Bad Beaver Publishing

Here are some musings of mine about the advent of the doula and the social context that led up to the emergence of this new birth-worker in the US:

I have to confess, as a midwife I really didn’t “get” the role of the doula for a while. I didn’t understand her profession. Was she really just a midwife wanna-be who didn’t have the ovaries to take on the responsibility and potential legal liability of being a full-fledged midwife? Or was she just another birth junkie who wanted to be in on the miraculously high energy of birth? More importantly, should I be threatened…or supportive of her? And was this new person really necessary?

It wasn’t until I was doing a book signing for Lady’s Hands, Lion’s Heart, A Midwife’s Saga in 2009 in New York City sponsored by Choices in Childbirth that I “got” the phenomenon of the doula trade. That night there must have been over 100 doulas in the hall and I watched as they responded to my reading, their eyes shining and glistening with pure joy for the birth stories. Yes, these women were the real thing—in love with birth with their bodies and their souls. Many were young, college-aged women who did not have children of their own (yet). But they were all clearly called to their profession, willing to fight alongside their sisters for autonomy in childbirth. What was going on?

Let me backtrack a little bit with my own personal herstory, as it does dovetail with all this. I was the first (modern) midwife practicing in NH. Because there were no other midwives to teach me, I was trained by an old country doctor who taught me the art and science of obstetrics. He was the only doctor still doing home births in the state. I didn’t even know I was a midwife for the first year of attending births with this wonderful doc. I just thought there was something wrong with me and that I was obsessed with birth.

By the mid-1970s, a spontaneous grassroots movement developed to “deinstitutionalize” maternity care and to “demedicalize” critical life events, such as childbirth. Many hospitals were still doing archaic practices such as strapping women down—a holdover technique from when women were drugged with Scopolamine. Childbearing women in the early 70s were refusing any pain medications but were still subjected to rote, unnecessary routines and sometimes dangerous practices.

The next logical step was to avoid going to the hospital for birth altogether. The interest in home births derived, at least in part, from a desire to escape unyielding medical dominance as well as from the sterile environment of the hospital. Women maintained that childbirth was not a disease and that normal deliveries were not a medical emergency and did not require the supervision of an obstetrician. There was a growing interest in childbirth education, breastfeeding, and natural childbirth. Consumers of hospital-based, mechanized maternity care began to rebel. Women and families who were pessimistic about their chances of having a safe and satisfying birth in the hospital began to explore the option of home births with midwives.

This consumer criticism of aggressive medical management of childbirth resulted in the advent of the “lay midwife,” the apprentice-trained midwife attending home births. Women began to stay home to birth their babes. I was created by these brave women. I was their response to the degrading and demeaning approach to birth in the hospitals. I caught my first baby when I was 24 years old. I was so blessed to be chosen by those families to help them. They sought me out, they taught me, and, eventually, I like to think that I actually knew what I was doing. I ended up attending 1,200 babies born safely in their own homes.

In those years, due to consumer demand, the pendulum swung to the side of pro-mother/baby practices. There were tremendous strides forward for active, upright birth. Even the hospitals jumped on the bandwagon of mother-baby friendly initiatives. Hospitals that didn’t adapt lost many women patients. Women were listened to and respected and it seemed like things would always remain sacred and sane.

Ahhh…but the heyday of natural, unfettered birth didn’t last. Since the 1990s, obstetrical practices have slid down a slippery slope of increasing medical interventions until childbirth in some institutions seems worse than the 1950s. VBACs have been prohibited in most smaller hospitals. Water births are extremely rare. Many OB residents state that they have never seen a birth that wasn’t induced with pitocin in all the years of their training. The current practice of routinely inducing women at 40 weeks makes me particularly nuts. Where are the studies that show that this improves outcomes? There aren’t any. All this does is increase the Cesarean section rate due to fetal distress from lengthy inductions on an unripe cervix. In some urban hospitals, the Cesarean section rate tops 50%. Most of these practices are driven by an overwhelming fear of malpractice litigation.

The pendulum has swung way backward, back to ignoring the needs and desires and, potentially, the safety of the women (think misoprostol inductions on a scarred uterus).

Enter the doula. (Here’s where they come in…finally, after all this rambling!) As I see it, the doula’s role is to prevent a tiny snowball from escalating into a full-blown avalanche. The doula needs to have a magician’s hat full of damage control and patience, as well as be a master manipulator. The doula actually has three clients:

First and foremost, the doula has the responsibility for the mother. The doula’s job is to create a bubble of safety and serenity around the laboring woman, to block out all the frenetic activity around her, so she can focus on her body and her baby without distractions—not a small feat in today’s “efficient” hospitals. The doula needs to protect the normalcy of birth, even in an abnormal environment, and make it look seamless and pleasant. She must protect the mother from an onslaught of unnecessary interventions. Studies have shown that just a doula’s reassuring touch and words alone have reduced the need for a cesarean section by 50%. And let’s not forget the magic and mystery of birth—most importantly, the doula is there to remind everyone of the sacredness of the moment.

