection. When the practice no longer allowed their patients do use doulas, the cry was 'sexism' which was funny because all the OBs were women. I think since then the issues with doulas have been resolved. However, certifying the training would help avoid some, if not all, of these issues.
1
I've been a doula for 18 years and a doula trainer with DONA International for fifteen. I absolutely agree with you. There need to be consistent certification requirements or you end up with the sad story you mentioned, of women no longer having access to the amazing care a doula can provide because a handful of "doulas" are acting inappropriately. I hammer that home in my trainings. If we overstep our bounds of solely providing non-medical emotional, physical and informational support within a parameter of a Code of Ethics and Standards of Practice (which DONA has in place), we end up hurting the system further and not being able to help women or be seen as a valuable person on the birth team. That doula acted inappropriately. We empower the client to speak for themselves and to choose a place to give birth that best suits her. If we disagree with her choices, it's not our job to jump in and rescue her.
3
It is unfair and unfortunate that all doctors and at times some trained midwives are put in the category of uncaring individuals!
Well, then there are doulas, who come in between a pregnant laboring woman and her partner and patients from receiving appropriate care!
Did any one address the issue of the expense which an obstetrician faces in New York city? The charges of malpractice premium above yearly $130,000! And then constant fear of law suits! Not to mention practice expenses and pressures from hierarchy of hospital and universities in academic institutes.
Doctors obstetricians generally take pride in their profession and give the best care to their patients under the circumstances.
A doula gets paid the same amount that an obstetrician gets paid through insurance for 9 months of obsterical care, caring patients in labor for hours and postpartum care and then added responsibility minus expenses of continuing education, recertification costs and more.
Speak about burnout.
No wonder young medical school graduates shy away from obstetrical practice.
As much as doula may give emotional support to a patient, an obstetrician or high risk pregnancy specialist often does the same, let us not forget that and furthermore educates the next generation to continue the same as a good role model with examples and experience.
Well, then there are doulas, who come in between a pregnant laboring woman and her partner and patients from receiving appropriate care!
Did any one address the issue of the expense which an obstetrician faces in New York city? The charges of malpractice premium above yearly $130,000! And then constant fear of law suits! Not to mention practice expenses and pressures from hierarchy of hospital and universities in academic institutes.
Doctors obstetricians generally take pride in their profession and give the best care to their patients under the circumstances.
A doula gets paid the same amount that an obstetrician gets paid through insurance for 9 months of obsterical care, caring patients in labor for hours and postpartum care and then added responsibility minus expenses of continuing education, recertification costs and more.
Speak about burnout.
No wonder young medical school graduates shy away from obstetrical practice.
As much as doula may give emotional support to a patient, an obstetrician or high risk pregnancy specialist often does the same, let us not forget that and furthermore educates the next generation to continue the same as a good role model with examples and experience.
5
What a lovely picture of mother, baby, and doula at the bottom of this article!
As an indicator of the uncertainty of the role of doulas, it's worth nothing that the word comes up as a spelling error as I type in this comment. We have a ways to go, it seems...
Mr.Pizarro came across as almost an afterthought in this process. Is that accurate?
As an indicator of the uncertainty of the role of doulas, it's worth nothing that the word comes up as a spelling error as I type in this comment. We have a ways to go, it seems...
Mr.Pizarro came across as almost an afterthought in this process. Is that accurate?
4
"Why pay a doula when a husband or other family member can do the same thing?" Because a husband or other family member can't. My husband has no medical knowledge - probably most people's husbands don't, and, prior to our first child's birth, had never been present when a child had been born. And neither had I. Even someone who has given birth themselves has limited knowledge or the process and how to support the mother. Contrast that with somoene who has attended dozens, if not hundreds of births, received specialized doula training, and in many cases, might be a RN or LPN.
Amazing that commentators here would think that it's perfectly safe to sit in labor by yourself at home, or with your husband who has no idea what's going on, but that having a doula sitting there with you is somehow dangerous.
Amazing that commentators here would think that it's perfectly safe to sit in labor by yourself at home, or with your husband who has no idea what's going on, but that having a doula sitting there with you is somehow dangerous.
3
If doulas didn't exist, I wouldn't have had my second child. My first pregnancy had been completely uncomplicated, but as soon as I walked in the hospital door (much earlier than I needed to, because I didn't have anyone to tell what the "right" time was), I was strapped to machines and lectured by nurses who wouldn't let me move or walk, and then shook their heads at my lack of progress in labor, warning that if my labor didn't progress (as if I could do anything about it), I'd need a C-section.
Fast forward to pregnancy #2, with a doula, who came to my house as soon as my labor started and helped me relax and get ready for the birth. She knew when it was time to go to the hospital, she talked with the nurses in the labor & delivery ward and advocated for me in a way that my husband wouldn't have known how to do. It's time to make doulas part of standard labor and delivery practice for women who want them, and have insurance cover the costs.
Fast forward to pregnancy #2, with a doula, who came to my house as soon as my labor started and helped me relax and get ready for the birth. She knew when it was time to go to the hospital, she talked with the nurses in the labor & delivery ward and advocated for me in a way that my husband wouldn't have known how to do. It's time to make doulas part of standard labor and delivery practice for women who want them, and have insurance cover the costs.
6
This article focuses on doulas as a fad among the wealthy, but many doulas also provide care free of charge to the very poor. I am a social worker and frequently refer single homeless new mamas to a local doula group for free care and birth support. Doulas provide an essential service to mamas who have no one trustworthy in their lives with whom to give birth.
6
I am not rich and had a doula for both of my sons' births - and she was worth every penny. She offered my husband and I, who had no idea what to expect of the birth experience the first time around, invaluable support. She did not judge my decision to have an epidural and helped me through a long pushing phase with my first baby, and gave me the encouragement to have a beautiful non-medicated birth with my second, both at NY Presbyterian. She was clear from the beginning that she was not there to offer medical advice or replace the doctor. Let's be real - in a time and place where people may not have experience with babies, much less the birthing process, someone who has that experience and who can stay by your side throughout labor and delivery can be extremely comforting, reassuring, and as another commenter wrote, can provide critical reassurance during what is a dramatic, physically painful and foreign experience.
4
I have no doubt that doulas are extremely helpful to expectant mothers, that they reduce stress and help foster healthy pregnancies, births and post-natal care for mom and child. They seem to fulfill the role that mothers, grandmothers, aunts and older sisters used to play when people lived in small towns and babies were born at home.
The question is, are doulas medically necessary? Probably not. Is this a tragedy? Well, if you're an upper middle class or very wealthy household, it may seem like one. But it's not. I would rather see insurance companies and hospitals invest in community services that provide excellent pre- and post-natal care to families. All families, not just the ones who live in nice apartments in good neighborhoods. Nurses, nurse practitioners, nutritionists, lactation specialists and, if it is a good fit for the program, doulas. But personalized doula service for one single family is not a necessity. I liken it to the difference between a nanny, which is a luxury, and a government-subsidized daycare program. Or, as one person mentioned, a personal trainer vs. your local YMCA or community center gym.
The question is, are doulas medically necessary? Probably not. Is this a tragedy? Well, if you're an upper middle class or very wealthy household, it may seem like one. But it's not. I would rather see insurance companies and hospitals invest in community services that provide excellent pre- and post-natal care to families. All families, not just the ones who live in nice apartments in good neighborhoods. Nurses, nurse practitioners, nutritionists, lactation specialists and, if it is a good fit for the program, doulas. But personalized doula service for one single family is not a necessity. I liken it to the difference between a nanny, which is a luxury, and a government-subsidized daycare program. Or, as one person mentioned, a personal trainer vs. your local YMCA or community center gym.
5
Have you given birth in America? Doulas ARE a necessity. Our system is broken. We need doulas to fill the gap. They are NOT a luxury item. As a now low income mother I had a doula and I would not trade that for anything!
Do you need a surgeon to catch your baby? That is debatable but having a doula at your birth is 100% every woman's right!
And as someone who worked as a fitness professional before becoming a mom I can honestly tell you that there is a huge difference in a certified trainer coaching you one on one versus an inexperienced group class instructor (usually just starting out) at the local Y.
Do you need a surgeon to catch your baby? That is debatable but having a doula at your birth is 100% every woman's right!
And as someone who worked as a fitness professional before becoming a mom I can honestly tell you that there is a huge difference in a certified trainer coaching you one on one versus an inexperienced group class instructor (usually just starting out) at the local Y.
4
What always amazes me about these articles is the ahistoricity of them.
African, Asian and other cultures have for centuries recognized that the presence and support of other women during labor, delivery and post-partum is necessary for a spiritually and physically healthy birth experience. Especially given the physical risks. Yet there is no mention of the age of this practice, or its true origins. Indeed, these practices were considered "backwards" as far as modern medicine is concerned.
Once again, it took upper class white women paying others for the service to legitimize a cultural practice, with no understanding of its origins and no thanks to those "backward" people who, once again, appeared to have figured something out long before the white Western world of privilege did. First this happened with midwifery, now with doulas.
Perhaps the NYT could do more to educate about these things, when it chooses to write these stories?
African, Asian and other cultures have for centuries recognized that the presence and support of other women during labor, delivery and post-partum is necessary for a spiritually and physically healthy birth experience. Especially given the physical risks. Yet there is no mention of the age of this practice, or its true origins. Indeed, these practices were considered "backwards" as far as modern medicine is concerned.
Once again, it took upper class white women paying others for the service to legitimize a cultural practice, with no understanding of its origins and no thanks to those "backward" people who, once again, appeared to have figured something out long before the white Western world of privilege did. First this happened with midwifery, now with doulas.
Perhaps the NYT could do more to educate about these things, when it chooses to write these stories?
13
Completely agree.
4
I totally agree Shanikka - I grew up in the Middle East and this vital role in the gestation, birth and post-partum journey of the parents and child is something that isn't taken lightly. Doulas don't replace the medical caregivers, they enhance the experience for all involved and there's nothing like watching the incredible bond that persists for many, many years after the birth of a child like the one I shared with my Grandmother who played that role for my Mom who appreciated every moment and gesture. Italian has a wonderful expression for giving birth "Dare alla luce" (giving to the light) and I would bet a glass of prosecco that it had something to do with presence of maternal support in the birthing experience.
9
All cultures had practices like these! I come from a bi-racial multiethnic home and had women & relatives assist my great grandmothers during labor on both sides of my family.
This article makes everyone look bad. European women have a rich history of supporting each other in childbirth too. That history is just as valid as African, Central American, and Asian to name a few.
You are right that women supporting women is not a new thing. We pay cash now and call them doulas and we have different and bizarre birth settings so the stage has changed but the support hasn't.
This article makes everyone look bad. European women have a rich history of supporting each other in childbirth too. That history is just as valid as African, Central American, and Asian to name a few.
You are right that women supporting women is not a new thing. We pay cash now and call them doulas and we have different and bizarre birth settings so the stage has changed but the support hasn't.
1
It is quite fascinating all the arguments against Doulas! It unfortunately seems many are under the presumption that Doulas are anti-medicine and anti-hospital but that could not be farther from the truth. The reason that this discussion has credence is that doulas have been proven to alleviate many of the stresses of childbirth and why would we as a society be against that? Costs? well an average hospital birth is over 3x as expensive as a birth center or a OMG homebirth...for the truly crunchy. Doulas are an intrinsic part of that model. they do not take away from the husband or partners help, they only enhance it. Also most women I know who have used Doulas are simply educated brave women who want a positive birth experience. There are many organizations that provide low cost doula services to low income families. it is not solely a luxury of the rich. and if you are to argue that a doula is a superfluous expenditure then the same could be said of an epidural which."hey it is only to relieve pain..why would we want women to have that??" many doulas are even less expensive than epidurals. i think people have mistaken this argument to think that we are giving young doulas medical license...but please talk with anyone in the profession and they are very clear about their role,to comfort and support. There is so much fear and ignorance surrounding childbirth in our modern age. At least we can be a little open minded as to how to make this experience more positive
11
Before hiring one of these medically untrained people to care for the birth of your child, read the actual independent medical and clinical studies and statistics in Europe and Asia about the number of deaths and injuries about home births.
Claims that European public health agencies and insurance companies support home births are false - at this point after years of propaganda, they are urban legend. In fact, with only a handful of exceptions, home birth is discouraged or illegal in most European (and Asian) countries. Why? Because the instance of death and injury during home birth skyrockets versus in a professional hospital or clinical setting. Why? Because doulas and midwives are largely untrained, and don't have necessary tools and facilities to deal with birth emergencies.
Because of the propaganda of one individual in the US, primarily, to promote home birth, this, like avoiding vaccinations has become popular with the rich hippie crowd, especially older mothers, who are at the highest risk. It is a stupid mistake, and places innocent children's lives at risk, as well as the mothers.
Writing from direct experience.
Claims that European public health agencies and insurance companies support home births are false - at this point after years of propaganda, they are urban legend. In fact, with only a handful of exceptions, home birth is discouraged or illegal in most European (and Asian) countries. Why? Because the instance of death and injury during home birth skyrockets versus in a professional hospital or clinical setting. Why? Because doulas and midwives are largely untrained, and don't have necessary tools and facilities to deal with birth emergencies.
Because of the propaganda of one individual in the US, primarily, to promote home birth, this, like avoiding vaccinations has become popular with the rich hippie crowd, especially older mothers, who are at the highest risk. It is a stupid mistake, and places innocent children's lives at risk, as well as the mothers.
Writing from direct experience.
4
Doulas don't replace the doctors and midwives, and this article had nothing to do with home birth. Your entire comment is off topic.
18
Absolutely. Let's raise our insurance premiums with this unlicensed, untrained personal coach for pregnant women. And, by the way, I'd like my insurance to pay for a personal fitness trainer three times a week (many of whom have no formal training in anything).
13
I'm stunned how negative everyone is about doulas being included as part of insurance.
I'm already stuck paying for someone else's prenatal care, their delivery, their early c section so the birth can get done faster, etc, etc, etc. Heck, I even have to pay for your painkillers, which are completely optional.
Once you get your hands out of my pockets for all that optional crap (you know, you could have the decency to not get pregnant rather than impede on my insurance pool, or at least pay yourself) I'll sign on to exclude another person. But until then, if the person who doesn't believe in pain killers or doctor led birth have to contribute for all your ridiculousness, maybe you can allow another family their one?
Then again, I live in a country where pregnancy is treated as an option, and insurance does not cover the basics (prenatal, standard delivery, painkillers, etc, etc). So at least here doulas would just fall in line with everything else that is optional.
I'm already stuck paying for someone else's prenatal care, their delivery, their early c section so the birth can get done faster, etc, etc, etc. Heck, I even have to pay for your painkillers, which are completely optional.
Once you get your hands out of my pockets for all that optional crap (you know, you could have the decency to not get pregnant rather than impede on my insurance pool, or at least pay yourself) I'll sign on to exclude another person. But until then, if the person who doesn't believe in pain killers or doctor led birth have to contribute for all your ridiculousness, maybe you can allow another family their one?
Then again, I live in a country where pregnancy is treated as an option, and insurance does not cover the basics (prenatal, standard delivery, painkillers, etc, etc). So at least here doulas would just fall in line with everything else that is optional.
3
Used in the manner intended doulas save hospitals money and doctors and nurses time. For each of my 3 births, I spent hours laboring at home with my husband and doula and then arrived at the hospital ready to deliver. Very little nursing care was required for me. Even during my longest delivery, the nurse assigned to me was free (until the very end) to tend to other patients because I felt cared for and supported by husband and had a doula there for extra support and assistance. The nurses and doctors there agreed it was a win-win situation. And a wonderfully empowering experience for me.
17
Arnzenml,
Do you have a peer-reviewed study on the effectiveness of doulas vs. non-doula households, including all costs? BTW, if everyone on the maternity ward has a doula, you still need the same number of nurses on the floor. Doulas cannot replace the expertise of a registered nurse. So the cost of including doulas on the floor with the nurses is an increase. if everyone has a doula paid for by insurance.
Do you have a peer-reviewed study on the effectiveness of doulas vs. non-doula households, including all costs? BTW, if everyone on the maternity ward has a doula, you still need the same number of nurses on the floor. Doulas cannot replace the expertise of a registered nurse. So the cost of including doulas on the floor with the nurses is an increase. if everyone has a doula paid for by insurance.
3
the downside of doulas is when they arrive at the hospital having created and fostered an adversarial relationship between hospital staff and the parents about to give birth. Saying things about midwives like "they're really there for the waist down, we're there for the waist up," of themselves, is typical. There are wonderful doulas, but there are also ones who are birth junkies and want to be the star of the show. These types prey on families by setting up a dependence on the doula that is based on planting fear of the hospital staff in the patient's mind. There was a time when labor and delivery nurses gave support at birth - now when a laboring mother comes in with a doula, we have to wonder "is this one of the doulas who respects what we do and the opportunity we have to contribute to a wonderful birth, or is this a doula who while teaching hypnobirth taught the parents not to talk to or trust the staff?"
14
It's sounds like you've had some bad experiences with doulas. Hope you haven't had a bad experience with self-hypnosis used for birth. Both my children had fast, easy, serene and pain-free births thanks to my hypnosis training. My mother used the technique four times quite successfully to give birth to me and my siblings. I have a lot of respect for the safety net of a hospital birth and the medical staff and they respected my choice. Here's hoping you meet only doulas who respect you and the rest of the staff.
2
I am sure doulas are great and provide a valid and useful service. However, there is a belief that the pile of money for healthcare is almost unlimited and it that pile is crawling from alternative therapies, quacks and outright frauds to a degree that is staggering the health care payments system. Doulas need to be acknowledged as a luxury that cannot be added to the evergrowing list of things that are part of the health care mess
8
Here's what the American Congress of Obstetricians and Gynecologists reported in a study March, 2015 in a published professional article titled: Safe Prevention of the Primary Cesarean Delivery. Doulas are NOT a "luxury" item, they are a necessity in the reduction of unnecessary cesarean deliveries and in preventing serious physical and emotional consequences. Our care begins many weeks before delivery and ends weeks and sometime months after birth with postpartum support, local referrals for professional support of a wide variety and introduction to other new mothers and breastfeeding/new moms groups.
"Continuous Labor and Delivery Support
Published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula. A Cochrane meta-analysis of 12 trials and more than 15,000 women demonstrated that the presence of continuous one-on-one support during labor and delivery was associated with improved patient satisfaction and a statistically significant reduction in the rate of cesarean delivery (111). Given that there are no associated measurable harms, this resource is probably underutilized."
