Dr Cynthia Gabriel PHD and doula from Michigan comes from a rich background in anthropology studying the cultures of birth in Canada, Russia and the United States as a doula. I once hear her speak about her experience of supporting 65 births in a Russian hospital where all the births were completely natural with absolutely no intervention except 1 which was a C-section due failure to progress. This kind of statistic is unheard of in the United States! Her assessment is that the outcomes of birth and the use of medical intervention are largely cultural. In the United States birth has become highly medical-ized fundamentally, due the mass commercialization from pharmaceutical companies, allopathic medicine and mass media that have molded an idea that only external applications can assist in healing. Were as in Russian, the culture has a general belief that the body was designed to have a more natural healing ability.
As doulas, we are constantly faced with the confronted of this cultural upbringing. Many clients find our way into our care with the wish and desire to have a natural/un-medicated birth, spend much time planning and preparing for natural childbirth only to have that dream disintegrate during the vulnerable moments of birth, the gentle offering for an epidural or by the authoritative suggestion of the medical staff. It is important for our clients to know that there is an authoritative bureaucratic process that surrounds hospitals is somewhat disempowering by design and that we are all products of our culture; doctors, nurses, patients. Somewhere within our upbringing we have been groomed to accept external forces as a part of our well being both emotionally and physically.
We know many of the ways to support labor and delivery; things like breathing, relaxing, massage, changing positions, water, walking and being upright, surround dynamics of supportive words, dim lighting, warm and dark environments. However, to support a natural birth in a hospital within the United States, almost requires another set of skills that entails social engagement and how to interact with hospital staff. This is a skill that gets built over time and as experience grows. The ability to gain this skill can determine the longevity of our careers as doulas, by either setting us up for success or burnout.
One of the most effective ways to begin building these skills lies in the preparation process that we do with our clients. Prenatal care (in the unique way only a doula can offer) is very important and should not be skipped. Doulas learn a lot about their clients by going through birth plans, birth desires and talking about scenarios. There is so much information that a pregnant woman has to muddle through. A Doula can help her to focus on where it is important for her to concentrate her research before the birth while also helping her to interpret the medical aspect of labor and delivery in the hospital when details arise. A doula also helps the mother think through what she wants to do during the medical side of birth. Birth preparation meetings with families also help her to figure out the best way to support.
If a woman is seeking a natural/un-medicated birth, it is important for the doula to know how committed a woman is to the process. Doulas should encourage moms to talk to their caregivers beforehand if they truly want a natural un-medicated birth and to get special permission for extra time during their labor. One of the best questions for a mother to ask their caregiver to get feel for their true support of natural/un-medicated childbirth is ‘tell me about the last un-medicated birth you attended’. How a caregiver answers a question like this can indicate their true level of support in natural childbirth.
Another very helpful tool that doulas can use to help prepare families for natural/un-medicated birth is to talking about scenarios like how to deal with doctors, nurses and medical figures who are presenting with a sense of authority in the face of wanting to assist the progressive state of the labor, when it may be appropriate and when it may just be coming out that deep cultural need to assist by using external forces; or how to deal with a very sweet and supportive feeling nurse who is offering pain medication during a moment of vulnerability when the true wish of the mother all through her pregnancy has been a natural childbirth.
A doula can also facilitate practice with the father on how to work with a natural birth both physically and how to handle the medical staff. When there is a suggestion for a medical intervention the father can say something like ‘It is so important to her to have a natural birth. I would like to wait an hour.’ Or ‘I really appreciate all that you are doing for us’ ‘please help us with a natural birth’ ‘we would really like to wait and hour’ ‘we are doing so well right now’. It is also important to understand that in a real emergency the medical staff will not be willing to have a conversation they will absolutely be stepping taking control. A doula can also prepare the father or partner how to support a woman during the times in labor where she is saying she thinks she is going to die, or that she cannot do it. These are normal parts of the process during birth and at can often mean the woman is getting very close. In birth preparation with a doula she can help the partner to formulate what to say (things like ‘I love you’, ‘you are doing well’, ‘let’s just take this one contraction at a time’, ‘just breath with me’).
First and foremost a doula’s role is to create a team atmosphere around the mother as she labors. We must not react out of anger because of our cultural up bring around the medicalization of birth. A war mentality never works in birthing rooms it only hurts everybody involved. The most important thing about supporting a natural birth in a hospital is to learn clear and compassionate communication skills before and during the stay at the hospital.