And journalist makes five

Debuting my blog on a bittersweet note, I’d like to point to a story I wrote in yesterday’s New York Times on doulas and lactation consultants. The story is about how with the increased use of doulas and LCs, has come a (not surprising) increase in conflicts. I hoped to provide a balanced view of the issue, because I think expectant and new mothers can use (almost) all the help they can get. However, I’ve heard and I reported on an unfortunate number of negative experiences with practitioners in both fields. At heart, as I write in the piece, is a lack of standardization and oversight. Anyone can call themselves a doula, and there is a tangle of organizations that accredit LCs, some requiring only a weekend workshop. (Anyone who has breastfed can attest that the complications that arise might require a bit more expertise than that!)

To my surprise, I have received a lot of flack from doulas and from breastfeeding moms (of which I am one). Many felt that I attacked doulas unfairly and didn’t properly give credit to either field. I actually thought (and hope) I treated both with respect. Perhaps the story will lead to improvements in standardization in both fields, or at least to more diligence among parents who want to hire either one (or both). I think the shared goal here is to make sure all women get the support they need in childrearing.

9 thoughts on “And journalist makes five

  1. Nicole Trombley, San Diego

    Dear Pamela,
    Thanks for your article in the Times. I actually blogged about it yesterday, and as I started writing I was feeling a bit defensive (as a trained doula), but by the time I finished, I found that I appreciated your article more than I realized. I’ve inlcuded my url — I hope you find my comments fair.

    I actually sought out doula training precisely because a few very close friends and clients (I’m a pregnancy massage therapist) had bad doula experiences. In the childbirth support field, it’s far too easy to run across people I call Natural Childbirth Nazis (harsh, I know) or “professionals” far outstepping their own scope of practice. One doula even tried to perform vaginal exams on a friend of mine!

    I reacted to your article defensively at first because I think the certification process put in place by DONA really strives to eliminate many of the problems faced by the families with whom you spoke. The training I received assumed that almost every birth we attended would be a hospital birth, and accordingly, in order to receive DONA certification, the doula-to-be must receive positive evaluations from the attending nurses and physicians (and the moms, of course) from at least three births they attend.

    There are so many birth support professionals that have worked hard to create a culture that is about supporting families making informed decisions for themselves. Your aticle was perhaps a good reminder of the need to further professionalize pregnancy and childbirth support roles and to educate the public about making informed decisions about all aspects of pregnancy and childbirth. Or perhaps a reminder that we need to further publicize hat there are indeed standards in place that families can screen for before they hire somebody.

    Interestingly, I was less concerned about the lack of positive doula and LC stories, and more worried about the impression that it’s mostly in these support and advocacy communities that the ideology is so thick. It is not just among birth support professionals that we find “doctrinaire” individuals. In fact, one might argue that OBs and the larger medical community have done more to push their ideologies — under the cloak of science– on women and birthing families than the tiny pregnancy support field ever could.

    I look forward to reading more of your work!

  2. Kristi

    Hi, Pamela,

    You may have hoped to provide a balanced view, but the article published in the Times was decidedly unbalanced. I don’t dispute your contention that standardization and oversight are in short supply amongst providers such as doulas and lactation consultants, but you did little to help the cause. For starters, some examples of parents who have been happy with their experiences with these providers would have helped balance the article. You close the article with a quote about expectant parents needing to do due-diligence, but no suggestions about how to begin such a project.

    Based on my own experience with support providers, I agree that there are many who behave in ways that ultimately do not support the parents. But I’m disappointed by your article, and concerned that it will cause expectant parents to dismiss the idea of working with a doula or a lactation consultant as too hazardous to consider.

  3. Elizabeth

    Hi there. I was a big fan of your starter marriage book and have sent copies to lots of friends. But onto the topic of this post – I totally understand the need to make sure that the people who are supporting women and couples in their pregnancies are well-trained and good at what they do. However, I was disappointed that your article mostly focused on the problems lactation consultants and doulas can cause and very little on the reason that doulas and lactation consultants are so often needed is because doctors and nurses don’t provide the sort of support that moms and couples need. You did note:

    In an era of nurse shortages and high Caesarean rates, doulas and lactation consultants can be godsends for many women. Indeed, multiple studies show that a doula’s presence during childbirth leads to shorter labor, less medical intervention and a happier experience.

    Which is great, but rather than focus on that for at least half of the article – the gist that I came away with was “Watch out because those doulas and LC are always coming in to hospitals being all ideological and everything and messing with what the doctors are trying to do.” Without a word about how doctors and hospitals often fail to encourage and support breastfeeding well enough, and often press women to go with more medical interventions than they are comfortable with, often resulting in more difficult births, and more c-sections. It isn’t that there are a few bad doulas or LC out there, but it is too bad you chose to focus on the problems with doulas and LCs rather than the benefits that they provide to the vast majority of women and families who use them.

  4. Chris

    I don’t see how you can feel this article was balanced. With a few caveats citing studies that found some positive benefits, the majority of the article has specific, personalized stories of doulas and lactation consultants causing problems or even harm. Nevermind the inches dedicated to the two points of view, statistics and personalized stories are not equivalent! This was, without a doubt, a critical article. That’s not indefensible, it’s not like you made the stories up, but don’t try to pretend like it was a fair and evenhanded look at doulas and LCs.