"Continuous Labor and Delivery Support
Published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula. A Cochrane meta-analysis of 12 trials and more than 15,000 women demonstrated that the presence of continuous one-on-one support during labor and delivery was associated with improved patient satisfaction and a statistically significant reduction in the rate of cesarean delivery (111). Given that there are no associated measurable harms, this resource is probably underutilized."
2
The study said "support personnel, such as a doula." So it does not have to be a doula.
And who exactly would the "support personnel" providing one on one support during labor be, if not a doula? Would you support having insurance pay for a registered nurse to sit by each mother's bedside providing the support services that a doula could? That would certainly be more expensive.
2
Giving birth is quite ordinary, as most of the world realizes. I feel qualified to speak to this, after having 4 babies in 5 years. As my mother would say, "these people have more money than sense."
10
I had the benefit of a doula AFTER the birth of both of my children. They did not participate in the medical aspects of the birth and in fact came only to provide support services immediately afterwards. As paid providers and not intermittent family help, they provided much needed consistent assistance in the first few days, helping me to get enough sleep and food for my entire family and helping with the overwhelming responsibility of caring for a newborn while recovering from surgery. I recommend their services highly, but I found them of greatest service after the fact, when you start down the road of caring for your child, a process that lasts much longer than the 12-24 hours of the birth process itself that is such an object of obsessive examination. I would consider their services similar to home health care provided for the elderly, worthy of insurance compensation.
11
What I've learned, from painful experience, is that EVERYONE who is admitted to a hospital needs a someone who will advocate for them -- someone who will notice and go get help when the pain levels suddenly increase or when you stop responding to conversation, someone who will ask questions for you when you're too out of it to ask them yourself, someone who will demand better care if the care you receive is sub-par. It would be nice to think that nurses can do this, but in many hospitals, nurses are stretched thin. Ideally, that person is a family member, but when your family can't or won't do this, a doula can be a life saver. Not only do I think they're a great idea for pregnant women, they would be great for frail elderly as well.
Should they be reimbursed by insurance? If systematic studies show that patients who are accompanied by a personal advocate have better outcomes than patients who do not have one, then yes -- and they should all be reimbursed for their service.
Should they be reimbursed by insurance? If systematic studies show that patients who are accompanied by a personal advocate have better outcomes than patients who do not have one, then yes -- and they should all be reimbursed for their service.
17
What you are talking about is a patient advocate, not a "doula" as described in this article. Big difference.
2
What you are talking about is a patient advocate, not a "doula" as described in this article. Big difference.
Yes, bokmal2001 is right, you are talking about a patient advocate. Friend, family member, private duty nurse, doula, et al. Hospitals have also been hiring patient experience specialists to address complaints.
2
My partner and I live in San Diego where alternative birthing solutions are not well supported. However, we found an excellent birthing center in a major hospital and Sarah, a full-time doula, who helped us realize our vision for a natural birth for our son. Sarah spent time with us both, but mostly my partner, during the pregnancy helping us train and prepare for labor and delivery. When my partner finally went into labor Sarah came to our home and coached her from the time she arrived until the time she gave birth in the hospital. I cannot overstate the value of having her there. Her presence was calming for us both. Her coaching helped my partner get through the pain. And very importantly, she was our advocate at the hospital where she and the medical team worked together to make the experience as wonderful as it could have been. When mom and baby were resting comfortably Sarah left for a few minutes and returned with a bag of burgers and fries from a nearby gastropub. I've never tasted a better burger in my life. If anyone asks me, don't hesitate to use a doula.
15
I am glad you had a positive experience and nothing went wrong. You do not mention what medical training your "doula" had, if any. I am not a physician, but I can imagine many thing that could to wrong with an untrained person in this position that might harm mother or baby.
3
As a PA with many years of experience in ob-gyn, I have seen doulas who respect the medical and nursing teams and those who treat them with disdain. I do not see the benefit of reimbursing for doula care. It is not medical and is not necessary; our medical insurance system is so badly managed now I certainly don't want to see more money spent on such care. Finally, most labor nurses do a fine job of coaching laboring parturients.
15
The advantage of having a doula is a calmer labor, with better outcomes; it can often be be the difference between unneccessary medical interventions which do not benefit the mother or child, and better outcomes (unneccessary Caesareans, anyone?) "Most labor nurses" are too overworked and underpaid to nurture 'parturients,' and if you think that getting rid of doulas will result in labor nurses getting a pay increase, you're awfully naiive
3
I certainly mean no disrespect and would like to clarify that doula support for laboring women far exceeds the limits of education, information, emotional and physical support along with logistics getting to the hospital at an appropriate time .. than any labor nurse, PA, OB or Midwife can provide given the number of patients and time restrictions they must manage currently. Perhaps if hospitals were staffed effectively and nurses were not stationed outside the room watching contractions on a computer screen (as their job dictates) and doing so for more than one laboring patient .. shall I go on? A "fine job" we all know is resulting in far too many dangerous complications for healthy mothers and babies. Let's work together, we need each other.
I'll quote the American Congress of Obstetrics and Gynecologists in a March 2014 study, Safe Prevention of the Primary Cesarean Delivery ~ Continuous Labor and Delivery Support
Published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula. A Cochrane meta-analysis of 12 trials and more than 15,000 women demonstrated that the presence of continuous one-on-one support during labor and delivery was associated with improved patient satisfaction and a statistically significant reduction in the rate of cesarean delivery (111). Given that there are no associated measurable harms, this resource is probably underutilized.
I'll quote the American Congress of Obstetrics and Gynecologists in a March 2014 study, Safe Prevention of the Primary Cesarean Delivery ~ Continuous Labor and Delivery Support
Published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula. A Cochrane meta-analysis of 12 trials and more than 15,000 women demonstrated that the presence of continuous one-on-one support during labor and delivery was associated with improved patient satisfaction and a statistically significant reduction in the rate of cesarean delivery (111). Given that there are no associated measurable harms, this resource is probably underutilized.
6
Not sure what world you're living in, but nurses do not coach laboring parturients. They try to push medication on your constantly and basically come to check vitals then leave.
3
What an inappropriate word for these women. It's not antiquated at all. It means "female slave" in Modern Greek.
7
I agree. I'm a volunteer doula at a local hospital. When people ask, I prefer to say I'm a birthing assistant, or labor assistant. We really don't need one more word devaluing important things that women do.
If hospital policy included respect for women and were less focussed on profit and paranoia about litigation, we could do more to help laboring women have a good experience. But dream on. Almost every client I've worked with through labor has been subjected to the same cascade of interventions, and every single nurse and doctor is convinced of their necessity. The most pernicious is not allowing women in labor to have anything to eat. It's hard to feel positive and strong if you haven't eaten anything at all for 24 hours. We make suggestions but never contradict the medical staff.
In only one case, working with a client and her midwife in a different hospital, the laboring woman was able to be free to move around, unmedicated, no IV, no panic.
If hospital policy included respect for women and were less focussed on profit and paranoia about litigation, we could do more to help laboring women have a good experience. But dream on. Almost every client I've worked with through labor has been subjected to the same cascade of interventions, and every single nurse and doctor is convinced of their necessity. The most pernicious is not allowing women in labor to have anything to eat. It's hard to feel positive and strong if you haven't eaten anything at all for 24 hours. We make suggestions but never contradict the medical staff.
In only one case, working with a client and her midwife in a different hospital, the laboring woman was able to be free to move around, unmedicated, no IV, no panic.
5
Elizabeth, obgyns are sued more than any other physicians are. The malpractice premiums in New York are, as I understand it, as high as $150K or more a year. There are bad doctors out there. But most physicians are good to excellent, and the tort system treats them shamefully. So do families who, when a birth goes awry, believe that the physician controls absolutely everything and must somehow be responsible for making the wrong decision, even if that decision was the best one at that particular moment. The birthing experience is made litigation-proof. The doula is not responsible for medical outcomes. There you have it.
5
I am a Physician and my wife is a Nurse and we used a Doula after our children were born. I can emphatically state that for post partum care nothing beats it. A baby nurse will care for your baby but the Doula does it all from cooking, to errands to care of older kids leaving the new parents free to concentrate on the new baby. It's also an in house expert on new baby care as well as mom care. The cost is a lot less than an extra hospital day or the baby nurse and you get so much more.
As far as pre birth care, I am not convinced we need another opinion in the birthing room, there are already at least 2 doctors and 2 nurses in the room with the 2 parents. A 7 th opinion is needed, probably not.
As far as pre birth care, I am not convinced we need another opinion in the birthing room, there are already at least 2 doctors and 2 nurses in the room with the 2 parents. A 7 th opinion is needed, probably not.
11
An informed opinion to counter the whims of the hospital (whose policies the nurses must carry out) and doctors is always needed. People compare doulas disparagingly to "personal trainers" - which they indeed are in one respect, but they play twin roles of experienced coach and advocate during delivery. If you live in an area where midwives are common, great, but having a doula on your side along with the medical staff is a godsend.
The mentality of most medical professionals at hospitals is that you wouldn't be there if you didn't want them to do what they always do. Why, if you had wanted a specific birth experience, surely you would have shopped around and found a hospital that offered it, they must feel.
While that is good advice, it still turns out that most doctors and nurses will NOT volunteer willingly anything about your rights as a patient to deviate from their standard practices - standard because they hospital considers them so, because that's the way they "always do it," and so forth. You have to know what to ask for, you have to ask for it, and then nearly always you then must sign a waiver acknowledging the potentially grave consequences of your course of action.
I readily acknowledge that if doctors, nurses, and hospitals focused on evidence-based medicine more than fee generation and their personal convenience (because that's about the only thing that can explain the absurd rise in interventions), then doulas would be far less necessary.
The mentality of most medical professionals at hospitals is that you wouldn't be there if you didn't want them to do what they always do. Why, if you had wanted a specific birth experience, surely you would have shopped around and found a hospital that offered it, they must feel.
While that is good advice, it still turns out that most doctors and nurses will NOT volunteer willingly anything about your rights as a patient to deviate from their standard practices - standard because they hospital considers them so, because that's the way they "always do it," and so forth. You have to know what to ask for, you have to ask for it, and then nearly always you then must sign a waiver acknowledging the potentially grave consequences of your course of action.
I readily acknowledge that if doctors, nurses, and hospitals focused on evidence-based medicine more than fee generation and their personal convenience (because that's about the only thing that can explain the absurd rise in interventions), then doulas would be far less necessary.
15
Doulas don't come in to give their opinions. That's pretty contrary to the very nature of doula work, actually. One can be a terrific doula and never say a word, unlike being a doctor or nurse. I was trained to ask questions of my client instead of telling her what I thought, because it's not about me and what I think. Instead of saying, "I'd tell that doctor to stuff his early C-section up his tailpipe," I'd say, "What do you think about having an early C-section? Do you feel like that's right for you?" Or I could just not say anything at all, especially if she didn't seem distressed!
4
Ok, so when in Rome? What you're describing is not what happens in New York City. Here, and this is specific to New York City, not the U.S. in general, getting medical insurance is easy. You are given tours of the hospital, birthing classes are offered in conjunction with the medical group or hospital, and your plans are known in advance. Are there nurses who push the bottle? Of course! Do you have to speak up for yourself? I found that they read the plans from the clipboard, which had been ok'd by the doctor (no sepsis, no water breakage approaching 24 limit) and there you go. This is not to say that birth plan wouldn't be scrapped if there was danger. With both of my boys, the oxygen levels were dropping and if they hadn't popped, I would have needed a Cesarean Section. They did. Even through the fog of labor, the medical team made sure I understood why they were considering major surgery. I don't know about you, but I can't really underrate breathing, as it were. Luckily, the births proceeded apace.
One of my kids was almost 9 lbs, and he was four weeks early, another smaller baby was also quite early, and one was late and losing weight in utero.
I know two healthy children whose hears were operated on while they were fetuses. I find this bashing of the medical profession one step above not vaccinating one's children.
One of my kids was almost 9 lbs, and he was four weeks early, another smaller baby was also quite early, and one was late and losing weight in utero.
I know two healthy children whose hears were operated on while they were fetuses. I find this bashing of the medical profession one step above not vaccinating one's children.
1
It's pretty simple. Doulas meet to be responsible for a body of knowledge, have exams and certification, to get reimbursed. You can't have it both ways.
6
With the assistance of a "doula", is the father loosing his place in the birth experience? I am from what they term " the Lamaze" generation. My husband was an integral part of the drug-free birth experience for us. We both went through the training and he was an important coach. It was extremely intimate and personal. Lamaze breathing works, I found myself using the technique for years afterwards when experiencing pain.
7
The father is NOT losing his place, except for those women who were too shy to say, "Honey, you're no good around me when I'm giving birth. Get out and don't come back until the kid's crowning."
Of course the partner can't be replaced. That's just nuts. But as a doula, I find partners can relax into their role more fully when I'm there to take care of less emotional birth work, such as pressure on the lower back, constant rewetting of washcloths with cold water, getting the shower to the right temperature, getting snacks, rubbing her feet, whatever doesn't involve being there with her in a closer, more meaningful sense. Sometimes, I just quietly provide suggestions for when they run out of ideas. Sometimes I'm the bad cop and they're the good cop. "Yes, sweetie, I know, she is the worst person ever. But you have to walk." But when I was getting evaluations for my certifications, partners were explicitly excluded, because no matter how bad a doula you were, they were so relieved to have you there.
Of course the partner can't be replaced. That's just nuts. But as a doula, I find partners can relax into their role more fully when I'm there to take care of less emotional birth work, such as pressure on the lower back, constant rewetting of washcloths with cold water, getting the shower to the right temperature, getting snacks, rubbing her feet, whatever doesn't involve being there with her in a closer, more meaningful sense. Sometimes, I just quietly provide suggestions for when they run out of ideas. Sometimes I'm the bad cop and they're the good cop. "Yes, sweetie, I know, she is the worst person ever. But you have to walk." But when I was getting evaluations for my certifications, partners were explicitly excluded, because no matter how bad a doula you were, they were so relieved to have you there.
5
I'm a dad who has experienced both the role as primary coach and a secondary coach alongside a doula. Both were great experiences, but having the doula was a better experience for both my and my partner. The doula is a much better coach than I ever could have been and I never felt left out at any point. My partner completely trusted the doula and I was able to focus on supporting and appreciating this wonderful process in a way that I couldn't have had my role been more central.
6
My husband ran to the bathroom for a "sympathy hurl" at a crucial moment. Bet you never do that!
3
I am really disappointed in the negative comments regarding the use of a doula. It seems that this article has been misinterpreted as an upper class privilege rather than how doulas in the city are becoming more common and what they can provide. There seems to be a misunderstanding that doulas are only for upper class and that they seem to deliver babies but neither are true. A doula is there to help provide support to the expectant mother and father during the labor process and is also there for post-parturn aide regardless if they have a "natural" birth or c-section. Support has many meanings and generally is agreed upon by the parents and doula before hand. What a doula generally does not do is give medical advice and deliver a baby. It is up to the parents to work with their OB or mid-wife and also educate themselves on what the risks or advantages with whatever birth method they chose. Selecting a doula should also be treated the same as selecting a doctor, parents should ask for referrals and interview potential candidates to make sure that their doula understands their birth plan and also knows what to do in the case that labor turns out to be difficult.
As someone who is not a part of the upper class and not in NYC and who never gave birth before, I am glad to have had a caring and well researched doula that contributed to a great birthing experience for myself and my husband while respecting my doctor's/ hospital wishes as well.
As someone who is not a part of the upper class and not in NYC and who never gave birth before, I am glad to have had a caring and well researched doula that contributed to a great birthing experience for myself and my husband while respecting my doctor's/ hospital wishes as well.
22
"It seems that this article has been misinterpreted as an upper class privilege ..."
That is the way it is presented. Read the examples. It is the buzz of the moment, little more.
That is the way it is presented. Read the examples. It is the buzz of the moment, little more.
1
The comments here are shocking, and saddening. I would guess a lot of the people commenting have not ever been pregnant, given birth, or had any contact with a doula. My doula was not someone I hired to be self-indulging. She was an extremely well-trained assistant in birthing - the doctors and nurses asked me if she was a trained midwife because of how much she knew. They all worked together as a team. She helped incredibly during the long pushing phase, with different positions to get into and could tell just from the noises I was making how far the baby was from crowning - right when I felt like giving up. She made the experience incredibly empowering and amazing for me, and my husband. My husband loved her, and she supported us so much post-partum too with breastfeeding and other issues. Doulas aren't only for the wealthy - I am a social worker and most definitely middle class. She charged less than 15% of the cost cited in this article. It's amazing to me that people here are making such insulting comments toward people who do a job because they love supporting women, and new moms, and honor and cherish the incredible experience of childbirth. As a social worker, I frequently listen to female clients who have been deeply, negatively impacted by birth experiences during which they felt unsupported, helpless and unable to make choices. I wish more people could respect women's choices. I wanted to share the incredibly positive experience I had with a doula.
74
Great summation of your experience with doula! I totally agree they support the process in a way Western Med can't and never will.
5
Research supports doulas as solid care. We reduce the need for pain medications, shorten labor and reduce complications. We are not rent a friends.
7
Sure sounds like rich-girl rent-a-friend from the story. Maybe if the focus had been a working class person instead if J Wow Diddy's wife...
But wealth and inequality in our supposedly egalitarian culture is clearly part of this story, as it is an inexorable part of every story in America. Imagine how much more J Grand is paid than the nurses and then compare the contribution to society. Just silly.
But wealth and inequality in our supposedly egalitarian culture is clearly part of this story, as it is an inexorable part of every story in America. Imagine how much more J Grand is paid than the nurses and then compare the contribution to society. Just silly.
4
I do not care whether a Doula is a friend or fad for the rich or the poor. The fact is they have virtually no training and are not prepared to handle complications should they arise. That said, we should not squander our insurance dollars on Doulas.
9
Most doulas ARE trained and they are also trained to handle complications if need be. If a mother were to give birth before they make it to the hospital, we are trained to handle that. Many are trained in infant resuscitation as well. I had 4 years worth of training and I know I'm not alone. You can become an RN in 2 years. So please don't speak of what you don't understand. I won't insult your career and you don't insult mine.
13
"Most doulas ARE trained and they are also trained to handle complications if need be. If a mother were to give birth before they make it to the hospital, we are trained to handle that. Many are trained in infant resuscitation as well."
