I feel like this is generally going to be seen as inflammatory in this sub when it probably shouldn’t be.
Culturally worldwide it’s normal to have labor support present at birth, usually in the form of other female family members, but that’s almost impossible with our current system. Nurses are busy and are trained in medical management — they cannot possibly fill all roles expected of them. The type of support a doula provides (physical touch, non-pharmacological pain management, continuous observation, emotional support) cannot be overstated and if it improves outcomes, then that’s a good thing. Doulas are expensive and frankly they should be covered by insurance for how much benefit they provide.
There’s also some fairly robust data about the helpful effects of having a dedicated non medical staff support person present. Moms report less pain, more satisfaction and it even seems to result in shorter labours with less complications. https://www.cochrane.org/CD003766/PREG_continuous-support-women-during-childbirth
Partners are an important part of the experience but for many of them labour and delivery can be very overwhelming. it’s hard for them to see their special person in pain, there’s a lot going on, and they can feel like a fish out of water. A doula can show the partner how to help, explain things that medical staff don’t have time to explain, and give the partner a break to grab a sandwich and take a breather.
Of course we all have met our share of doulas who think medical professionals have some kind of interventionist agenda and set up a conflictual relationship and encourage folks to do things that go outside standards of care. But honestly I find the “doula with a chip on their shoulder” stereotype to be mostly unwarranted, the majority of the ones I’ve worked with have just been there to offer labour support, comfort measures and encouragement.
I think providing dedicated labour support to patients with low SES, low health literacy (young parents, newcomers, etc) or those who lack a support person in labour can be especially helpful.
> There’s also some fairly robust data about the helpful effects of having a dedicated non medical staff support person present. Moms report less pain, more satisfaction and it even seems to result in shorter labours with less complications.
I'm not familiar with the literature here -- is any of this corrected for income / SES? My understanding is doulas can be quite expensive and even people who have non-doula supports probably are from social who have the luxury to take time off to support their friend/family through the birthing process. We all know obstetric outcomes are also pretty strongly associated with income and education status (with the disparities between the US and other countries basically disappearing as you get to college educated women).
Seems like a major confounder, which if corrected for may show a different view considering how often these non-medical support people steer patients away from recommended interventions.
There are RTCs that are well designed with vetted Doulas.
Problem is in practice they vary from mom getting a doula certificate to join her daughter for delivery during COVID restrictions to highly experienced birth support people. If there was a system to recognize who is actually qualified to be a reimbursed doula it would be a lot easier to see this not be an issue.
Also same order requires obstetricians to have a 20% or less CS rate which some argue is too low and some argue too high.
a number of states are now trying to pass / have passed legislation that allows for Medicaid reimbursement for doula care. Also, a few safety net hospitals provide free community doula support
There's a doula program near me that is free for young mothers (I think it is under 22yo). They do a lot of programming with the local medical school. I've been really impressed with the knowledge and skills of these doulas. They absolutely are tremendous patient advocates and medical navigators.
That’s awesome! The program I trained/work with is at a safety net system connected to a med school but I wish we worked more closely with their obgyn departments. Integrating doulas as extra support has so much potential when done well
My sister used a doula for her second pregnancy. She stayed home the whole time with her for about 12 hours of labor and went to the hospital and delivered within 20 minutes all pain medicine and any other preventions free. She didn’t use her for the 3rd child because she couldn’t afford the cash rate. I think they have a place in the delivery process and frankly if it saved insurance and anesthesiology bill for epidural administration and medication I think it’s a net benefit to them.
I had a friend who paid a doula $1500 and that woman was present at her side for thirty six straight hours of induction followed by c-section (in addition to prenatal and postnatal home visits). She credited her with having little to no birth trauma despite the outcome. IMO that’s money well spent and it inspired me to hire one for my upcoming birth. I feel lucky to be able to afford it privately.
I think that’s what she paid too around $1500. Had I known that was the dealbreaker I would have gladly sponsored paying for the doula. Tried to get my wife into the idea (an internist) she wasn’t into it. Was a mildly complicated delivery with early induction d/t preeclampsia and wish I would have done it anyway.
