(Blogger's note: words in italics are quotes directly from the BBC article)
The December 2 article from the BBC titled "Doulas: Holding Hands or Stepping on Toes" has been picked up by a number of news agencies. It is circulating and generating alot of interest and conversation.
But one doctor would like to see more debate about the role of these women, who have no medical training and whose work is at present unregulated by an outside body.
Writing online in the British Medical Journal, anaesthetist Dr Abhijoy Chakladar says doulas are taking over roles that midwives should be performing and may even be compromising care by disrupting the relationship between the medical team and mother and affecting clinical decisions.
While it is a truth that sometimes doulas enter into doula work with their own agendas at the forefront and do disrupt the relationship between the medical team and mother and affect clinical decisions, it is also true that nurses, midwives and physicians do the same. With the agenda of avoiding litigation, being more efficient by observing 3-4 active laboring patients from the nurses station via EFM, care providers limit the freedom of mothers who have uncomplicated labors and sometimes actually cause complications.
Jean Birtles, head of British Doulas, says there are birthing assistants who may be doing just that.
The opposite is also true of doulas, nurses, midwives and physicians: that they LISTEN to laboring women, respond to laboring women and have uncomplicated outcomes. Generally the doulas do answer to their certifying organization, many of which have grievance committees and investigation protocols. I am not sure what Dr. Chakladar wants by an "outside body".
So there is a perceived "fault" on both sides. Neither is pure.
However, whether doulas do in fact decrease interventions remains a moot point, as it is possible that the kind of women who are very determined to achieve a "normal" birth are more likely to hire a doula than those who do not see medicalised childbirth as a problem.
The issues surrounding the relationship between doulas and clinicians are part of a broader discussion about how polarised the childbirth debate has become, according to Dr Chakladar.
Dr. Chakladar, an anesthesiologist, thinks that all 25+ years of research about the effectiveness of doula care is a moot point. I think not.
Rather, I believe that while there is some polarization in the childbirth debate, it is because of a lack of information in nursing schools and residency programs about normal birth. As it should be, nurses and physicians are taught crisis management for those situations when crisis management is necessary and expertise is required. However, birth is not a situation of crisis. Nearly 85% of the time, birth is a normal and natural event that requires little intervention.
Regretfully, in the short time nurses and physicans are in the obstetrical clinical rotation, they do not have the time to learn how to work with a natural and uncomplicated birth. They literally are not trained to work with a non-crisis. The old adage "if you see everything as a nail, all you will use is a hammer" applies.
Instead of enabling Dr. Chakladar's theory of polarization in the childbirth debate to continue, I say we should teach all nurses and all physicians (regardless of where they are in their careers) how to work with women who have normal, uncomplicated labors. To that end, if you are reading this, watch for the new program Evidence Based Maternity Care: Turning Aha Moments into Practice in January from Perinatal Education Associates. This program is applicable for hospital nurses in labor/delivery, childbirth educators, doulas, physicians, midwives, nursing schools, and residency programs.
If you are interested in having this program at your facility, please contact us. We'll add you to the growing list of places where we will be presenting it in 2010!
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