As a 12 plus year doula with close to 450 births attended and a doula trainer for 9 years, I can assure you that doulas are not trained to handle complications. Doulas provide emotional, physical, and informational support. In our role as doulas we do NOT provide medical support. I call 911 if at home and I call the hospital staff back into the room in the hospital. I am not trained to catch a baby and it is not my responsibility. Please do not misrepresent the role of the doula. While research supports improved outcomes with a doula, it is NOT because we provide medical training. Rather, it is because we have a different role and leave the medical evaluation and actions to the health care providers. If a doula is trained as a midwife, L&D nurse or other health care professional, then when she uses those skills, she is no longer working in the capacity of a doula and should not call him/herself one.
As a 12 plus year doula with close to 450 births attended and a doula trainer for 9 years, I can assure you that doulas are not trained to handle complications. Doulas provide emotional, physical, and informational support. In our role as doulas we do NOT provide medical support. I call 911 if at home and I call the hospital staff back into the room in the hospital. I am not trained to catch a baby and it is not my responsibility. Please do not misrepresent the role of the doula. While research supports improved outcomes with a doula, it is NOT because we provide medical training. Rather, it is because we have a different role and leave the medical evaluation and actions to the health care providers. If a doula is trained as a midwife, L&D nurse or other health care professional, then when she uses those skills, she is no longer working in the capacity of a doula and should not call him/herself one.
35
That's true. We're not medical professionals for babycatching or management of the course of labor.
However, most doulas certainly ARE trained, and our training is NOT meaningless. I think all reasonable people would support requiring certification before being eligible for insurance reimbursement.
The OP betrays a complete failure to understand what it is that doulas really do, which is understandable, given this article. It's not our job to handle medical complications. Confusion, frustration and hopelessness are fully in our court, however, as are natural, reasonable comfort measures and education on what to expect in birth- which is huge when you're rafting the rapids!
However, most doulas certainly ARE trained, and our training is NOT meaningless. I think all reasonable people would support requiring certification before being eligible for insurance reimbursement.
The OP betrays a complete failure to understand what it is that doulas really do, which is understandable, given this article. It's not our job to handle medical complications. Confusion, frustration and hopelessness are fully in our court, however, as are natural, reasonable comfort measures and education on what to expect in birth- which is huge when you're rafting the rapids!
6
Let's put the whole insurance issue in perspective. Most insurances cover multiple sonograms at a total cost of multiple thousands of dollars. There's a huge range of what different providers recommend in terms of how many a pregnant woman should get, from just a few to more than 10. And there's no evidence that more ultrasounds lead to better outcomes, or that they're not harmful to the fetus, for that matter. It is not difficult to schedule an additional ultrasound just because you want a better picture of the baby's face, with the insurance picking up the tab.
Doulas cost between $200 and a couple thousand dollars and are trained to deal with the emotional and mental component of birth, which is considerable. Think of them as a non-chemical anti-anxiety drug for women going through a process fraught with emotion and worry. There's plenty of waste in the medical system, but recognizing the nature of birth as fundamentally different than treating an illness and providing appropriate emotional and pain management support to that end? Not a waste.
Doulas cost between $200 and a couple thousand dollars and are trained to deal with the emotional and mental component of birth, which is considerable. Think of them as a non-chemical anti-anxiety drug for women going through a process fraught with emotion and worry. There's plenty of waste in the medical system, but recognizing the nature of birth as fundamentally different than treating an illness and providing appropriate emotional and pain management support to that end? Not a waste.
28
But using a doula won't help pay for the ultrasound equipment...
1
Reminds me of a tribe. In a good tribe a woman had some help. I've always thought the way new mothers are often by themselves in their home is cruel. And its not the man's fault since generally the man has little choice but to get the money in to pay the mortgage and the bills. Not much help for him either.
And to those commenters who tell the stories of listening too closely to a doula, well, listening to much to someone else is what is happening. As a parent, no one except you (and maybe your parents) are going to have the same kind of unrelenting responsibility to do the exact right thing by your child.
And to those commenters who tell the stories of listening too closely to a doula, well, listening to much to someone else is what is happening. As a parent, no one except you (and maybe your parents) are going to have the same kind of unrelenting responsibility to do the exact right thing by your child.
6
And now a new birthing fad for the busy but au courant upper class makes the front page!
"Her husband, a music producer known as J Grand, in shower sandals and gym shorts, was busy tending to their toddler daughter, the financial news on TV and his iPad, where he was still rearranging tracks on a forthcoming release."
"Her husband, a music producer known as J Grand, in shower sandals and gym shorts, was busy tending to their toddler daughter, the financial news on TV and his iPad, where he was still rearranging tracks on a forthcoming release."
13
As a doula who offers services to low-income families, I see where you're coming from, but its not limited to upper class and definitely is creating change for the better.
15
In today's society, anything and everything can be turned into a fad. That should not discredit the importance of doulas, nor overlook the fact that they've existed throughout humanity in all cultures - just under different names.
20
As a doula who focused on working with women who were sexually abused and teenage mothers, I would like to kindly invite you to shut the mouth part of your face. Every woman deserves a doula- especially the ones who aren't so lucky. We're not a fad to the women we help.
13
I want someone to hold my hand and be supportive in all of my life's crises and difficult events. This is called a friend. If you want to pay somebody to be your friend that is your business, but to spread the cost via insuance to all the rest of society is really asking too much.
15
Doulas are professionally trained to support women prentally, in birth, and the postpartum period. I dont know about you but non of my close friends are trained to do that. I do MUCH more than hold someones hand and support them. You can read any of my testimonials to see how much a doula offers someone or talk to any of my clients who are incredibly grateful for the physical, emotional, and informational support I offered them. They will tell you they couldn't have the birth they did without me. Sorry for your misconception.
15
That would be exactly what we're working towards, do try to keep up, you catty thing.
I'm certified by DONA as a birth doula and Childbirth International as a childbirth educator. I have a bachelor's in biology, as well. I have also taken special courses in working with women who have been sexually abused as well as living with domestic violence.
I have skills. I'm proud of them. I'm a great friend, too, but I'm a better professional when it comes to the women I serve.
I'm certified by DONA as a birth doula and Childbirth International as a childbirth educator. I have a bachelor's in biology, as well. I have also taken special courses in working with women who have been sexually abused as well as living with domestic violence.
I have skills. I'm proud of them. I'm a great friend, too, but I'm a better professional when it comes to the women I serve.
15
I unfortunately had a doula who almost cost me my child's health/life. Beware. When things started to turn south during labor she became judgmental, strident and down right rude to the nurses who were trying to assess. She created a hostile atmosphere that made decision making difficult and treated me with contempt and 'pity' when I didnt agree with her opnions about options. Luckily, i didn't listen to her because she was wrong. I'll add that she then talked badly about me after the fact and told lies to protect her reputation!
15
There are also awful doctors, nurses and midwives. Always choose your birth team carefully and talk with referrals first. I'm sorry for your experience.
15
Precisely why doulas should be certified and included as official members of the healthcare team.
4
That's a ridiculous response to the op's experience. I'm sure the op thought they were hiring the right person for them. You basically wrote that they should have chosen better, and the unfortunate experience was their fault. In fact, it was no one's fault. It just was what it was. You unwittingly make their case that the doula they hired, cared more about being 'right' than caring for the birthing mother.
2
I think the comparison to a personal trainer is spot-on. A good doula is one who supports you through the normal, healthy process of laboring.
Just like a personal trainer wouldn't attempt to set a broken leg if you fell during a workout, neither would a doula attempt to intervene if a labor went from normal/healthy to medical-intervention-needed.
A doula is a great resource as part of a team of people there for a laboring woman. In my experience (in Eastern Tennessee - not as a Manhattan socialite, thank you very much) the people who might have traditionally done that - nurses - we're far too overworked to help me with different positioning, massages, breathing coaching, and all those little things that get you through labor. My husband was great to have but what the hell does he know about laboring positions?
I totally support doulas and think that accreditation and insurance reimbursement is an excellent idea.
Just like a personal trainer wouldn't attempt to set a broken leg if you fell during a workout, neither would a doula attempt to intervene if a labor went from normal/healthy to medical-intervention-needed.
A doula is a great resource as part of a team of people there for a laboring woman. In my experience (in Eastern Tennessee - not as a Manhattan socialite, thank you very much) the people who might have traditionally done that - nurses - we're far too overworked to help me with different positioning, massages, breathing coaching, and all those little things that get you through labor. My husband was great to have but what the hell does he know about laboring positions?
I totally support doulas and think that accreditation and insurance reimbursement is an excellent idea.
29
Also, doulas wouldn't fall into the category of "uneducated", "unlicensed" paid help---compared derisively to nannies and personal assistants (usually also women)---if we respected women's wishes for doulas and honored the roles they play by creating structured training and certification courses for doulas. This might be the equivalent of an associates degree to a midwife's bachelors- or masters-level education the way we have medical assistants who work with RNs and MDs. It bothers me that people are so quick to reduce valuable experience in traditionally female domains to soft skills or mumbo-jumbo not worthy of pay or professional recognition.
32
Very well "said," and I could not agree more!
7
I offer up my own doula story as none of the other comments have touched on the "blind spot" involved with the concept of staying at home with a doula until fairly late in the labor game. We hired a lovely doula who provided many of the positives people have already mentioned--advice, information, warmth over the course of several months leading up to our first son's birth. Our blind spot as soon-to-be parents, however, was not to recognize the danger in staying home through hours of labor with a doula only (as opposed to a midwife, who is licensed to measure the cervix and perform other crucial tests to track progress). Despite our doula's assurance that things were progressing wonderfully and that there was no rush yet to head to the hospital, I trusted my motherly/animal instincts that it was time to go. When we arrived at the hospital shortly thereafter, all hell broke out. The baby's heart rate was dangerously low, an (ultra) emergency c-section was announced, I was given full narcotics (i.e, was unconscious for the birth)--essentially the opposite of my imagined natural, no-intervention scenario. Thankfully, our son was fine. (He would've likely died without the emergency-C we were told by both doctors and our doula afterward.) Every case is obviously different, but in ours, "Western medicine" saved our baby's life and a misinformed decision almost ended in disaster. Doulas are not substitutes for midwives or doctors--their role is different, people!
28
I too know of some people whose baby nearly died in an at-home birth. Why would one risk that?
I have a hard time relating to people who refuse drugs and insist on home births. My father is a neurologist, and I believe in doctors and in the medical profession.
I believe in science, and I love my gynecologist here in Paris, and I love the French system (where everyone is covered, no one even wants to do home births and I have never heard of a doula).
French hospitals and French medical care is the best in the world.
A friend of mine gave birth in a public hospital in Paris (not in a chic neighborhood either) and she had a choice of birthing procedures (water etc) and received great postnatal care including help with breastfeeding, bathing and dressing the baby.
My nanny was in the hospital after a Cesarian for a week.
Perhaps the key is improving care in hospitals rather than messing around with risky "alternative" methods.
I have a hard time relating to people who refuse drugs and insist on home births. My father is a neurologist, and I believe in doctors and in the medical profession.
I believe in science, and I love my gynecologist here in Paris, and I love the French system (where everyone is covered, no one even wants to do home births and I have never heard of a doula).
French hospitals and French medical care is the best in the world.
A friend of mine gave birth in a public hospital in Paris (not in a chic neighborhood either) and she had a choice of birthing procedures (water etc) and received great postnatal care including help with breastfeeding, bathing and dressing the baby.
My nanny was in the hospital after a Cesarian for a week.
Perhaps the key is improving care in hospitals rather than messing around with risky "alternative" methods.
1
I'm so sorry you went through that, and SO GLAD your baby was okay!!! What a terrifying experience!
Staying at home with a midwife is not an antidote to what you went through, though... unless you have a CNM (Certified Nurse Midwife), you may end up in the same boat you did with your doula. Unfortunately a lot of the CPM's and other "lay midwives" who attend home births have little or no medical training (NONE WHATSOEVER is required to get the CPM certificate), and on top of that a fair amount of them are hostile to western medicine and resistant to transferring patients unless it's an obvious emergency.
Staying at home with a midwife is not an antidote to what you went through, though... unless you have a CNM (Certified Nurse Midwife), you may end up in the same boat you did with your doula. Unfortunately a lot of the CPM's and other "lay midwives" who attend home births have little or no medical training (NONE WHATSOEVER is required to get the CPM certificate), and on top of that a fair amount of them are hostile to western medicine and resistant to transferring patients unless it's an obvious emergency.
hmmm i wonder if it's a coincidence that this particular doula is related to that girl from "Girls" and who was born with a silver spoon in her mouth? must be hard not to get recognition as a doula when you're already rich
1
How about getting a male doula?
2
That's called a 'husband' and they're often useless and annoying during labor, because they will never be in the position of enduring labor. But whatever floats your boat.
4
The fight between high-intervention advocates and natural childbirth advocates is getting ridiculous. It's not an either/or question. The two sides need to work together to provide the best birth outcome. Hospitals don't help women with labor, resulting in overly high pain medication and intervention rates. Doulas and midwives cannot perform surgeries and other medical interventions. You need the entire team, working together, in a non-adversarial manner, to be successful.
18
Not sure where you get the impression that hospitals don't help women with labor. I had a nurse spontaneously start talking me through preterm contractions I was having during an NST (fetal stress test), telling me what to do to reduce the pain ("breathe, and keep your eyes open--don't close them because then you're just aware of the pain, and you feel all alone. Open them and see we're here with you, you're not alone, and there's more going on in this room than just your pain. Look at your husband, look at me, and breathe..."). She was wonderful, and I wasn't even in labor, so I can only imagine what a help she would be to someone who was.
2
I work in a busy NYC labor and delivery suite and have mixed feelings on Doulas. I see some women benefiting from their experience and support (something that it is difficult for physicians or nurses to provide for the extended lengths of time of normal labor).
Some doulas, however, aside from supporting the woman, also try to force their beliefs on the client/patient. It's sad to see a woman denying herself modern labor analgesia, or putting her fetus at risk because of due to the advice of the medical opinions of a person who is not a medical professional
Some doulas, however, aside from supporting the woman, also try to force their beliefs on the client/patient. It's sad to see a woman denying herself modern labor analgesia, or putting her fetus at risk because of due to the advice of the medical opinions of a person who is not a medical professional
16
This correlates with my experience. The only doulas I know (two) are very anti-Western medicine (coincidentally, they're very anti-pain medication; neither has given birth). I watched one go through her training and it sounds like her particular community attracted a very anti-science crowd. I would worry about having them in my delivery room.
6
while I understand your point of view, I have to mention that there are also nurses, obs and Midwives who push their agenda on women causing harm and sometimes trauma. This is even more reasons for hospitals to meet with doulas personally to establish trust and a connection so they can connect their patients with professional doulas who do not push Anything on women. I personally have great relationships with local obs and Midwibes who enjoy working with me.
6
It's interesting, when I started as a doula, I was slightly pro-natural birth; however, I did my research, and more importantly, I paid attention at my births and focused on supporting my clients in what they needed, and now I'm completely pro-whatever a woman chooses in terms of pain medication. I think it's just as wrong to force an epidural as it is to deny one, because it's about consent. Yeah, whatever, not having pain medications theoretically is slightly better- but not if the mom is miserable, in pain and terrified to push. And sure, epidurals can be a godsend- but I've seen women deliver no problem with no pain medication at all. It's about what the mom is most comfortable with!
And risking lives? Let me tell you, I would not look kindly on someone who risked a nine-month fetus on some kookamamie nonsense. Use your head, God put it there for a reason. Jesus!
And risking lives? Let me tell you, I would not look kindly on someone who risked a nine-month fetus on some kookamamie nonsense. Use your head, God put it there for a reason. Jesus!
5
Where I'm from, we say
"Whatever floats your boat"
and
"There is more than one way to skin a cat"
If an expectant mother wants a Doula, I think that's great. I've worked with many Doulas in my career and for the most part have found them to be a valuable resource for the mothers. What Doulas lack in training, they more than make up for with time and a personal connection with mom.
The thing I like most is that a Doula can get women who would otherwise consider home births into the hospital for the delivery.
The insurance reimbursement issue is a tricky one, and not easily solved.
One workaround could be to take the savings not spent on epidurals and other anesthesia, and apply them to the Doula's bill. In other words, the Doula would be technically paid as a pain control modality.
The only concern I have with this is that it would encourage a Doula to force a woman to avoid pain control medications if/when a mother chose to go that route.
But if we could find systemic medical savings by using a Doula I'd be happy to share the (found) wealth.
Lastly
one must be careful looking at research regarding Doula vs Non-Doula births, because of major selection bias. In general, people using Doulas have a far higher educational and income level compared to those without a Doula. Also, there are far fewer high risk pregnancies that use a Doula. There are not many good studies looking at this issue. I'm still for them, but we need to understand that research is weak
"Whatever floats your boat"
and
"There is more than one way to skin a cat"
If an expectant mother wants a Doula, I think that's great. I've worked with many Doulas in my career and for the most part have found them to be a valuable resource for the mothers. What Doulas lack in training, they more than make up for with time and a personal connection with mom.
The thing I like most is that a Doula can get women who would otherwise consider home births into the hospital for the delivery.
The insurance reimbursement issue is a tricky one, and not easily solved.
One workaround could be to take the savings not spent on epidurals and other anesthesia, and apply them to the Doula's bill. In other words, the Doula would be technically paid as a pain control modality.
The only concern I have with this is that it would encourage a Doula to force a woman to avoid pain control medications if/when a mother chose to go that route.
But if we could find systemic medical savings by using a Doula I'd be happy to share the (found) wealth.
Lastly
one must be careful looking at research regarding Doula vs Non-Doula births, because of major selection bias. In general, people using Doulas have a far higher educational and income level compared to those without a Doula. Also, there are far fewer high risk pregnancies that use a Doula. There are not many good studies looking at this issue. I'm still for them, but we need to understand that research is weak
6
Dream on: any 'savings' would go straight into the pockets of for-profit corporations, not to the doula. And don't forget how much money those hospitals and insurance companies make on medical interventions and equipment that may not be neccessary.
1
Add "doula" to the list of feel-good jobs attempting to morph to professional status through the adoption of a name. Recent additions to the list include: "barista".
12
have you ever been to a birth? It is NOT all feel good. It's intense, challenging, dramatic, most of the time it ends on a happy note but it can also be traumatic. It is the hardest work I have ever done and I have pursued many professional trainings and certifications. My work is very different from what a barista does including 40 hour births, with no sleep and highly emotional experiences.
12
It comment shows how incredibly ignorant you are to this. Being a doula is not a "feel good" job. Being up for 48 hours or more with a laboring mother while doing a lot of physical labor to help support her, takes a lot of dedication and hard work. Plus, most doulas have gone through a lot of training. Almost 4 years worth for me. Yet, you can become an RN after only 2 years and they are still looked at as professional.
