A lot of people have a very skewed perspective of what a professional doula is and how this differs from other birth support. This is because doulas, like all birth professionals... and humans, are different. Their perspective on birth is different, their practice is different, the locations that they work within are different. This doesn't make one way right or wrong... just different. A lot of hype has come up recently about a doula's ability to "really help" a birthing mother.
I wanted to shed some light on one perspective of this...If someone is a part of certain doula certification organizations - those organizations limit what their certified doulas can or cannot say/do. It is different for each one. It is a liability for the company if a doula starts telling moms "no, you don't need that medicine. No, there isn't anything wrong...etc...etc." It is also an issue for the women when the doula should not be providing medical care... that isn't her experience or area of expertise (as a doula). A doula is support NOT a care provider or nurse. An independent doula *can* say whatever she wants without risking her certification... but if she starts giving medical advice, she risks issues from the hospital or care provider regarding that... and possibly lawsuits depending on what her suggestions affect. It will be her personal business if she offers that service or not. (Esali Birth mentors are completely independent and accept their own personal risks for how they carry out their services. They should, however, practice logic and understanding).
A doula can't tell a provider or hospital staff what to do... but neither can her husband. In the end, it is the MOTHER's choice to do or not do anything until she is in a position of not being able to make a decision for herself - in which case she has already signed her rights over to the care provider to make decisions on her behalf in the moment. If a situation is not "in the moment" then a living will provides someone else rights to make decisions for her - that is, if she has a living will. Esali Birth mentors encourage birth students/clients to make their wills when they're pregnant if they haven't already.
However, in the US, we do have laws protecting people from abuse... any abuse... and anyone can speak up about that. We also have programs like Improving Birth that shed light on various maternity related issues which also include birth abuse. A lot of people (doula or not) won't, however, because it can be an awful feeling to have a bully come down on you for speaking up against any form of abuse. Right or wrong to not speak up, it is one of the reasons it doesn't happen when it could. Additionally, not many will say when... or if... medical staff are abusive; they just go along with it believing a birthing women has to "listen to her doctor." What can a doula do in this situation? A doula can *remind YOU* of your rights and unbiased options. They can speak up against #birthabuse. If they will is individual. What your responsibility is, as with all birth responsibilities, is to interview your potential doula and ask what THEY will or will not do for you. Every doula is different, just like every care provider is different. An OB is not the same everywhere. A midwife is not the same everywhere. Hospital birth is not the same everywhere. Home birth is not the same everywhere.
All this being said - the reason women hire a doula is FOR the emotional and physical support because even with a hospital that supports birth plans, there is usually not enough staff to provide continuous support to the mother - and because birth is *mostly* an emotional event (OXYTOCIN gets the baby out AND provides mom with a satisfying experience... when its natural oxytocin) - moms NEED to feel safe. For most moms, feeling EMOTIONALLY safe is often only attainable through a doula.... like a mother that *really* understands birth.... not understands birth in the past 50 years... but real, raw, birth. Some of us have this, others don't. This doesn't mean a doula replaces a mom or a husband... it is just a different, often incredibly beneficial, style of care.
Doulas rates on increased positive outcomes (both emotionally AND physical health of the mom and baby) are because of their *continuous* emotional and physical support.... NOT because of medical or perceived medical assistance.
That being said. If you NEED someone telling you your provider is lying to you.... then you NEED to hire a new provider. If you NEED someone whispering that the nurses at the hospital are lying to you... then you NEED to birth somewhere else.
[heading type="h3" margintop="28px" marginbottom="28px" bordered="no" align="center"][color]Whether a doula can or cannot say things doesn't fix a choice that should have been changed because you know you're not birthing in a supportive environment. [/color][/heading]
Most doulas I know don't provide on the spot childbirth education... they either recommend/require childbirth education before taking on a client, offer classes themselves and/or won't take clients unless they've proven they're educated or taken a class from that specific doula. This isn't just for the doula, it is also so the mom... family... can have the best birth (health and happy) possible. It is so that the client isn't expecting the doula to be a superhero during the birth. They can certainly seem like superheros, but they want to enjoy their job, too... and they want to be able to do their job to the best of their ability.
We wouldn't have so many issues in births as it is if providers *required* .... offered... excellent perinatal education. Unfortunately, again, most classes that are scantily recommended are "how to be a good patient." Or, "you can have a great birth if you don't have an educated birth philosophy or wish to do things 'out of the norm' - just do what we say, and here is #whattoexpect." At Esali Birth we share how to make choices and why they're important.
Knowing your options and making choices that support your birth beliefs comes *before* hiring a doula. The doula then supports you AFTER you've chosen a supportive environment. No matter what a doula can or can't say - if the mom hasn't chosen an environment (provider/location) that supports her wishes - the doula can't magically create a positive experience. It might happen (because doula support can make that big of a difference) - but it isn't the best situation for anyone. If anyone has to fight for the mom's rights - even though that's a legal option - it makes the birth space an intense place to be for someone... often the mother or the father... and neither of them need to be doing anything other than bonding with each other and their baby! We're trying to build oxytocin, right? Not just because its safer for mom and baby... not just because it progresses the birth process... but also because oxytocin builds in everyone in that birth space. This is an event from a higher power that knew that mom and baby will need a lot of love and support during the postpartum period.
[heading type="h3" margintop="28px" marginbottom="28px" bordered="no" align="center"][color]Make birth as simple as it can be by understanding that birth is a profoundly intricate transformation.[/color][/heading]
Believe this, make the choices that support it, and birth is (in most cases) incredibly simple.
In an environment (location/birth team) that SUPPORTS biological birth AND a mom that has a birth partner (her husband is wonderful when they're relationship is connected and respectful, or mom, or friend...etc....... a midwife)... that truly understands biological birth and the need to be quiet and let mom instinctively do her thing... a doula might not be necessary. Or, a doula might be that birth partner that is quiet and lets mom do her thing - and giving her the confidence to do so.
You have to understand that [color]BIRTH IS EMOTIONAL[/color]. Almost all complications with birth these days stem from an incredible misunderstanding that humans can or should meddle with birth. If you don't believe that you can #freebirth (birth unassisted... birth alone... birth without a care provider) - then I would encourage positive continuous support... which is exactly what a doula provides. Someone else on your birth team may already provide that, I don't know... but it isn't a black/white "a doula does this" kind of situation. It depends on what you need, what you want, and where you're preparing to birth.
A montrice on the other hand is often a midwife who is providing doula services. They can do limited provider care for the mom because of their midwifery background.... but they don't intend to catch the baby as a provider nor take responsibility in that manner. Once they get into a birthing facility or hospital, their ability to act as a sort of care provider stops because of liability with the hospitals and providers in that location. Their role moves towards that of a doula.
I hope this clears up some of the issues regarding if you should really save/spend the money on a doula. What have your experiences been? Can you add to this?