Dr. Christine Morton Discusses Dilemmas in Providing Support for Birthing Women in Her Webinar Entitled, Women, Doulas and the Medical Management of Childbirth

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An increasing number of women in the U.S. are hiring doulas, women who provide continuous support to women in labor. But there are a number of dilemmas that doulas face as they work in health care settings where they may not be welcome, as Dr. Christine Morton describes in her upcoming webinar co-sponsored by Praeclarus Press and the Simkin Center for Allied Birth Vocations at Bastyr University.

Doulas provide continuous support to women in labor. Photo credit: Kyndal May

Doulas are the Birth Ambassadors to the midwifery model of care in the U.S.

Childbirth in America continues to be a challenging experience for many women. Rates of cesarean sections are at an all-time high. Almost half of American women described their recent childbirth experience as “traumatic,” with 9% meeting full criteria for posttraumatic stress disorder.

There has to be a better way. And there is. For many women planning hospital births, hiring a doula, a woman who provides continuous labor support, is seen as a way to counter the highly interventionist births available at most hospitals. The number of women hiring doulas to attend their births is increasing.

The doula’s role is to provide individual attention, information, and support to her client, and to facilitate the same from the maternity clinicians. But the role of doula does not come without dilemmas, as Dr. Christine Morton describes in her upcoming webinar, Women, Doulas and the Medical Management of Childbirth. This webinar will be presented September 9, 1 p.m. EDT., and is co-sponsored by Praeclarus Press and the Simkin Center for Allied Birth Vocations at Bastyr University.

One dilemma doulas face is how to advocate for the woman in a setting where they may not be welcome. While most doulas report positive experiences working with physicians, nurses, and midwives in the hospital setting, difficulties can occur. Nurses, for example, may perceive that doulas are encroaching on their job of providing continuous labor support. However, in most hospital settings, it is unrealistic for a nurse to attend continuously to one patient. Also, doulas prioritize women’s emotional experience of birth, which health care providers often minimize.

Another dilemma is what doulas should do when hospital policies or clinical practices violate doulas’ core belief that women have the right to plan for their birth, to be active participants in their care, and to be treated with dignity and respect. This core belief can be at odds with the structural care models currently in place at most U.S. hospitals. Thus, doulas sometimes find themselves in awkward and emotionally charged interactions with health care providers.

Doulas also face conflicts between their desire to provide both informational and emotional support. A doula may know what her client is entitled to as a healthcare consumer, but drawing attention to this during the interaction with a nurse or obstetrician may be perceived as interfering with the delivery of medical care.

While egregious cases of obstetric maltreatment do occur, more common are cases in which a woman’s desire for an unmedicated birth is not respected, or when interventions are proposed without allowing for a full discussion of risks and benefits. Women may feel coerced into intervention because clinicians implicitly--or explicitly-- convey the idea that if a woman does not comply, she will harm her baby.

Doulas often become doulas because they want to support women in childbirth. But they often need to find ways to navigate the challenges inherent in their role.

Dr. Morton conducted a study of doulas and will present her findings, while describing some of the dilemmas doulas face and how they addressed them. Her findings are also available in her forthcoming book, co-authored by Elayne Clift, Birth Ambassadors: Doulas and the Re-Emergence of Woman-Supported Childbirth in America, available from Praeclarus Press.

To register for the webinar, click here.

Praeclarus Press is a small press founded by Dr. Kathleen Kendall-Tackett and specializing in women’s health. It is based in Amarillo, Texas, USA.

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