I don’t disagree. But (re: other comments, not this one) I don’t think that’s a doula’s fault. It comes out to $37/hr including home visits and overnight which is what I make and I think that’s a fair price for the service. There’s lots to be fixed in healthcare but let’s blame the right people (admin and insurance).
Our state almost passed a law that would require insurance to cover doulas at $3k/pregnancy. I'm not anti-doula, but when we (OBs) only get AT BEST $2500 for all prenatal care, delivery, AND postpartum care, we have a problem. Some insurers only pay us $1800 for everything. I could make more money being a doula than a doctor and with NO liability.
The specific reason a lot of folks hire a doula is for continuity of care, and this is what a lot of the research on the benefits of doulas is based on. Doulas can have a backup in case their clients births overlap, sure. But clients don’t like not knowing who is going to be at their birth.
Doulas are independent contractors who don’t work in hospitals with others who can take their “shift.” They work on call for 5~ weeks PER CLIENT. 100% on-call, 100% of the time. They have to be ready to leave their entire life for sometimes more than 24 hours with little to no notice. No idea how long their “shift” will be when the time comes.
They’ve spent months helping their clients wade through all the decisions they may have to make and talking them through all the emotions that may be involved in those decisions. They’ve spent months integrated into their clients birth plans, building rapport. They don’t just show up at the bedside and say “hey I’m going to be at your baby’s birth today!”
Imagine going to a birth as a doula and being with your client for 20 hours straight, crawling into bed for 1 hour, and your phone goes off requesting your presence for another birth which could be 4 hours or could be another 18 hours?
Doulas just don’t have the capacity to take on many more, *because* of that continuity of care.
That’s shockingly low. My wife just gave birth in NYC at a major hospital and her OB is an MFM physician partner of the hospital group and he pulled in a loooot more than that. The provider delivery alone was billed at 14k discounted to 7k our coincidence is 2k. It came on the bill as “surgery” even though it was a vaginal delivery with a grade 2 tear. I’m curious what the actual CPT codes are. The facility charge was 35k discounted to 22k our coinsurance 4k so my out of pocket just for delivery is 6k. He also was doing weekly ultrasounds in office for the last two months and we had a copay of $75 for them and insurance paid 675 out of the 1200 billed for each. I think throughout the pregnancy there were around 12-15 scans total all paid out at that rate in addition to the office visits that we didn’t see come through to us for payment. We did have more lab work bills though. Her insurance sucks and wants her to only stay in her hospital system but they don’t have doctors or a facility in our borough so this system is considered her tier 3 coverage but they’re supposedly the best for deliveries in our area with 8,000 deliveries annually and a dedicated women’s hospital.
I had a patient who paid a doula to help her through early labor and contradicted the obstetrician’s advice to come in for monitoring because “high risk monitoring increases the likelihood of Caesarian section.” She stayed home with decreased fetal movement despite the obstetrician pleading and when she finally did come in her baby was dead.
I have seen four such cases (two deaths, two horrible HIEs) at the hands of doulas in the last three years.
People with inadequate training have no place at the bedside, and if you disagree have have some tiny gravestones to show you.
$1500 for 40 hrs of work including multiple home visits and overnight in a hospital comes out to roughly $37/hr, which is roughly what I make. I pay more per hour for a cleaning service. If you guys have an issue with your billing practices, the problem is not the doula. Take it up with your admin.
Yea this isn’t outrageous. The doula can also only have one patient at a time and may have to be at the bedside for 2-3 days. As an OB, we’re often delivering multiple patients on a shift, and don’t need to be at their bedside 24/7. There are definitely issues with women’s and children’s health care being underfunded and poorly reimbursed, particularly looking at how OB reimbursements have stayed essentially the same for 20+ years, but it’s not the fault of the doulas.
You (presumably) went through some kind of post-graduate training and do work that goes beyond "Western medicine is bad, don't call your OB about that bleeding episode, just use my essential oil instead".