10
RNs are recognized as professionals because they are trained and certified in a medical discipline with a strong foundation in medical science and evidence-based outcomes. Doulas are not. You can have a sports coach, a life coach or a birth coach, but that does not make them medical professionals and they should not be treated as such.
1
It's unbelievable that sometimes people in the rest of the country see New Yorkers as out of touch coastal elites. It simply boggles the mind.
9
AS WE FOLLOW THE MONEY OF . . .
...Big Pharma, we must do the same with the medical establishment. Many hospitals claim to be non-profits -- but behave as for-profit corporations. Just take a look at the compensation of the CEO's.
...Big Pharma, we must do the same with the medical establishment. Many hospitals claim to be non-profits -- but behave as for-profit corporations. Just take a look at the compensation of the CEO's.
2
Doulas may not be licensed or trained, but TFA teachers only have 5 weeks of "training" before they are unloaded onto low-income kids. Districts pay a fee to TFA for providing these quality teachers.
If it's okay for TFA, why not for doulas? Tax dollars pay TFA; why shouldn't insurance dollars pay for doulas?
If it's okay for TFA, why not for doulas? Tax dollars pay TFA; why shouldn't insurance dollars pay for doulas?
3
Because a poor teacher is not life threatening? ummmm.
1
"There’s warmth there, but they [midwives] are really for the waist down, and doulas are for the waist up."
Boy, do I take umbrage at this comment. My wife started going to a mid-wife in mid-pregnancy. We heard from a nurse at the hospital that our OBGYN like to induce on Fridays so he could go to his weekend house with his family. We wanted a birth that was more on the timetable of our child, not the doctor. So we went to a woman named Maureen, a midwife. It was a difficult labor and birth, and now 20 years later, my wife and she are still in contact.
Boy, do I take umbrage at this comment. My wife started going to a mid-wife in mid-pregnancy. We heard from a nurse at the hospital that our OBGYN like to induce on Fridays so he could go to his weekend house with his family. We wanted a birth that was more on the timetable of our child, not the doctor. So we went to a woman named Maureen, a midwife. It was a difficult labor and birth, and now 20 years later, my wife and she are still in contact.
22
Yeah, that was crazy. There are lots of great midwives. But some are a lot like doctors- show up for the good part.
2
So doulas are the big problem?
Hardly a word about C-section rates - which in some NYC hospitals are four times the WHO recommended level.
Hardly a word about midwifes - who are increasingly banned from the delivery room.
The US is light years behind European childbirth practices, generating unnecessary trauma, expense, and risk for mother and baby.
The statistics prove it.
Hardly a word about C-section rates - which in some NYC hospitals are four times the WHO recommended level.
Hardly a word about midwifes - who are increasingly banned from the delivery room.
The US is light years behind European childbirth practices, generating unnecessary trauma, expense, and risk for mother and baby.
The statistics prove it.
25
Until we have real data, no way to know if doulas actually move the needle here.
What "WHO recommended" ideal c-section rate? That is a flat-out lie--not by you, since you didn't know it wasn't true, but by the WHO. In 2009, the World Health Organization admitted that the "ideal" 15% c-section rate it had been promoting since 1985 had no basis in reality. That is, there was never ANY evidence to support that rate and there is still no evidence to suggest what the optimum rate might be. Buried deep in the WHO's handbook Monitoring Emergency Obstetric Care, it says:
"Although the WHO has recommended since 1985 that the rate not exceed 10-15 per cent, there is no empirical evidence for an optimum percentage … the optimum rate is unknown …"
Here's a link where you can read about that. This article also includes a direct link to the 2009 WHO publication where they admitted that the supposedly optimum 15% rate was made up out of thin air.
http://www.skepticalob.com/2014/06/the-childbirth-lie-that-will-not-die....
"Although the WHO has recommended since 1985 that the rate not exceed 10-15 per cent, there is no empirical evidence for an optimum percentage … the optimum rate is unknown …"
Here's a link where you can read about that. This article also includes a direct link to the 2009 WHO publication where they admitted that the supposedly optimum 15% rate was made up out of thin air.
http://www.skepticalob.com/2014/06/the-childbirth-lie-that-will-not-die....
1
This child bearing generation of women have been taught since the first day of school to become team players, just as all students of this generation and onwards have been. When a human is taught to seek a company of like minded players for every single aspect of their lives then it is unreasonable for anyone to expect that a woman moving through pain and discomfort to suddenly become a loner and grit her teeth. She is not her mother, who used the breathing techniques. Nor is she her grandmother who, when realizing that she was in labor hurried into the kitchen to prepare enough meals so that she wouldn't have to prepare them after coming home from the hospital 12 hours after the birth.
However should it be covered by insurance. My opinion is no but then again, I am the woman who was in the kitchen preparing meals for the family while in labor and washing the dinner dishes the next day while my 12 hour old newborn slept strapped to my chest.
If the woman want insurance to pay for a doulas then the doulas need to collect the proof that pregnancy outcomes are improved by their involvement while at the same time demanding to be licenced and certified.
However should it be covered by insurance. My opinion is no but then again, I am the woman who was in the kitchen preparing meals for the family while in labor and washing the dinner dishes the next day while my 12 hour old newborn slept strapped to my chest.
If the woman want insurance to pay for a doulas then the doulas need to collect the proof that pregnancy outcomes are improved by their involvement while at the same time demanding to be licenced and certified.
6
The most important point here is that we lack an 'integrated' birth system: women choosing where and with whom to give birth, and the health care structure supporting that. We had that here in VT before the Guys Of OBGYN eroded the connected home-birth system, with skilled home-birth midwives who worked in teams, with apprentices, to make sure that every client had full-on support from the first sign of labor - NOT the 'waist-down' hospital approach that many CNMs are forced to practice in 'shift' work covering multiple patients. The midwife teams recommended terrific MD backups for whenever hospital admission was necessary. By the late 1990s the OBGYN surgeon manarchy, the VT Medical Association (more men) and Blue Cross Blue Shield (ditto) had eroded all of that. So if a woman in a hospital wants actual full-on, one-to-one full person care, yes, she has to hire a doula. This is nothing more than another example of the top-down OBGYN surgeons pushing all the stuff they can't & won't do (CARE FOR PATIENTS) onto people - women - who are not allowed into their domain ('actively managed' birth, 30% cesarean rate, etc). The people who know what will work best at any birth are the women themselves. When the Health Care Industry starts listening to the consumer, we might have a workable, affordable system with much better outcomes.
27
Katherine
I had a homebirth in Vermont in 1976. My homebirth doctor, a GP, was sitting in my rocking chair in my bedroom when I was in early labor and stayed with me in the room until after my son was born. He trained midwives too, and provided an amazing service. Those days are sadly long gone, from what you say. I'm a midwife in London, UK now.
I had a homebirth in Vermont in 1976. My homebirth doctor, a GP, was sitting in my rocking chair in my bedroom when I was in early labor and stayed with me in the room until after my son was born. He trained midwives too, and provided an amazing service. Those days are sadly long gone, from what you say. I'm a midwife in London, UK now.
7
Last April we had Clyde at home with a midwife and doula present. Sarah was risk free very healthy Mom. Our Doula was very helpful and worked often with our midwife at other births. We interviewed and got what we paid for. The midwife cost $3000 and we saw her once or twice a month during pregnancy for 2 hours each time. The doula was $300.
I hope everyone remembers giving birth is not a medical emergency, and Dr's only relatively recently entered the delivering baby business. (1950's) Its true doulas are not medical doctors, they just seem to know more about helping Moms thorough the process than most doctors do.
I hope everyone remembers giving birth is not a medical emergency, and Dr's only relatively recently entered the delivering baby business. (1950's) Its true doulas are not medical doctors, they just seem to know more about helping Moms thorough the process than most doctors do.
19
"I hope everyone remembers giving birth is not a medical emergency, and Dr's only relatively recently entered the delivering baby business. (1950's)"
I suggest you read the following article from Slate (and check the first graph):
http://slate.me/16QS8sa
Short version: death of the mother during childbirth in the US dropped from around 600 per 100,000 births in the mid-late 1930s to less than 50 by the mid 1950s.
People tend to forget things like that when pining for "the good ol' days."
I suggest you read the following article from Slate (and check the first graph):
http://slate.me/16QS8sa
Short version: death of the mother during childbirth in the US dropped from around 600 per 100,000 births in the mid-late 1930s to less than 50 by the mid 1950s.
People tend to forget things like that when pining for "the good ol' days."
9
Try 1850s for when doctors started delivering babies. In the 20s they really started making a run for midwives and homebirths, publishing ads and pamphlets smearing them.
The more you know!
(Also, any birth without a doctor or certified nurse midwife(CNM) present is not a safe birth. Birth is like Aslan- it's not a TAME lion. It's natural, but there are plenty of natural things that will kill you- and more importantly, your baby.)
The more you know!
(Also, any birth without a doctor or certified nurse midwife(CNM) present is not a safe birth. Birth is like Aslan- it's not a TAME lion. It's natural, but there are plenty of natural things that will kill you- and more importantly, your baby.)
3
I so agree. It really bothers me that so many states issue licenses to lay midwives like CPM's, LDM's and others who have zero medical training (or "near-zero," if a CPR class at the YMCA and reading a booklet counts as medical training). Most people hear "licensed midwife" and assume that the person must have some medical knowledge. SO not the case.
LONG STORY SHORT: The only real midwives in the US are CNM's (Certified Nurse Midwives). CPM's (Certified Professional Midwives), Direct-Entry Midwives and other "lay midwives" would not be allowed to practice at all in any other developed country.
LONG STORY SHORT: The only real midwives in the US are CNM's (Certified Nurse Midwives). CPM's (Certified Professional Midwives), Direct-Entry Midwives and other "lay midwives" would not be allowed to practice at all in any other developed country.
1
Wow, regardless of how someone pays for a doula, many find the service invaluable. Especially given the state of medical care today - very impersonal, focused on making money, and with very little nursing support because quite frankly, hospitals overwork nurses. In any other comments forum, for other procedures, this would be acknowledged. But because this article involves women and reproduction the hateful comments flow, just like for the articles on IVF, surrogacy, and any other article on women having children. Childbirth is hard and painful and support is helpful, and many people don't live in the same neighborhood as family, or even the same state. I am just blown away by the disrespect to women and process of childbirth in these comments. Really disturbing.
34
I couldn't agree with you more. I am so shocked at the comments here and so saddened. I had to write about my own positive experience because I think the article and comments are extremely unrepresentative of the doula experience and the women who have doulas at their births.
5
Another new age cockamamie idea-- not unlike the anti-vax movement.
5
Not really, the concept of midwives and other non-medical birthing help has been around for a very long time.
1
So very much not new age. Women have been supporting women in childbirth for millenia. Having the training to offer techniques to bear pain and retain confidence on our own ability to give birth without intervention -- priceless. A doula also supports the non-birthing partner, who is free to witness in love without the perceived responsibility to take away the pain.
9
Nothing new-age about it -- doulas have been around since women have given birth.
10
It never ceases to amaze me how vitriolic people get when it comes to the matter of a woman's reproductive choices. Why is the concept of live and let live so hard to grasp for so many people?
23
Because they want insurance to pay for it and it does sound like something that should be elective, right? Live and let live is fine as long as I am not paying for it.
4
Doulas have also been shown to reduce unnecessary cesareans. 1 in 3 women in this country give birth by cesarean, number that the World Health Organization deems to be to high. Not even taking into account the emotional satisfaction factor. Here are the stats:
31% decrease in the use of Pitocin
28% decrease in the risk of C-section
12% increase in the likelihood of a spontaneous vaginal birth
9% decrease in the use of any medications for pain relief
14% decrease in the risk of newborns being admitted to a special care nursery
All of this will SAVE thousands of dollars in maternity costs. All of the people here who are commenting that they don't want insurance to pay $1000-$2000 for a trained professional doula need to wake up and see all of the unnecessary interventions they are already paying for.
Even ACOG, the governing body for obstetricians and gynocologists, recommends doula support for preventing primary cesareans.
31% decrease in the use of Pitocin
28% decrease in the risk of C-section
12% increase in the likelihood of a spontaneous vaginal birth
9% decrease in the use of any medications for pain relief
14% decrease in the risk of newborns being admitted to a special care nursery
All of this will SAVE thousands of dollars in maternity costs. All of the people here who are commenting that they don't want insurance to pay $1000-$2000 for a trained professional doula need to wake up and see all of the unnecessary interventions they are already paying for.
Even ACOG, the governing body for obstetricians and gynocologists, recommends doula support for preventing primary cesareans.
5
Have you ever paid attention to who the readership of the NY Times is? Ever notice how much print is devoted to the lifestyle choices of upper class individuals like us? That coverage is no longer reserved to the Style and Arts sections but must extend to every section of this paper. Because our lifestyles are what we care about most, we wouldn’t keep reading if it were otherwise.
Ms. Hartocollis knows her readership well and was kind enough to report upon a wealthy couple that chose to hire a doula. She smartly deduced we would care little to read about the majority of doulas in this country who provide care for and act as advocates on behalf of underserved, low-income women. We scoff at women who can’t hop in an Uber cab to the nearest hospital for their scheduled C-section. So why would we wish to read an article about how women outside of NYC benefit from the care doulas provide? I certainly don’t want to read about women from families who can’t afford an iPad that might receive limited natal care or get fleeced deeper into poverty by the medical establishment were it not for doulas.
Let's stick to what we are doing here and just flat out refuse to see a world outside the confines of narrow condo towers and converted warehouse lofts. We can even pretend that the vitriol espoused in our comments is not in part a product of how much we detest women being able to make choices for themselves, especially about their health, doubly so when they are pregnant.
Keep sharing!
Ms. Hartocollis knows her readership well and was kind enough to report upon a wealthy couple that chose to hire a doula. She smartly deduced we would care little to read about the majority of doulas in this country who provide care for and act as advocates on behalf of underserved, low-income women. We scoff at women who can’t hop in an Uber cab to the nearest hospital for their scheduled C-section. So why would we wish to read an article about how women outside of NYC benefit from the care doulas provide? I certainly don’t want to read about women from families who can’t afford an iPad that might receive limited natal care or get fleeced deeper into poverty by the medical establishment were it not for doulas.
Let's stick to what we are doing here and just flat out refuse to see a world outside the confines of narrow condo towers and converted warehouse lofts. We can even pretend that the vitriol espoused in our comments is not in part a product of how much we detest women being able to make choices for themselves, especially about their health, doubly so when they are pregnant.
Keep sharing!
28
You don't have to be wealthy to hire a doula. You just have to be smart enough to.
19
You have to have resources. You have to know what a doula is and live in an area where doulas live and work. You have to have money. A lot of people simply don't, and that isn't their fault and it doesn't make them stupid.
4
This is why healthcare and healthcare insurance costs are so out of control.
8
My $300 doula saved me $10,000 in anaesthetics.
15
This is a puzzling comment. The proposal is made that someone at a lower pay grade might be better than a board-certified specialist for certain tasks and you think this is part of the problem. This is part of the solution.
6
After my first birth ended in C-section, coupled with post-partum, breastfeeding issues, and terrible pain (which lasts for years at the incision site), my doctors recommended that I have a scheduled c-section for my second child, since I'd only have a 50% chance of successful vaginal birth.
I went for a second opinion at a practice with a reputation for promoting natural methods, with a very low c-section rate of about 12% and they would take me ONLY if I agreed to have a doula. They recommended someone who we could afford and who they thought would be a good match. This woman was a lifesaver, providing me with massage and accupressure techniques that alleviated pain without drugs, encouraging me, helping me talk to the resident who was pressuring me for an epidural when my doctor had clearly not wanted me to get one (she wasn't yet in the room). I had 2 successful VBACs with my doula.
It's great that the NYT wants to make fun of about them as if they're newfangled for hipsters, but they're more than babysitters, and more than a sister or mother in terms of the support they give. Ideally, a doctor would be there the entire time, but that doesn't happen. All my nurses were fantastic, but unfamiliar faces, and had specific medical/technical tasks they were busy with, and couldn't always take that time to massage/alleviate pain like the doula.
I get that people will dismiss a doula as a first world, hippy-dippy amenity. I did too, until I experienced the difference myself.
I went for a second opinion at a practice with a reputation for promoting natural methods, with a very low c-section rate of about 12% and they would take me ONLY if I agreed to have a doula. They recommended someone who we could afford and who they thought would be a good match. This woman was a lifesaver, providing me with massage and accupressure techniques that alleviated pain without drugs, encouraging me, helping me talk to the resident who was pressuring me for an epidural when my doctor had clearly not wanted me to get one (she wasn't yet in the room). I had 2 successful VBACs with my doula.
It's great that the NYT wants to make fun of about them as if they're newfangled for hipsters, but they're more than babysitters, and more than a sister or mother in terms of the support they give. Ideally, a doctor would be there the entire time, but that doesn't happen. All my nurses were fantastic, but unfamiliar faces, and had specific medical/technical tasks they were busy with, and couldn't always take that time to massage/alleviate pain like the doula.
I get that people will dismiss a doula as a first world, hippy-dippy amenity. I did too, until I experienced the difference myself.
45
I really regret not having a doula. I feel like I was pressured into both of my c-sections and bullied by over-worked, impersonal nurses. I could have used an advocate in there. Neither me nor my husband really had an idea as to what was going on. I have two beautiful kids now, for which I am eternally thankful, but my predominant memories of their deliveries are those of trauma and heartbreak.
14
My post-partum doula was a godsend. She was helpful and knowledgeable, a certified lactation consultant. With her help and support I was able to get the hang of tandem breastfeeding my new born twins. She made sure I drank adequate water, ate nutitiously, got some rest and was able to shower. The reality is my husband was a frazzled new parent himself - not to mention he had to return to work rendering him gone for 10 hours a day - and honestly could not provide the same level of support.
I absolutely credit having a doula with my success at breastfeeding and with firmly establishing a confident, calm and happy approach to new motherhood.
I absolutely credit having a doula with my success at breastfeeding and with firmly establishing a confident, calm and happy approach to new motherhood.
23
You're very fortunate. How about considering the needs of those who don't have your mom?
9
Some of us don't have moms who breastfed. Some of us don't have moms who want us to breastfeed. Some of us don't have moms who know how to deal with breastfeeding problems. Some of us dont' have moms who are sane, or loving, or nurturing. Some of us don't have moms. Or sisters. Or any nearby female friends. What is your problem?
3
Kathy, they would, in theory, be taken care of by a public health care system. A doula is not a substitute for a mother or for a proper public health care system.
