Photo by Shea Hardy Baker

The Doula Dialogue

by Shea Hardy Baker | September 1, 2017

Editor’s note: This article first appeared in Midwifery Today, Issue 123, Autumn 2017.
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Midwifery Today, where I have been working as the conference coordinator since earlier this year, is my new work home. I have been a huge fan of the organization since I became a birth and postpartum doula and childbirth edu-cator. It is wonderful to be working alongside Jan Tritten and the rest of our amazing staff to help create inspiring, heart-centered and skill-based conferences for the remarkable practitioners who come together with us to connect, learn and be inspired. My work as conference coordinator taps into my Type A planning skills and organizational geek-out moments, and I love it. Through this position, I have the opportunity to collaborate with some of the global birth community’s most renowned practitioners. My favorite part of the job is meeting all the outstanding people who attend our conferences; they are simply wonderful and so inspiring. Yet I am still a doula at heart. I treasure the experiences I’ve had witnessing the most precious moments life offers. Seeing a new being stretching through to Earthside or the first gaze held between mother and baby is beyond rewarding and it is my calling. I will always be a doula. Doulas hold a unique and special place in the birthing community. We walk between two worlds and bridge a gap in maternal health care that I believe is vital to neonatal health, as well as women’s overall health during the childbearing years. No matter our training backgrounds, generally speaking, doulas are, at heart, advocates of normal physiological birth. Beyond what we each may personally feel about birth, the code of ethics a good many of us practice by calls us to support choices without judgment and to help facilitate a dynamic where a woman feels encouraged and supported to make her own health care decisions. Our job is to inform, with evidence-based information, and then support women’s decisions around their bodies and babies. Informed choice is power and being empowered at birth can happen in a myriad of different forms—including choosing how and where to birth. In my career as a doula, I had the honor of serving pregnant and parenting teens through a program I co-founded: Doulas Supporting Teens (DST), located in Lane County, Oregon. Over the course of the nine years that we functioned as a nonprofit organization, I worked primarily in the hospital setting. Having a homebirth was out of the question for most of the pregnant teens I had the privilege of serving. Often, there was not a safe home to birth in, or the idea was culturally beyond what they felt safe doing. It broke my heart, too. I love homebirth. I am a homebirth mama myself and I served alongside one of our greatest practitioners for a time as an assistant. What better place to facilitate an empowering birth to happen than at home. I agree; I am with you. I wish all women were called to homebirth, because I know it’s magic. There is no other place to witness the true essence, without interruption, of a birthing woman’s full power as a human. It is divine and sacred and I will always be a strong advocate for homebirth and the incredible practitioners who fight every day to keep this an option for women. The truth is (and it is the reality of our culture worldwide), women will predominantly choose a hospital setting, even when out-of-hospital births are easily attainable. Doulas often have the greatest impact in the hospital setting. When I first started as a doula, working in the hospital was a challenge. At that time, in 2003, the relationship between doulas and the medical community was strained. There was a great deal of distrust and misunderstanding on both sides. Regardless of that, as Doulas Supporting Teens grew and began to serve more clients annually, we became a regular part of the care team with our clients. As a result, relationships between the doula community and the medical community began to improve. You simply cannot help create a positive birth experience for a woman in the hospital—especially a young woman—when doulas and the medical staff have an adversarial relationship; it is unproductive and damaging. One thing I am most proud of through our work with Doulas Supporting Teens is the legacy that created positive relationships between the medical community and doulas. After all, when we walked into a hospital room with a 15-year-old young woman in labor with her 15-year-old boyfriend, everyone understood that extra support was imperative. We all became part of a support team to help these young families have the best experience during birth—with the hope that it would propel them into parenting in a positive, empowered and healthy direction. It really worked and our outcomes were outstanding. We had a 99% initial breastfeeding rate at time of discharge, our induction and cesarean rates were very low and we had a solid and positive community of pregnant and parenting teens supporting each other. When DST doulas walked into the hospital, we were more often than not warmly welcomed and our relationships with doctors, CNMs and nurses were, for the most part, very positive. That doesn’t mean that there weren’t differing opinions on care options; but we were factored into the conversation with care providers. We had those conversations in the halls of the hospital at 2 am—collaborating on what we could do together to make a birth work for the mama. I know this isn’t what happens at home, where women are surrounded in the environment that supports their most primal instincts during birth. I hear you, but it’s what happens at the hospital and it must, so that positive outcomes can be achieved and clients can feel supported. We still had to advocate often for informed choice and sometimes create a bubble of protection so our clients had the time to make informed decisions. It was tough, often frustrating and it took a lot of case review processing within our team of off-the-charts incredible doulas and it worked. It. Just. Worked. It was the most rewarding work I have ever done and I miss it every day. During my nine years of active practice and call work with DST, I learned many lessons that challenged me on different levels. I experienced heartbreaks and the greatest joys. My clients were amazing—each and every one of them. Professionally and personally, however, what I carry forward into my everyday life is this: Who am I to define anything for another person? I mean really, who am I to define what an empowered birth experience should look like, feel like and be like for another woman? An even bigger lesson for me: I don’t empower other women; that control is not mine to own. My role as an advocate and support professional is to encourage women to empower themselves with information and to understand that some will inform themselves thoroughly and some will not seek out information, will not be open to other options and will make choices based on misinformation or cultural norms. They have the right to do so despite the fact that personally, being the information junkie that I am, I cannot relate to not informing myself fully, especially in regard to health care decisions. On a professional level, the code of ethics by which I practice provides me with the personal boundaries to understand that I must respect a woman’s inalienable right to make her own decisions and choices. If I have provided the education, information and op-portunities for learning then I have done my job and all that is left is to respect her right to make choices for herself and her baby. My intention with “The Doula Dialogue” is to create open dialogue regarding topics that bring to light issues that affect women’s health during the childbearing years. Would you like to join in this dialogue with me? Do you have comments, questions, topics or feedback to offer to this article? If so, please submit to Shea Hardy Baker at [email protected]. I truly look forward to hearing from you. Your voice, your opinion and your thoughts matter and we want to highlight you!