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Expecting parents: What is a doula?

Wed Nov 19, 2008 5:26 PM EST
health, only-on-msnbc-com, labor, birth, experience, dads, sinatra, midwife, birthing
msnbc.com News — Marisa Belger, msnbc.com - Only on msnbc.com

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— By the eighth month of my pregnancy, I had become accustomed to the blank stares and raised eyebrows I received at each mention of my doula. Maybe it was the “doo” or maybe it was the “lah,” but there was something about the tone and feel of the term that rendered the uninitiated people in my life either instantly confused or quickly judgmental.

The former were usually unfamiliar with the concept of a doula, or trained birth assistant, while the latter often held a preconceived notion of what it is that a doula does — one such person going so far as to ask if my doula would be dancing around me with a rain stick while I breathed through my contractions.

If a rain-stick dance is what I felt I needed to enhance my birth experience, there’s a good chance that a doula would deliver. But my reasons for enlisting the services of a doula were much more simple, going back to the origin of the word.

Doula is Greek for “a woman who serves,” and when considering the best — i.e., speediest and least painful — way to give birth naturally, being served seemed like the only way to go. “A doula is trained in the psychological and emotional aspects of labor and birth and is also trained in common hospital procedures, interventions and physical comfort measures,” explains Debbie Young, president of DONA International, a doula-certifying organization founded in 1992.

Comfortable, safe and informed
At first glance, it may be challenging to see where a doula fits into the birthing process. An obstetrician or midwife monitors the physical health and safety of the mother and baby and is the one who actually catches the newborn. Nurses and other hospital or birthing center staff see to outstanding medical needs like pain control and induction. And husbands, partners, mothers, sisters and friends provide a warm and nurturing support system for the laboring women.

This leaves the doula to fill in the missing piece of the birth experience. Since they focus solely on nonmedical care, doulas can spend their energy comforting and encouraging the mother and her family and helping them navigate the slew of questions and decisions that often need to be addressed during labor and delivery. “When I’m working with parents as a doula I want my role to be uncomplicated by the clinical aspects of birth,” says Young. “I’m there to meet their emotional needs, physical comfort needs, to help them with information.”

Though I was prepared to utilize my doula wholeheartedly, our son surprised us by arriving three weeks early in less than three hours. He was practically born in the car on the way to the hospital and we were unable to connect with our doula in time. From the reaction of my midwife — who sprinted to the delivery room to catch our kid — my experience is not the norm. Most parents-to-be get to reap the benefits of the doula with whom they have been talking and planning for months.

Take Alison Sinatra. The 34-year-old new mother in Woodstock, N.Y., believes that her doula’s strength and experience helped her navigate a three-day labor ending in an unexpected Caesarean section. “My doula was about as essential as my midwife because she was the guardian of my birth experience,” Sinatra says. “She’s been to thousands of births and I had complete confidence in her. I totally trusted that she would guide me. I felt that no matter what happened I would be completely fine because she was there.”

Sinatra, a proponent of natural birth, was thrown off when faced with the possibility of a C-section after days of labor. “To make a clear decision in the throes of labor is nearly impossible,” she says. “When someone asks you if you want a C-section you might immediately opt for yes if you didn’t have an experienced doula to bounce the idea off of.”

Partners are people, too
When a baby is on its way, the mother and child are the obvious stars of the show, but dads and other partners are also in for a life-changing experience. Doulas recognize this fact and work to ensure that the nonlaboring members of the family stay involved and acknowledged.

“Most dads or other partners are probably not as familiar with birth as a doula is, and they are also emotionally tied to the birth process,” Young says. “Including a doula who has been through the process many times gives the birth partner the chance to participate at his or her own level. The doula can ask the partner, “Remember how much she liked it when you were rubbing her feet?” or the doula can rub the mother’s feet herself while the partner holds her hand. That way we allow the birth partner to participate in a way that makes them comfortable while recognizing that they too are having a baby today. And there are times when I’m rubbing a dad’s back or getting a dad a glass of water.”

Sinatra appreciated this dad-centric attention while she was in labor. “My doula was tuned in to both of us and helped us work together in a deeper way,” she says. “And sometimes your husband is not enough. It can be very important to have someone to relieve your husband if he gets overwhelmed or if he needs to step out to get a sandwich. An experienced doula can give you that comfort. She is your point person, your front guard.”

Visit dona.org to find an experienced doula near you and to discover what questions to ask during the interviewing process (e.g., What training have you had? What is your philosophy about birth? Do you have one or more backup doulas? etc.).

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InformedMama

I am angered and saddened after watching your article about the Doula Profession.  I believe that your article was extremely biased.  Of course doctors are not going to like anyone to question them! Medical professionals rarely handle birth from an evidence based perspective, consequently making many mothers feel insecure and scared. Doctors so rarely see normal births they treat every delivery as an event shrouded in danger  - this is not true!  Birth is NORMAL and NATURAL for most women.  There are going to be instances where medical intervention is absolutely necessary, however, that is just not the case in most births. Doulas can play a vital role in advocating for and reassuring both the expectant mother and her support network.      

The article suggested that expectant mothers should do their homework in regards to Doula care. I would suggest that mothers also do their homework in regards to the doctors and the hospitals they are going to deliver in.  Unnecessary C-section rates and maternal/infant complications due to medical overzealousness are increasing every year in this country.    

I believe that articles like the one broadcast today simply increase misperceptions surrounding birth and continue to contribute to the poor care that mothers are receiving in American maternity wards.

