There. It's out in the open and there is no gray area about my feelings as we delve into tonight's rant. I hate just about everything about the occupation and the way the media puts them on a pedestal. I hate that they and many of their supporters confuse words like occupation and profession, as well as licensure, certification, and accredidation.
As we begin, I want to share a blog I read years ago. I remember shaking my head in agreement, so glad that I wasn't the only one who felt this way about this fad.
Wednesday, July 27, 2005
THE DOULA
posted by Dutch @ 11:08 AM
I thought I would never have to see the doula again.
I have been boycotting the Frisco neighborhood known as "the mission" for almost a year now, vowing never to venture south of 14th street and east of Noe. The Mission is the gentrified hipster neighborhood full of artist chicks with carrie-donovan glasses and yoga mats, panhandling Mexican troubadours, and "dive bars" crammed with Judds on the prowl every Friday and Saturday night. The Mission is the juddliest neighborhood because, just as most San Franciscans can't fathom living anywhere else in the country, most Mission-dwellers cannot imagine living anywhere else in the city. It's just like the Marina in that way. Instead of Marina chicks you have Judds and artists. I haven't made up my mind about which is worse.
The woman who was our doula for a few weeks lives there, so I figured I would never have to see her. I was wrong.
Let me back up. Back before Junebug was born, Wood was sure she wanted a doula to assist during the birth. All the books said doulas were such a great help. I think she just like the sound of the word. Doula. Doula. Sounds so peaceful, right? Helpful. Knowledgeable. A little hippie-dippy maybe. Knowing my predilection for all things ancient and Greek, Wood told me that it was an ancient Greek word for "female assistant." I was like, no, sorry, it means slave. Doula is the ancient Greek word for slave.
So Wood really wanted one of these slaves. I didn't. I pictured the doula as an annoyance, an interloper, wafting aromatherapy bottles in Wood's face and talking about chakras and chanting over the placenta. The birth slaves in the videos we watched in our birthing classes certainly did not shake this idea from my head. They were all fifty-year old lesbians with gray marine-corps hair and wood-beaded necklaces and flowery muumuus. One of them was wearing one of those little stiff caps with an African print on it. I looked at my wife as if she was nuts. "You want one of those in the birthing room with us?" Sure, if we were Ina May Gaskin types having Tantric sex and reading books by Deepak Chopra and listening to "world music" I could picture inviting someone like that into our home for a home birth in the sacred porcelain claw-foot bathtub, and I wouldn't have blinked when she showed up on our doorstep with a boombox blasting Enya and a selection of vegan snacks. But that's not who we are. It's chicks like that that drove us away from the Rainbow Grocery co-op forever by rudely elbowing us to get at the last carob-coconut squares. Having already been driven away from Whole Foods by the Judds and yuppies, where could we shop? What choice was there for two reasonable people who wanted to have a natural hospital birth? Wood was convinced she had to have a slave in the hospital room to hold back the anesthesiologists and clogged-foot nurses clutching hypodermics and IV bags and stop her OB from slicing into her and pulling the baby out so she could make a dinner appointment on time. At first I indulged her.
Wood smartly kept me out of the process of interviewing slaves. I didn't want to have anything to do with them, and I let her know I wasn't happy about it. I wasn't just my new-agey hippie prejudice that made me feel this way, it was my honest feeling that we didn't need a stranger in the room with us. That this was something we could do, just the two of us. I told Wood there wasn't anything a doula could do that I couldn't do. I bought and read "The Birth Partner" and declared myself the doula. Still, Wood searched on.
Wood conspired with the doula for several weeks over the telephone before I was allowed to meet her. "I really, really like her," Wood said. They had met for coffee. She had shown Wood her bag of tricks, full of patchouli-smelling gewgaws and oils. Wood said she was going to hire her. I braced myself for the inevitable. We were hiring a slave. Wood nervously scheduled a time for the doula to meet me. I came home from work that day wearing a suit, and slumped into a chair across our living room from her after weakly shaking her hand.
