Owning Our Practice

When we are working with such an elemental and mysterious thing as birth, it is often hard to tell where the lines that define ourselves and others can or should be drawn. I was speaking with another very experienced doula the other day who took exception to something I said. I suggested that inexperienced doulas may not be as successful at preventing unnecessary cesareans as a doula who has had years of experience working in a hospital environment with many diverse clients.
She countered, and rightly so, that the essential role of the doula is to offer companionship and respect, and those qualities will triumph, whatever the outcome.

I agree. To a point. Love works wonders. But a combination of things are at play, especially in a busy hospital that may or may not have a sensible approach to natural birth. A younger, less experienced doula may not know quite how to respond when a resident reaches for the amniotomy hook as she is doing a vaginal exam and prepares to do an amniotomy, all without saying anything to the laboring woman. Although we don't like to admit it, it is true that even the presence of a more experienced doula will help doctors to exercise caution. A less experienced doula will not know the policies and protocols of the various hospitals as well as a more experienced one. She will not have built relationships with the medical staff she is working alongside. All these elements can and sometimes do lead to the inexperienced doula accompanying a woman along a very different path than the one they had hoped.

That said, is that not our ultimate mandate? To accompany? To be a companion as the woman makes her journey? If we are beside a woman and her partner as they are becoming parents, and we are there to support, to love and respect, as the woman moves through labor, is that not sufficient?

Yes, if the environment she is birthing in is a sane and healthy one. Definitely. But what if a woman is birthing in an environment where the professionals are overworked, the infrastructure is crumbling, the focus is on risk instead of health, statistics are distributed as freely as narcotics, and the emotional and spiritual side of bringing a child into this world are more or less ignored? Then, possibly, a birthing woman needs more than a companion in love. She needs a watcher, a guardian. Experience, skill, humility, and an open heart are the foundation blocks that a doula can build her practice upon. And one important rule is: never stop learning. When you have a chance to change your mind, change it. When you feel you know enough, know you are wrong. The responsibility is great, the stakes are high. Ego should not take part in the miracle of birth.


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