Every single doula out there wants to make sure you know about ACOG's (American Congress of Obstetricians and Gynecologists) recent recommendation "Approaches for Ob-gyns and Maternity Care Providers to Limit Intervention During Labor and Birth in Low-Risk Pregnancies."
The beginning of the fifth paragraph of the article states that, "The recommendations also suggest that women benefit from continuous emotional support and the use of non-pharmacologic methods to manage pain. Support offered by trained labor coaches such as doulas has been associated with improved birth outcomes, including shortened labor and fewer operative deliveries."
Yes! Job security! Validation! The epitome of true collaborative care for our clients! Let's do a little shoulder shimmy, booty shake and high five on proving our effectiveness for our clients AND their care providers! Alright, keep your smile and work with me on what all this actually means. Because I don't know if it is just me, but after my grin sits there slapped silly on my face, it fades a little and my first reaction is to take a deep breath and whisper under my breath, "No pressure, Sarah."
What is it about the doula that makes ACOG make such significant statements?
What does all this really mean? What is this magic doula fairy dust that we bring with us when we walk into your home, birth center or hospital room? Is your doula an insurance plan against the fears rummaging around in your brain? Was she that ONE thing your friend had at her birth that made everything perfect? Is she simply an addendum to your expectation of your best birth? Is she the result of "get a doula" crossed off your to do list when preparing for baby? How can this person quietly walk in and by simply being present make any difference in your own personal statistics and outcomes?
I don't know. I really don't.
And I'm a doula walking through 8 years of this work and hundreds of families served in some capacity of birth and postpartum support - over 200 in the agency in the last 2 years alone. So, did every one of them have a picture-perfect intervention-free birth? End up not needing a cesarean, instrumental delivery or transfer to a hospital from a birth center? Did each of these families walk away completely empowered from their experiences or did they tear up when recounting certain events or outcomes? Did all their babies immediately take to their mom's freely flowing breasts with eager appreciation for sustenance? Did not a single one suffer from crippling postpartum mood disorders that threatened their sanity and their family's survival?
I can't speak each of their stories for them, but I can easily answer "no" on their behalf. I can answer that way because I was present when the tear-filled eyes looked up at me for help, words, safety, change, encouragement, and pleading for swift removal from this one moment that they wished would never have crossed their path.
So what good is a doula then if these experiences still happen when we are there?
How do we become so very invested in our clients, yet removed from their outcome? Attached to their personhood and yet unencumbered by their own educated decisions? Present in their joy and their trauma and determined to not feel beyond appropriate levels of professionalism? Educated on risks and outcomes yet hold our tongues when not asked? That push and pull is staggering to experience. That feel and not feel is a quivering line that we all as doulas balance on, and on which we sometimes lose our footing and barely hang on with our bleeding fingertips.
Because we are only human. Doulas aren't magical. And we don't carry around any secret doula fairy dust in our mysterious doula bags that will give you your picture of an ideal birth.
So why all the recognition from ACOG?
I remember the very first client I served all by myself after shadowing and before my official in-person doula training (*gasp* cue remarkable doula industry controversy and let the daggers fly!). This client was a referral from a local midwife that risked out of a home birth because of high blood pressure. She was determined to have a natural birth and ended up needing to be induced. Because of her blood pressure readings, she was told not to get out of the bed except to go to the bathroom and those trips to relieve bladder pressure could not be prolonged bathroom visits either.
I stood beside that woman as the nurse and I maneuvered her bed into what is anecdotally called the "throne" position for the duration of her labor. The foot of the labor bed descends, the back tilts to an upright position and the resulting height of the bed literally makes the woman appear that she is indeed royalty sitting on a throne - fitting isn't it?
There were no mysterious rebozo tricks that happened during this labor; no position changes that swooped in and freed the mom's pelvis to make room for the baby. No experiential anecdotes that came through years of various trainings on how to read a laboring woman, navigate the dynamics of the hospital staff and coordinate an ideal experience.
She rarely opened her eyes as she sat upright in that hospital bed. She breathed, moaned, whimpered and opened as her baby navigated and came down to exit out of her body. Her husband was on her right side holding her hand and I was on her left mirroring him. I repeated the words my nurse had spoken to me just a few short months prior at the birth of my own baby, and she responded with a voice that mewed almost to the point of breaking.