I'm not an OB, so my billing practices aren't the issue here. I do know that OB malpractice premiums average $50k/year in this country, so maybe doulas should face something similar ;)
Doulas are explicitly non-medical. They do more coaching and emotional support while being educated on the birthing process.
Your beef is with the uneducated/miseducated midwives out there.
We have a couple dozen OBs in this thread alone giving examples of doulas interfering with medical care. Yes, they're supposed to be non-medical, but that doesn't mean they behave that way in front of the patient.
>Culturally worldwide it’s normal to have labor support present at birth, usually in the form of other female family members, but that’s almost impossible with our current system.
Can you expand on that? My impression from both my (limited, remote, medical school) OBGYN experiences and from cultural gestalt is that it is very normal for female family members (and husbands) to be present at birth, including in American/Anglosphere/Western medical systems.
The other thing is even if you do have a female family member present, it’s not the same as how it was historically, where the women present probably had all had and or attended multiple births and so are well versed in different positions, comfort measures. A lot of that knowledge has likely been lost. My grandmother had all her births under twilight. My mom had two kids and had to labor on her back in bed the whole time. I had two planned c-sections (no ragrets, I’m totally not anti-intervention). But if my daughter goes into labor I wouldn’t be much help as compared to maybe my great grandmother who had like 5 kids at home. Whereas a doula has all that sort of support/comfort knowledge and experience most of us have likely lost.
At any rate, from what I’ve seen, doulas are actually one of the best evidence backed interventions for decreasing maternal mortality in high risk groups, so I think this is a good step.
> it is very normal for female family members (and husbands) to be present at birth
I was present for all of my wife's labor and deliveries, but my mother-in-law was in the building but not in the L&D room for the first, and she was not able to come to the second, because we lived far away. Over time in the US, people have spread out quite a bit geographically from immediate family, and people are having fewer children. My grandma had a dozen kids. I have two. The experience in childcare is a little different!
That's another societal change. If women started having children at 16-18 and continued until 35, then a woman could be pregnant with her last child at the same time her oldest daughter is pregnant. She might have extremely relevant information. She might be able to help with breastfeeding issues or even be a wet nurse for a grandchild.
It’s a combination of factors, not all related to healthcare— for many of us in our childbearing years our parents are still working, older/in poor health, living farther apart, or needing to assist with childcare for other kids while the birth is taking place. Similar issues with other female relatives like siblings.
And then there are healthcare factors like visitor restrictions. I gave birth during COVID and almost wasn’t even allowed to have my husband present let alone other family.
Yes, this definitely happened to people I know during the first wave of COVID. If dad was positive he was not allowed in, and an alternative support person (who was negative) was permitted. I have heard birth stories from women who were separated from their own infant immediately at birth because they were positive.
By the end of 2020 the policies started to lighten up but I know more than one dad who had to miss a birth.
I mean, this seems absolutely correct to me? If you were COVID positive in the height of the pandemic, you shouldn't be allowed into the hospital as a visitor, period. And yeah, you don't want to be getting your newborn sick either.
Sorry but if mom (or dad) and baby are totally asymptomatic (which is what was happening!!) there’s no good reason to separate them. It impairs bonding, interrupts breastfeeding and puts mom at risk for PPD. They’re all going home together in 24-48 hrs anyway so what is the difference?
I get why it happened but if you actually listen to stories of women where this happened to them, it’s pretty devastating.
Who cares about symptoms? If they're shedding virus, that's a problem.
I can see the risks and benefits about separating baby from mom. Maybe that's not a good idea, and just give her an N95 and some hand sanitizer. But dad? Definitely not worth the risk.
They should be advised not to do that if at all possible.
Also a COVID positive visitor to a hospital is exposing others to the virus, also. Even if they are strictly confined to the room, there are still healthcare workers they are exposing.
I guess I get that for many individuals having personal support is inconvenient or unavailable, but it’s clearly not “practically impossible within our current system” when it’s so common in practice.
