Doulas aren’t Superheroes.

This blog has been swirling around in my head for a few years now and every so often it comes back into my conscious awareness, and I feel the urge to sit down and write it. I feel that time is now.

I have been a Lamaze Certified Childbirth Educator for over 10 years and a birth doula for around six years. I also train Lamaze childbirth educators and doulas.

As a doula, I have supported clients from all walks of life who have birthed with midwives in public hospitals, with obstetricians in private hospitals, and home births.

If you work in the birth world, what I am going to say is not a surprise.

Fear totally dominates and pervades the birth space and fear is the arch nemesis of normal physiological birth.

Women are fearful. Partners are fearful and care providers are fearful. Add to this the fact that hospitals are more risk averse today than they ever have been, and birth has been medicalised to the point where almost 50% of Australian first-time mothers will have their labour induced (AIHW 2022), 37% of women will give birth via caesarean section and we have created the perfect storm.

Over the last few years, I have seen an increase in awareness of the role of a doula and the evidence-based benefits of having continuous labour support from a person who is not the woman’s partner or medical care provider.

More women are now seeking out doulas to support them during their pregnancy journey. Some are first time mothers-to-be who may have heard about doulas from friends, family members or from the media. Others are women who have previously birthed, and very likely had less than positive birth experiences and who now desire to have a very different birth experience with their second, or subsequent baby. And of course, there are many women who are still suffering the aftershocks of profound birth trauma and are desperate not to repeat the experience of their last birth.

In Australia, one in three women will report that their birth was traumatic[1]. Of these women, approximately 1-2% will go on to be clinically diagnosed with PTSD[2].  

Australia’s maternity care system is fragmented, with fewer than 10 per cent of women receiving continuity of care from a known midwife – widely accepted to be the gold standard of maternity care worldwide. Covid has also provided us with a massive wakeup call and highlighted the fact that hospital may not be the ideal location to birth your baby, particularly if you don’t want to have restrictions on how, where and with whom you birth placed upon you. Is it any wonder that women are now actively seeking out alternative models of care, such as homebirth with a private midwife and/or hiring a doula to help them navigate what they now understand to be a complex, conveyor belt like system that is less than woman-centred?

While hiring a doula will increase your chances of having a physiological birth and a positive birth experience, we are not birthing superheroes. Most doulas work according to a fairly universally accepted code and scope of practice which is designed to ensure that we “stay in our lane”. We are not medical practitioners, and it is not our job to make medical decisions for you, assess your health or your baby’s health, or to undermine your care team.

In saying that, we are also pretty cluey when it comes to all things related to labour and birth and we also have pretty finely tuned bullshit detectors, so we can definitely let you and your partner know when you are being thrown the “dead baby card”, or if your care provider is using unethical bullying tactics designed to coerce you into to consenting to something they ultimately want you to do.

We will do everything in our power to ensure you have a positive and empowered birth experience. But as much as we would like to – we can’t guarantee that.

If you’ve had a previous traumatic birth, we can’t guarantee this birth won’t be.

If you were hoping for a completely natural, physiological birth, we can’t guarantee that.

If you’ve had a previous Caesarean, we can’t guarantee that you will have a vaginal birth this time.

Sadly, in the absence of holistic, evidence-based, woman-centred maternity care, I believe that doulas are now carrying the enormous emotional burden and responsibility to protect women from traumatic births. Whether they are consciously aware of it or not, I believe that many women are hiring doulas with the belief that this alone will protect them from “the system”.

Hiring a doula is a fantastic and valuable addition to your birth support team, but we alone can’t fix the broken system. Having a doula at your birth is not an insurance policy that guarantees the perfect outcome.

If you are a doula reading this blog, I would strongly encourage you to have extensive and meaningful conversations with your clients around creating realistic expectations of what you can and cannot provide – and this includes not giving your client a 100% guarantee that you will be at her birth. If Covid has taught us anything, it is to expect the unexpected! As doulas, we need to support each other better and personally, I would like to see more doulas work in teams (not unlike the MGP, or midwifery group practice model) and less in solo practice. It creates a more sustainable workforce and provides better and more reliable support for our clients.

If you are a pregnant woman who is considering hiring a doula, please know that we care so deeply about you and want nothing more than for you to have a positive and transformative birth experience that will stay with you for the rest of your life. But there are some powerful forces working against us and trust me when I tell you, that we feel the weight of those forces at every single birth we attend. It can be emotionally crushing for us as we vicariously absorb your trauma. There is a reason why the lifespan of the average doula is three years. The burnout is real.

Many people (including myself) would argue that “the system” is not in fact, broken. Quite the opposite. In fact, it is functioning exactly as those who designed it to be. I recently watched the powerful and heartbreaking documentary, Aftershock (available on Hulu if you are in the U.S. or on Disney+ if you are in Australia) which follows the families and loved ones of several African-American women who tragically died as a result of preventable childbirth complications, and explores the U.S. maternal health crisis.

Renowned obstetrician gynaecologist and birth advocate, Professor Neel Shah says in the film; “I think that the wellbeing of moms is a bellwether for the wellbeing of society in general and that’s why every injustice in our society shows up in maternal health and in maternal health outcomes.”

“Labour and delivery units in the modern era resemble cardiac ICUs. The only difference is that our operating rooms are attached. You take 99% of people giving birth in America, we put them in ICUs, and we surround them by surgeons, so we see a lot of surgery. It doesn’t take rocket science to figure it out.”

And don’t be lulled into a false sense of security by saying “Oh that’s in America. That doesn’t affect us here in Australia.” Our intervention rates (induction of labour and Caesarean section in particular) already far exceed those in the United States, and it is well documented through research that Aboriginal and Torres Strait Islander women, as well as other women of colour in Australia have some of the poorest maternal and neonatal health outcomes in the country.

Despite the overall improvements in infant and child mortality over the last two decades for all Australian babies and for babies born to Aboriginal and Torres Strait Islander mothers, disparities remain in the proportion of low birthweight, preterm births, perinatal deaths as well as in infant and child mortality (AIHW 2018a).

Throughout the course of my professional working life, I have been fortunate enough to have had some amazing jobs over the years that have taken me all over the world. But birth work is my life’s work. It really is my true calling and what I believe I was meant to do. Whether I am teaching a childbirth class to a group of wide-eyed, anxious first-time parents-to-be, training a new generation of childbirth educators or doulas, or supporting a woman through the most intense physical and emotional experience of her life, I am constantly in awe of this amazing work I am blessed to call my “job”.

But working in this space does not come without its frustrations, disappointments, and even profound grief.

Still, I wouldn’t change what I do for anything in the world.