Even the word Doula sounds a little hippy dippy. I mean that’s fair, I used to think the same thing in the before days (before babies). “How does Ms. Merriam Webster define it?”
DOULA: “a woman whose job is to give advice and comfort to a woman who is giving birth”
I believe that a doula can mean different things to different people, and the role she fills can be different woman to woman and depending on clients needs.
A doula can be a teacher, a personal trainer, a coach, a sister or a friend, an advocate, a wise woman, a witness. I see myself as all the above. I know that for my second birth, I specifically wanted a doula who would be my bodyguard if I ended up transferring to hospital again from my planned home birth. Even doulas have doulas!
Doulas can be highly trained and educated on a topic, but they did not go to medical school. I have not attended medical school, but I have read the works and teachings of well respected medically trained individuals who are educating about the nuances of childbirth, and I feel like I have formed opinions based on their birth philosophies. Ina May Gaskin, Dr Sarah Wickham, Dr Rachel Reid, Dr Melanie Jackson, Dr Stuart Fischbein, Dr Kirsten Small are a few of my favorites.
But there's a more practical reason to consider a doula right now, and it has to do with the state of maternity care in this province.
Having a doula on your team can help you have a more personalized birth experience. Whether you are under the care of a family physician who attends births, a midwife, or an OB, there are medical standards and guidelines that are followed, typically referred to as “Standard practice” or “Hospital policy”. When you have a doula, it can be eye opening to learn that any and all standards are offerings, some offerings you might want to accept and others you might want to decline depending on your personal life experience, your wishes and desired outcomes for your birth. It’s my job as your doula to help you understand your options, so that you can make true and informed decisions regarding your birth.
In the Fraser Health region, staffing has become a real issue, maternity units have at times been put on diversion to other hospitals and in some cases that means women are birthing without a known practitioner. The system women are navigating isn’t always set up to give them the kind of individualized attention. A doula is a constant and continuous support person who follows you wherever you go. A well-known Cochrane review looked at continuous labor support across thousands of births and found real benefits. There were more spontaneous vaginal births, lower rates of cesarean delivery, shorter labors, and fewer women reporting a negative birth experience.
The staffing limitations we’re facing also mean that women can be put under real time constraints during labor. I suspect this is contributing to higher rates of intervention, especially for first-time mothers, who tend to have longer labors and take up more of a system’s limited, rationed resources. Providers may move to intervention sooner than medically necessary to do procedures “while they have the staff available.” and That’s not speculation on my part - this is an actual quote from a provider, said during one of my client’s births.
It’s hard for me not to feel a little cynical about the situation we find ourselves in. My own first birth ended in a cesarean, and I’ve come to believe it was, at least in part, a victim of exactly this kind of time pressure.
Women in Fraser Health are facing a health care system with a very high cesarean rate. For comparison’s sake, Canada’s C-section rate was 28.8% in 2018-2019, a steady increase from previous years and well above the World Health Organization’s recommended range of 10-15%. BC has long run above that national number too, and Fraser Health has had the highest cesarean rate in the province for years. According to the Perinatal Health Report for 2023-2024, it was 46.3%, nearly half of all births! It’s almost a David vs. Goliath story for women who want to experience a normal birth.
So, are doulas as woo woo and hippy dippy as they once seemed? Attitudes are changing, especially among younger generations who are asking more questions and taking a more active role in how their births go. Having a doula is starting to look less like a “nice to have” and more like the ultimate hack for better odds at a normal birth, with fewer interventions along the way.
Now, I’ll be honest with you: no doula can guarantee a birth outcome. Nobody can… not me, not your OB, not your midwife. Birth doesn’t work that way. But we can darn well try our best to set our clients up for the best possible chances and walk beside them through whatever unfolds.
Thank you, gentle reader.
— Angela