Call Me Doula!

By Ana Paula Markel

The first time I heard the word doula, I was a pregnant mother, newly transplanted to Los Angeles from Sao Paulo, Brazil, where I had a career in fashion. Little did I know I would soon be a doula.

My goal was to have a vaginal birth after two cesareans in a time when VBAC (vaginal birth after a Cesarean) rates were low. There is a lot to share about my first two cesareans, but mainly I did not want them, I did not need them, and they were absurdly different from each other. (As a side note, Brazil has a 83.9% cesarean rate in private hospitals).

And yet, I am grateful for them. It was through being undermined within a system that did not work that I found my voice as a mother and an activist, and learned that understanding my options, including risks, benefits and alternatives, was not only my right but also my responsibility.

Pregnant with my third baby and taking a childbirth class for the first time, I hired a doula!

All aspects of the doula’s role were helpful to me, including informational, physical and emotional support. It was equally important that my doula held me accountable to my own strength. My labor began at 42 weeks and 5 days, and it hurt from the first contraction. I had to walk the walk of “I am a woman; hear me roar,” even if it sounded more like an Italio-Brazilian saga at times. My doula held me accountable through all of it. She knew birth, she knew me, she called me out on things when necessary, and she modeled courage.

The process of self-discovery through labor was so powerful to me that less than six months later I was assisting in childbirth classes and soon after, attending births. I never looked back.

As a doula, educator, activist, volunteer and entrepreneur I continue my labor daily with hundreds of other families. The exercise to be present, efficient and happy in my career and family life forces me to breathe with each contraction of life: Labor does not end when you push the baby out! The coolest thing about the pregnancy, birth and postpartum time is that you never know enough; it is humbling and evocative. There is nothing more energizing than having no absolutes. Doulas are constantly learning through quiet observation, listening skills, kind and creative questions combined with data, hands-on skills and experience.

DONA International, the largest professional doula association in the world, just held its annual conference, and this year’s theme was ENGAGE! It has never been clearer that the time for doulas to step up is now. The evidence of labor support is clear, and yet Penny Simkin called everyone’s attention to the fact there is not enough data for postpartum doula support. The postpartum period is, in fact, neglected and not discussed enough, from the general public to childbirth classes, data and care. The messages were powerful, and the speakers and topics were brilliant, from “The Year of the Doula” to quality data to horizontal violence.

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Ana with DONA founders Penny Simkin and Phyllis Klaus

The most crucial message and call to action, in my opinion, is the fact that in all major studies that reflect the value of a doula the word doula does not appear, instead the term used is labor support, which could lead hospitals, health organizations or third party payers to interpret that any other professionals such as nurses or midwives could provide labor support. That is not it! And it is not that nurses or midwives don’t provide support to people in labor — they do when they can. To compare the clear scope of practice of doulas to other professionals completely misses the point that doulas have a definite role in the care of a birthing person and absolutely no other task.

The primary ethical responsibility a doula has is to the person giving birth, not to an institution or medical group, even when working in a hospital. Doulas are advocates for the birthing person, and this still means doulas don’t make decision for them. But doulas absolutely make sure that people are making empowered and informed decisions.

This is exactly where the empowerment everyone talks about comes from. For a doula to come in and call all the shots would be to take the power from the medical system and give it to the doula, not to the family. The concept that empowerment comes from natural or vaginal birth is a throw-back to more than 30 years ago. Empowerment comes from the parents discovering their voice and using it. A professional who is focused on vital signs, clinical skills, charting, taking care of two or more patients at time or who work in shifts could not provide the continuous care a doula can. To dismiss the word doula is to dismiss the value of our profession. See here and here for more info.

It is time for DONA International, as the leading professional doula organization, to engage doulas to unite and act in unison to promote doulas and increase doula compensation. It is time to engage in this conversation with consumers, third party payers, health departments, institutions or anyone who can fund doulas to promote this service to everyone who wants a doula. And it is time to do so without having to make doulas work for free or for fees that are demoralizing and not sustainable for a professional career.

Don’t call me a labor support person. Call me doula!

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