  • 4 votes
Reply#1 - Thu Nov 20, 2008 8:39 AM EST
Linda Bowles

I am the Director of Volunteer Services at UNC Health Care in Chapel Hill, NC and we have had an active volunteer Doula program since 2001.  These Doulas are not only certified by the DONA program but also are screened and processed as volunteers of the healthcare system.  Our program has never had any problems with a Doula and the professional medical staff because they adhere to the guidelines set by the hospital.  The relationship the doulas have with the L&D staff is excellent.  Our program will provide this service to any patient without cost.  It has been particulrly helpful for non-English speaking patients and patients who do not have family here to support them through the labor process.

  • 1 vote
Reply#2 - Thu Nov 20, 2008 9:10 AM EST
Olivia-679179

It concerns me that you say that the Doulas "adhere to the guidelines set by the hospital".  Does that mean they can't fully inform and help the patient make evidence-based decisions if it goes against what the hospital wants?  What happens when the patient goes against what the hospital says after hearing the doula?

    #2.1 - Thu Nov 20, 2008 9:59 AM EST
    Reply
    kmp96

    I, too, am sick and tired of the medical profession feeling like they can chastise women into making sure that they do whatever makes life easiest for the doctors and nurses.  Hey Today show, how about your do a real story on the state of birth in America.  How about you actually talk about why women feel the need to have a doula there. Talk about why the woman in that particular story did a homebirth for her second child.  Talk about how the US has an atrocious C-section rate with an abysmal outcome for mothers and children compared to many other countries - some of them developing nations.  I would find it absolutely refreshing if you would actually employ a few of those journalism skills you learned in college and report some real news.

    • 2 votes
    Reply#3 - Thu Nov 20, 2008 9:27 AM EST
    Courtney-736374

    I was greatly disappointed in the doula segment today.  As a labor and delivery RN and student nurse-midwife I was thrilled to see Today was going to talk about doulas. 

    It was a real disappointment to see the doctor featured imply that doulas cause babies to be born injured or die-- first off I would like to see one case where a doula was responsible for a poor outcome.  Secondly, the sad fact is that many obstetricians and hospitals have only their own interest in mind when imposing interventions on laboring women.  Frequently women are induced, augmented, and sectioned to save the hospital and doctor time and effort.  Of course the doctor does not wish to be questioned when her motives may not be pure, but women need to protect themselves. 

    A hospital that would ban doulas is CLEARLY not working in the best interest of women-- do they restrict the type of guests heart attack patients can have? If that doctor and the staff of the hospital were true professionals with the best interest of their patients in mind they would not restrict women's access to labor support or be insecure about a non-medical professional questioning their recommendations. 

    Women have the right to question their doctor or midwife's advice and make decisions for themselves.  This story is an example of what is wrong with obstetric practice in the US today and why we rank WORSE than most developed countries in perinatal mortality statistics.  I have worked in environments from a major academic medical center to a small community hospital and this treatment of women is pervasive.

    • 2 votes
    Reply#4 - Thu Nov 20, 2008 9:39 AM EST
    Reply
    Olivia-679179

    As a Doula I see far more doctors creating problems and bullying my clients than I cause problems.  I rarely speak to the medical staff, instead I give my client my full attention and help her to ask questions about the care she's receiving.  Some doctors and nurses should be grateful that women hire doulas because we are with them contiuously instead of out at a desk staring at a monitor.  Doulas trust birth, trust that the mother's body knows what to do and how to do it.  When you throw the medical profession in, they are trained to solve problems.  Most births, if left to happen in their own time, will have no problems to be solved.  As the Trust Birth Initiative says: "Birth is Safe, Interference is Risky".

    • 2 votes
    Reply#5 - Thu Nov 20, 2008 9:56 AM EST
    Krystal-736421

    I am a Doula and I have not and will not ever speak for my client or talk to the medical staff.  I simply do my best to explain the benefits, alternatives, and risks to my clients and encourage them to communicate with the medical staff.  Certainly, we will have bad Doula's - just like their are bad Dr's and Nurses but let's not throw the baby out with the bathwater here.  Let us now have a newspiece that reflects the daily corruption and completely unethical behavior of the medical staff.  I could write a book on what I have witnessed the medical "professionals" do.  Examples: How about a nurse explaining to her patient(my client) that the warnings/risks of a cytotec induction "are not true"; a Dr. ruptures my clients membranes without checking the babies position - the baby was breech and because of his hasty act(without the patient's permission or knowledge) this Dr. could not attempt to turn the baby and he ordered the c-section(my clients greatest fear - a near paralyzing fear); one of the best ones too is a nurse who demands to see me in the hallway(taking me from my client which is a big no-no for Doula's) and when we are in the hallway she begins to plead with me to get my client to get an epidural so that the patient is not uncomfortable anymore - the Nurse was the one uncomfortable- as she began to say to me that it is so hard for her to watch her patients be in pain when she could take that pain away!  This woman needs a new profession! My client was not complaining, she was not loud or screaming, she was simply a laboring woman going through the process nature intended, moaning gently and calmly with each contraction.  It was truly beautiful to watch this first time mom tune into her body and follow its lead.   Sadly, I could give many more examples but I think you get my point. 

    If you talk to nurses - you will find that on one hand they like the help a Doula can provide them with their patient load.  Let's face it, $ drives the hospitals so they don't have the staff needed to meet the needs of all the patients.  On the other they are frustrated because the reason they wanted to be a L&D nurse is to provide the care the patient is receiving from their Doula.  Nurses have had to become so completely engrossed with the machines and the Dr's and they didn't ask for this change.  So, their frustrations get misdirected and Doulas become the scapegoat for everything bad in the room.  Doula's are emerging again because needs are not being met not because we want to impose on someone's turf.  Really, who causes the incohesive team?  I think we all know the answer to that.

