Hello! My name is Cheyenne and I’m a doula in Richmond, VA. When I tell my friends and others in my community, “I’m a doula. I help women create their birth plans and support them as they give birth to their child,” I often hear a chorus of responses something like this:
“Oh, wow! I’m terrified of birth!”
“How many babies have you delivered?”
“People plan their births?”
I would have given some variation of these same responses a few years ago, before I knew what a doula was, and before I’d explored the realities of birth in this country. But now, being in my role instead, I often answer something like this:
“Birth is definitely hard work, but there are lots of ways to support women coping with contractions and to make labor manageable until baby is born and the ecstasy-inducing hormones take over. Plus, believe it or not, there are some women who’ve felt little pain or even a lot of pleasure during birth. Kind of surprising, I know!”
“Zero! Doulas definitely don’t deliver babies; we are non-medical support for moms. That said, only mothers birth babies! Not even OBs (obstetricians) and midwives can take that credit! Even in a c-section. If he/she’s coming out of your body, you birthed him/her.” “Yes! Just like we plan for other significant life experiences, we can and should plan for birth! After all, you’re only going to experience your child being born once, and you won’t have any choices in how you experience it if you don’t know your options.”
As much as midwives and doulas and birth centers and home birth are beginning to be discussed in greater depth, the foremost thoughts about birth still remain centered around pain, hospitals and doctors delivering babies (I’ll refer to this concept of birth as institutionalized birth from here on). Why do we think this way?
Why We Think of Institutionalized Birth First
For one thing, it’s what we see. Think of the last television show/movie you watched in which some character gave birth? What kind of medical provider did they have? Where did they go to give birth? And what was their experience depicted to be like? Most likely you’re going to check all the way down the institutionalized birth list: OB, hospital, painful with extra helpings of yelling, maybe cursing out the father, red in the face, and terrified.
It’s also what we hear about. My mother gave birth to me and my siblings in hospitals with doctors, not midwives. Her mother had her and her siblings the same way. My grandmother’s mother didn’t have that experience, but that was so long ago! People today easily count her experience out as outdated, and honestly, there are a lot of things that weren’t available in my great-grandmother’s time that could would have made childbirth a lot safer and more manageable for many women. But there are also elements of birth experiences of the past that we’ve lost in our one-size-fits-all, medicalized approach — like the involvement of a community in care, the appreciation of the laboring body, and the experienced matriarchal approach to care.
This brings me to the next reason: for a long time institutionalized birth has been promoted as the safe, legitimate way to have a baby. In the early 1900s, campaigns were run by medical professionals to delegitimize midwives; black midwives were called “witch doctors,” and all midwifery was attacked as uneducated and unsafe.
What was considered educated and safe? Not natural birth. Medical interventions. Doctors at that time believed that natural birth itself was dangerous, and couldn’t be handled properly without medical intervention, including pain-reducing drugs, contraction-creating drugs, inducement, breaking womens’ water, stripping the membranes, using forceps, vacuums, and ultimately c-sections. All of those practices are still used today. When used in the right context, they can offer much-needed support and even save lives. But as their uses have increased over time, it’s commonly been the case that they’re used when they’re not needed, and can even be detrimental.
The c-section rate, for example, went from 5% in 1970 to 20% in 1996 to almost 30% in 2015. Unfortunately not because more women needed them. C-sections have been favored by some providers (and some women) as easier/more practical, have been chosen out of fear of vaginal birth, out of fear of lawsuits, or out of an unnecessary desire to speed birth up.
The maternal mortality rate in the United States has increased in recent decades, too, and experts take the correlation seriously. We’ve now learned that C-sections only help bring maternal mortality rates down to a point; after the c-section rate hits 20%, it stops impacting maternal health positively. That’s why many hospitals are beginning to start initiatives to use them (and other forms of intervention) less.
So How Should You Approach Birth?
Own your birth, before, during and after. My hope is that people would begin to think about birth a lot more, with less hesitation and more empowerment.
Be Diligent about Choosing a Care Provider
Put some thought and research into whether you’d like to have an obstetrician or a midwife. Talk to others about their experiences with specific providers in your area. And no matter which type you choose, make sure your care provider is qualified, answers your questions and doesn’t dismiss them, is receptive to your thoughts and concerns, and shows respect for you and your time.
Consider Your Emotional and Physical Health & Circumstances
Does the idea of giving birth at home or at a birth center just seem entirely worrisome to you? Then don’t let anyone make you feel bad for choosing a hospital birth. Would you prefer giving birth outside of the hospital, but you have some concerns about whether you would be able to do that healthily? Talk to your care provider about your options, and if hospital birth is a best for your situation, talk to your care provider and/or doula about how you can choose the right options for you in that setting.
If you can, visit the place you plan on giving birth for a tour beforehand and learn about what their specific policies and resources are. Not every hospital or birth center experience is equal.
Take Childbirth Education Classes
By taking a childbirth education class you not only learn more about your options and ways you can be supported in and prepared for labor and birth; but you also meet other expecting parents in your area. Talk with each other about what you’ve seen and heard and experienced. There’s power in numbers!
When I’m “doula-ing” — what I’m doing for my client is really no different than what I’d do for my sister, my cousin, my friend, or anyone I know. I’m listening to them, I’m equipping them for an important life experience according to who they are and what they’re going through, and I’m walking beside them the whole way.
Institutionalized birth practices don’t naturally do that, and quite honestly we couldn’t expect them to. They’re so large and wide-scale that they have to standardize. But with determination and support, we can make sure that they standardize wisely, with families’ interests in mind — and we can even work out ways to get members of the institutions of medicine to treat pregnant and birthing women like individuals undergoing a natural process, rather than medical problems in need of medical solving.
So bottom line, if you take nothing else from this long blog post, take this: Birth is a beautiful, natural, and significant process that you can prepare for in a variety of ways. While doctor/hospital/pain are probably the main associations you have with birth, your options extend far beyond them. Know them, choose them, and walk confidently into the birth that ultimately brings the most magnificent squishy little new life safely into your arms. That’s what this is about at the end of the day. Informed, accessible birth choices lead the way to healthy moms and healthy babies.
Photos © Pinterest, Neva Michelle Photography, Annapolis Birth Photography | Baby Jackson