Are Doulas Just for Natural Birth?

I can’t use the phrase “white hippie witch” without a shoutout to Stevie Nicks.

Misconceptions about birth doulas abound. Ever heard Ali Wong’s bit about doulas? (Spoiler: I don’t even like quinoa. Marci might, though. I speak only for my own taste.)

White hippie witch or no, I spend a lot more time reading Evidence Based Birth than I do perfecting my quinoa recipes.
(Seriously though, I ate it once on my first foray into Paleo, ten years ago, and thought it was gross. Has it improved?)

I SWEAR I HAVE A POINT. Lots of them, in fact. Here’s my point for today: Doulas are not just for natural birth.

I say again, DOULAS ARE NOT JUST FOR NATURAL BIRTH.

Here’s why:

1. Nobody actually knows what that even means. I’m not trying to be cheeky (for once). Natural birth is neither a technical medical term nor one with an accepted colloquial standard. Wikipedia gives a pretty good overview, but concepts like “routine medical interventions” vary depending on the time and place in which a birth occurs.

Perhaps you are thinking “Um hello, obviously natural means without medication.” But, many women describe their birth as natural despite having a vaginal birth that was induced or augmented by pitocin. (I’ve witnessed birthworkers arguing over this distinction as well.)

Now, you’re rolling your eyes. “I meant pain medication.” Well, what about the women who describe their births as natural because they eschewed an epidural… but used IV pain medication for therapeutic rest, or nitrous oxide for pushing? Or hell, what about the women who relaxed in early labor with a glass of red wine?

Maybe by natural you mean vaginal. In western society, it isn’t popular to use proper terms for genitalia, so we like to use euphemisms. (Protip: When you’re looking for a specific comedy clip, Googling ‘vulva vulva vulva’ will probably not get you there. Go ahead, ask me how I know this.)

Clearly I need to make one of these for #MeetTheDoulas.

Here’s where I’ll make a little side-argument: It’s at the core of our nature as mammals to secure our own survival and the survival of our offspring. In that sense, utilizing any means available and necessary to do so is a natural thing to do. While birthing via safe cesarean section wouldn’t happen without technology, it occurs due to the skills we’ve developed as a species. When other animals learn to use tools, we don’t kick them off of Animal Planet. Mind you, I’m not making an argument for a greater-than-necessary rate of cesarean sections. I’m just illustrating the point that concepts like natural are open for pretty broad discussion, depending on context.

So, hopefully we are now in agreement that there’s no agreement about what natural means in the context of birth. Let’s move on…

2. Instead of “doulas are just for natural birth,” let’s say the misconception is “doulas are only for women seeking to have a vaginal birth, without the use of any pain medication.”

Yes, the vast majority of our clients hire us intending to have a vaginal birth. There is no reason to sugar-coat that, because (in the absence of special circumstances) attempting a vaginal birth is the right choice for most women.

Beyond that, I’d say it’s a fairly even split between clients who prefer to avoid pain medication and those who plan to use it. In either case, we talk in advance about what those options look like, and what the best times are to optimize their efficacy. We also discuss non-pharmaceutical options for pain relief. Our goal is not to influence any client’s birth in the way we think it should go – it’s to load their toolbox and stack the deck in their favor so they have the best odds of achieving their preferences. As long as a client has the opportunity to offer fully informed consent (or refusal) for any procedure or intervention offered to her, I’m content.

3. To build on the last point, we talk often with our clients about birth plans versus birth preferences. For better or worse, I have never seen a birth go 100% according to “plan,” including my own, even when they turn out uncomplicated. Much of the work we do as doulas is helping clients determine their best-case scenario, next-best, next-next-best, and so on. Regardless of where those preferences begin, things change, and changing course with you is what we do. That isn’t to say we’re not going to work our butts off in pursuit of your preferences – just that our ultimate goal is your peace and satisfaction with the process.

We’ll talk soon in detail about what working with a Palouse Women’s Wellness doula looks like. In the meantime, know that our marker of a job well-done is not seeing a woman through a vaginal birth or one without pain medication. It is knowing that that woman, whether it is that day, a month, a year, or ten years on down the road, will look back on her birth and feel she was supported, respected, and heard. (I can’t speak to Marci’s quinoa preferences, but I will speak for her on that!)

Laurel

WHAT EVEN IS THIS STUFF!?

1 Comment

  1. I so look forward to working with you ladies during my child evacuation no matter what that ends up looking like. Also, I’ll have to bring you some quinoa Laurel.

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