Monday, April 27, 2009

5 things that being a doula changed about me

I think being a doula changes everyone who does it, to some extent, but I think it may have changed me a little more than average, because I took kind of an unconventional path to becoming a doula. There are many reasons people go through doula training and start attending births, but probably most start out with a real passion for natural birth and for supporting women during this special time in their lives. I thought those things were really interesting, but I also wanted a job. I was graduating college and I wanted a job where I would move to a new city, try out this whole "public health" thing, and hopefully get some new skills out of it. And I got a job in Denver that fit those criteria, through AmeriCorps, where I would do various things including be trained and work as a doula.

If I hadn't been hired for that job, I would have taken one in Minneapolis working for a refugee health organization on issues like tuberculosis control and mental health services. My guess is I would never have pursued doula training independently - I would have been interested, but never interested enough to actually put the money and time in.

So unlike other people who go through doula training, I didn't have any strong belief systems about birth going in. I had always been fascinated by birth - I watched "A Baby Story" religiously in high school. But I thought the epidurals on "A Baby Story" looked pretty sweet, and based on the stories my aunt told about her labors I had already decided that someday I'd get me one of those. I had started to get more familiar with issues of medicalization by writing my senior thesis on breastfeeding, but knew little about birth. I was not at all comfortable with homebirth - I thought it sounded unnecessarily risky. But that was kind of it.

By the end of the year I had attended over 30 births, all in hospitals, taught childbirth classes, newborn care classes, and done breastfeeding support. How did all that change a birth neophyte?

1) I became much more proactive about all aspects of my own health care. I no longer expected that health care providers would just tell me the "right" thing to do, because I realized that in many situations, there was no one "right" thing to do. Instead, I followed up medical advice with my own research and judgment. I asked more questions in the doctor's office ("What do these numbers mean? What would be normal? What if instead of taking action, we wait to see what happens?") Ultimately, I realized that I made my own medical decisions - and always had, even if that decision was just to do what the doctor said.

2) Correspondingly, I also came to believe that the goal of all women's health care should be empowerment. Pregnancy and birth are a great time for women to begin to take ownership of their health care, because it's such a crucial time period and involves so many health decisions. But why wait until then? Every significant interaction with the health system - annual paper smears, check-ups - should be a chance to involve women in their sexual and reproductive health.

3) When it came time for me to give birth, I no longer wanted the automatic epidural. Yeah, it looked pretty sweet on "A Baby Story". But they didn't show (or at least attribute) the stalled labors, or women itching and itching because of the medications, or such heavy epidurals that women had no idea how or where to push, or epidurals with a "hot spot" of pain. They didn't discuss how a woman with an epidural can't move around to speed her labor or move a malpositioned baby. I wasn't anti-epidural: I saw them as a great tool, where women stuck at 6 cms. for hours finally relaxed, and progressed to complete in 30 minutes. But applied indiscriminately, it seemed like they caused more problems than they solved.

5) I no longer wanted to give birth in a hospital. Over 30 hospital births taught me that anything I wanted that was out of the norm would likely be an uphill battle, and that a lot "norm" practices caused problems. It's not like I saw all uncomplicated births. I saw c-sections for fetal distress. and instrumental deliveries, and shoulder dystocia, but none of them made me feel like I would be better off in the hospital - just that I'd be fine with a hospital easily accessible if needed. Watching women spend their whole labor fighting just to have their wishes respected was exhausting and depressing. There were the occasional exceptions - like the birth story I just posted - but those (like that story) resulted from "textbook" labors where women got exceptionally lucky (not a single nonreassuring heart tone, 1 centimeter of dilation per hour, etc.)

5) I became more aware of disparities in our health system, and more committed to working to overcome them. I am coming from a place of relative privilege in getting all empowered and owning my health care and thinking about out-of-hospital birth. I have the race, class, educational, and financial privilege to easily contemplate all of these things. The women I worked with did not. Many of them did not speak English, nearly all were on Medicaid, very few had access to higher education, most were women of color. They did not have many options for their medical care and they did not have anyone suggesting to them that things could be different. When I get excited about spreading the word about birth alternatives, I have to remind myself that while I may want to make sure all my friends hear my spiel, this is one of the ways privilege works. We need to change not just our own attitudes, but the system. That's ultimately why I'm getting my MPH now - because being a doula and fighting the system one person at a time wasn't enough.

What has being a doula/involved in birth work/learning more about these topics changed about you?


Kate Zondervan said...

hi- i just found your blog-- it's great! what a wonderful journey you have undertaken. looking forward to following you posts. -kate

publichealthdoula said...

Thank you! :-) I see you work at the Brooklyn Birthing Center, I used to live in NYC. I hope you're enjoying doula work there!