      Reply#6 - Thu Nov 20, 2008 10:13 AM EST
      Tank-736434

      I am so thankful for this service. I am 21 and was having my first baby, without family and mu husband. My husband was deployed to Iraq and was unsure if he's be home in time for the birth. I live 5 states away from my family and everyone i know was gone,cause their husbands were deployed also. So i was ALONE.. I had no idea what to expect or what to do and I got this service "just incase" They were willing to come at anytime of the day or night. Wheneveri called them. Thankfully my husband got home 4 hours before i went into labor, but if he didn't make it home they would of been my"support" So it may cost a bit of $ but overall well worth it under certain circumstances.

        Reply#7 - Thu Nov 20, 2008 10:25 AM EST
        Michelle-736488

        Once again. The TODAY SHOW is promoting the Doctors interest and maintaining relationships with their media sponsors and producing MORE bad "NEWS". I never watch the TODAY SHOW because neither Matt Laur or Katie Couric or any other of the "news" castors have the ability to offer the information in a non-biased way.

        I had two hospital births, both with many interventions and iotrogenic compications. After the second birth and being forced into decisions I did not want to make I took the leap and  I finally hired two doulas and a midwife and had a safe and intervention free birth at home twice! It wasn't luck that everything went well at home. It was because of competence and trainining.

        WOMEN WAKE UP! You are risking your life, your babies life and the future lives of other potential children walking into a hospital today to give brith to your baby. Your chances are 33% or higher depending on your doctor and hospital for getting a cesearean, if you get induced you increase that risk by 25%. (Having a big baby, is the biggest reason women are told they need to be indduced!)

        While it is true some doulas don't know how to naviagte the maternity ward and you should interview at least three doulas before making your choice, having a doula can actually save you money and your physical well being. Having a doula decreases the c-section rate and the rate of all other interventions drastically. Doctors don't want doulas present because that invites a third person into the room as another witness to the event!

        I agree do your homework. If your doctor doesn't like DOULAS then RUN RUN RUN. Why? Because they are practicing for their own interest and not in your interest!

        It is about money and liability, it is not about your safety or your babies. Go to the MARCH OF DIMES and research were AMERICA stands in infant mortality. Learn about the rising MATERNAL mortality rates more csections = more dead mothers!

        Go to CONSUMER REPORTS and learn what they did!

          Reply#8 - Thu Nov 20, 2008 10:57 AM EST
          Ann-736934

          The story that aired on The Today Show was flat-out wrong on several points:

          1. The main offering of a doulas is not her "doula bag" of massage tools. They provide real support and nurturing to the woman on a personal level, and they do everything in their power to make her comfortable and make birth an positive experience for the family.

          2. When you search for a doula, it is not their medical background that you should be researching--doulas do not pretend to be medical professionals!

          3. Doulas are not a "luxury" as stated by Dr. Snyderman. Different types offer different services, but they are worth the time and the money. In general, they are surprisingly affordable.

          Just as a hospital chaplain brings dignity to a person's leaving of this world, the birth doula imbues the labor and delivery room with a nurturing sense of peace upon your baby's arrival, and they deserve equal respect.

          Since giving birth in May, I have credited the united team of Birth Doulas of Pittsburgh, Midwives at Magee, and Magee Women's Hospital for a birth that was wholly satisfactory and empowering, and any other combination that lacked one member of this team would have denied me of this experience, truly one of the highlights of my life.

            Reply#9 - Thu Nov 20, 2008 2:48 PM EST
            jec-737078

            I am shocked and saddened by this piece on doulas.  NBC, I expected better.  The state of maternity care in the US is abysmal.  For a county with such advanced medical procedures, we have a horrible c-section and infant mortality rate.

            Women need to wake-up.  Most OBs and hospitals are not looking out for your best interests.  They are looking out for themselves.  Doulas are there to provide comfort and support to the laboring woman and her partner.  This is increasingly necessary, as hospitals cut L & D nursing staff. 

            Oh yeah, and Nancy Sniderman, I have to correct you.  The dr. and nurse are not the head of the L & D team.  The laboring Mom and baby are!  That comment shows how arrogant drs. have become.

              Reply#10 - Thu Nov 20, 2008 4:14 PM EST
              Elisha-737378

              I'm extremely disappointed in the Today Show for their doula segment today. It seems that anytime they report on an issue that doesn't jive with the mainstream. the story has a negative slant.

              What the Today Show forgot to mention are the statistics and studies about doulas that show that a doula's presence at birth tends to result in shorter labors with fewer complications, reduces the need for pitocin, forecepts or vaccuum extraction, and reduces the requests for pain medication, epidurals and C-sections.

              Although I'm sure that every doctor and many parents have had negative experiences with doulas, isn't this true of any and every profession... bank tellers, DMV employees, doctors, dentists, etc. Why do those few bad experiences have to give the entire profession a bad name?

              I'm giving birth in January and am looking to go the natural route (if it is possible) and have enlisted the services of a doula. Indeed, I am going through a birthing class through our hospital, but that only gives you so much preparation. We will have heard once the information on how to relax and make the labor process as smooth as possible. The doula has done int countless times. I would rather have her there as support in addition to my husband than just him.