The commentary on this issue is very myopic. We are looking at a HUGE societal problem and proposing doulas is like telling someone with breast cancer to buy a more comfortable bra.
The commentary on this issue is very myopic. We are looking at a HUGE societal problem and proposing doulas is like telling someone with breast cancer to buy a more comfortable bra.
So fortunate to have a doula present at my son's birth! Fantastic lady who became my great friend. Plus a nurse mid-wife, who, though technically off, came in for the birth. She is a true health care provider; also became a dear friend. Also a female RN. And a doctor, male, the most conservative of the 12 possible docs on rotation. At one point he suggested C-section. The nurse, the nurse mid-wife, the doula and I all vociferously yelled "No" in unison. Son born healthfully, beautifully. I can not express enough appreciation to these three women who assisted me. Bless them, their families, their healthcare, their existence.
10
Doulas are not trained in any health care profession. Nurses are qualified for this kind of work, and I would rather see more nurses available to women in labor than adding on yet another person of dubious background and training. We keep shifting care to the least qualified people and you get what you pay for.
I had a certified nurse midwife for my first delivery. Best decision I ever made. She was wonderful, and worked in partnership with the nurses, and with an obstetrics resident who was nearby. She did need to consult with him once, but otherwise handled everything herself.
I had a certified nurse midwife for my first delivery. Best decision I ever made. She was wonderful, and worked in partnership with the nurses, and with an obstetrics resident who was nearby. She did need to consult with him once, but otherwise handled everything herself.
5
The only additional training that nurses in my hospital require in order to work in the labor dept is fetal monitoring. Doulas on the other hand learn how to help a woman through childbirth. Yes they should be certified, ideally by the hospital.
2
I believe you missed the point - doulas do not claim to be health care professionals; though they are a kind of birth professional in their own right. What you state nurses can (ideally) do is difficult to accomplish in the current medical system, where numbers (dollars and monitoring devices) reign supreme. Doulas ARE trained and experienced. Like yourself, I also had a CNM at my labor...AND a doula :)
2
Maybe someone making the "don't trust doulas, trust your doctor" argument can explain why C-section rates have exploded over the last 10 years. I don't expect our doula to be a health care provider. But I also know she's focused on the best birth experience for my wife, rather than recommending an unnecessary C-section to protect herself from malpractice claims or just go home before 10pm.
15
I had a doula for both of my births. She was invaluable in both cases. My second labor was precipitous and my husband was only there for the last few minutes. Because it was so fast, an epidural was not an option. My husband was basically freaking out from seeing me in so much pain. Having a calm supportive face to get me through an unplanned unmedicated birth was just more helpful than I can say. The birth was - and still is - traumatizing, but it would have been far worse if I hadn't had my doula's support.
There is a wide range in the cost of duolas. In the Pacific NW where I am, they are typically between $300 and $1000. Many take a minority of their cases gratis or a much reduced rate.
There is a wide range in the cost of duolas. In the Pacific NW where I am, they are typically between $300 and $1000. Many take a minority of their cases gratis or a much reduced rate.
2
I had a doula for both of my births. She was invaluable in both cases. My second labor was precipitous and my husband was only there for the last few minutes. Because it was so fast, an epidural was not an option. My husband was basically freaking out from seeing me in so much pain. Having a calm supportive face to get me through an unplanned unmedicated birth was just more helpful than I can say. The birth was - and still is - traumatizing, but it would have been far worse if I hadn't had my doula's support.
There is a wide range in the cost of duolas. In the Pacific NW where I am, they are typically between $300 and $1000. Many take a minority of their cases gratis or a much reduced rate.
There is a wide range in the cost of duolas. In the Pacific NW where I am, they are typically between $300 and $1000. Many take a minority of their cases gratis or a much reduced rate.
10
I had a fabulous doula for the birth of my first child 15 years ago. She was a massage therapist as well and she helped me survive days of labor and did not leave the hospital until it was clear that I would need a C-section -- and she expressed no judgment about the c-section and was very supportive of my right to choose how to proceed. Her fee was peanuts compared to what she provided to me and my husband. I am far from a crunchy granola Mom, but I would recommend a doula to any woman giving birth for the first time.
15
As a doula I am disappointed by the tone of this article - granted it is in the NY region section, but doulas are used outside of Manhattan and the NY region and are not at all like a "personal trainer". A good doula should not be in conflict with the medical care a woman is receiving whether doctor or midwife, rather she should be supporting the woman and her family through the process of birth and immediate post partum. This support depends so much on the family. In some cases it has meant helping the father figure out how he can help his wife and the doula is just extra hands and support. Sometimes for an immigrant family it may mean translation of medical practices (and potentially language as well). Sometimes it is sweaty physical work helping the woman manage her pain. Sometimes it is managing the environment (other people present or who the woman wishes were not present). Always it is respecting the families wishes for the birth and, if the doula does not have any further medical certification, deferring to the certified health care providers and the scope of her role as doula. Many labor and delivery nurses are excellent doulas, midwives can also be excellent doulas and doctors can be as well: birth companions who champion the woman's right to a positive birth experience resulting in healthy baby and healthy mom who feels empowered by her birthing experience.
23
I am a certified birth doula (DONA). My background is in Nursing and I have 10 years of experience working in labor & delivery. I am disappointed at the tone of this article for one simple reason. The quality and experience of birth and early parenthood have far reaching consequences for individuals, families and society as a whole. This critical period of transition presents a unique opportunity for personal growth and transformation. Birth is an amazing life altering journey and empowers a woman for the rest of her life. Studies have shown that when a doula attends births, labor a are shorter with fewer complications, babies are healthier and breast feed more easily. Simply said, when women are nurtured, they make better nurturers.
9
Again, please, cite the study or studies? I've been hearing about this for decades, but have never found evidence.
Yet another advocacy group for a new medical "necessity." Is it any wonder our costs for medical care kept going up. Insurance reimbursements aren't free: someone pays for them. Once something is covered it becomes an entitlement and cost for everyone. On and on.
7
Doulas are hardly new, except to you perhaps. In the long run, they save the health establishment money because they lessen the strain on expectant and new mothers.
6
How is it even a question of trying to figure out how to get non-medical, non-essential care paid for by health insurance, when in this country we still haven't figured out how to get asthma medication and insulin pumps to everyone who needs them?
We need to get realistic. Doulas may be worth their weight in gold to the people who hire them, but that doesn't make their service a medical necessity or a medical expense.
Let's focus our concern on getting everyone covered for illness and emergencies. If we solve that, we can turn to trying to get comfort care.
We need to get realistic. Doulas may be worth their weight in gold to the people who hire them, but that doesn't make their service a medical necessity or a medical expense.
Let's focus our concern on getting everyone covered for illness and emergencies. If we solve that, we can turn to trying to get comfort care.
12
Yet, doulas can save insurance companies and the state 10s of thousands of dollars. Doulas don't just offer "comfort" care. While they may not be considered medical professionals, they make a huge difference in cost, intervention rates, and even mortality rates. So I would argue that doulas should definitely be considered an essential part of the birthing team.
7
Doulas are not health care providers. Why should insurance cover them? They're paid-for friends, to hold your hand and offer moral support. Nice to have, sure, but not definitely not necessary. Their services are absolutely not medical services and should not be considered as such.
Also consider that unlicensed doulas can and do cost hospitals and society thousands and thousands of dollars when their (non-medical!) advice sometimes puts women and babies are risk of adverse outcomes. A lot of doulas are very "crunchy", and some advocate risky behaviors like skipping OBGYN appointments and tests such as for GBS (a bacterial infection in the vagina that can lead to babies getting sepsis if not treated during labor) and gestational diabetes. They can also push women who are in agony (because of their focus on lack of pain relief) to avoid necessary C-sections and monitoring, which again, can lead to very bad outcomes for woman and baby.
Not all doulas do this, but some (perhaps many) do. Why should anyone be forced to pay for the services of a person who is actively advocating an adversarial relationship between the woman and her actual medical team?
Also consider that unlicensed doulas can and do cost hospitals and society thousands and thousands of dollars when their (non-medical!) advice sometimes puts women and babies are risk of adverse outcomes. A lot of doulas are very "crunchy", and some advocate risky behaviors like skipping OBGYN appointments and tests such as for GBS (a bacterial infection in the vagina that can lead to babies getting sepsis if not treated during labor) and gestational diabetes. They can also push women who are in agony (because of their focus on lack of pain relief) to avoid necessary C-sections and monitoring, which again, can lead to very bad outcomes for woman and baby.
Not all doulas do this, but some (perhaps many) do. Why should anyone be forced to pay for the services of a person who is actively advocating an adversarial relationship between the woman and her actual medical team?
54
None of the doulas I know, or any organizations supporting or representing doulas would advocate for skipping appointments.
Why should doula care be considered for medical coverage? Consider the following (from dona.org):
Numerous clinical studies have found that a doula’s presence at birth
•tends to result in shorter labors with fewer complications
•reduces negative feelings about one’s childbirth experience
•reduces the need for pitocin (a labor-inducing drug), forceps or vacuum extraction and cesareans
•reduces the mother’s request for pain medication and/or epidurals
Research shows parents who receive support can:
•Feel more secure and cared for
•Are more successful in adapting to new family dynamics
•Have greater success with breastfeeding
•Have greater self-confidence
•Have less postpartum depression
The above has also been my experience with two births.
Why should doula care be considered for medical coverage? Consider the following (from dona.org):
Numerous clinical studies have found that a doula’s presence at birth
•tends to result in shorter labors with fewer complications
•reduces negative feelings about one’s childbirth experience
•reduces the need for pitocin (a labor-inducing drug), forceps or vacuum extraction and cesareans
•reduces the mother’s request for pain medication and/or epidurals
Research shows parents who receive support can:
•Feel more secure and cared for
•Are more successful in adapting to new family dynamics
•Have greater success with breastfeeding
•Have greater self-confidence
•Have less postpartum depression
The above has also been my experience with two births.
53
We had a birth at home with a midwife and doula. Would not trade that for in hospital medical birth. 1000's of generations of women have had births at home with midwives and doulas. MD's are pretty new on the scene.
4
M - you're just flat out wrong I'm afraid. It's in the best interest of insurance companies TO cover the cost of a doula - they are statistically proven to decrease the incidence of medical intervention and reduce the cost of childbirth. So, nice to have or not, with all the waste in our medical system this is one expense that's entirely worth it for the patients, the provider, and the insurance company. Your characterization of the profession and perceived notion of an 'agenda' is also just flat out wrong. By the way, I'm a man, not crunchy, and potentially shared your opinion until interviewing, working with, and having a doula attend my son's birth.
3
Having a doula has been shown to positively affect birth outcomes.
While the couple featured in this story might invite mockery, this is an evidence-supported fact.
While I would really love to hear occasionally from some other NYC obstetrician besides Jacques Moritz (yes, there are a few others here), I do agree with his assessment that, while doulas can be a valuable part of the OB team, it's important for doulas to "know their place." There are times when a doula’s fervent belief in how birth “should” go can actually be an impediment in the delivery of care. A doula might not understand the difference between a specious intervention that will lead to a cascade of them and eventually a suboptimal outcome, and a medically indicated intervention that will optimize the chances for a safe, healthy, and – yes – normal birth. I have seen doulas attempt to advise birthing women to refuse the course of action recommended by the woman’s chosen health care provider. This is crazy. Doulas are helpful, wonderful LAYPEOPLE who provide labor support, not clinical judgement. Do your homework ahead. Choose a midwife or doctor that shares your outlook on pregnancy and birth, and make sure that person works in an institution that supports the kind of care you expect to get. And then, if your midwife will potentially be attending to multiple patients in labor at the same time, and consequently not be available to provide continuous care, (or if you’ve chosen an OB) hire a doula.
While the couple featured in this story might invite mockery, this is an evidence-supported fact.
While I would really love to hear occasionally from some other NYC obstetrician besides Jacques Moritz (yes, there are a few others here), I do agree with his assessment that, while doulas can be a valuable part of the OB team, it's important for doulas to "know their place." There are times when a doula’s fervent belief in how birth “should” go can actually be an impediment in the delivery of care. A doula might not understand the difference between a specious intervention that will lead to a cascade of them and eventually a suboptimal outcome, and a medically indicated intervention that will optimize the chances for a safe, healthy, and – yes – normal birth. I have seen doulas attempt to advise birthing women to refuse the course of action recommended by the woman’s chosen health care provider. This is crazy. Doulas are helpful, wonderful LAYPEOPLE who provide labor support, not clinical judgement. Do your homework ahead. Choose a midwife or doctor that shares your outlook on pregnancy and birth, and make sure that person works in an institution that supports the kind of care you expect to get. And then, if your midwife will potentially be attending to multiple patients in labor at the same time, and consequently not be available to provide continuous care, (or if you’ve chosen an OB) hire a doula.
20
14 years ago my first child, my son, was born after 33+ hours of active labor. I still get almost weepy with gratitude when I think about our doula who was with us the entire time, and was such a calm, gentle, non-judgmental presence. I do not know how we would've gotten through it without her kindness and support.
19
At least this article does not mention anyone / anything being "nestled," "nourished," or "healed."
5
I know one doula. She has no medical training but is convinced that a C section is NEVER necessary because a woman's body will never give her a baby she can't handle and that a woman's body is designed for birth. She's the last person I'd want at my birth-telling me not to have a C section that was necessary to save my life and the life of my baby. Buyer beware.
65
I guess that doula was unaware that through most of human history, a significant number of women DIED in childbirth. That it used to be ROUTINE to die in childbirth, and considered a normal risk of womanhood. That all those fairy tales about children and wicked stepmothers have their ROOTS in the fact that probably 1/3 or more of children ended up being raised their father's NEXT wife, after their mothers died in childbirth.
27
Sounds like you were reading "Cinderella" or another fairy tale, and not this well written article. Not sure why you chose to focus on mortality, when it's a reality in all dealing with the human body. Reality check: "doulas" have existed throughout humanity, in all cultures, just under different names. This coming from someone who (1) studied anthropology and (2) used a doula and is grateful for having done so. Comments should pertain to the article, guess you missed that point as well.
6
Piece of mind, you missed the point, succinctly and articulately expressed moreover, that yes, doulas have always been around, but infant and maternal mortality are decreasing in countries where women have access to modern medical care, facilities and staff.
If you had a good birth with a doula, that's great. But that's because you clearly didn't have a complicated procedure. If you had had a complication, which arise OFTEN (as Concerned Citizen points out, for hundreds of years, death in childbirth was considered normal) then a doula would not have been adequate.
If you had a good birth with a doula, that's great. But that's because you clearly didn't have a complicated procedure. If you had had a complication, which arise OFTEN (as Concerned Citizen points out, for hundreds of years, death in childbirth was considered normal) then a doula would not have been adequate.
I moved to a new city when I was seven months pregnant. Having a having a doula at the birth was very helpful. She was able to provide calm emotional support and a sense of continuity as nurses and midwifes changed shifts. Could an aunt or a sister have provided the same support? Sure. But not all moms have that support available. We paid out of pocket, but I was able to be reimbursed by my healthcare FSA. That seems about right. I think it is a valid healthcare expense, but not necessarily one that should be covered by insurance.
7
My wife and I had a doula with our first child. During birth, my wife bled a lot. I will never forget how the doula just stood there with this deer-in-the-headlights look as I worked with my wife, and the doctor and nurses, to stem the bleeding. It was nice to have her for support, but she's not a healthcare provider.
49
Yes lets wrap one more set of tasks in state regulation and exclusionary licensing procedures to pretend it is one more learned profession that needs all of that baggage "to protect the public". Rates go up, aspiring new entrants are kept out and then what? Surely there is enough regulation right now on the books covering the unauthorized practice of medicine; if it is not the unauthorized practice of medicine then it is just a nice feel-good service that does not need licensing or close regulation. If it is a public danger, then ban it. "Problem" solved, either way.
5
My doula might very well have helped to save my life after an emergency c-section (foot breech baby). I had massive internal bleeding after the c-section, and she is the one who alerted the medical staff that something was wrong post-surgery - and getting them to take it seriously (it still took them a while to figure out it was internal bleeding). She was also a great support to my husband when they whisked me away into a second surgery. Worth every penny, I'd say.
17
That is fine. Then you pay for it. But this article is about insurance.
2
As of now, there is no requirement of any type to be a doula. It is unregulated, unlicensed, and untrained. DONA "certification" is voluntary.
Some doulas are excellent. Some are wading well beyond their field of expertise and giving medical advice. Doulas are not nurses or midwives and have no role beyond support.
Insurance is not about to start paying for people whose sole qualification is a weekend seminar and attending a few births as an apprentice.
Some doulas are excellent. Some are wading well beyond their field of expertise and giving medical advice. Doulas are not nurses or midwives and have no role beyond support.
Insurance is not about to start paying for people whose sole qualification is a weekend seminar and attending a few births as an apprentice.
16
I note that a few of the comments seem to conflate doulas with midwives. Not being either, I think it's important to correct that, although the article already says so. My kids were both delivered by Certified Nurse Midwives, in hospital, with an Obstetrician on call if needed. The CNMs are highly trained medical professionals who actually deliver your baby, address the placenta, etc. A doula is not that. A doula is a nice lady who holds your hand through the birth but does not (and could not) actually deliver the baby or provide any actual medical help. I didn't need a doula. I had lovely midwives, a husband, and my mom to give me all the support I needed through labor and delivery. Because they are nice, but not medically necessary, there is really no reason that insurers should cover the services of a doula.
16
Not everyone across the country has access to the amazing healthcare and midwifery programs available to us here in Minneapolis. Just something to consider.
1
I had a doula when I gave birth in 2013-she was invaluable in helping me achieve a medication-free birth (in a hospital setting). My insurance company was able to save thousands of dollars since I did not get an epidural (and not even an Ivy). I wish insurance companies would recognize potential savings and cover the services!
14
I am an OB/GYN. I highly support a team approach for labor support although I don't fully understand hiring a stranger when a family member or best friend can also do the same thing, if not more rewarding. That said, every mom is different and women should and must have their choices. Insurance coverage does not make sense until proven benefits are well established.
16
Actually, the use of doula support is well documented in medical literature. The Doula Report, will help you understand a doulas role in supporting women of every race and income class.
https://choicesinchildbirth.org/wp-content/uploads/2014/10/Doula-Report-...
The benefits of doula care are strongly supported in the medical literature.