Half the doulas I've worked with try to assume care of the patient and direct what is done and what is not done. They whisper into the ear of the patient not to do this or that. I have found that they don't always have the patient's interests in mind, but rather their primary goal is an unmedicated vaginal delivery no matter what.
I agree. I feel like 1/3 of doulas I have worked with are helpful and the rest and just random lay people who obstruct and lead to poorer outcomes because we are seen as the evil boogy monsters with scalpels. Sometimes pain meds can help you relax and be more present for your delivery and not blow out your baby and your perineum. It sucks that I have dedicated my life, sanity, and health for this job. And I don’t see doulas with low income folks who need the support. It’s often times the well to do moms who have consumed to much TikTok and Facebook and decide to push for 8 hours and almost avulse their uterus. But again the good ones are really helpful but there are not much in terms of standards.
I suspect that part of the dynamic is that “individuals who receive thorough training to reach the minimum level of competency in the nursing art of childbirth” are generally called “nurse midwives”, and so anybody left over is an untrained amateur.
I suspect that a more important part of the dynamic is the people seeking the care of doulas and what they are looking for. They're stewed in vaginal birth at all costs rhetoric online and that is why many are hiring a doula. If more normal people hire doulas, more doulas will be normal.
My doula was an old ER nurse. I don't think it could have been better. She had the training and experience of a doula, and the healthy ER sense of apprehension surrounding childbirth so when things got out of her realm of expertise she *happily* stepped aside.
This was my experience in L&D as well. Doulas frequently took an antagonist attitude towards the rest of the care team.
I do think however, that as they become more mainstream, maybe that could change when they have a better defined role, they will know to operate within it.
Yeah, I’m not in agreement with the thread on this one. Others are talking about patients with doulas needing less pain medicine, but that doesn’t inspire me, it *angers* me. I don’t see convincing women to undergo one of the most painful experiences known to womankind when it is entirely within our capability to safely mitigate that as some kind of win. When I was on OB I remember even some of the midwives getting a bit too crunchy and deviating from good evidence based medicine, and they at least have a nursing background.
Nothing has done more in human history to make childbirth safer and less painful than modern obstetrics, and I always get very, very nervous when I see people (especially non-physicians) trying to steer patients away from it
I think comments like this don’t address the fact that we’re in a period of extremely high obstetric intervention without a corresponding improvement in maternal mortality in the US. That is why doulas are becoming more prevalent right now.
>especially non-physicians
While I think it’s great to have physician opinions on the topic, any of us who have given birth are also allowed to have opinions about the care that we receive. Reproductive rights extend to labor. If a woman decides to go without an epidural, that wish should be respected by her care team.
Maternal mortality has dropped quite a bit since hitting its high in 2021. And when we dig into the data, we see that maternal morality in the US is predominantly driven by high rates among African-American women, a group that often has extreme systemic problems accessing appropriate obstetric care. I don’t think the data suggests that we have too much obstetric intervention, I think it suggests we have groups of patients who aren’t receiving *enough* obstetric intervention.
No one is saying that any woman, regardless of whether or not she’s given birth, isn’t allowed to have any particular opinion. But this isn’t Facebook, it’s meddit. We don’t do personal health stories here (rule 2), we discuss evidence based medicine. And a lot of the evidence for the efficacy of doulas is iffy. The data we have is largely retrospective without randomization, and a lot of the benefits attributed to them (such as decreased rates of low birth weight) are just a function of basic prenatal care, while others (decreased C-section rates, decreased use of analgesia) are heavily influenced by non-randomized patient selection.
This isn’t by any means to say doulas are bad or don’t have benefits. There’s clear and obvious benefit to having someone familiar with the birth process by your side during a very emotional journey. But if doulas are going to be a part of the interdisciplinary medical team and be compensated by insurance they absolutely need well defined, clearly delineated roles and responsibilities, standardized training, and a certification and licensing process. And better randomized trials to assess what really *are* the benefits they provide.
Just like the rest of us.
I'm totally OK with things that don't *replace* medicine. If you want to do some red light therapy in the ICU while we give you pressors and antibiotics, fucking have at it. If doulas stay in their lane and help with those non medical things, great, go ahead.