                Reply#11 - Thu Nov 20, 2008 7:16 PM EST
                Kate Gordon-737468

                Once again, the media has failed in doing their homework. I'm disappointed that the doula profession was trodden down due to the doula's "lack" of medical training. A doula is not there to get in the way. A doula is someone who supports those experiencing childbirth, both the woman and her partner. It's even been documented the the presence of a doula or other labor support person reduces the use of unnecessary medical intervention in a woman's labor and delivery. Not because the doula is bullying or getting in the way of the medical staff, but because they offer nonmedical procedures such as massage, position change and other alternatives. Far less women that have a trained doula end up with painful episiotomies, c-sections, and epidurals.

                I again can only say I am extremely disappointed that the TODAY show would fail to recognize the doula as a real profession that provides real results for thousands of women across the country, myself included.

                I was able to get through a labor and delivery that was early and went incredibly fast. Not only was my doula calm and collected, but the nurses were the ones running around creating an anxiety filled room. It was my doula and partner that kept me focused on the experience. If I'd had to rely on the nurses, I would have had a much worse experience.

                I LOVE MY DOULA!!!!

                  Reply#12 - Thu Nov 20, 2008 7:52 PM EST
                  Colorado Bubbie

                  As an RN, I would be very grateful to have a doula's presence in the labor room. I do not work l and d, but I know that extra support, advocacy, and service is always a good thing for the patient. It is known that people get better faster, have better outcomes, and overall better experiences in the hospital with this kind of support.  And why would any medical professional, who has the BEST interest of the patient at heart, denounce such a gift?

                  This profession should be recognised as such..part of the patient care team.

                  • 1 vote
                  #12.1 - Tue Nov 25, 2008 1:32 AM EST
                  Reply
                  Debbie Young-737519

                  Marisa, thank you for your well researched and accurate portrayal of doulas in the companion piece to this morning's segment on doulas.

                  There were many points left unsaid in this morning's on-air piece and I realize that the time constraints of live TV are partly to blame.  Over 17 studies have been done on the real benefits of doula including shorting labor, reducing cesarean births, reducing the use of many interventions including epidurals, forceps, Pitocin, narcotics and more.  Having a doula at the birth also increases the parents ability to bond with their child and they rate their new baby as cuter and smarter than families who don't use a doula.  Women also tend to breastfeed sooner and longer in terms of months/years than mothers who do not use a doula.  There are so many intangible benefits to doulas that we will be able to see as time goes by.  The cost saving of just the identified benefits are so outstanding that a new study at ChildbirthConnection.org titled, "Milbank Report: Evidence Based Maternity Care" points out that doulas are among the best ways to reduce cost and increase safety in birth.

                  I appreciate the TODAY Shows willingness to tackle this issue and hope to see more accurate information presented on another segment in the future.

                    Reply#13 - Thu Nov 20, 2008 8:18 PM EST
                    SwaykinDoula

                    I'm disappointed, but not surprised. Ratings are all any network and news organization cares about. Over-sensationalizing a topic has been perfected by the media. There were absolutely NO STATISTICS in that report about how doulas at Reston Hospital Center caused harm to a mother or child. I would be interested to know what the c-section/intervention rates are at that hospital.

                    I applaud all the women commenting on this irresponsible report. I went into the birth of my child well-educated, birth plan in hand, doula by my side and came out 36 hours later, with little intervention and no epidural, completely satisfied with my experience (and I think a better mother for it).

                    The Coalition for Improving Maternity Services is compiling data from mothers about their birth and postpartum experiences at hospitals and birthing centers as we speak. Go to www.thebirthsurvey.com to fill out a survey on your experience. It's kind of like a consumer report on your providers and facilities. And no, I do not work for them, I just think it's an awesome idea!

                    I LOVE MY DOULA AS WELL (and she was recommended by my OB/GYN, so there are obviously doctors open to the concept). IN FACT, I LOVED WHAT SHE DID FOR ME SO MUCH, I BECAME A DOULA MYSELF.

                      Reply#14 - Thu Nov 20, 2008 8:24 PM EST
                      Jessica-737560

                      To the writers of the segment on Doulas,
                       
                      I am severely disappointed at the piece you have compiled regarding Doulas and their assistance in labors and deliveries.  It was clearly biased in the worst way.

                      Thank goodness you had the mom who LOVED her Doula and had the types of birth she had always wanted.  If you looked into her eyes, you could see the pride she had over her births.  And included in that pride, is the support she received from her Birth Doula. 
                       
                      If you had chosen to do any research, you could have found the statistics regarding the outcomes of births where a Doula is present. 
                      Research such as:
                      "Primary Results. Fourteen trials, involving more than 5,000 women, are included in the review.1The continuous presence of a support person reduced the likelihood of medication for pain relief (odds ratio [OR] 0.71, 95 percent confidence interval [CI], 0.62, 0.81); operative vaginal delivery (OR 0.77, 95 percent CI, 0.65, 0.90); cesarean delivery (OR 0.77, 95 percent CI, 0.64, 0.91), and a five-minute Apgar score of less than 7 (OR 0.50, 95 percent CI, 0.28, 0.87). Continuous support also was associated with a slight reduction in the length of labor." (taken from: )  There's much more research where this comes from.
                       
                      All that you showed was a nasty Doctor who had apparently had a bad experience with a Doula and choose to Ban them from Her one hospital.  I have never heard of anyone banning labor support; to do this would be ridiculous.  The Doctor from Virginia said that often Doulas "Created a Hostile Environment..."  SO ridiculous!  The whole goal of a Doula is to create a peaceful environment for the laboring mom.  We do everything we can to make her surroundings calm, serene and conducive to a beautiful experience.  And your doctor said we make labor rooms Hostile.  Unacceptable. To ban a woman's right to have a supportive person by her side is one of the more asinine things I've heard of to date.  And The Today Show found the one Hospital where it happened and decided to use it as their example.  Someone at your organization is trying to prove something.  But in the end it has only made you look silly and uninformed.  
                       
