What’s a doula to do?

There is such a deep chasm and fracture within the doula community regarding in-hospital and out-of-hospital birth. On the one hand there are those who say anything goes in supporting women and their choices. On the other, there are those who say no doula should support a woman in the hospital environment because it is a “bad and dangerous” place to birth,  or at the very least should get kicked out if she is doing her job “right”.

Who is right? This is where it gets tricky to be sure.

With upwards of 98% of the birthing women going to the hospital in the United States, are WE really within the general doula scope of practice by taking such a hard stance of ignoring those women in need? Who is benefiting here? It is well known, that I am all for a doula deciding her practice style, what scenarios she is best suited to support within, and knowing who she is best able to support.  But to abjectly say, no doula should ever support a woman in a hospital birth, is to me akin to very interventive practitioners who believe that birth is inherently dangerous and a trauma waiting to happen. Thus, viewing every women and baby through high-risk lenses and subjecting them to high-risk protocols where there is no medical need encourages more intervention and higher-risk scenarios to actually occur.

Who does this serve taking such a hard line? Perhaps those speaking it, thinking they are pressing for the greater good. Definitely not the mothers who need the support and assistance navigating a sometimes difficult and stressful system. The mothers and babies are caught then between a rock and a hard place. Then they are effectively forced to go without support and help. The truth is women having hospital births NEED DOULA SUPPORT MORE than women choosing an out-of-hospital option.

Bottom line: I make no claim that it is an easy task to doula within the hospital environment. It is not. It can be brutal. Imagine for a moment, really, close your eyes and think of what happens, what you witness as a doula when you are there — then think of all the women who have no doula present — what happens to them? What do those women experience? What do those babies experience? Now, open your eyes and breathe for a moment. It is not pretty is it?

Right there is what keeps me taking hospital birthing clients. It requires very open communication and immense work prior to labor during prenatals running through scenarios, detailing needs and desires, making certain informed consent and refusal is understood for a variety of procedures, medications, and cesarean. A mother needs to be well-versed in how to use her self-advocacy voice as does her husband, partner or other main support person.

Looking at the flip-side now.

So the other ideal, er rather idea, is that a doula should support anyone and anything because she is a doula poses other issues in my mind.  I do not see anywhere in the job description that this is what a doula ought do.  Any one doula cannot be the right doula for every mother or scenario. This way of thinking can fall into  a cookie-cutter way of practicing, thinking one can be all to everyone. Doulas are people too. Each has individual abilities, biases that need to be addressed, history and points of view.

I think it has been mistaken that a good doula is one that has no say in how she practices or who she is best to serve.  I believe there is a doula for every type of scenario and mother. It is a very individual pursuit and fit.

I know some amazing niche doulas out there who support only high-risk mothers, multiples, same-sex couples, in-hospital birthers, planned cesareans….. The list could go on.

Honestly, I will say there are some amazing doulas who can work under this very open practice style effortlessly and with excellence.  I applaud those doulas, though I think that is the minority and most are not able to keep it up without finding a comfort zone long haul.

Childbirth is such a deeply intimate and intense process with so many variables, being the right fit all the way around is necessary in my humble opinion.  I have seen doulas deeply wounded and traumatized by what happens in the birth room. Sometimes that is unavoidable, but through years of interaction with many doulas, the running thread is that the doula had misgivings even during the interview that this was probably not a good fit but chose not to refer the mother out to someone she knew was better suited for whatever the reason.

Are women and babies really being served best under this model of practice? This is for you to go ahead and answer for yourself.

Bottom Line: Women and babies need individual care whether from a doula, nurse, or care provider. Can a doula be all things to all mothers? Some, I am sure. Overall I believe not. For the health of a doula and the health of her ability to practice and support well, finding the “comfort zone” can make the difference for the mother, baby and doula. Why? Because doula work is such an intense giving of oneself (emotionally, physically, even spiritually). A continual self-assessment needs to be done just where her true and honest “comfort zone” is. By doing this, a doula is caring not only for herself by avoiding burnout, but also for her future clients and her ability to care for others with excellence and utmost professionalism.