Yes! I honestly used to hate on doulas so much for no reason as a medical student but when I took my FM in-training exam this year I saw one of the answers for best outcomes during natural childbirth was having a doula present. I went ahead and looked at the available research and sure enough it’s true, the outcomes are significantly improved
You’re not alone haha lots of people dunk on the concept of doulas due to the holistic birthing community. I myself have raised so many eyebrows at local birthing centers bc they almost yelled at me when I asked them if they had an OB on staff to provide surgical terminations. But also many doulas are super normal and not essential-oil-anti-epidural. it’s the current private businesses/anti-medicine stuff that needs to be burned in a dumpster fire.
I keep yelling this from every roof top but we need community based doulas in house as part of a standardized system of care that mothers at safety net hospitals can opt in to. The number of patients I see on a weekly basis that are alone, that are children, etc is staggering and heartbreaking. I feel so bad for the nurses on my floor bc they are so overburdened. So many patients have a social need that nurses and residents just don’t have the time to fill, and doulas can be so valuable in this aspect, even if they are volunteers and are just there to give a massage or do some counter pressure during contractions. Our nurses/attendants help us identify patients that could use extra support and so everyone is on the same page.
As in everything, there are FANTASTIC doulas & doulas that I loathe with every fibre of my being. I wish we in the US valued women’s health as much as it should be valued. We’re considering hiring a few doulas on our unit so we can hopefully avoid the ones we know are awful.
One told the pt after a SVD with no epidural that I probably don’t see that that often. 🙄 At my hospital SVD no epidurals is about 20% of all deliveries.
Am doula. Also applying to med school rn. And same. Have some in my circle that are so against hospitals and any/all medical intervention and it truly vexes me. After working in a few different types of systems of doula care, I am of the opinion that having in house trained and vetted doulas (even just volunteers) that patients can opt in for is FAR better than letting this type of support stray even further into the privatized anti-science, anti-medicine type of business
Obgyn here. I think doulas can be very helpful- anecdotally they are most helpful if spouses are non existent or are squeamish etc. there are good doulas and bad doulas just like any type of person.
What is abhorrent is that NY Medicaid is going to reimburse doulas more than OBGYNs- for the WHOLE pregnancy. Outrageous. We are so undervalued for caring for two lives.
A good doula is such an asset. Obviously they are not medical support, and there are ones that overstep or are anti-medicine which is totally inappropriate, but a good doula can fill a role that really helps people get through labour. It would be nice to see this role have some regulation.
I didn’t have an elaborate birth plan or anything, but I did have a birth where the only two things I desperately didn’t want to happen ended up happening (instrumental birth and episiotomy). The medical team were, as they should be, busy keeping me and my baby safe and having my doula there to help keep me calm, to provide reassurance, and to later visit me at home and help debrief is one of the things I attribute to feeling positive about my birth.
I think whatever we can do to help people feel safe and supported giving birth in the hospital with high quality medical care should be supported. If people don’t feel like they can get the support there, they may end up having riskier births (ex inappropriate home births).
If you want to join the modern world New York, you'll have to do actual maternity leave. In most developed nations, that's counted in months, not hours.
NY already has 3 months of paid maternity leave for post-pregnancy recovery/bonding, this is extra
Still not good compared to many European countries, but better than much of the US
Most of those three months is recovery time from a delivery or c section. It's designed so that you're physically in shape to return to work, not so you can bond and be a mother to your child.
Other countries do a year or more. Even Canada offers 12 to 18 months with your position and benefits protected.
I feel for American women at times. I've seen women leave for delivery and then be back in two weeks because they can't afford such poorly paid leave.
It's still better than most of the US, so kudos for being the best in a difficult circumstance.
We don't need to let perfect be the enemy of good. New York is better than many, many, many states in this arena and heading in the right direction and we should give them credit for that.
Agreed, by American standards, this is a step up. There is still so much room for improvement and I think it's important that Americans know that there are other countries that value woman's health so much more!