                      What you didn't show was what a real Birth Doula is really like.  She is a honest hearted woman who loves childbirth.  She has chosen to enter a role in her life where she doesn't need to have serious medical training, because we don't perform medical tasks.  The training is minimal, but complete.  We support women.  We inform women.  We mother a laboring woman.  That's what we do. 
                       
                      Doula's aren't mean people.  They aren't out to "get" anyone.  Your piece made Doulas look like the bad guy.  All we do is Mother a Laboring woman.  Your piece on Doulas focused several times on the fact that we only have to go to a few simple classes.  That's because we DON'T perform medical tasks.  If that Doctor wanted us to perform medical tasks, we'd take medical courses.  But again, we don't.  We are there for a woman's moral, mental and physical support.  This role is done throughout the entire world...from Africa to China to Europe to India.  Women Helping Women. 
                       
                      And The Today Show tried to make Doulas look like a bad force to be reckoned with.  So silly it's ridiculous.
                       
                      What you don't know though, is that each and every Doula love what we do.  And we do it because of our passion.  We get hardly any money.  There are only a few areas in the country, one being Manhattan, where Doula's get over $1,000 a birth.  Mostly we get only a few hundred.  In the end, for all the hours prior to a woman's labor starts when we get to know and love the woman we are working with and discover her vision of her birth, and then the labor itself which can last well over 20 hours, we only get very little money an hour.  But that's ok.  We love what we do.  But thanks you YOUR piece about Doula's, you've hurt our chances to help our own families with the little money we do earn.  THAT is unforgivable. 
                       
                      I feel the writers at The Today Show need to revisit the topic of Doulas and their support.  I feel in order to correct the wrong you have put upon us as a whole, you need to do more research, interview and show some discussions with the founders of DONA.  And Discuss with your audience the abounding benefits to having a Doula and one's birth. 
                       
                      Your Piece was biased, untrue, discriminating and unfair.  It was based on one female doctors experience with possibly one doula who went beyond her role.  As a whole, the rest of us Doula's don't do that.  We know our roles and stay within the boundary of our scope of practice.  None of my clients have ever had a C-section.  Very few have had any pain medications.  All have had wonderful memories of their childbirths.   
                       
                      Bad Performance, Today Show. 

                        Reply#15 - Thu Nov 20, 2008 8:35 PM EST
                        notofchildbearing age

                        I was angry about the story on two fronts. While I understand and empathize with doulas being considered second-class citizens according to the medical profession, I am very tired of the Today Show's continually broadening focus on what most of the nation would view as the habits and behaviors of the privileged class. I received the following email from one of my former students today:

                         "thought i would send you an update im in the middle of my 15th week of pregnancy the baby moves more now..We are still at rock bottom and i am worried of a chance to even come up a notch. Bill still dont have a steady job. Life is sucky right now.Billy is doing okay in school and tiphanie is being a 2 yr. old. Bill is now being told he has a possible heart problem..I am so scared I cant even afford to give my kids a real christmas or barely put diapers on tiphanie..But I just wanted to give you an update our new temporary address is"

                        Although I am sure not all locations in our nation have the abysmal literacy rate of 67%, an unemployment rate that averages 12%, the highest prescription pain-killer abuse rates in the state and a majority of people uninsured for any medical situations, this story seems to continue Today's focus on  those in our nation that are high earners. With the economy in a slow nose-dive, many in "my world" are more worried about feeding the children they have and hoping no one gets sick than about the plight of doulas and those they assist in birth. Please understand, this is not personal against doulas or those who can afford to employ them, I just become increasingly disillusioned with what the Today Show covers and am slowly coming to realize that the show really isn't about my world at all.

                          Reply#16 - Thu Nov 20, 2008 8:47 PM EST
                          jule-739089

                          This post touches on one of the many negative statements in the doula segment we are talking about, the notion that a doula is a luxury only available to women with money. There are more and more hospitals who have volunteer doula programs as well as many doulas who work on a sliding scale to give every woman who wants a doula the opportunity to have one. 

                          And it is a shame that insurances don't pay the doula fee. A doula is far less expensive than paying for a c-section, epidural a labor enhancing drugs that in many many cases can be completley avoided.

                            #16.1 - Fri Nov 21, 2008 2:29 PM EST
                            Reply
                            Marie-737737

                            I am very disappointed in the Today Show's report on Doulas.  It was very one sided from one Doctor's oppinion.(The video segment, the written article is a little bit better.)    Why not have another Doctor that has had many positive experiences with doulas?  Why not hear from a hospital where there is a volunteer doula program and it works out really well??  It is not just a service that wealthy expectant parents can look for, but there are many doulas that will help parents that really want doula!  This segment was very bias and little research was mentioned about the benefits of having a doula!

                            I hope that in the future more positives are presented along with a look at hospitals that offer doula services!

                              Reply#17 - Thu Nov 20, 2008 9:53 PM EST
                              Sharon Muza, New Moon Birth, CD (DONA), LCCE

                              I felt compelled to write to you in order to comment on the tv piece about doulas.  I felt that the piece portrayed doulas in a negative light, failed to mention the years of evidence based research that document the benefits of doulas, and that fact that there are no know risks!  Trained doulas practicing within the scope of practice of their certifying organization realize that they are a valuable member of the birth team making significant contributions to the way that the mother and her family experiences and remembers the birth.

