by Bethany Hays MD, FACOG, Honorary CBD(BWI)
It’s not easy to let go of everything you know and learn to be something very different.
My transformation from Perinatologist to Doula didn’t happen overnight. Let me go back and tell you about my journey.
I decided to become a perinatologist because I wanted to be the best in my chosen field and I thought that meant having the most information about pregnancy and delivery. By the time I finished my fellowship, I knew something was wrong. All my mothers were sick and all my babies were premature. So, I looked around to see who had the best outcomes…. and, of course, it was the midwives. I set out to learn everything they knew about keeping birth normal. I learned a lot. My practice improved. My cesarean rate fell AND the number of babies going to high risk nurseries also dropped. But I wasn’t done.
My first encounter with a doula occurred when a childhood friend and med school classmate of mine returned to me to have her second child. I thought Carol had had an acceptable first birth. I vaguely remembered that she had a forceps delivery after a hard labor, but the baby came out ok. And she and the baby went home together. Carol remembered something quite different. the long labor, hard second stage, forceps delivery, severe rigors, feeling terrible, separation from her baby, a sepsis workup that all turned out to be negative. She vowed to have a better second birth. She decided to hire a Doula.
I was initially a bit offended. I could be her midwife/doula. Why would we need someone else? But she was insistent, and she was a friend…what could I say?
I’m going to skip over the part about going overdue, surreptitiously rupturing membranes in my office (on a monitor) so we could qualify to use the birthing room, her two mile walk to the hospital with the Doula trailing along in the car. It could have been a catastrophe and I’m not recommending anyone else do that. So, we skated off the thin ice and I arrived at the birthing room to find Carol, her husband, the Doula, and six of her best women friends.
It was chaos. There was a friend massaging each extremity, one at her back, one bringing water or juice, the Doula was in the birthing bed (a habit of hers to keep the birthing woman from getting in the bed). A nurse who was, amazingly, just quietly going about her business. I couldn’t even get to my patient. It later occurred to me that THAT was precisely Carol’s plan. She was soon complete and exchanged positions with the Doula on the birthing bed. I was trying to slow the delivery a bit. I wanted to impress the Doula that I knew how to do a delivery without episiotomy or tears. But there was so much exuberant hooting, cheering, encouragement that Carol whose eyes were closed, couldn’t hear me. At this precise moment the Doula did something that forever changed my understanding of her profession.
Recognizing the problem I was having, she leaned in and said “Carol, listen to BETHANY.” Carol’s eyes flew open, we connected, and together managed a beautifully coordinated delivery over an intact perineum. I was hooked on Doulas! (A doctor is often drawn to that which makes her life easier.)
Doulas were a part of my practice until I retired. Or I thought I had. After thinking that the birthing room was in my rear-view mirror, I began to realize that through all those births, I had become a Doula; to my daughter-in-law at the births of my first two grandchildren, to my niece with her two daughters. I taught my sister-in-law how to be Doula to her daughter in London. I have been “Doula” to my brother as he went through cancer surgery, my sister as she went through surgery, chemo and radiation for breast cancer, a good friend who almost died of cancer and two more who got that diagnosis. And I’m currently awaiting three more babies. I guess you could say I’m the “Family Doula”. I am reminded of the book: “Brought to Bed”, which describes the importance of the gathering of women to support a family member in birth.
So let me share with you some of the things I have learned since becoming a Doula.
My job is to FIT IN. To be a part of the team, not the star of the event. If no one remembers that I was present and the mother thinks she did it all by herself, and her partner thinks she was amazing and he helped, I leave happy. After all, the gifts of a great birth are many and thank you’s aren’t necessary. I can provide information when asked. I can provide encouragement and stories of women who had great births…not always the ones they planned. I can help make the mother more comfortable. To do all of that I have to watch, listen, be receptive, be respectful, and FIT IN.
I learned that where a woman gives birth doesn’t really matter if she feels safe there. Feeling safe in birth is primary. As we used to say in Texas: “When the wolves are chasing the herd, the cows don’t calve!” In labor, adrenaline is not your friend. I used to think that feeling of safety had to do with WHERE you gave birth. But Carol, and many other women taught me that it was actually WHO you gave birth with. One birthing woman told me after her birth, “I looked at my husband, and he looked scared. I looked at my nurse, and she looked scared. I looked at you, and you DIDN’T look scared…so I just kept looking at you and everything came out O.K.”
I make the safe space by trusting the process of birth and the birthing woman. I learned to trust birth and birthing women by, unlike many of my colleagues, being there for the labor, not just the birth. If you are not there to see what mother nature can do, you don’t trust what she is doing. I paid attention to what was happening and more and more…I did less and less.
I have learned not to have preconceptions of what the perfect birth looks like. After all it is not my perfect birth: it is her perfect birth…and it’s never the way we think it will be anyway. So how can I help her deal with that uncertainty? What can I do to help her be strong and patient and soft and yielding and focused? What can I do to help the baby’s father tolerate being helpless in the face of so much power in someone else’s hands, to be loving in a way that will help his partner rather than pull her energy away from her task toward him when she needs both their energies focused on bringing their child into the world safely? How I can model for the family ways to help the birthing woman?
I was once the Doula to the wife of one of my colleagues being delivered by another one of my colleagues. Three perinatologists in one labor room! When it came time to push, the obstetrician-perinatologist offered to let the perinatologist-father…”because we are buddies”… “do the catch”. “No way!” he replied. So, I jumped up and said, “I’ll do it.” I knew the mother wanted no episiotomy and that wasn’t going to happen no matter which of these guys “did the catch.” “Uh, O.K. they said,” so I helped the mother deliver her baby over an intact perineum. It gave me a taste of something that has allowed me to let go of being a perinatologist and become a doula. That something was the feeling of freedom in NOT being responsible for the outcome. I don’t make the decisions when I am a doula. I support the decisions that are made. That freedom allows me to be completely present to the task presented by each contraction. Being a doula isn’t quite as satisfying as the freedom I felt at that birth…but it’s close. And it makes it easier for me to let go of all I think I know and just be there for the mother in each contraction, for the father as he partners in the birth, for the nurses who are working hard, and for the doctor who may get the kind of help I got from Carol’s Doula.
Maybe, some day, my words will change his or her practice like mine was changed.