Second, the doula has the father of the baby to gently guide and reassure that his partner is not going to die from the crushing tsunami of pain that is engulfing her at the moment. He may be overwhelmed by the power and the beauty of what he is witnessing. Or he may be terrified that his sweet beloved has just turned into Linda Blair in The Exorcist, vomiting vile green stuff. Either way, the doula has to talk him down from the ledge.

Last, but certainly not least, the doula must interact with and be the mediator with the birth attendant. It is truly an art to get an obstetrician to do what you want and then get him/her to think it was their idea in the first place. The doula must be skilled in negotiating for what is safe and sane without pissing anyone off. For some reason, most OBs have very fragile egos (I speak from experience here…I was married to one). The doula must be assertive but at the same time be savvy enough to forge a working communicative relationship. And then, when all are safely delivered earthside, she has to congratulate the obstetrician on a job well done.

In the case of a home birth, the postpartum doula can be a godsend. Home birth women tend to be Super Hero-types and often arrange for only minimal support in the postpartum period. The postpartum doula is invaluable for breastfeeding assistance and as well as helping with physical recovery and family chores to allow the new mother to rest and relax and focus solely on her newborn babe.

In short, the doula is a multi-tasking saint.

In 2012, the United States has the highest maternal mortality rate in the industrialized world. Cuba is ahead of us, for godsake! This is totally unacceptable. American women are not told when they are routinely scheduled for a C-section that there is a 4 times higher maternal mortality rate with this surgery. This is criminal.

It is precisely this backward swing of the pendulum that has caused the arrival of the doula. Just like the renaissance of the apprentice-trained midwife in the 1970s, the modern doula has been created to try to regain birthing equilibrium and normalcy. And just like the Suffragettes of the early 20th century, doulas are birth activists who are here to fight for the safety and dignity of their laboring sisters.

Yes, this new person is most definitely necessary. The doula is the bellwether of our broken maternity system—telling us it needs to be fixed.

~ Carol Leonard is a midwife and the author of the best-selling memoir LADY’S HANDS, LION’S HEART, A MIDWIFE’S SAGA, Bad Beaver Publishing, 2008.

My 87 year old mother, Louise McKinney, was showing some friends of hers our little camp at Bad Beaver when she fell and smashed her head against the woodstove. It was truly horrifying. She had a huge four inch gash in her left temple. She kept saying, “I’m alright. I’m alright.” as blood pooled everywhere. I was trying to assess how bad it was and whether we needed to go to the ER. She claimed she was trying to swat a mosquito on her knee.

I said, “Mom, next time why don’t you just let the mosquito bite you? It would be a hell of a lot cleaner.”

We did end up in the Ellsworth Hospital ER. My mother had 10 staples in her temple which I was fascinated with so I was perversely taking pictures of her head with my cell phone. This aggravated her to no end. When they were done, my mom was all wrapped up with just her eyes peeking out. She looked like The Return of the Mummy. She looked so tiny and vulnerable lying there. My heart lurched as I thought, “What if this has long term consequences?” Then I thought, “Nah. She’s a tough old bird. She’s going to be fine.”

Before we left, she complained to the ER nurse-practitioner that her “tailbone” hurt. She dropped her shorts so the nurse could take a look at her bruised behind.

My mother turned to me and said sarcastically, “Oh, aren’t you going to take a picture of this too?”

I said, “No, mom, I don’t want to terrify anyone.”

When we were leaving, my mom’s head was all wrapped up in a huge white bandage. She looked like the guy with the bandaged head in the Fife and Drum painting. When we entered the ER waiting room, it was packed with a couple dozen people who were waiting miserably. They all looked at my mother in horror.

I pointed to my mother and said very loudly to the waiting room folks, “THIS IS WHAT HAPPENS WHEN YOU DRINK TOO MUCH.”

The entire waiting room burst into laughter. My mother, who is a tea-totaller, gave me a withering look.

She hissed under her breath, “I can’t believe you just said that! Now they’re going to think I really had been drinking.”

“Mom, there is not one person in that room who knows who you are.”

“I don’t care. That was not funny one bit. You are terrible.”

And so on and so fawth. She reamed me out the whole way back to her cottage in Surry. But I was grinning the entire time. I love my mom. It was good and healthy to get her blood boiling again. It was totally worth it.

Postscript: Several days later my mother was checked out by a PA who told her that she had “a hole in her eardrum.” My mom is going to physical therapy to improve her equilibrium. She is going to be just fine.

Somehow it has become my job to re-register our little aluminum fishing boat so we can troll for mackerel on July 4th. The whole family is at our ocean-front cottage, “The SeaWitch” in Surry, Maine and I want to fish mostly as a means of getting away from all the familiness that has started to suffocate me. Don’t get me wrong, I love my in-laws, but after several days of being rained-in a small camp with everybody lolling around eating and drinking and then eating some more and listening to the Red Sox lose…even fishing sounds fabulous.