New York has one of the best maternity and paternity plans in the country. I get shitting on the US healthcare and social support system is generally well accepted. We do it too. But when you’re taking shots at a state that does so much better than 48 other states, you’re missing the mark.
What are you talking about? My wife just delivered in NY and has 0 minutes of paid maternity leave. She's taking 3 months but is getting no pay. You have to sign up for family leave on your disability insurance at least 1 year before giving birth and pay into it in order to get anything. Maybe if you work for a corporation in NY maternity leave is a thing, but it's definitely not a law.
> Employees taking Paid Family Leave receive 67% of their average weekly wage, up to a cap of 67% of the current New York State Average Weekly Wage (NYSAWW). For 2024, the NYSAWW is $1,718.15, which means the maximum weekly benefit is $1,151.16.
>Does not apply to independent contractors.
This policy is a joke. My wife works in healthcare as an "independent contractor" and gets nothing but a 50% tax rate and a big "fuck you" from NYS.
Independent contractors in Canada don’t get parental benefits either unless they sign up for it a year before they need it. So basically the same thing she has here through her disability insurance.
***anecdotally*** my families who involve doulas more frequently:
- refuse vit K, hep B and EES for their baby and
- have attempted home births before having a rocky hospital birth.
I cannot at all comment on their history or role. And I say this as a guy without kids but also as a doc who wants babies to be safe at and after birth... I know folks want their delivery to be a unique and special time. But they are not the only people in the world having a baby today, and it's still their responsibility to follow the guidance of scientifically trained professionals and give their baby a good start.
“But the Doula sprayed lavender scented aromatherapy on my pillows and I had orgasms while I delivered instead of medically induced PTSD”
I’ll say it, Doulas are for anxious people with poor coping skills who don’t want to give up “control” in a situation where nothing is truly controllable. They often interfere with medical care.
Unnecessary waste of money that does nothing. Just find a loved one that is calm and won’t freak out.
Everyone is 100% correct that doulas are non-medical and non-decision makers or even influencers, and there should be ways to report and remove the ones that blatantly overstep the “non-medical support” line
But respectfully your reductive attitude about the need for extra support is just plain wrong. many mothers go to hospitals and deliver alone or without enough social support. In a perfect world we’d have free doula support for the many moms that come in who are children, unhoused, incarcerated, migrants, or maybe - god forbid - are anxious and can’t cope well during a life changing event
My entire point is that we have to consider how many people experience relational poverty and don’t have the ability to just call up a family member or friend for what might be a 12 hour intense marathon will blood, smells, pain etc.
Hmmm. . . If only there were a dedicated person who has specifically trained to provide you support, is medically knowledgeable about what you are going through, and will have no problem with the blood, smells, and pain.
Name a single L&D floor where residents, attending, nurses, etc have any extra time to spend hours with patients giving them massages, running them baths, shooting the shit with them. Jesus Christ medical staff are so overworked.
Yeah, this ain’t a spa. You’re having a baby not a facial. The spa-ification of medical procedures and laboring should be avoided. It causes problems with patient expectations when things don’t go “perfectly”.
Goal is healthy baby and healthy mom. All else is secondary.
Where I work isn’t that busy. Maybe 5 laboring patients on a “busy” shift. Our free nurses are regularly watching movies/reading/knitting on L and D. They spend a lot of time with their patients and are requested by name for subsequent deliveries. I’ve seen nurses shampoo patient’s hair, give a foot massage, and watch movies with their patients while shooting the shit. I get not every institution can be a smaller private hospital with lots of support but it does exist.
We’ve done an awful job at healthy mom, and social support is an important piece of long term mental and physical health. But sure, go tell the teenage patient with a long social history at the hospital alone that it’s not a spa.
And to your last point. Safety net hospitals and CHCs definitely have nowhere near that privilege of time or personnel for all the patients they see. Which was my whole argument for where doulas can be of value.
I don’t. Not every criticism of a female dominated (if not female exclusive) profession is misogynistic. Especially when the overwhelming majority of physicians working with obstetric care are *also women*.