She was cute. Young, at least. A hipster. No muumuu. No wood-beaded necklace. No African print stiff cap. Maybe this won't be that bad, I thought. I looked at her business card M____ C_______, "mother, doula, knitter, artist," it said. Oh crap.
It was the most awkward conversation ever. As Wood and I tried to articulate what we wanted from the birth experience, she just sat there, nodding. But nothing we said seemed to be having an impact. "You should try to change from the hospital to the Sage Femme Birth Center in the mission," she said. "It's run by midwives. It's much more supportive." I tried to tell her my insurance might not cover that, and she said many insurance plans cover it. We told her we wanted to have the birth in the safety of a hospital, and she told us that Sage Femme has a relationship with San Francisco General in case of an emergency. San Francisco General? That's where junkies go to die! Does she consider that a selling point? I'm sure Sage Femme is a great place to squeeze out a kid but at the time Wood and I weren't ready for that. We were nervous first-time parents. Maybe next time, we said. She looked peeved. I realized she was judging us. Worse, she was condemning our choices. Fucking Mission hipster. The conversation only got worse. I was trying to be honest, and it was my understanding that a doula's first responsibility was to be understanding and tolerant of the choices of the family she would be working with. Not this one. Her $700 fee did not include tolerance or understanding, but damn did she have some aromatherapy bottles and a tennis ball in a sock that felt great when rubbed across a pregnant woman's spine! Well, I already had a sock and I could find a tennis ball in the bushes outside the courts in Golden Gate park.
What good is a slave if she doesn't listen to you?
Wood was uneasy about the meeting. She didn't like the way it had gone down. She didn't like how judgmental and awkward the doula had been. The next day, the doula called her. "I really don't think I should work with you and your husband," she said. What a relief.
If there is a fundamental difference between Wood and I, it is tolerance. Wood is open to things, like astrology, that I have no patience for. I got kicked out of the psychic fair that they have in the county fair building in golden gate park once for making nasty faces at the tarot card readers while Wood and the Leggy Swede had their auras cleansed. I hate that fakey new-agey spiritualist tripe. I mean, I despise it equally with all those other wacky religions out there (you know: Christianity, Islam, Mormonism, Judaism, Scientology). I think the doula knew I would call her out on all her bullshit and like any snake-oil salesman, she turned tail and ran once suspicion was aroused. Wood knew it was all bullshit too, but Wood is a much better person than I am. She is far more tolerant of bullshit, even entertained by it. But Wood was also scared. She wanted a voice in the room that had gone through birth before. She wanted somebody in the room who could be strong, and she didn't know yet if she could trust me to be that person. The 20th century has been such a dark age of obstetric philosophy. I wholeheartedly believe that Ina May Gaskin and others in the midwifery/natural childbirth movement have the right idea, 100 percent. But I am troubled at the overall stranglehold these new-agey archfeminist muumuu types have over the movement. I think all the Enya and aromatherapy and meditation are a barrier to changing birthing policy across the social spectrum. If this shit is continued to be viewed as "wacky" or "weird" it is going to be much harder to convince the medical establishment to change, let alone convince your average Southern Belle scheduling her epidural. So peace to all midwifes and doulas who handle their shit with the professionalism their job deserves. Safe, natural birth shouldn't just be the province of nutbuckets.
Wood and I were alone for 95 percent of the birthing process. We left home for the hospital almost eight hours after the contractions started. My hands never left her. I helped her fight the urge to succumb to a nurse's offer of narcotics. She didn't have an epidural. She didn't use any pain relieving drugs. It was painful as hell for her. Junebug came out in two pushes. I did my best to fill the role she saw a doula filling, but even more I filled the role I myself wanted to fill. I was her birth partner. We had relied on each other for nine years at that point, and I was not going to let her down. I was going to do everything that she needed from me, and more. I do not think I could have been that person if a doula had been in the room, acting assured and relevant, pushing me to the sidelines, a stranger there in our way during the most poignant moment of our lives.
So when I saw the doula the other day, eating in a cafe outside her blessed Mission District with her kids and husband, I looked at her and kissed Junebug's head and thought: "We didn't need you after all."
Now, I don't agree 100% with this man's post. I don't have the anti-gay, anti-new age views, but I agree with him on the mindset of the doula movement.