Me, quietly, intimately: "You can do this. Keep breathing. Relax your shoulders and bottom and let this wave wash over you and just take over." Her: "Okay" breathe, sigh "Okay". Each ending of the words she barely spoke upturned like a question.
And then her pushing came, her energy built, her strength pulled from unknown stores as she increased the number of souls breathing on earth by one. She had her baby. Magically. Her baby came out without me. Her baby came out because that mama pushed slippery, wiggling bones and flesh out of her own body. My muscles weren't the ones that bore down as the top of her fundus gained thickness and strength. I wasn't the one that sweat and gasped and marveled at the feeling of strength expressed through one of the most intimate parts of the female body. As her doula, I wasn't the catalyst or the cause of her birth or her experience, I was just witness to it.
Believe me. It's not us. It's you.
There isn't anything that we bring into your space that you don't already hold within yourself. But we recognize a flaw in our society and work tirelessly to mend that gap. Missy David, my friend and shared call partner, says frequently when we are with our clients that our community suffers from the effects of a garage door society. A pregnant woman goes in to the hospital, the doors close, and then a couple days later, she is wheeled out beaming with a beautiful snuggly baby wrapped in a blanket in her arms. Birth isn't a community event anymore. So the unknown fosters fear, anxiety and the removal of the normalcy of the process of birth.
Then, I'll add, this new mom gets in her car, sits beside her baby in the back seat and her smile maybe falters a bit. Then the tears flow as she feels the weight of the heavy world pressing her to a thin, transparent version of herself staring down at her heart beating outside of her body strapped safely in a rear-facing car seat. Every car is a villain. Every gust of wind an invasion. Every potential threat to this new, innocent life she is now bound to protect (but not too much, as helicopter moms are a no-no) is an overwhelming mass of expectation sitting like an anvil on her mind and her chest as she fears every step of the unknown on her own path of motherhood.
She breathes a sigh of relief when they make it safely home. But then the garage door closes again and she is left to navigate the most important unpaid job on earth. Thankfully there are dads, partners, friends and family to help fill the gaps in the garage door to keep it from getting too drafty. That only works, however, when the family and "framily" portion of our societal support group is functioning well. But the scrubbed clean version of social media parenting and the perverse dichotomy of "If you're not with me, then you are against me" in differing parenting styles makes this task of community-based motherhood almost unintelligible.
Helping fill the gaps
So we sit with you, sweet new family, and provide that education, ear, encouragement, task completion and support so you can walk confidently into birth and parenthood of YOUR baby with what works for YOUR family. We provide no guaranteed results and outcome for your birth. Our aura doesn't keep the forceps, episiotomy or scalpel at bay. Our presence doesn't prevent or predict anything about how your parenting adventure will present itself.
But we hear you and we see you and we validate your words, thoughts and plans. We are that voice that tells you to see yourself the very same way we see you: strong, autonomous, capable, empowered, educated, life-giver, intimate molder of the future generation. We join the team you have chosen for the medical care for your birth and we say, "Bravo! Keep your eyes on the goal! Okay, this plan is changing. It's hard, but you can do this. I will help you walk this uncharted path. I'm so sorry you feel so sad." And last, but not least, "You overcame. You are strong. You did it even if it wasn't and even if it was your perfect version of birth."
If only wishes came true so easily
Gosh, I wish we, as doulas, were perfect. I wish we did have magical doula fairy dust to sprinkle on your birth and make it everything you want it to be. I wish we never had to go through any instances that made us feel like we were failing our clients, not giving enough, not having the right answers, or not having the right person on our team.
I wish our birth communities honored each other in birth work instead of wearing each other down by the gossip of each other's "failures" and "I would never" conversations and "Look! I'm right!" diatribe. I wish I didn't feel like I had to battle my personal version of ideals and fears rummaging around in my own brain on how to balance caring for my clients, their outcomes, my family, our future and my passion. I wish I didn't feel that I was fighting for my future and my business against those who wish me failure.
My one guarantee
I really wish there was magical doula fairy dust not just for birth, but for our whole messy, real lives. But there isn't. What I can guarantee that there is, however, is us, as doulas, standing there holding your hand, removed from your decisions, but feeling every single one of your feelings and cheering quietly for you through the whispers that slip out of our mouths.
That's what ACOG is recognizing with their newest report.
I'm not saying that we are the best doulas, but I am saying we will give you our absolute best every moment we are with you.
With so much love,