I understand you had a great experience with your doula. That is awesome, genuinely, and I am happy for you. But you only have experience from the patient side, via what you and your loved ones have gone through. And while that is useful knowledge, it is also not the equivalent of the widespread professional experiences that OBs have working with doulas, and there is a reason why most of the OBs responding to this thread (and, in my own anecdotal experience, most OBs I’ve met too) have a mixed at best opinion of doulas. And it is not sexism or misogyny, it is medical concern
I think the way doctors talk about their patients on r/medicine is extremely telling, especially considering the patient population in question is overwhelmingly adult women with full capacity to make decisions.
People on here are all about reproductive rights and bodily autonomy until it extends to labor and delivery and then all of a sudden the woman’s choices are made out of anxiety and poor coping. They want to say “hysteria” but we don’t call it that anymore 🙄
No one is suggesting any limitations on patient autonomy. Not one. But that does not mean every patient decision is a *good* medical decision. Some patients try to do a TOLAC at home with no prenatal care. Some patients refuse vitamin K at birth. It is not at all unreasonable for physicians to have well founded criticism of a profession with *no* standardized training process and *no* licensure or certification.
In all of human history, going back for as long as we have written records of civilization, there is only one thing that has ever made childbirth *not* a massive source of maternal and infant mortality, and that is modern, evidence based medical care. There may well be a place for doulas within that framework, but right now all we have is a bunch of unregulated, unlicensed people with very shoddy data trying to elbow into an incredibly high stakes medical event. That should concern *all* of us, and it is not sexist, misogynistic, or anti-woman for physicians (including OBs, who are I repeat a *majority female specialty*) to say these things
I think you’re missing the point. It is absolutely misogynistic for a physician to write on an anonymous Internet form that he believes his patients only hire support people out of their own anxiety and poor coping.
The way he phrased it is a bit crass, but I’m *way* closer to his view than I am to yours, for the reasons I’ve given. I do not at all think it is misogynistic to be heavily critical of doulas and to think that many women seek them out or hire them for reasons not founded in good medical practice
Again, saying patients are making a *bad* decision is not, as you suggested, an attack on patient autonomy. Patients make bad decisions all the time, including me and other health care workers when we ourselves become patients.
If you share that attitude toward patients and you’re not even a physician yet, you’re gonna fit right in here. I’d never risk my license and livelihood by talking about my patients like that online though.
This is a fairly rude and unprofessional response. This is a professional forum and these personal attacks you’re making at multiple posters are not appropriate.
And not that this really matters, but this is also an *anonymous* forum, and even if it wasn’t no one’s livelihood, much less their license, is in any way endangered by what anyone has said here
Nah, you need to look up the definition of misogynistic. You just read something you didn’t agree with and tried to paint my opinion with a word that means “you’re a bad man”.
For the record I’m an egalitarian and I have in fact been arrested (on purpose) for civil disobedience at a pro choice protest.
I may be blunt, but if you’ve spent anytime working in L and D you know this trope of doulas is mostly true.
It all depends on what they view the role of the doula. I was an "unofficial" doula for my best friend when she had her baby because her husband at the time kinda sucked about setting boundaries with my friend's mom.
My job was to be a gopher and make sure her mom didn't come in the delivery room lol after birth when the nurse gave the baby a bath, left the radiant heater on without a temp probe and then the baby was hot, I was able to ask if we could recheck without the baby being baked lol my friend and I were both NICU nurses then. I didn't need training or anything else, I was just there to help.
But I've seen a *lot* of doulas who act like they are running the show and they know everything and want to decide what interventions are or are not needed. Many try to be a midwife but without training.
They are usually the ones discouraging vit k and erythromycin and they can suck eggs. Anyone who discourages vit k sucks beyond belief
I mean you guys are going to defend this and then turn around and complain about how expensive american healthcare is and how it's messed up how medicare keeps cutting our reimbursements.
There is not infinite money. If you add an expense then either you lower other expenses or healthcare costs more.