I bound up the steps to the Ellsworth City Hall where there are a few workmen replacing some granite stairs. All of a sudden I get the distinct feeling that my khaki skirt is way too short as I walk up above them. I tug my hem to see if I can cover another inch or two of exposed thigh. I look behind me, and sure enough, a worker averts his eyes away sideways. I want to yell, “Are you kidding me?!? I’m a flippin Senior Citizen for gawd sake” as I huff and slam the heavy front door and enter the city offices.

I walk to the desk that registers boats where I did the exact same thing last summer. I figure it’s a piece of cake. They’ll have us in the data base and I’ll be outta here in a jiffy. Unfortunately, that is not at all how it plays out. The registrar is a youngish woman with enormous bubble-shaped bosoms and a very low-cut blouse that reveals a terrifying expanse of apparent bottomless cleavage. It is the day before July 4th vacation and she does not appear to be in such a terrific mood.

Nevertheless, I give her an attempted dazzling smile and explain that I’d like to re-register our little fishing boat before the holiday. With absolutely no affect, she taps the keyboard with 3 inch long plastic nails and then squinches her brow.

“We don’t have anything under your husband’s name with that date of birth owning a boat.”

I take a deep breath. “That’s interesting. I registered the boat right here at this very desk a year ago. It is a 1981 12 foot long aluminum Grumman with a 4.5 HP Evinrude outboard motor.”

“Nope. Nothing.” She starts to turn away to wait on the next customer.

“Wait. Wait…this is not working for me. You have to have this registration. I paid you $40.00 last summer.”

She taps the keyboard harder, this time with emphasis to make her point. She sighs and flips her hair. I re-spell Tom’s last name again and say his birth date very slowly.

“I’m telling you we don’t have anything with that name in the computer with a boat.”

I pinch the bridge of my nose to try to prevent the gathering migraine.

She moves on to the next customer in line bouncing her bodacious, unnaturally enhanced twin appendages.

I go back out to my car and call Tom on his cell. He is getting lobsters from our friend Perry Long on Newbury Neck. Tom says to just register the boat as if it is a new boat and forget it was ever registered before if it is so problematic. Okey dokey, sure. Fab idea.

I go back in and stand in line. When it is my turn she says, “Weren’t you just here?”

“Yes, but I’d like to register a new boat.”

“OK, but you have to have a bill of sale.”

Obviously, I don’t have a bill of sale because we’ve already registered the freakin boat. I slam my purse down on the counter. I’m about to have a stellar conniption-fit, but instead, I regain my composure.

I plead shamelessly, “OK, look. I’m sure we can resolve this like adults. You’ve got to have the information…and I’ve got to register my boat. I’m trying to do the honest thing here and I’m trying to give you my money.”

She makes a huge sound of exasperation and says, threateningly, “Well, you’re just going to have to talk to Bill in Augusta.”

“OK, terrific, let’s get Bill on the line.” Bring him on. I’m feeling semi-encouraged.

She picks up a phone as though she can’t believe this is really happening and speaks into the mouthpiece with clipped words, “Bill, there is a lady here who is very persistent. She won’t leave until she can register her boat.” To emphasize her point, she rolls her eyes for the people behind me in line. She hands the phone to me.

I greet Bill thankfully and give him the same information. I wait for about two lifetimes while he checks the state data base and he finally drawls back.

“No, deah, the only thing we got under Tom Lajoie with that birth date is a U-Haul.”

“We don’t own a U-Haul.”

“Well, sure you do, deah. It was registered last yeah.”

I’m beginning to feel like I am stuck in a perverse ‘Burt & I’ skit…like “You Can’t Get There From Heah”…only this is “You Don’t Really Own A Boat…You Own A U-Haul.”

“I don’t know what to tell you. WE DON’T OWN A U-HAUL.”

“Yuh. That’s all we got. Anything else I can help you with, deah?”

I make a sound like a strangling cat. I can feel my blood pressure throbbing. Actually, I’m pretty sure I’m about to get a nose bleed.

“Listen, Bill, before you hang up. Can you read to me the description of our U-Haul?”

“Sho-ah. It’s a 1981 12 foot long aluminum Grumman U-Haul.”

“Let me guess, this U-Haul has a 4.5 Evinrude outboard motor?”

“Ayuh! How did you know, deah?”

Jaysus H. Christ.

The boobalicious registrar registers my U-Haul/boat but she’s clearly annoyed that I have caused so many problems for her and her patient customers.

The next day, I’m talking this over with Tom, trying to come to grips with what happened.

Tom turns to me, his eyes wide, and he says, “Do you suppose it could possibly be because we originally told them our boat was a V-Hull?”

Yes. Yes, I do suppose…deah.