                              With cesarean rates soaring over 50% at some US hospitals, and our rate of premature births, inductions and interventions at their worst ever, including the USA being ranked 42 for infant mortality among industrialized nations, how can it be negative to have a birthing woman receiving continuous emotional, physical and information support that may help may her birth more in line with her wishes.  I like to believe that it is the woman and partner who lead the birth team, not the medical staff of doctors and L&D nurses, as stated in your piece, and I agree, also not the doula!

                              Additionally, doulas are not just a luxury item, as you stated, for there are doulas to fit every budget!  Many doulas do pro bono births each year, newer doulas offer services in exchange for evaluations, and there are community based doula programs all over the US providing doulas to low income women.  When the end result of using a doula is a mom who is at reduced risk of postpartum mood disorders, who has a better breastfeeding relationship with her infant, who is more satisfied with her birth and may have experienced less interventions during the birth process, how can that be viewed as a luxury!  That should be every womans' right!

                              Please consider doing some more research that accurately states the role of the doula, and return with a follow-up that demonstrates the power of such a simple solution and the impact it can have on birth!

                                Reply#18 - Thu Nov 20, 2008 9:53 PM EST
                                Erin Phillips, Doula, FL

                                I too am very disappointed at the video segment on Doulas.  I understand that there are always "bad apples" that spoil things for the others in their profession that DO work within guidelines and restrictions, which very well may have been the reason they were banned in VA (and a few other hospitals in the US)... but that's EVERY profession.  Not just Doulas. 

                                I have recently finished my training, and I will be sending my required documentation to DONA shortly.  It wasn't JUST a few classes that we have to take.  It's extensive research, two to three day intensive training seminars and required births (minimum 3), that require evaluations from not just the mother, but also medical staff (doctor AND nurse)... even after we're certified, we must re-certify every three years, which require pretty much the same process.  And there's also a grievance policy for providers as well as clients to write in to so that those that are working outside their bounds can be penalized,  up to and including canceling certification.  I provide all hospital staff with that information, and ask my clients to allow me to attend at least 1 prenatal appointment so that I can become familiar with the doctor...

                                We are NOT to step in the way of the staff.  It's right there in our scope of practice (by-laws) statement.  If we do, we loose our status.  Plain and simple.  I have had one birth end in a cesarian (later found out it was necessary), but the client told me that there was no way that she would have been able to go through all of it without me to help her and her husband.  I like to think that I have a good demeanor to work WITH hospital staff- because they are subject to hospital protocol first and foremost.

                                I also don't like that the on-air doctor emphasized the $1000+ figure for doulas... I've only heard of two places nationwide that a doula asks that much- Manhattan and LA.  I purposefully base my rates on a sliding scale, based on income.  I also keep my rates available for payment plans and do 1 pro bono birth a quarter... all because I had two very different births, and believe it or not, the natural was without a doula... the medicated one was with... and I NEEDED a doula at both!  And I wasn't in the higher echelon of society.  We were one income, and low at that, so I don't view it as this frivolous expenditure for the rich.

                                Please air another segment with more balanced interviewing... it's really not fair that all the women in America that may not have heard what a doula was have a not-so-great taste in their mouths now.  A lot of people won't read the article, which was much better balanced in my opinion.

                                  Reply#19 - Fri Nov 21, 2008 12:06 PM EST
                                  mammaof3

                                  This program puts a very poor light on doulas which is completely wrong!  Doulas are hired to help women through labor because they are the one consistent person in a labor and delivery room (in a hospital) and knows what the patient desires because it has been discussed.  The rest of the labor and delivery people may never have met the patient before or even seen a patients birth plan.  Doulas are there to ease and relax the mother therefore make labor more bearable.  The tv segment acts as if doulas get in the middle of medical procedures, at the very least they are trying avoid more medical procedures and reduce costs.  The doctor who was against doulas probably does not know what unmedicated birth is and feels threatened by the doulas, she is taking power away from the birth experience and making it all her own.  She should be ashamed of herself, it is a patients right to have who they want in the room and not have unnecessary medical procedures.

                                    Reply#20 - Fri Nov 21, 2008 3:14 PM EST
                                    Leanne Palmerston, Doula

                                    I wrote the following rebuttal of the on-air segment on my website,

                                    I was pretty excited when I heard that doulas would be the focus of a . But, when I watched that segment - finally airing November 20, after being pre-empted two other times - I was disappointed.

                                    While the mother in the story was clearly thrilled with her doula’s support, enough to hire her a second time for the birth of her youngest child, the medical response within the segment was misleading and the commentary by the Today Show medical consultant was contentious and chilly.

                                    The doctor interviewed for the segment was an Obstetrician at a hospital that claims it has “banned” doulas for interfering with patient care, implying that doulas have caused fetal harm by fomenting dissent against medical staff and confusing mothers. The Today Show medical consultant implied that doulas without midwifery or nursing backgrounds are woefully underqualified to provide care, that doctors and even labour nurses should be consulted about hiring doulas and that the cost of doula care is a frivolous luxury.

                                    Each of these assertions were misleading. Let’s looks at them individually.

