When Doulas Go Wrong: What a Doula Should and Should Not Do

I've already written about what a doula is, and I used the DONA International (www.dona.org) definition in my very first blog post. However, I will go ahead and re-post it just for clarity:

"What is a doula?

The word "doula" comes from the ancient Greek meaning "a woman who serves" and is now used to refer to a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period.
Studies have shown that when doulas attend birth, labors are shorter with fewer complications, babies are healthier and they breastfeed more easily.

A Birth Doula

• Recognizes birth as a key experience the mother will remember all her life
• Understands the physiology of birth and the emotional needs of a woman in labor
• Assists the woman in preparing for and carrying out her plans for birth
• Stays with the woman throughout the labor
• Provides emotional support, physical comfort measures and an objective viewpoint, as well as helping the woman get the information she needs to make informed decisions
• Facilitates communication between the laboring woman, her partner and her clinical care providers  
• Perceives her role as nurturing and protecting the woman's memory of the birth experience

• Allows the woman's partner to participate at his/her comfort level"

I love this definition. This is the exact definition I give when people ask me, "What the heck is a doula, and what do they do?" But it does present a problem. It tells you what a doula is. It doesn't tell you as much about what a doula does, and even less about what she does not do. And the things a doula does not/should not do are even more important. For this, I reference one of my favorite sites about everything pregnancy, labor, and birth, Evidencebasedbirth.com:

"It’s also important for you to understand what doulas do NOT do:

• Doulas are NOT medical professionals
• They do not perform clinical tasks such as vaginal exams or fetal heart monitoring
• They do not give medical advice or diagnose conditions
• They do not judge you for decisions that you make
• They do not let their personal values or biases get in the way of caring for you (for example, they should not pressure you into making any decisions just because that’s what they prefer)
• They do not take over the role of your husband or partner
• They do not deliver the baby 
• They do not change shifts"

Isn't that great? It's nice to see it laid out so plainly. Any doula worth her salt adheres to those guidelines. However, not all doulas do. It's a sad truth that the women who are supposed to be the strongest advocates and supporters of birthing women can also be their biggest critics and hindrances.

So if you're interested in having a doula attend your birth, make sure to interview several. You may click with the first one you meet, but it's still a good idea to shop around, especially if the one you choose ends up unable to attend your birth. That way, you already know who else you would be comfortable calling in an emergency. You should be sure to ask lots of questions, to be certain that your philosophies are in harmony (I know, I say that a lot) and that she'll respect your choices without reservation. The American Pregnancy Association (americanpregnancy.org) has a good starter list of questions you should ask:


"Questions to Ask a Potential Doula:

• What training have you had?
• What services do you provide?
• What are your fees?
• Are you available for my due date?
• What made you become a doula?
• What is your philosophy regarding childbirth?
• Would you be available to meet with me before the birth to discuss my birth plan?
• What happens if for some reason you are not available at the time of my birth?"

If you don't like even one of the answers she gives you, walk away. She's not the right one. Remember, you're hiring her to support you, and what you want, not so that she can push or promote her agenda. The last thing you want in the delivery room (wherever that may be) is someone you don't trust to be behind you 100%.