Sisterhood is complicated: Midwives and Doulas

I love the doula concept. It is a women for women idea just as midwifery is. Women in childbirth have always relied on other women for support, sometimes their mothers, sisters, and friends and sometimes an experienced support person. That experienced support person was the midwife. It was like that forever. Still is really. But then it got complicated. Midwives, for better or worse, started professionalizing. Many became licensed and there were many kinds of licenses and credentials. And with the many kinds of licenses and credentials came many turf wars, between certified nurse midwives and "lay" midwives, between certified midwives and certified professional midwives, between proud-to-be-traditional unregulated midwives and licensed midwives,and between all of the above and the doctors. And then came the doulas. Doulas support a woman through childbirth. They may put pressure on her low back or squeeze her hips. They may put a cool cloth on her forehead and whisper encouragement. They encourage the father of the baby too, to step forward and support the mother in the ways that she wants and needs. For a family intending a hospital birth the doula provides support at home before they go to the hospital, perhaps encouraging a father to get rest so that he has the energy he needs for later, perhaps helping them to decide when to leave for the hospital. And as we know, the hospital can be a very difficult place for the birthing mother! So the doula plays a vital role. She is there to humanize a potentially very inhumane process during a very important time. She continues to provide direct physical and emotional support to the birthing mother and father while adding another element to her care. She explains calmly what she sees and understands. She helps parents to grasp all their options and sort which ones suit them best. She does this while keeping her ego and opinion to herself. It is a challenging and to me an unenviable role, but definitely a vital one. I would recommend that no woman should plan a hospital birth without a doula.

But what happens when a doula and her sister, the midwife, work together? Doula and midwife have an interesting sister relationship which can be rewarding and can be fraught with misunderstanding. I had the interesting opportunity the other day, to teach a class of budding doulas about doulas and midwives working together. It was a fun class and stimulated some thoughts about my sister doulas and how doulas and midwives can and work together.

It is a dirty secret that out of hospital midwives do not usually feel delighted when their pregnant clients say that they have employed a doula. Yes, I really think that doulas can screw things up royally. But I also believe that the foremost right of every birthing mother is to do it her way. If the birthing mother invites someone into the space of her labor and birth, that person should be there. It is the midwife's duty to fit in with the mother's wishes. So, what are the ways that the doula can screw things up? She steps on toes! She may usurp the role of the mother's mate. A man who is nervous and unsure how to support his woman in labor is easily pushed aside by a doula who is having fun answering her calling. Instead of placing the dad's hands on her hips, she will do it herself. Instead of modelling for him supportive words and modelling relaxed breathing, she may instruct, inadvertently disempower or just do the job herself. I have seen it. At most out of hospital births there are 2 midwives or a midwife and an apprentice or a midwife and a birth assistant. Ideally the 2 work together, making suggestions, supporting each other's roles and ideally, the doula should fit seamlessly into this process.  The three work together, feeding off each other, including the father and supporting the mother to birth the way that suits her. But the doula often does not fit in easily to this process. My experiemce of doulas is that many are so into what they do that they take up a lot of emotional and physical space. They may occupy the father's space (as just described) or they may occupy the midwife's space. This they do innocently, unintentionally, despite themselves. A doula may be reveling in the dependence of the mother on her support (that is what she is there for after all) and may not encourage calling the midwife. (Been there). Or she may enjoy the confidence that she inspires to the extent that she interferes in decision making. (Been there). She may document the birth story in her own words and her own way for the mother but in doing so rewrite the mother's memory. It is the mother's birth and her memory. (Been there).

Doulas are excited to do what they do. Their enthusiasm is an asset. But it  can lead to unprofessional conduct. It can lead to their taking away from others. Doulas: Humility is the first act of honoring the mother