                                    1. Banning of doulas. This idea of banning support persons is odd. While it’s certainly true that the staff at a hospital can remove anyone who they feel is interfering with their ability to provide health care to their patients, a blanket ban on one type of support person does not put the hospital in a good position. They have basically stated that they want no impediment to their ability to control a mother in labour. While it is absolutely against a doula’s scope of practice to speak to the medical staff about what mothers do and do not want in labour and birth, it is within her scope of practice to remind mother that she has the right to question what is being done to her body. If a care practitioner proposes to do things to a mother without her consent, a doula may remind mothers to ask about what is happening and to participate actively in the decision making process. The vast majority of Obstetricians, nurses and midwives care deeply about about each individual mother’s needs and desires and take those into account when managing her labour and birth. But, just as there are rare “rogue” doulas who may operate outside of their scope of practice thereby tarnishing the reputations of the vast majority of doulas, there are medical staff who take advantage of a labouring mother’s suggestibility and lack of obstetric education to manipulate those mothers into making the birth process more convenient for the care giver. Luckily the “rogue” doula and the manipulative care provider are exceptions. Especially here in Hamilton, Ontario, doulas, nurses, midwives and obstetricians, along with mothers, partners and their families, operate as part of a multi-disciplinary maternity care team, each playing a specific role that supports the others while keeping the focus on helping mothers give birth in a positive and healthy environment.
                                    2. Doulas interfering with patient care. All health care decisions should be made by the mother. If a doula attempts to influence the content of the decision or make decisions instead of the mother, she’s operating outside of her scope of practice. This may be because of her inexperience or her mistaken understanding of her role. What is common, however, is that a doula may help a mother consider the pros and cons of any health care decision, ensuring the mother has the information she requires to make her own informed decision. It’s never bad when a mother exercises her autonomy and participates in her own medical care. It may not always be convenient for the care provider and the care provider may not be used to working collaboratively with patients, but that does not mean that anyone is attempting to impede care or confuse mothers and somehow “foil” care providers. It is very simple for care providers to deal with a doula speaking out of turn, they can merely address the mother directly and ask her what her wishes are and then privately remind the doula that she’s operating outside the scope of her practice. I’m sure there are situations where less experienced nurses speak out of turn, too, and the entire practice of nursing is not denigrated for making birth less safe.
                                    3. The adequacy of doula experience and education. Since doulas do not provide any clinical support whatsoever, since they do not analyse and interpret clinical information, it seems rather over the top that they should be expected to have the same kind of educational background as clinicians. We specialize in emotional and physical support prenatally, during labour, birth and the postpartum period. Because it is our professional realm, we gather a great deal of information about the childbearing year that we are able to vet, provide our clients and arm them with the tools to interpret the information for themselves. Because we have no clinical responsibilities, we are freed to accompany a woman and her family continuously through the course of her entire labor and delivery in a way that nurses, obstetricians and even midwives cannot in our modern health care system. This continuity of care also affords amazing learning opportunities for doulas as they can observe labor and birth from beginning to end with little or no interruptions. To suggest that a woman who massages backs, speaks soothingly, helps women change positions and reminds them to make informed health care decisions should require four years of full time advanced schooling is ingenuous. It is really a red herring argument designed to take the focus off of what’s really going on: doulas are filling a vital role in maternity care and the women that use them are overwhelmingly grateful for their support.
                                    4. A doctor’s permission. Some doulas meet with health care providers before labor commences, usually accompanying a women to a prenatal appointment. This is not usual. Some women tell their doctors that they’ll be using a doula during labor and some do not. Some begin their search for a doula by asking their health care provider for recommendations of doulas they’ve worked with. The idea, however, that a woman should have permission or ‘run it by’ an OB or even a labor nurse, is odd. After all, it is the pregnant woman who assembles her birth team. It is her body and her baby that all of this support is centered on. Should she not be expected to be in control of all decisions regarding those things?
                                    5. A doula is a costly luxury. While a doula does cost money, those who have hired doulas agree that the money was very well spent. In fact, I’ve been told a number of times that I’m worth far more than I currently charge! Other costs associated with having a child such as prenatal vitamins, strollers, play pens, exersaucers, disposable diapers and more could also be considered luxury costs associated with having a child: in no ways required to be a parent to a child, but they sure can make life easier and more pleasant. If finances are a problem for a woman’s family, there are many options. All doula organizations encourage their members to provide some manner of volunteer support to those who truly need it. Most doulas would be only too happy to set up payment schedules or consider bartering some or all of their fees. Women in Ontario who require volunteer doula support can contact for assistance.

                                    There was something glaringly obvious when viewing the Today Show segment: the birthing mother loved having doula support and the medical personnel were skeptical. Those who had everything to gain from a doula were, of course, supportive of their use. Those who perceived the doula invaded their territory did not speak positively of doulas.

                                    The Today Show squandered a prime opportunity to share that the use of doulas can result in 50% less c-sections, 40% less pitocin use, 60% fewer requests for epidurals, 40% fewer forceps delivery and labors that are 25% shorter than women who do not have doulas. They also experience less postpartum mood disorders, breastfeed in greater numbers for longer than their peers and report greater satisfaction with their husbands and more confidence as mothers*. These good health outcomes are consistent across many studies.

                                    This is powerful information that is not being given to women by their healthcare providers. If you were sick and your doctor knew how you could get better faster with less chance of surgery and invasive treatment, would you expect them to tell you about it? Would you feel angry or duped if they deliberately withheld this information? Would you wonder what their motives were?

                                    Would you be curious to talk to the woman who could help you have a healthier and more satisfying birth?

                                    If you are in pregnant in the Hamilton, Ontario area email me, , and let’s talk about the kind of birth you want to have.

                                    *These statistics appear in “A Doula Makes the Difference” by Nugent in Mothering Magazine, March-April 1998.