  1. Kayce on October 10, 2010 at 10:22 am

    Great great post! I haven’t taken doula clients at all this year for some of the reasons you mentioned. Being a doula is hard. As you said, you give so much of yourself, and can get burnout really fast if you don’t take time for yourself and find where you are most needed.

    I do believe there is a doula for every woman. Regardless of where she births. She just has to reach out and find that doula, and as doulas we have to know how to feel that connection so we make sure it is the best fit for us too.

    Again, great post!

  2. Julie on October 10, 2010 at 11:12 am

    As a doula who has supported many births in all sorts of different circumstances, I agree that women who choose hospital births need doulas even more. I don’t believe it’s within our Scope of Practice to be militant and coerce women into making choices they may not be comfortable with just because we feel strongly about what birth “should” be. I am grateful that the births I’ve attended have presented challenges and tested my ability to overcome any prejudices or biases I may have started out with.

  3. Shannon on October 10, 2010 at 12:36 pm

    Well said!

    When I first became a doula I believed that I had to be open and OK with anything a mom chose. Don’t get me wrong I do believe that a woman has the right to choose what ever type of birth she would like! I have fought my entire adult life for reproductive freedoms.

    But, I have come to realize that I need boundaries and I need to stay true to my beliefs too. I have a problem with doulas who go into interviews and make statements like “I have no biases”. I believe that if you don’t stand for something you will fall for anything.

  4. Tara R. on October 10, 2010 at 1:11 pm

    Interesting that you bring that up right now. Just last night I was thinking about one OB practice that is really unsupportive of women’s choices. They kick mothers out of their practice who take Bradley classes. I had one client with that practice and since have been considering referring out if a potential client was with this practice. Then I got to wondering whether that would be doing the same thing as the OB group was doing – limiting women’s choices.

    As far as whether a doula wants to work for women who are having a hospital birth, that is up to each individual doula to decide, and I’m sure there are some (perhaps many) who do not want to work in a hospital environment. However, I think that it is in the hospital where we do the most good. I have sometimes felt nearly redundant when a woman has a good, supportive, caring homebirth midwife attending her labor. It really depends on the woman, the midwife, and the circumstances. I have never felt not needed at a hospital birth.

    There are legitimate reasons for many women to birth in hospitals, and those women need support. And if we really support a woman’s right to choose what is best for her, her children, and her family, doulas as a group must be there to support in the environment she feels most comfortable in. I feel we would be hypocritical as a profession otherwise.

    For some doulas to insist that no doula should support a woman in a hospital environment is, I believe overstepping a boundary. I *don’t* feel I must support a woman in a situation that makes me personally uncomfortable (probably, no doula should do so, as she wouldn’t be particularly effective in that case), but I do not presume to tell women how they should give birth. I guess it really depends on one’s paradigm in all of this. I personally do not accept clients who are not planning an unmedicated birth, for example, but I would not presume to tell other doulas that they should practice in the same manner.

  5. Enjoy Birth on October 11, 2010 at 6:18 pm

    I am sort of choosy in the clients I take. I typcially only take my Hypnobabies students, then I know that they are well informed of their choices. I have a relationship with them that has been formed over weeks of classes together.

    I attend home or hospital births. If my clients express any concerns about their care providers I encourage them strongly to follow their intuition and change to a more supportive care provider (of which I have a few to refer to)

    This works well for me.
    🙂 There are times when moms make choices I wouldn’t make. But I remind myself, “It’s not my birth” I just support them the best I can in that situation!

  6. Heather on October 12, 2010 at 10:37 am

    Maybe I haven’t been around the “birthy” community long enough, but I’ve not yet come across the “mothers birthing in a hospital don’t deserve a doula” faction. YIKES! I believe that mothers birthing in a hospital are the most in need of doula support!