• In 2013 a Cochrane Database systematic review of 23 individual studies concluded that “all women should have continuous support during labour,” and that trained doulas are the most effective at providing continuous labor support.3
• A 2008 study in the American Journal of Obstetrics and Gynecology concluded that doula support was among the most effective of the 41 birth practices reviewed – one of only three to receive an “A” grade.4
• A joint statement of the American College of Obstetricians and Gynecologists and
the Society for Maternal-Fetal Medicine released in February 2014 found that
continuous labor support is among “the most effective tools to improve labor and
delivery outcomes” and is likely underutilized.5
Doula care has been found to improve birth outcomes and reduce health disparities. Substantial evidence demonstrates that doula support increases the likelihood of safer, healthier, and more satisfying birth experiences.
https://choicesinchildbirth.org/wp-content/uploads/2014/10/Doula-Report-...
The benefits of doula care are strongly supported in the medical literature.
• In 2013 a Cochrane Database systematic review of 23 individual studies concluded that “all women should have continuous support during labour,” and that trained doulas are the most effective at providing continuous labor support.3
• A 2008 study in the American Journal of Obstetrics and Gynecology concluded that doula support was among the most effective of the 41 birth practices reviewed – one of only three to receive an “A” grade.4
• A joint statement of the American College of Obstetricians and Gynecologists and
the Society for Maternal-Fetal Medicine released in February 2014 found that
continuous labor support is among “the most effective tools to improve labor and
delivery outcomes” and is likely underutilized.5
Doula care has been found to improve birth outcomes and reduce health disparities. Substantial evidence demonstrates that doula support increases the likelihood of safer, healthier, and more satisfying birth experiences.
24
Doulas know how to help a woman through childbirth. Family members don't. My doula saved me from an epidural. My family members were highly stressed and had no idea what kind of support I needed.
3
She "saved you" from a safe, proven form of pain relief?
Stories like that make doulas less credible, not more.
Stories like that make doulas less credible, not more.
2
Many of the commentators have a real misunderstanding about what a doula does. A doula does not deliver the child or do any of the medical tasks. She is not a medical professional. But she is experienced and knowledgeable about the birthing process and she provides care, support, and information to the new mother. "Mothering the mother"! Doulas do improve health outcomes! Stress is horrible, doulas alleviate this, childbirth is scary, doulas are a comfort, and YES- there are a lot of people that are not comfortable with hospitals and doctors- doulas can help with this too. I had a doula. She was a godsend to me.
37
Where does she get this knowledge of the birthing process? Usually not from any formal medical training such as nursing school. It is possible that doulas are giving mothers incorrect information or passing on their own biases. For example, one doula I know doesn't believe that c sections are ever necessary. I don't think this is good advice to pass on to an expectant mother.
20
Lamaze classes and reading a book is free. Why should insurance pay for a Doula.
1
My doula was a huge support to me throughout the entire process as I labored and delivered my now-17-month-old. If you do the research, too many women are having planned/scheduled c-sections (that are not necessary) and are in fact costing the insurance companies far more than a doula would cost them for a birth. Yes, some women need c-sections to prevent death or injury to mother, baby, or both. However, if you think that a doula is just a "luxury," I hope you think similarly about scheduled c-sections that are merely for the convenience of doctors and patients to plan when the baby will come. This country needs to start focusing more on preventative care, and a doula can be just that. I spent $1000 on my doula. An insurance company spent over $30,000 on my sister's c-section. So, you tell me which would be more cost-effective in the long run.
10
That is a false comparison. Are you suggesting your sister needed a C-section because she had no doula? I had a C-section for medical reasons and no doula would have been able to prevent that. You were just lucky that an amateur was sufficient in your case.
11
My sister did have a doula, actually. I am suggesting that those who claim the cost of doulas would cripple the insurance companies are not understanding the full picture of the cost of c-sections on the system. I am saying that while many c-sections, like my sister's, are medically necessary, there are women who could use the support and encouragement of a doula to get through labor and deliver vaginally. Birth is, most often, not a medical emergency and it should not be treated like one in hospitals.
2
You need to accept that a lot of women WANT a planned C-section. It's their CHOICE.
It is pointless to argue about choice regarding contraception, abortion or birth plans, when you deny OTHER women the choice of a C-section.
Every woman I ever knew who had a "birth plan" asking for pain control and an epidural, ended up going to the hospital at 3AM -- their doctor not available at that hour! -- got a house physician who was a total stranger -- and thus, was denied their epidural until it was TOO LATE to get one. They had miserable, agonizing deliveries.
On the other hand, every woman I know who had a planned C-section (as opposed to an emergency; that is different and presumably no argument there) had plenty of pain medication. They also avoided miserable complications like episiotomies, stitches, urinary incontinence and so on.
Note: Most female OB-GYNs insist on planned C-sections.
It is pointless to argue about choice regarding contraception, abortion or birth plans, when you deny OTHER women the choice of a C-section.
Every woman I ever knew who had a "birth plan" asking for pain control and an epidural, ended up going to the hospital at 3AM -- their doctor not available at that hour! -- got a house physician who was a total stranger -- and thus, was denied their epidural until it was TOO LATE to get one. They had miserable, agonizing deliveries.
On the other hand, every woman I know who had a planned C-section (as opposed to an emergency; that is different and presumably no argument there) had plenty of pain medication. They also avoided miserable complications like episiotomies, stitches, urinary incontinence and so on.
Note: Most female OB-GYNs insist on planned C-sections.
4
I think doulas are useful for mothers who need a gatekeeper to keep family members away while they're in labor. My niece went through a difficult childbirth last year, and her doula was quite firm about keeping everyone but the husband out of the hospital room. My niece, though, wanted some of us there with her to give her moral support. Once we came in the room, the doula didn't have much to do.
She ended up asking us to leave
She ended up asking us to leave
3
I really like the imagery setup in the article:
music producer husband
in his shorts & sandals
tinkers with his IPad
rearranging music tracks
schedules an SUV VIP style
though Uber Uber Uber
while the doula keeps the rhythm
pausing for contractions
of expectant wife mother
and then there's a birth
and then there's sushi
and life goes on for
j grandly for ever after
in lower manhattan
music producer husband
in his shorts & sandals
tinkers with his IPad
rearranging music tracks
schedules an SUV VIP style
though Uber Uber Uber
while the doula keeps the rhythm
pausing for contractions
of expectant wife mother
and then there's a birth
and then there's sushi
and life goes on for
j grandly for ever after
in lower manhattan
18
Yes, J Grand does seem a bit self-absorbed while his wife is in labor. I hope he's not as much of a jerk as this article makes him out to be, but ...
I'm a midwife working in the National Health Service as Home Birth Lead, my experience is that women choose the services of a doula when they don't have confidence in their midwives - as a midwife I think it is integral to my practice to support women in an holistic way throughout their pregnancy, labour and postnatal experiences, and that means listening to their stories, providing direction for their education and choices, rubbing their backs and wiping their bottoms, empowering them to birth their babies, then supporting their transition to motherhood. As a midwife I couldn't work in any other way! The advantage for a mum is that I am qualified, trained and experienced and I am regulated - surely that makes women safer than they might be with someone who actually isn't?!
13
As an obstetrician I would be honored to work alongside you, a competent midwife. Unfortunately, too often patients seek not only comfort but medical guidance from those not qualified to provide it.
So... childfree people can barely get onto Medicaid even if they are poor and have cancer ... but now the rest of us are expected to foot the bills (via inflated insurance premiums) of birth coaches for women who already have the luxury of medical insurance for an entirely optional event such as childbirth?
Is there no end to what reproducers think they are entitled to at others' expense?
Have a doula, cleaning lady, diaper service, hypnotist or pool boy, whatever does it for you, but please pay for it yourselves like your fellow citizens do.
Is there no end to what reproducers think they are entitled to at others' expense?
Have a doula, cleaning lady, diaper service, hypnotist or pool boy, whatever does it for you, but please pay for it yourselves like your fellow citizens do.
18
What a sad, unresearched article. It calls doulas the 'latest wave' in maternity culture that are just now organizing- when the first formal doula training and certification group was founded over two decades ago, and it ignores all of the scientific backing that shows how having a trained, professional support person improves birth outcomes across the board.
Instead it makes it sound like doulas are some sort of yuppy fad of paying someone to hold your hand during labor, something only the well-to-do would even bother to care about, a second job akin to 'waitressing'.
The fact is that, in our western hospital culture, where women are unattended and unsupported by overworked nursing staff for hours on end, a doula provides continuous, unconditional education & support throughout the labor, and that support has a documented effect of reducing interventions- interventions that cost thousands of dollars.
And there is ample evidence that providing this support to low income women, women who are less likely to have binge enducated themselves during their pregnancy, women for whom the risks of pregnancy and birth are far greater than for the trendy uppercrust of New York, the rate of interventions drops even more dramatically.
Doulas, despite the fact that they provide no 'medical' care, do no medical procedures or interventions, absolutely are providers of healthy, safe care- and there's no legitimate reason for them to remain uncovered by insurance.
Instead it makes it sound like doulas are some sort of yuppy fad of paying someone to hold your hand during labor, something only the well-to-do would even bother to care about, a second job akin to 'waitressing'.
The fact is that, in our western hospital culture, where women are unattended and unsupported by overworked nursing staff for hours on end, a doula provides continuous, unconditional education & support throughout the labor, and that support has a documented effect of reducing interventions- interventions that cost thousands of dollars.
And there is ample evidence that providing this support to low income women, women who are less likely to have binge enducated themselves during their pregnancy, women for whom the risks of pregnancy and birth are far greater than for the trendy uppercrust of New York, the rate of interventions drops even more dramatically.
Doulas, despite the fact that they provide no 'medical' care, do no medical procedures or interventions, absolutely are providers of healthy, safe care- and there's no legitimate reason for them to remain uncovered by insurance.
7
Please provide any citations showing that doulas improve birth outcomes for low-income women.
6
Here are a few examples specific to low-income women:
http://www.ncbi.nlm.nih.gov/pubmed/16881989
http://www.ncbi.nlm.nih.gov/pubmed/23837663
http://www.ncbi.nlm.nih.gov/pubmed/19323712
http://www.ncbi.nlm.nih.gov/pubmed/8841285
http://www.ncbi.nlm.nih.gov/pubmed/15670325
http://www.ncbi.nlm.nih.gov/pubmed/16881989
http://www.ncbi.nlm.nih.gov/pubmed/23837663
http://www.ncbi.nlm.nih.gov/pubmed/19323712
http://www.ncbi.nlm.nih.gov/pubmed/8841285
http://www.ncbi.nlm.nih.gov/pubmed/15670325
1
Your first link is to a study that trained the mother's friend in doula techniques in 4 hours. While it's exciting that that helped, it doesn't really support adding another professional services bill.
But making the four hours of classes available free seems like a good idea.
But making the four hours of classes available free seems like a good idea.
It seems like it can be appealing to the dad, not having to worry about following up with the doctor as much. This way he can relax, forget about the need to be assertive, and focusing on helping to comfort his wife. Less stress in the hospital environment, and he can experience the birth of his child in peace.
I probably would have brought in a doula for the birth of my child, except we couldn't afford it. My sister in law served as "I can't believe it's not doula", and she was a tremendous help.
I probably would have brought in a doula for the birth of my child, except we couldn't afford it. My sister in law served as "I can't believe it's not doula", and she was a tremendous help.
5
India, my husband was a full partner in all 3 of our children's births and upbringing. For our first son's delivery, however, he was overwhelmed by my pain and doctors telling us that it was time for me to get my epidural (Chicago in the late '90s). Thanks to my stubbornness, my husband's support and the excellent care of a nurse, I gave birth to my son without any drug interventions. It was beautiful.
For our two other children's births, we hired a doula. She was a prenatal massage therapist who eased my aching muscles in the months before labor, and came to our home when contractions started. She calmed us both, got us laughing, and freed up my husband to stay with our toddler as we prepared to go to the hospital. My husband and my doula both allowed me to deliver two more children without drugs.
It's such a shame that anyone would try and shame a woman for seeking help at such a vulnerable, emotional time. To say that one's marriage is doomed is the most ridiculous thing, just because a doula is used! The aid they give is one that's no longer available in our society (a topic for another day), but each of my children got off to a wonderful start because I was calm, comforted and supported. What's wrong with that?
For our two other children's births, we hired a doula. She was a prenatal massage therapist who eased my aching muscles in the months before labor, and came to our home when contractions started. She calmed us both, got us laughing, and freed up my husband to stay with our toddler as we prepared to go to the hospital. My husband and my doula both allowed me to deliver two more children without drugs.
It's such a shame that anyone would try and shame a woman for seeking help at such a vulnerable, emotional time. To say that one's marriage is doomed is the most ridiculous thing, just because a doula is used! The aid they give is one that's no longer available in our society (a topic for another day), but each of my children got off to a wonderful start because I was calm, comforted and supported. What's wrong with that?
13
The article's headline should be revised to read: "Doulas, the Latest Wave in Rich People's Maternity Culture; Nobody Else Has Ever Heard of Them"
And the big example is music producer J Grande's wife, Marisa, with her high-priced girlfriend-doula, Domino, all of whom live in Manhattan? Meanwhile back in 99%-er land, a pregnant woman has just put her second load of laundry into the washing machine, and plans to drive herself to her doctor's office for a maternity checkup later today.
This article must be another example of what the NY Times' reporter, Ron Lieber, of the Your Money columns, talks about when he says the Times is proud of its affluent readers, and needs to serve them as well.
18
Forget the NYT headlines - I think many posters simply do not read the articles or their comprehension is so poor that they have trouble discerning what is and what is not being said.
1
I had a doula for the birth of my youngest daughter in 1998. Guess I was ahead of my time! My first birth was a C-section and I was determined to avoid a repeat if at all possible. I did, in fact, have an unmedicated vaginal birth (in a hospital, with an OB-GYN). For 24 hours after the birth I kept exclaiming "I can't believe how good I feel!" Of course the credit is not all to the doula, but she was a part of the framework for me. I think it is too much to expect husbands to become birthing coaches. They don't have the experience or knowledge and they have their own anxieties. My husband was there for me and I didn't have to rely on him for strategies on managing the pain.
8
Well put! Besides the feeling good part :-) my experience was similar, and I feel likewise. And I used a doula in 2000.
1
There is no way insurance companies will start covering doulas until there is some sort of formal training and licensing system. They won't even cover doctors who graduated from medical school unless they are in or have completed a residency, and they're going to cover someone who self-appointed her/himself a doula? yeah right.
15
'Maternity Culture" has gotten out of hand. Doulas are yet another ingenious career concocted by those lacking post secondary education that need a living wage. If they weren't a doula they'd be: yoga instructor, personal trainer, life coach, waitress, secretary, etc. My grandmother gave birth to 11 children, including a set of twins, over a span of almost 20 years. According to her the most painful and stressful thing that she ever experienced: the passing of gull stones.
12
You forgot "barista".
2
And you probably walked 10 miles to school in the snow?
As others have said, a mother during childbirth benefits from continuous support. This support can be provided by a husband, mother, sister, or a doula. Nurses and midwives and OBGYN doctors are all a necessary part of the birthing team but not fully present during the birth.
My wife's OB GYN came in for the last 5 minutes. Nurses were in and out all the time. We struggled alone as many others do and did quite well (or my wife did!), but I see nothing wrong, when some of the other resources are not available, to supplement the support to the mother with a caring person (emphasis on the word 'supplement").
Just make sure that just as you choose an OB GYN doctor or a midwife that you are comfortable with, do the same with a doula - or any other partner that will assist you in that intense and wonderful moment.
(And it is gall not gull. But that may be just a typo.)
As others have said, a mother during childbirth benefits from continuous support. This support can be provided by a husband, mother, sister, or a doula. Nurses and midwives and OBGYN doctors are all a necessary part of the birthing team but not fully present during the birth.
My wife's OB GYN came in for the last 5 minutes. Nurses were in and out all the time. We struggled alone as many others do and did quite well (or my wife did!), but I see nothing wrong, when some of the other resources are not available, to supplement the support to the mother with a caring person (emphasis on the word 'supplement").
Just make sure that just as you choose an OB GYN doctor or a midwife that you are comfortable with, do the same with a doula - or any other partner that will assist you in that intense and wonderful moment.
(And it is gall not gull. But that may be just a typo.)
2
You think waitresses and secretaries are careers 'concocted by those lacking post secondary education that need a living wage'? Why not blame the Templars or the Freemasons while you're at it.
People in dull houses shouldn't throw gull (sic) stones.
People in dull houses shouldn't throw gull (sic) stones.
3
A friend was in labor recently, attended by a midwife (CNM) in a hospital. She had hired a doula. My friend was a VBAC, and in labor for more than 2 days. Eventually the midwife became concerned by the decelerations of the baby's heartbeat and recommended a C-section. The doula made it clear that she thought my friend should wait-- disregarding the opinions of the midwife and attending OB. Moments later, my friend experienced a placental abruption and uterine rupture. A stat C-section was performed. Luckily, everyone seems to be more or less fine.
Who was the doula to contradict the midwife? The midwife has medical training, has had to meet rigorous standards for medical practice. The doula had none of these things. She overstepped her professional limits. Sadly, this is not the only story I have heard of doulas doing exactly that. The reality is that there are few standards set for doulas and almost no enforcement of the standards that exist. The most you can hope is to get the doula expelled from their professional organization, but even then, they can continue to "practice."
Insurance should not pay for untrained staff who have no meaningful professional standards.
Who was the doula to contradict the midwife? The midwife has medical training, has had to meet rigorous standards for medical practice. The doula had none of these things. She overstepped her professional limits. Sadly, this is not the only story I have heard of doulas doing exactly that. The reality is that there are few standards set for doulas and almost no enforcement of the standards that exist. The most you can hope is to get the doula expelled from their professional organization, but even then, they can continue to "practice."
Insurance should not pay for untrained staff who have no meaningful professional standards.
31
Yowza, that's scary! So glad your friend was ok. Actually, SO SO glad she chose birth in a hospital rather than the insane option of a home VBAC.
I always say that "the doula is for the partner." Meaning that having our doula present allowed me to be able to be much more focused on my wife than I would have been had I been alone. The way I see it, for most of human history women in labor were attended by other women, their mothers, sisters, daughters, neighbors... Modern birth practices took that community away. And doulas bring it back. As a man, there are things that I could never know or intuit about what my wife needed or how she was feeling. And thanks to the doula, she did not need/expect me to know that stuff. And so I was able to be there in my fullest and to the best of MY ability. Doulas are a blessing.
9
THANK YOU for this lovely comment. My husband tells me he felt exactly the same way. He loved having our doula at the birth of both of our children. It's nice to see a positive comment from a father here.