  5. Amy

    Another way this could have been fair and researched journalism may have been to have spoken with a doula? Just a thought.

  6. Denelian

    Hi, Pamela

    Doula’s actually give me whip lash. on the on hand, my mother is a nurse practicioner specialized in OB/Gyn; on the other, i myself have way to many reasons to distrust doctors, and take an advocate with me to most of my appointments.
    further, i know that during the 5 year period my mother was employed by a hospital in northern California, SHE delivered twice as many babies as the OBs who worked out of that hospital.
    my opinion changes all the time on this issue – sometimes i think its great, other times i think it just makes parents more conflicted. and while the over-all negative of your piece is discouraging at first, there IS the point that at least this article does help circulate some of the alternatives expectant parents have. i would really like to see a companion piece, on WHY Doula’s and LCs are becoming more common (not to mention midwives!), and maybe advice on how to search for one who suits.


  7. pamelapaul


    Hi there. I think you may have read a different article! I interviewed a number of doulas for my story, and quoted several within it, including one of my favorite childbirth educators, Penny Simkin, a cofounder of DONA. (I personally loved her childbirth prep book). There must be some confusion.

    All best,

  8. Judy

    Pamela –

    Absolutely loved your article on doulas. Thank you for shining light on the occupation. More women need to be aware of the downside of using a doula and going natural.

    I became pregnant with my daughter late in life. Being a bit OCD, I approached my pregnancy like a student studding for the bar, absorbing and reading every little tidbit of information I could find while also taking a host of classes. I was caught up in the doula thing and even considered hiring one until I attended a “Meet the Doula” night at the local hospital. Upon questioning these women, I was amazed by their lack of experience. Sure, there were a few seasoned women in the group, but some have never given birth, much less breast fed, and now they were to coach me?

    However, my real issue is the holier than thou these women, and others who advocate natural, take. I was taking a pre-natal yoga class when pregnant. As it turned out, my baby was late and the doctors decided they were going to induced if I didn’t soon go into labor. I remember telling a young pony-tailed mom at the yoga class and she smugly said, “Well there are exercises and natural things you can do, so your baby will drop,” as though it was my fault.

    Turns out that that my daughter was trapped in the pelvic region. After her heart beat dropped, the doctor had to perform an emergency c-section. Twenty hours after the delivery, she entered NICU with a blood sugar of 14. The next six months she would be in and out of the hospital, until she was eventually diagnosed with a rare congenital disease. One in 50,000 kids have it.

    Looking back I was glad I skipped the doula. Once the _hit hits the fan, that doula ain’t going to be much use, as I learned. And modern medicine can be a wonderful thing. It saved my daughter’s life.

  9. Catherine Angell McCabe

    I arrived at my client’s house, hired as their Professional Labor Companion (PLC). She was in labor, so doula made 4. The NYT, sections here and there, were spread around as usual in a conscientious household. Your doula article, still open on the kitchen table, was obviously the dominant interest this week while the other sections were re-folded and set aside. My heart sank, they read it. When I saw it last Sunday, I knew at first glance it was going to be bad.

    The picture of the doula palpating the mother’s abdomen and the fact that it was in the Style section, started the downward collapse of everything I work toward. It’s against standards and ethics for a doula to palpate a women’s abdomen and to soap box natural birth through her paying customers. As a Professional Labor Companion, certified through the HypnoBirthing® Institute, I provide emotional and physical support for the family during labor and birth. Although, as a Registered Nurse, I am licensed to assess and provide nursing care, it is outside the code of ethics and standards of practice as a PLC.

    We prepare women For Whatever Turn Their Birthing Takes….This is a well known birthing affirmation of the HypnoBirthing® program. Through education, women achieve autonomy and their decision-making builds confidence and empowerment. This is the goal. Not a cookie-cutter birth experience that excludes ALL considerations of special circumstances. PLCs and HypnoBirthing practitioners promote safe and positive outcomes through a model of education that places the women, the family and the baby first. Deserting a client is a crime. Mary Beth Harris should be fired and re-educated.

    Thank you for closing with due diligence placed up the consumer. I hope your article accomplishes 2 things, 1) increase consumer awareness about birth options through comprehensive childbirth education that emphasizes the benefits of natural childbirth through an understanding of birth physiology and the science behind controlling fight or flight with hypnosis and relaxation for a more comfortable birth, (whehhh!) and 2) Get birth nazi’s off their soap boxes and make a difference by being a true birth advocate-Stop giving us a bad name!

    Hopefully there are enough positive outcomes through professional birth support and it will continue to grow, not just for white collar, organic-fruit buying mothers, but through conscientious nurses, midwives, doctors, and managed care organizations as a needed service for all laboring women.

    Oh, and the labor and birth of my client that day, was the most beautiful, inspiring, and empowering event for the family, the nurses and the doctor. It was a pure birth, no interventions, which is a tough feat in a hospital that has a 37.8% c-section rate. Mom and dad, not me, made all the decisions. Autonomy is the ethical standard in maternal decision-making.


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