Since I first heard the term back in early 2003, I've met many doulas in person and many, many more online. I can honestly say that I really only know one or two that don't fit the mold and who I'd actually trust to assist me during a labor and delivery.
The way the media gushes over these women makes me want to vomit. And that's say a lot seeing how I feel about the whole act of emesis. I just feel that it is import to inform the general public of a few points that the preganancy magazines and online forums seem to always omit.
First, doulas are not uniformly "trained" nor are they professionals. And that training they do receive is scant, at best, and doesn't even require a high school diploma. Many doula organizations do offer "certification" but that is deceptive as well, but I'll get to that in a moment.
The Flexner Report, for example, stipulates that a profession is based on a body of knowledge that can be learned and is refreshed and refined through research, and is taught through a process of highly specialized professional education. (from "Professional Nursing," fourth edition, by Kay Kittrell Chitty) A true profession requires a bachelor's degree at minimum and a license to practice.
Nurses, for example, are considered as being a member of a "semi-profession" since one can be an RN with only an Associate's degree. If a registered nurse, who does a vast majority of the floor work with patients, isn't a true professional, then how can one say that a doula, who has had no formal training, is? Being a doula is an occupation, nothing more.
Many, many people confuse not only the issue profession vs. occupation, but the issue of licensure vs. certification. When one reads pro-doula propaganda, they assume that doulas have some educational background in medicine and the birthing process and are recognized members of the healthcare team. This a dangerous assumption and should not be perpetuated by the publications we trust.
Licensure is a legal matter and is granted through a governing body, generally through the state. It gives permission to do something that is otherwise forbidden (think practicing medicine or law, dispensing drugs, driving a car, etc.). A certification, on the other hand, is a voluntary process and is granted through a private organization. It merely states that one has been recognized by the organiztion for reaching certain criteria. It does not carry legal status. Of even more importance, not one doula organization is accredited by The National Commission for Certifying Agencies.
The process of earning a certification through a doula organization does not even meet the standard of those in the automotive or construction industries, let alone those of the health care industry. (A complete list of accredited organizations can be found online at http://www.credentialingexcellence.org/NCCAAccreditation/AccreditedCertificationPrograms/tabid/120/Default.aspx)
I often see doulas described as being "compassionate," too. In theory, having a person with you and your partner during labor in delivery, a person who can help keep you calm and focused, is a good idea. The problem is that many doulas have an agenda that is staunchly against medical interventions of any kind. They use scare tactics to get their clients to do what they want in an effort to further the "nature" movement. Suein Hwang, a reporter for The Wall Street Journal, wrote a story in January 2004 that broke the doula hype, and made a lot of doula organizations mad in the process. The story, "As 'Doulas' Enter Delivery Rooms, Conflicts Arise: Hired to Help in Childbirth, They Sometimes Clash With Doctors and Nurses," can be found online at http://online.wsj.com/article/SB107446888698004731.html?mod=home_page_one_us and is a must read.
Doula antics, such as telling clients that an emergency cesarean really isn't necessary, that interventions such as a simple IV drip, a dose of Nubain, or even an epidural are harmful to the baby, and even messing with pitocin drips have rightfully earned them the name "nature nazis," which is used commonly in many circles to refer to these women who practice with an anti-medicine agenda. This agenda is a lot of things, but compassionate is not one of them.
When I was pregnant with my daughter in 2003, I looked into obtaining a doula after reading the hype in many of the parenting magazines. However, after talking to friends who were nurses and to my obstetrician, I changed my mind. When I "met" a couple of doulas on an online mother's board a year or so later, I was confident that I made the right choice in not allowing a doula in my delivery room. My opinion was solidified during the birth of my second daughter in 2008.
I prefer to put my life and that of my child into the hands of trained PROFESSIONALS, not some yokel who might or might not have even a high school diploma.
In ending, an anonymous quote found online at http://doulicia.blogspot.com/2005/09/guests-at-birth-part-i.html says it best:
"The person who cuts your hair has to have a license…why not someone helping in the birth of your child?"