2
This is lovely if done along with a doctor, but you'd better know that problems arise quickly, and not all labors are as easy as the one featured in the article. Pain meds are not a bad thing either.
8
I've had two drug-free hospital births, assisted by certified nurse midwives (although OBs were on the floor to step in when necessary). I would never do it otherwise. The first baby was an extreme close-call (literally moments away from a c-section), but still managed a vaginal birth thanks to my midwives and doulas. For my second child, I was at the same hospital and midwife group, with 2 friends acting as my doulas. I walked in, stood beside the bed for 2 hours, and gave birth. No unnecessary medical interventions, not even an IV. Of course, I was in a hospital and surrounded by medical professionals so I could have received help if it was needed, but I didn't need medical help, I needed emotional and physical comfort. I needed someone to massage my back, to squeeze my hips, to bring me juice, and to hold me as I positioned to push. I needed someone to assure my husband he was doing a great joba and that everything was fine. I needed someone to remind the nurse that I'd requested delayed cord clamping (hard to speak while birthing the placenta). These are the things a Doula does. These are the things that make a huge difference in how a mother perceives birth. Doulas are NOT the same as a midwife, since often hospital midwives are dealing with several laboring patients, many of whom they have never even met before. Anyone who says a doula is worthless clearly has never seen a good one in action.
11
"No unnecessary medical interventions, not even an IV."
A lot of women don't get what the IV, or rather the IV port (aka heplock), is for. It's there to save your life if you start hemorrhaging--a fairly common complication of childbirth.
When you hemorrhage you desperately need IV fluids to prevent or reverse hypovolemic shock (which will kill you if not treated). But the problem is, once you lose too much blood, your veins deflate and it's very, very difficult (sometimes impossible) to get an IV in. But if you already have a heplock/IV port in, there's no problem: they simply hook IV fluids up to that.
I know this because my IV port saved my life when I lost a quarter of my blood and went into hypovolemic shock after giving birth to my twins.
A lot of women don't get what the IV, or rather the IV port (aka heplock), is for. It's there to save your life if you start hemorrhaging--a fairly common complication of childbirth.
When you hemorrhage you desperately need IV fluids to prevent or reverse hypovolemic shock (which will kill you if not treated). But the problem is, once you lose too much blood, your veins deflate and it's very, very difficult (sometimes impossible) to get an IV in. But if you already have a heplock/IV port in, there's no problem: they simply hook IV fluids up to that.
I know this because my IV port saved my life when I lost a quarter of my blood and went into hypovolemic shock after giving birth to my twins.
1
Doulas are not just for childbirth -- I had a postpartum doula who came to my home several times in the week or two after my daughter was born. She was a wonderful source of advice and support. She helped me with everything from getting my newborn to stop crying to showing me a good way to stretch my sore back. And after a few hours, she was gone -- so I could be in charge and become more confident about my new role as mother.
11
I used both 'pre' & 'post' doulas; they offered support; expertise & nurturing to both me & my son [after he was born]. I was single & knew I would need support & practical help [in getting to hospital] with all my encumbering stuff [i.e., multiple pillows]. Into the early morning hrs, my pre doula was there for me, My 'post' doula cooked meals, did laundry [taking my infant son with her in a sling] & showed me how to bathe the baby, tips on comforting him & even taking him out for a brief walk. Since it was mid-June, the weather was ideal & her methods allowed me to catch some rest & sleep for the first 3 weeks. After that, finances mitigated that I had to stop using her services, although I wished otherwise. You may laugh to hear this, be she even helped me assemble the stroller & show me how to maneuver it through the crowed sidewalks! She also had a friend who made slings [her preferred mode of carrying a baby around] & had one made for me...I was sad when she left but it was time for her to let go.
5
The post doula is called a nanny.
5
This reads more about the breakdown of extended families and misplaced priorities. If a doula helps, great, but where is your husband/mother/sister/aunt/friends? Why do you need a stranger to comfort you at such a time?
10
There are many reasons a new parents might not want their relatives: 1) modesty/embarrassment; 2) handling both their own and their mother's emotions; 3) "professional" experience over a wide range of births/deliveries 4) recent experience. Then of course there is whatever issues might exist (and usually there are some) between a mother and daughter or between sisters.
Every woman is different. I gave birth to my last child thirty years ago and I can tell you for sure I did not want anyone in there with me besides my husband. My mother came in briefly; nice to know she was in the waiting room, but there was no reason for her to be in the delivery room. A friend's step daughter had her step and bio parents (two sets) as well as her husband - all watching while she delivered the baby. They thought it was a wonderful experience although the father of the new mother was a little uncomfortable. Our daughter-in-law had a doula. I wasn't particularly keen on it. In the end she had a c-section but while in labor the woman helped with various techniques. I respected and understood that our DIL did not want her in-laws with her and her own mother was apprehensive and would not have been much help. It was a high risk pregnancy to begin with. Our son was put off by the doula by the end; felt she made his wife more confused when the doctors recommended the c-section but also felt that initially she helped.
Every woman is different. I gave birth to my last child thirty years ago and I can tell you for sure I did not want anyone in there with me besides my husband. My mother came in briefly; nice to know she was in the waiting room, but there was no reason for her to be in the delivery room. A friend's step daughter had her step and bio parents (two sets) as well as her husband - all watching while she delivered the baby. They thought it was a wonderful experience although the father of the new mother was a little uncomfortable. Our daughter-in-law had a doula. I wasn't particularly keen on it. In the end she had a c-section but while in labor the woman helped with various techniques. I respected and understood that our DIL did not want her in-laws with her and her own mother was apprehensive and would not have been much help. It was a high risk pregnancy to begin with. Our son was put off by the doula by the end; felt she made his wife more confused when the doctors recommended the c-section but also felt that initially she helped.
2
IndieGirl-
If it really is a problem of, as you say, "the breakdown of extended families and misplaced priorities", why should any ONE woman have to pay the price for all of that? And at a time when she is giving birth, no less? Come on!
As far as "Where is your husband/mother/sister/aunt/friends", allow me to point out a few very common scenarios in our society that you seem to have overlooked in your rush to judgement:
Women who become widowed during their pregnancies (many of the military families in this country have experienced this);
Women who, through no fault of their own, don't have a husband or a partner that can be present for the birth;
Women who have already lost their mothers, or whose mothers don't want, or can't be, involved with the birth;
Women who have no sisters;
Women who lack friends that want to walk the road of childbirth with them (not every person is capable of doing this, even if they are well meaning and caring).
That's A LOT of women. More specifically, that's a lot of women that still need support during childbirth, despite your confusion about how they came to find themselves in that position. To these women, having ANYONE there that is willing to support them through the birth process is a far cry better than having no one there at all.
What may be strange to you may in fact be the only thing that allows these women to get through a very difficult time.
If it really is a problem of, as you say, "the breakdown of extended families and misplaced priorities", why should any ONE woman have to pay the price for all of that? And at a time when she is giving birth, no less? Come on!
As far as "Where is your husband/mother/sister/aunt/friends", allow me to point out a few very common scenarios in our society that you seem to have overlooked in your rush to judgement:
Women who become widowed during their pregnancies (many of the military families in this country have experienced this);
Women who, through no fault of their own, don't have a husband or a partner that can be present for the birth;
Women who have already lost their mothers, or whose mothers don't want, or can't be, involved with the birth;
Women who have no sisters;
Women who lack friends that want to walk the road of childbirth with them (not every person is capable of doing this, even if they are well meaning and caring).
That's A LOT of women. More specifically, that's a lot of women that still need support during childbirth, despite your confusion about how they came to find themselves in that position. To these women, having ANYONE there that is willing to support them through the birth process is a far cry better than having no one there at all.
What may be strange to you may in fact be the only thing that allows these women to get through a very difficult time.
20
It also speaks to the fact that people don't necessarily remain in their hometowns for the rest of their lives; with family members scattered across the country, it's increasingly possible for Mom to drive over as soon as the first labor pangs arrive.
It also speaks to the fact that women are having children later and later in life, when their mothers may not be able to come to a birth.
Who are you to say that these people have "misplaced priorities?"
It also speaks to the fact that women are having children later and later in life, when their mothers may not be able to come to a birth.
Who are you to say that these people have "misplaced priorities?"
1
I just saw my nephew who's an OB-GYN resident, and he's really down on midwives and doulas. Says they have to clean up the mess when home births go wrong so he's not a fan. I pointed out that he only sees the ones that go wrong, and asked "What about working as a team," and he just stared at me. Sigh. Meanwhile he's at a med center with a C-section rate 25% higher than the state average, which he attributes to litigiousness and the risks of VBAC. Lost another one.
15
What does he think about certified nurse midwives who work in hospital settings and doulas who accompany women to hospital births? Does he only think midwives and doulas do home births?
1
When a woman having a home birth with a midwife races to the hospital when something goes wrong and the baby and/or mother dies, the death is attributed to the hospital, not the midwife, so there is no way to know how many home births result in deaths.
It is not like the midwives would advertise this statistic.
That said, birthing chambers in hospitals for midwives and women is not a bad idea, as some normal labors can last for 24 hours or more and there is no reason to waste the time of medical doctors when everyone is simply waiting for nature to take its time.
It is not like the midwives would advertise this statistic.
That said, birthing chambers in hospitals for midwives and women is not a bad idea, as some normal labors can last for 24 hours or more and there is no reason to waste the time of medical doctors when everyone is simply waiting for nature to take its time.
4
You do understand that c-section rates depend on how many high risk patients a hospital has, right?
8
A friend of mine was just lamenting that he can't come up with the money for a subsidized ACA plan. If an expectant mother wants to pay someone to hold their hand, great, but this is not a medical expense and it should not be covered by medical insurance or Medicaid.
50
Thanks, I was about to post the same. We are struggling as a society with providing MINIMUM care to all citizens, and yet here you have spoiled upscale urban women demanding YET ANOTHER layer of medical care, from unlicensed non-professionals (!!!) who expect to be paid nearly as much as a OB-GYN -- for hand-holding and massages and positive encouragement.
Get it from your spouse, your mother, your best friend. Don't ask society to pay for this indulgence!
My god! and people wonder why our health care costs are so high.....
Get it from your spouse, your mother, your best friend. Don't ask society to pay for this indulgence!
My god! and people wonder why our health care costs are so high.....
2
The first time I ever heard about doulas was in an article in the Times a few years ago. The term was used in an article, with no explanation, as if everyone know just what they were, ie, "as I was interviewing for potential doulas..."
To me, a doula is like a nanny. That's fine, if you want one and can afford it. But insurance doesn't pay for nannies and it shouldn't pay for doulas.
To me, a doula is like a nanny. That's fine, if you want one and can afford it. But insurance doesn't pay for nannies and it shouldn't pay for doulas.
72
For what it is worth as a practicing anesthesiologist I have usually enjoyed working with doulas. I work in a rural, underserved setting and many of the doulas I have met work with poor single Moms who are half frightened to death. The doula can be a resource for information for the mother and provide emotional support that some of them might not get otherwise. I do believe that there is some local funding available to pay the doulas here as they certainly don't get paid by insurance or Medicaid. A far cry from the Kale chomping uberachievers discussed in the artilce !
5
Remember that wealthy white women in urban hipster enclaves, ALSO WANT to have "the government" pay for nannies and upscale day care and pre school and private school and after care and oh yeah -- free college! -- and of course costs do not matter, and don't they do this in Sweden?
1
If doulas can be shown to reduce the cost of births, by reducing interventions, their services should definitely be covered by insurance. It seems like it would be worth doing a study to examine this.
14
It has been studied, http://evidencebasedbirth.com/the-evidence-for-doulas/.
Twenty-two trials involving 15,288 women met inclusion criteria and provided usable outcome data. Results are of random-effects analyses, unless otherwise noted. Women allocated to continuous support were more likely to have a spontaneous vaginal birth (RR 1.08, 95% confidence interval (CI) 1.04 to 1.12) and less likely to have intrapartum analgesia (RR 0.90, 95% CI 0.84 to 0.96) or to report dissatisfaction (RR 0.69, 95% CI 0.59 to 0.79). In addition, their labours were shorter (MD -0.58 hours, 95% CI -0.85 to -0.31), they were less likely to have a caesarean (RR 0.78, 95% CI 0.67 to 0.91) or instrumental vaginal birth (fixed-effect, RR 0.90, 95% CI 0.85 to 0.96), regional analgesia (RR 0.93, 95% CI 0.88 to 0.99), or a baby with a low five-minute Apgar score (fixed-effect, RR 0.69, 95% CI 0.50 to 0.95). There was no apparent impact on other intrapartum interventions, maternal or neonatal complications, or breastfeeding. Subgroup analyses suggested that continuous support was most effective when the provider was neither part of the hospital staff nor the woman's social network, and in settings in which epidural analgesia was not routinely available. No conclusions could be drawn about the timing of onset of continuous support.
Twenty-two trials involving 15,288 women met inclusion criteria and provided usable outcome data. Results are of random-effects analyses, unless otherwise noted. Women allocated to continuous support were more likely to have a spontaneous vaginal birth (RR 1.08, 95% confidence interval (CI) 1.04 to 1.12) and less likely to have intrapartum analgesia (RR 0.90, 95% CI 0.84 to 0.96) or to report dissatisfaction (RR 0.69, 95% CI 0.59 to 0.79). In addition, their labours were shorter (MD -0.58 hours, 95% CI -0.85 to -0.31), they were less likely to have a caesarean (RR 0.78, 95% CI 0.67 to 0.91) or instrumental vaginal birth (fixed-effect, RR 0.90, 95% CI 0.85 to 0.96), regional analgesia (RR 0.93, 95% CI 0.88 to 0.99), or a baby with a low five-minute Apgar score (fixed-effect, RR 0.69, 95% CI 0.50 to 0.95). There was no apparent impact on other intrapartum interventions, maternal or neonatal complications, or breastfeeding. Subgroup analyses suggested that continuous support was most effective when the provider was neither part of the hospital staff nor the woman's social network, and in settings in which epidural analgesia was not routinely available. No conclusions could be drawn about the timing of onset of continuous support.
10
Insurance companies don't care about reducing costs in the aggregate, quite the opposite. Their margins are set by the gov't now, so they want overall spending to go up - that's the only way they can increase their profits.
1
My son would have been born dead or at least severely mentally impaired if my very experienced doctor hadn't intervened and insisted on a C-Section. The umbilical cord was wrapped around his neck 3 times and with every contraction his heartbeat became irregular. He needed to come out and fast - and he did and he is a very fine and healthy young man. I look at all this nonsense and just shake my head. You play with your childrens' lives if you wish, I chose otherwise, with no regrets and only graditude at what modern medicine can accomplish when used properly.
84
Ditto my niece (five times and she did sustain brain damage), but I am not anti-midwife and doula. I just want them all working as team with the OB in the hospital, not delivering at home.
10
Obviously, you have no idea what a doula actually does. "They offer tactics to help women manage the pain of labor, as Lamaze breathing classes did to a previous generation. They are familiar faces and patient advocates in a situation where the patient may be meeting the nurses or the obstetrician on call for the first time during the birth. They also consult on prenatal subjects like nutrition and postpartum challenges like breast-feeding." Exactly what about that strikes you as nonsense? The fact that you had a high-risk birth resulting in a medically necessary cesarean is absolutely irrelevant to this discussion. Your negativity demonstrates just how little you actually comprehended about the article, and I can only hope your future daughter in law doesn't have to deal with you in her labor room.
7
I am sorry your birth experience was intense and of course I am happy your son is healthy and fine. I obviously do not know the details of your birth. However, it is discouraging to hear time and again "my baby would be dead if my doctor didn't save him/me!". This perspective is often simply uneducated and fear based, and the reality is that interventions could have been avoided and with better results. The nuchal cord is a great example (cord wrapped around baby's neck). As a doula I have witnessed many births with nuchal cords, which are pretty common. Evidence based research supports a non-interventionist approach, certainly as a first step. When baby's head is born and the cord is wrapped (even 3 times), a skilled caregiver can first attempt to simply unwrap the cord and summersault baby out. I have witnessed this several times under midwifery care and at home births. At hospital with docs, I see the cord cut immediately (cutting off baby's only source of oxygen rich blood); then, and as a result of cutting it DOES become urgent to get the baby out - big episiotomy and pulling out the baby . As a doula I am not medically trained nor do I claim to be. But I am educated and I read the research, and witness many births in a wide variety of circumstances with different care providers, home and at hospital, so I connect the dots pretty well.
http://midwifethinking.com/2010/07/29/nuchal-cords/
http://wholepregnancy.org/index.php?id=articles_more&moreid=11
http://midwifethinking.com/2010/07/29/nuchal-cords/
http://wholepregnancy.org/index.php?id=articles_more&moreid=11
35
Well said Mary! We are expecting this month and have a Doula for the reasons mentioned in the article: over-medicalized birthing practices and cold, impersonal hospital environments that we don't entirely trust. We would prefer to birth at home, but live in a state that has somehow made this illegal! (While we wouldn't mind acting as scofflaws in this particular instance--we had trouble finding mid-wives that would.) I think most of the 'outraged' responses so far are misdirecting their ire: Doula's provide consultation and connection in perhaps the most emotionally fraught experience of many women's (and men's) lives. These are middle class women humanizing an alienating process that many increasingly distrust because procedures are recommended primarily for the convenience of the institution rather than the health and wellness of the mother or child. This holistic experience is precisely what is lacking in mainstream medicine. Those concerned about costs should look to single payer models instead and examine the bloated profits that flow to insurance providers--not middle class positions that re-humanize birth.
25
They are ignorant people without a medical degree. Pay for them yourself if you want but do not as the rest of us to pay for your emotional luxury.
32
Paul: '...We are expecting this month and have a Doula for the reasons mentioned in the article...'
Must be your first child.
Must be your first child.
6
Josh, why don't you experience childbirth, and then comment on "emotional luxury."
4
Doula's offer no real benefit. Midwives however offer a great deal of proven benefit. Midwives have been shown to reduce, sometimes dramatically, the rates of C-section and have been shown to decrease infant mortality in undeserved and rural communities. Midwives work with doctors and are medically trained. An informative article about them would be nice. Doula's however offer no benefit and are thus useless.
15
'...Midwives have been shown to reduce, sometimes dramatically, the rates of C-section...'
Because when a C-section is required, the midwife and woman race to the emergency room and it is no longer considered a home birth, so the midwife takes it off her references and any and all blame for things that go wrong are blamed on the hospital.
Nice scam.
