Thursday, July 1, 2010

The Role of Doulas and Birth Plans

Rixa posted the following comment she received on a post about the Doula Ban and OB Birth Plan at Kingsdale Gynecologic Associates: A physician speaks about doulas and birth plans. My response is a bit too long to put in a comment, so I'm posting it here.
So I am actually a physician. Doula's may be beneficial in some situations, but you all must remember that the role of a physician is to provide good medical knowledge and advice based on evidence.
Unfortunately, a lot of what physicians recommend is not based in “evidence,” but tradition and/or what looks good in court. There is no evidence that continuous fetal monitoring of low risk labor leads to better outcomes, evidence rules against restricting food and drink, physicians did routine episiotomies for years (and some still do), even though they’re were never proven to be beneficial, evidence suggests that clamping the cord right away may not be best—the list goes on.
Where Doula's may be thought of as positive most have zero training and often times may give inaccurate medical advice which is out of their scope of practice. If people want Doula's there should be a government agency licensing those individuals. As you wouldn't want just any person playing your doctor the same gaves for those helping. If they obstruct what we are trying to do they are not beneficial and can ultimately hurt you. Further, they do not have any medical liability. If you want a Doula they should accept medical liability for the 18 years that OB gyns do.
I am thinking of staring doula training soon, and I have looked at the requirements of various doula training organizations, and most are actually quite extensive. Just because they don’t have medical or nursing education does not mean they are not trained. I personally would not feel comfortable or ethical offering and charging for doula services without training or at least extensive personal research on what I was doing. If you have seen doulas offering medical advice, they are not doing their job. A doula’s role is not to speak for or make decisions for the woman, but to help her find her voice. I know I am a bit vulnerable when I’m in labor, and I think a lot of women are. Too often, this vulnerability translates into the woman’s voice being silenced. Doulas (and birth plans) are there to facilitate communication between the woman and the medical personnel—to encourage her to ask questions and be involved in decisions about her care. To me, doctors and nurses who have a problem with doulas and birth plans really have a problem with women having a voice. If what you are trying to do is not what the woman thinks Is best for her and her baby, then doulas are not hurting the woman by “obstructing” it. I don’t have a problem with the idea of having a system for keeping doulas from acting outside their non-medical role, but if they are really acting in that role, they shouldn’t need to accept medical liability
In regards to birth plans. They are all nonsense. When it comes to the delivery room most if not all mean nothing.
My OB actually encouraged me to write a birth plan for my son’s birth. I stated clearly in my plan that I wrote it to help the hospital staff know how to support me in the way that would be best for me. I think “plan” is actually not a good word for the purposes of this document—it is not designed to plan the details of your birth, but to let your care providers know what kind of care you want—a tool for communication. Then the providers know that if something comes up that conflicts with what you have written, you want them to discuss it with you. Of course, if you don't discuss the birth plan with your care provider before hand and they are not equipped or are unwilling to follow your wishes, then, yes, it is meaningless.

Women who write birth plans are sometimes accused of being "control freaks," and of trying to control something that is uncontrollable (birth). People claim that these uptight women are incapable of submitting to the power of nature that is necessary in natural birth and thus, they can't relax enough to progress and often end up with cesarean sections. However, most of what is in birth plans is actually about avoiding medical control of birth, because these women want nature to control their births, as long as nature is doing well, of course. So, is the beef with birth plans really about submitting to nature or is it about submitting to you? Maybe if physicians stopped trying to control birth themselves and quit trying to force women to follow their medical birth plans (whether written or not), then birth plans wouldn't be necessary?
Your in pain you said I don't want drugs you change your mind you get drugs. Happens everywhere all the time.
The implication here is that wanting an unmediated birth is a naive notion and most women wise up about it once they experience labor. Anyone with this attitude is someone who is likely very unfamiliar with natural birth and will not know how to support a woman in it. This attitude among physicians is exactly why we need doulas who know about natural childbirth to provide women the emotional and physical support they need.
Look the most important thing is not extra personnel in the delivery room. The important thing is a safe and healthy delivery for both the infant and mother. Any mother or father for that matter that thinks anything else is more important should not have children till they get their priorities straight.
Of course having a healthy mother and baby is important. Some people (including some women and some doctors) believe that having a birth with as little medical intervention as possible is a good way to accomplish that goal. It is not harmful for a woman to make sure a medical procedure is really necessary before agreeing to it. Frankly, the insinuation that people who are not willing to just do whatever the doctors want them to shouldn’t have children is insulting.

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