                                      Reply#21 - Fri Nov 21, 2008 5:39 PM EST
                                      Amy CD(DONA)

                                      In writing this comment, I feel as though I may be echoing previous statements, but I felt so strong about this topic that I needed to write. I watch the Today show every morning, and was so excited to hear there would be a segment about doulas. After watching the clip, I was deeply saddened. I felt that the topic was glossed over with only minimal true information included. They said there was an increased demand with pregnant women hiring doulas, but did they ever examine the reason why? I am a doula, and have witnessed one home birth and the rest in the hospital. After seeing how strong and competent a woman is with giving birth, I went into the hospital where women are treated as if they do not know how to deliver their own babies. Most labor and delivery nurses are wonderful, but they are overworked and understaffed, and can not physically be there as much as they would like for each patient. OB doctors are great to have when there are complications or emergencies related to childbirth, but other than that midwives tend to have a better success rate. I wish this news story would have had more statistical information on midwives and/or doula attended births not only in the US, but world-wide. I have always thought that the Today show presented a fair and equal representation of the news, but in this case, you delivered a biased and almost malice representation of what a doula does. The news story said to "do your homework", and frankly, I hope that all women do. Research will show the truth about quality labor support, and the "from the heart" care given by a doula.

                                        Reply#22 - Fri Nov 21, 2008 6:55 PM EST
                                        Ananda Lowe

                                        The average U.S. wedding costs $12,000 paid out-of-pocket, and does not offer the substantial health benefits a doula provides, but would you say that weddings are a "luxury" choice for most women?  Improved breastfeeding rates, decreased postpartum depression, and decreased cesarean sections should not be called a luxury.  Without doulas, the cost to society is much higher.

                                          Reply#23 - Fri Nov 21, 2008 7:47 PM EST
                                          MotherDoula

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                                          I am writing to you about the piece that just aired about birth doulas (Thursday, November 20th).  I too would like to thank you for tackling the difficult subject with such stringent time constraints.  However, I feel concerned  the "buyer beware" and "this is for the wealthy" messages came through more strongly than any research that proves having a doula greatly reduces  risks for unnecessary interventions such as induction, epidural and cesarean sections, to name a few.   This piece fell short in providing viewers with the best information about the proven benefits of having a doula present at a birth.

                                           

                                          I am a doula and mother of two who birthed naturally with a doula both times.  The second birth was at home and was filmed for a documentary called “Orgasmic Birth”.   Many of the births shown in the film are at home, but one message the film will leave with you is that a woman will have a better, even orgasmic birth in an environment where she feels safe and supported.  Most women today feel safest giving birth in a hospital, but because our epidural rates in most hospitals are 98% or higher, achieving an un-medicated and undisturbed birth in that setting is so much more difficult.  This is where I think doulas can play a key role and I wish this could have been acknowledged in your piece. 

                                           

                                          Doulas are not just for the wealthy.  There are programs such as the Philadelphia Alliance for Labor Support that offer free doulas to any woman that wants one, delivering in one of two area hospitals.  Many doulas volunteer their services at least once a year or quarterly in keeping with this philosophy.   Many doulas will work on a sliding scale or work for trade! 

                                           

                                          There are doulas who step out of their scope of practice and make it difficult for the rest of us, but most doulas abide by strict codes of conduct and are very respectful of and helpful to the medical team.  There are more experienced doulas and there are new doulas with very little experience.  There are doulas who go through nursing programs first or who are midwives in training, but every doula, no matter what her background, brings the belief that birth is a natural and transforming event in a woman's life and she deserves to be treated with respect, to be pampered, to be served,  and to be supported emotionally and physically.  She also deserves to have informed, evidence based care.  A doula, prenatally can offer information to her client that can help clarify what this is.  They can do this with studies, providing helpful web links to such sites as the FDA and The Cochrane Database, Childbirth Connection and many more.  She also can provide helpful books, resources such as childbirth education classes, local breastfeeding support groups and so much more.

                                           

                                          Ultimately, it is the doula's job to support the mother in whatever decision she makes for herself and her baby.  In labor, her job isn’t to change anybody's mind on a procedure or intervention that is being offered.  I wish some of this could have been said, instead of making doulas look like people who do little more than get in the way of the medical team.  I personally have received very positive feedback from several people in the medical community on the services I have provided as a doula. 

                                           

                                          Thank you for taking the time to read this!  I hope you will consider doing another more balanced piece on birth doulas in the future.

                                           

                                            Reply#24 - Sat Nov 22, 2008 10:38 AM EST
                                            Erin-740581

                                            I agree with many of these womens' comments.  Do you realize that most of your viewers are women and that doulas benefit women and families?  Why would you air a piece about a patient advocate that helps women make informed decisions about her labor, baby, and herself in such a negative light?

                                            I think it is important that you look at the labor and birth statistics of the United States in relation to other European nations that do not take the strict "medical approach" to childbirth, and instead see it as the natural process that it is.  They have lower infant and maternal fatality rates than the United States, they use less interventions that make it more difficult for mother AND baby, and the cost of birth is MUCH lower.  Unfortunately, in the United States, we take that medical approach that leads to higher rates of c-sections and other sometimes unnecessary interventions.

                                            I am very disappointed that you would portray a patient advocate in such a poor light- as a glorified masseuse that only the rich can afford.  

                                            Shame on you for not taking care of your viewers and putting such a bitter and biased FEMALE doctor on your show!  If she is a true physician, she should think more about her patients as a whole being and not be so concerned about putting down doulas and the services they provide to their patients.

                                              Reply#25 - Sat Nov 22, 2008 4:48 PM EST
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