Because when a C-section is required, the midwife and woman race to the emergency room and it is no longer considered a home birth, so the midwife takes it off her references and any and all blame for things that go wrong are blamed on the hospital.
Nice scam.
13
Just remember that certified nurse midwives are nurses with additional training and certified professional midwives do not need any medical training-just a high school diploma and apprenticing with another certified professional midwife.
2
Doula, n., a woman paid big bucks to take the call button out of your hand if you try to ask for an epidural, and whose presence is meant to communicate to your doctor(s) and nurse(s) that you trust them as far as you can throw them.
62
I worked as a doula for years, providing both labor and postpartum support. I know how much my patients appreciated having a supportive advocate with them during what was for many the most stressful situation they had ever been in. Labor is an intensely private experience taking place in an extremely non private atmosphere, so having an experienced doula (one who had given birth and attended births) was a source of great comfort to my patients. My job was never to contradict the medical professionals, but to make the experience more holistic and personal. The same was true for post partum work- I was there to support, not take over. A good doula is an invaluable resource, and one which every family could benefit from. Let the state regulate doula training, and insurances should certainly cover the cost- because in the long run, it will be a cost saver, I have no doubt.
15
Women should pay for a BFF themselves, as that is all a doula is, a replacement for their mother or aunt.
7
Do these women have husbands? Sounds like in the one family mentioned, the husband was only involved in the conception.
I had my first child nearly 45 yrs ago and did Lamaze. My husband and I went to weekly Lamaze classes at the hospital for 8-10 weeks prior to the birth and HE was my doula. When our son was born (after a 24 hr labor!), I truly felt as if WE had just delivered a baby! The women who taught the Lamaze (all nurses at that hospital), were a huge resource about breastfeeding as well. One delivered her 3rd child a day before I did, and while still in the hospital (5 days AFTER the day of delivery), she helped me with nursing issues and gave me her home number for later, which I did use. No paid lactation consultants needed!
If husbands help make that baby, the least they can do is help their wife have that baby and be her coach. If they're not up to that, I don't give that marriage much of a chance, to say nothing of the ability of the father to be a good parent.
I had my first child nearly 45 yrs ago and did Lamaze. My husband and I went to weekly Lamaze classes at the hospital for 8-10 weeks prior to the birth and HE was my doula. When our son was born (after a 24 hr labor!), I truly felt as if WE had just delivered a baby! The women who taught the Lamaze (all nurses at that hospital), were a huge resource about breastfeeding as well. One delivered her 3rd child a day before I did, and while still in the hospital (5 days AFTER the day of delivery), she helped me with nursing issues and gave me her home number for later, which I did use. No paid lactation consultants needed!
If husbands help make that baby, the least they can do is help their wife have that baby and be her coach. If they're not up to that, I don't give that marriage much of a chance, to say nothing of the ability of the father to be a good parent.
65
Most husbands have never seen childbirth. Most husbands have also never seen their wife in mind-blowing pain, clawing and moaning like an animal, while people in scrubs run around and machines beep everywhere. Most husbands are (rightfully) completely out of their element emotionally and cognitively during childbirth. A doula, on the other hand, has seen these things many times and is able to be a calming and helpful presence.
7
When our son was born (after a 36 hr labor!), I never felt as if WE had just delivered a baby.
Women get pregnant, not men, and women deliver the baby, not men.
Can't women even this without giving men credit?
Women get pregnant, not men, and women deliver the baby, not men.
Can't women even this without giving men credit?
3
Well, you did the work! But I agree that it's better, if possible, for the man to be involved. Husband, parents, sisters, sisters-in-law. All better than a doula, if were making the call. :)
When my daughter was only 5 days old, I was away from family, overwhelmed and having a hard time getting her to nurse. Phone calls to LaLeche League went unanswered and in desperation I found a doula in the local phone book. (After all, this was Santa Cruz, California in the early '90's) An angel showed up at my door, helping my daughter to latch on for nursing, and then noticed that she was jaundiced (by holding her up to a window and noticing her yellow skin color). She also gave a stern but gentle admonishment to my partner to keep things quieter in the home. I will never forget her strong comforting presence at this scary time of my life. My daughter, now 22, is now considering the doula profession. I couldn't be happier.
25
Sad that you had no family or friends close by or that you partner was not helpful, but why again should others pay for your doula, your BFF?
7
NM - one could make the same claim for counseling services. why should anyone pay for someone to be their emotional support BFF? regardless, your comments in this forum show that this is not about who pays, but some issue with women and doulas.
Oh what an easy target upper middle class NY women are, right? So easy to mock for their kale eating, yoga taking, doula employing! They ought to wilt under society's side eye, and be ashamed of their faddish choices.
Because it couldn't possibly be that these women have found something that actually helps them through the most physically and emotionally exhausting experiences of their lives, right? If we mark this as the "latest wave," then we don't ever have to critically examine how US birth culture tends to ignore women's voices and agency. We don't have to look at why women want someone who advocates for them in the midst of: "get the epidural, an episiotomy is necessary, do what I say or you're risking your baby's life." We don't have to look at the medical evidence - when women are under high stress, labor does not progress well, and when women are supported by a companion, labor is faster with fewer complications. And we certainly don't have to look at how birth companionship has a long and global history of (mostly) women supporting women.
By all means, let's get right to dismissing this and moving on to the next fad.
Because it couldn't possibly be that these women have found something that actually helps them through the most physically and emotionally exhausting experiences of their lives, right? If we mark this as the "latest wave," then we don't ever have to critically examine how US birth culture tends to ignore women's voices and agency. We don't have to look at why women want someone who advocates for them in the midst of: "get the epidural, an episiotomy is necessary, do what I say or you're risking your baby's life." We don't have to look at the medical evidence - when women are under high stress, labor does not progress well, and when women are supported by a companion, labor is faster with fewer complications. And we certainly don't have to look at how birth companionship has a long and global history of (mostly) women supporting women.
By all means, let's get right to dismissing this and moving on to the next fad.
150
Everything new has happened before. I was a midwife for my friend in 1970 when she chose to have the baby at home. After the birth it became obvious that she needed a doctor and her husband rushed her to the hospital while I stayed with the baby. She had two children previous to this without problems and had prepared for this event with support from family, friends, yoga, Lamaze classes, etc. We are all different and each birth can be different. Fads can be dangerous without a good backup plan. My friend survived.
13
Why all the dramatics over birth? Every person walking around today got here through that process, the vast majority without a doula.
19
By all means, let's get right to dismissing obstetricians. Their advice is surely nonsense. Like advice to get vaccines, right? (eye roll).
15
Doulas can be a very important source of comfort and support for mothers who might otherwise feel isolated and unsure of the birth process. There is considerable empirical evidence of their effectiveness in promoting breastfeeding and improving the family's comfort and satisfaction with the birth process, as well as a host of other outcomes, including reductions in c-sections. There is emerging evidence from cost-benefit analyses that doulas can save the health system money (such as through reduction in c-sections where possible), which adds to the argument that they should be considered for insurance coverage.
28
A nurse-midwife can do the same thing. The important difference is that she has had medical training, which a doula has not.
11
Not everyone has the opportunity to use a midwife, Spencer, and in fact, many nurses know nothing about breastfeeding, including those in the hospitals when each of my two children was born. I'm still grateful to the doula we used when my older child was born, 14+ years ago.
4
In Oregon I could complete a 4 day doula course, attend 5 births, and then apply to be on Oregon's Traditional Health Workers (THW) registry and attempt to get insurance to pay for my services. Minimum of 20 hours of continuing education every three years.
Certified nursing assistants in Oregon require a lot more training and supervision.
So why exactly should insurance cover someone who basically acts as a friend who had a 4 day workshop and was in the vicinity of a grand total of 5 childbirths?
Certified nursing assistants in Oregon require a lot more training and supervision.
So why exactly should insurance cover someone who basically acts as a friend who had a 4 day workshop and was in the vicinity of a grand total of 5 childbirths?
129
Because there are many women having babies who do not have anyone to act as a friend.
19
Women used to give birth surrounded by the women of their families and friends, in their homes. Obviously, safety-wise, hospitals are an amazing and vital part of the birth process now, but I have to think that some of the trend towards home births and hiring doulas is partly due to the impersonal, at times downright cold, atmosphere that surrounds mothers giving birth in hospitals, the most vulnerable position they've likely ever been in. Births are hurried along or c-sections are pushed to clear beds, there is almost no faith in or support for mothers who want to try to go at it without drugs, mobility is often limited - given all of those things, it's not surprising that women who can afford it would want an experienced person to be by their side to give them support and make them feel safer and more in control. It's a shame that they have to hire someone to do that.
55
Ah yes, the good old days....
Cold, you say? Try thinking of cold in its literal definition. Because women and babies certainly were cold in those good old days you miss so much. Especially in February in the Northeast. So cold that they sometimes did not survive.
Women today in the First World have no idea how good they have it.
Cold, you say? Try thinking of cold in its literal definition. Because women and babies certainly were cold in those good old days you miss so much. Especially in February in the Northeast. So cold that they sometimes did not survive.
Women today in the First World have no idea how good they have it.
9
And do the *men* in the first world have any idea how good THEY have it?
2
The healthcare industry is a highly regulated meritocracy for a reason. Untrained self appointed people fitting more into the mold of wedding planners or chauffeurs should have no special place in guiding or assisting medical care.
85
I don't think that's fair. I planned my own wedding and drive my own car, but when I had my son six years ago, I had a doula, and she offered me support I couldn't provide myself. Do you really think she's akin to someone's who hired just because the employer is too "good" or lazy or busy to drive himself?
When I was in labor, the nurses were nice and talked to me, but there were two shift changes (so I had three different nurses), and while I was my doula's only patient, I was one of several for them. My husband did the best he could, but he was as tired and inexperienced as I was (in other words, the blind leading the blind).
Perhaps not every woman in labor wants or needs to have the same experienced person present and committed to her for 16 hours, but I was in an unfamiliar hospital (a half-hour tour of a birthing suite does not familiar make) among strangers. The $500 I spent on a doula was the best $500 I've ever spent.
When I was in labor, the nurses were nice and talked to me, but there were two shift changes (so I had three different nurses), and while I was my doula's only patient, I was one of several for them. My husband did the best he could, but he was as tired and inexperienced as I was (in other words, the blind leading the blind).
Perhaps not every woman in labor wants or needs to have the same experienced person present and committed to her for 16 hours, but I was in an unfamiliar hospital (a half-hour tour of a birthing suite does not familiar make) among strangers. The $500 I spent on a doula was the best $500 I've ever spent.
49
Just don't ask the rest us to pay for it.
10
Great, as long as you pay for it yourself.
8
"I had to pay for my Doula out of pocket" is the epitome of first world problems. How about we spend the money on prenatal care for poor women, where you'll get actual results?
While we're at it we should start subjecting the alternative birth movement to the same scrutiny that the anti-vaxers are getting.
While we're at it we should start subjecting the alternative birth movement to the same scrutiny that the anti-vaxers are getting.
95
I agree doulas are often a luxury reserved for the well-off and that our country would be wise to provide better care (on every level) to indigent people, but how are people who chose to use doulas and mid-wives remotely analogous to the anti-vaccination folks? In what way are they unnecessarily endangering other people's health?
26
I wouldn't be so quick to lump together "anti-vaxers" and "alternate birth movement" folks (whatever they might mean). Hospitals and many OBs tend to emphasize cesareans and play down the risk because a surgery, even a major abdominal surgery, which a C-section is, because it appears to be more under the control of medical personnel than does a vaginal birth-- one in which medical professionals must wait around for the human body (a women's body no less!) to take over. The WHO recommends an optimal C-section rate of 5-10% to ensure that women who actually need them, get them. The rate in the US is about 30%, meaning that there are people getting unnecessary surgeries, with all the attendant complications from a very invasive procedure. Most mainstream health organizations no longer recommend C-sections as the rule, but only the exception.
36
Rachel, they're endangering their newborn child's health. Is that not another person?
9
Once again, US, get with the real "family values" program like the rest of the civilized world! In many European countries insurance companies and/or the state support such care. In the UK, 3 "home visitors" automatically came to my home after I gave birth to support me and my newborn both physically and mentally (including breast-feeding support). I had not even contacted them.
In Germany, my SIL's very attentive midwife pre and post-birth was completely covered by her insurance.
A friend of mine in the US is struggling to have her very successful and much more financially efficient home birth covered by her insurance, which previously may have done so (before Obamacare).
It's not that NY is a lonely place to give birth, but all aspects of child-bearing are a great challenge to parents who don't have time to reach out when help is needed. In the past we had had family and/or community support hovering over new moms. This we seem to have lost.
It's outrageous and shameful that women in the US cannot be trusted or reimbursed for their birthing choices to bring life into this world. Good luck to all dedicated doulas and new moms out there!
In Germany, my SIL's very attentive midwife pre and post-birth was completely covered by her insurance.
A friend of mine in the US is struggling to have her very successful and much more financially efficient home birth covered by her insurance, which previously may have done so (before Obamacare).
It's not that NY is a lonely place to give birth, but all aspects of child-bearing are a great challenge to parents who don't have time to reach out when help is needed. In the past we had had family and/or community support hovering over new moms. This we seem to have lost.
It's outrageous and shameful that women in the US cannot be trusted or reimbursed for their birthing choices to bring life into this world. Good luck to all dedicated doulas and new moms out there!
71
Trusted? Why, when so many people exhibit such an appalling lack of understanding of basic science that half the country is on useless nutritional supplements, and in some private schools, more than half the kids aren't vaccinated?
If someone wants to do something stupid, risky, and self-indulgent like giving birth at home, they should pay for it on their own dime, not on the public's.
If someone wants to do something stupid, risky, and self-indulgent like giving birth at home, they should pay for it on their own dime, not on the public's.
21
A health visitor is NOT a doula. A health visitor is a nurse or midwife who has undergone additional training in the profession of health visiting. Sadly home visits have been cut in recent years. Some insurers in the US, and some public health programs, also have visiting nurse services.
8
But what if there is an unforeseen PROBLEM? Not all births go according to plan, and all of my hospital deliveries were in the midst of wonderful, caring people. The health and safety of my child is not worth the hand- holding of someone who has little experience. Ahh, the good old days when women routinely died in childbirth, surrounded by family and friends! (Just go by any old cemetery....)
No thanks.
No thanks.
5
I good friend of mine had a Doula. In the end, her only function was to terrify her about C-Sections even after she had been in labor for far too long, and a C-Section was clearly indicated by any standard.
Given that they function more like a level-headed friend than anything else, (and they have nothing but informal credentials) I would not agree with them being covered by government-provided insurance.
Given that they function more like a level-headed friend than anything else, (and they have nothing but informal credentials) I would not agree with them being covered by government-provided insurance.
134
If doulas were certified or, ideally, provided by the hospital, this wouldn't happen, which is the whole point of this article. My $300 doula saved me about $10,000 in anaesthetics, which I was ready to try before she arrived and took all the pain and stress away.
1
A doula is nice to have.
A doula is not a health care provider, but more of a luxury item for those who want additional support. Let's not spend precious health care dollars on the affectations of the rich, while poor people are dying because of inability to access medical care when they are ill.
A doula is not a health care provider, but more of a luxury item for those who want additional support. Let's not spend precious health care dollars on the affectations of the rich, while poor people are dying because of inability to access medical care when they are ill.
164
Actually, women of every race and income class are dying from the huge gaping hole in maternity care in the US. The Doula Report, will help you understand these disparities. https://choicesinchildbirth.org/wp-content/uploads/2014/10/Doula-Report-...
The benefits of doula care are strongly supported in the medical literature.
• In 2013 a Cochrane Database systematic review of 23 individual studies concluded that “all women should have continuous support during labour,” and that trained doulas are the most effective at providing continuous labor support.3
• A 2008 study in the American Journal of Obstetrics and Gynecology concluded that doula support was among the most effective of the 41 birth practices reviewed – one of only three to receive an “A” grade.4
• A joint statement of the American College of Obstetricians and Gynecologists and
the Society for Maternal-Fetal Medicine released in February 2014 found that
continuous labor support is among “the most effective tools to improve labor and
delivery outcomes” and is likely underutilized.5
Doula care has been found to improve birth outcomes and reduce health disparities. Substantial evidence demonstrates that doula support increases the likelihood of safer, healthier, and more satisfying birth experiences.
The benefits of doula care are strongly supported in the medical literature.
• In 2013 a Cochrane Database systematic review of 23 individual studies concluded that “all women should have continuous support during labour,” and that trained doulas are the most effective at providing continuous labor support.3
• A 2008 study in the American Journal of Obstetrics and Gynecology concluded that doula support was among the most effective of the 41 birth practices reviewed – one of only three to receive an “A” grade.4
• A joint statement of the American College of Obstetricians and Gynecologists and
the Society for Maternal-Fetal Medicine released in February 2014 found that
continuous labor support is among “the most effective tools to improve labor and
delivery outcomes” and is likely underutilized.5
Doula care has been found to improve birth outcomes and reduce health disparities. Substantial evidence demonstrates that doula support increases the likelihood of safer, healthier, and more satisfying birth experiences.
17
RS, take a look at the Caesarean rate over the last two decades and go hide your head in shame. The money being squandered on unnecessary medical interventions during labor is the money that could be better spent, not money spent on somebody who is actually helpful to the natural birth process (hint: nurses seldom are as helpful, though they just follow orders from the hospitals they work in, and doctors are barely even involved until the end).
When does a doctor show up to a birth? When it's time to pull on something or cut something. When does a doctor not show up? When one doesn't follow his or her "preferred birthing guidelines" about inducing "late" babies or submitting to Caesarean section without a trial of labor first for a baby that is "too big." That's right; ob-gyns can and will fire pregnant mothers for laboring naturally!
Let doulas coach women through childbirth and it will save money, not "squander it."
When does a doctor show up to a birth? When it's time to pull on something or cut something. When does a doctor not show up? When one doesn't follow his or her "preferred birthing guidelines" about inducing "late" babies or submitting to Caesarean section without a trial of labor first for a baby that is "too big." That's right; ob-gyns can and will fire pregnant mothers for laboring naturally!
Let doulas coach women through childbirth and it will save money, not "squander it."
6
I've had doctors who were excellent about not pushing drugs, a midwife who barely paid attention, a nurse who taught my husband how to massage my legs so labor was much easier ... three births, three very different experiences. Walking into a hospital with no prep, I can't imagine how awful it would be.
Are there any studies showing doula care vs none vs just friends and family, normalizing for cildbirth classes?
Are there any studies showing doula care vs none vs just friends and family, normalizing for cildbirth classes?