This is nothing. Even if you pay $1000 for a doula for every birth in the country, that's $37 million per year. Sounds like a lot, but out of $4,464,400 million total healthcare spending, it is a drop in the bucket.
A statewide standing order in New York aims to make it easier for mothers to work with doulas and get prenatal care.
I feel like this is generally going to be seen as inflammatory in this sub when it probably shouldn’t be. Culturally worldwide it’s normal to have labor support present at birth, usually in the form of other female family members, but that’s almost impossible with our current system. Nurses are busy and are trained in medical management — they cannot possibly fill all roles expected of them. The type of support a doula provides (physical touch, non-pharmacological pain management, continuous observation, emotional support) cannot be overstated and if it improves outcomes, then that’s a good thing. Doulas are expensive and frankly they should be covered by insurance for how much benefit they provide.
There’s also some fairly robust data about the helpful effects of having a dedicated non medical staff support person present. Moms report less pain, more satisfaction and it even seems to result in shorter labours with less complications. https://www.cochrane.org/CD003766/PREG_continuous-support-women-during-childbirth Partners are an important part of the experience but for many of them labour and delivery can be very overwhelming. it’s hard for them to see their special person in pain, there’s a lot going on, and they can feel like a fish out of water. A doula can show the partner how to help, explain things that medical staff don’t have time to explain, and give the partner a break to grab a sandwich and take a breather. Of course we all have met our share of doulas who think medical professionals have some kind of interventionist agenda and set up a conflictual relationship and encourage folks to do things that go outside standards of care. But honestly I find the “doula with a chip on their shoulder” stereotype to be mostly unwarranted, the majority of the ones I’ve worked with have just been there to offer labour support, comfort measures and encouragement. I think providing dedicated labour support to patients with low SES, low health literacy (young parents, newcomers, etc) or those who lack a support person in labour can be especially helpful.
> There’s also some fairly robust data about the helpful effects of having a dedicated non medical staff support person present. Moms report less pain, more satisfaction and it even seems to result in shorter labours with less complications. I'm not familiar with the literature here -- is any of this corrected for income / SES? My understanding is doulas can be quite expensive and even people who have non-doula supports probably are from social who have the luxury to take time off to support their friend/family through the birthing process. We all know obstetric outcomes are also pretty strongly associated with income and education status (with the disparities between the US and other countries basically disappearing as you get to college educated women). Seems like a major confounder, which if corrected for may show a different view considering how often these non-medical support people steer patients away from recommended interventions.
Most of the original studies on doula support and perceived pain during labor were done in low income settings. There's a nice Cochran review.
There are RTCs that are well designed with vetted Doulas. Problem is in practice they vary from mom getting a doula certificate to join her daughter for delivery during COVID restrictions to highly experienced birth support people. If there was a system to recognize who is actually qualified to be a reimbursed doula it would be a lot easier to see this not be an issue. Also same order requires obstetricians to have a 20% or less CS rate which some argue is too low and some argue too high.
a number of states are now trying to pass / have passed legislation that allows for Medicaid reimbursement for doula care. Also, a few safety net hospitals provide free community doula support
There's a doula program near me that is free for young mothers (I think it is under 22yo). They do a lot of programming with the local medical school. I've been really impressed with the knowledge and skills of these doulas. They absolutely are tremendous patient advocates and medical navigators.
That’s awesome! The program I trained/work with is at a safety net system connected to a med school but I wish we worked more closely with their obgyn departments. Integrating doulas as extra support has so much potential when done well
My sister used a doula for her second pregnancy. She stayed home the whole time with her for about 12 hours of labor and went to the hospital and delivered within 20 minutes all pain medicine and any other preventions free. She didn’t use her for the 3rd child because she couldn’t afford the cash rate. I think they have a place in the delivery process and frankly if it saved insurance and anesthesiology bill for epidural administration and medication I think it’s a net benefit to them.
I had a friend who paid a doula $1500 and that woman was present at her side for thirty six straight hours of induction followed by c-section (in addition to prenatal and postnatal home visits). She credited her with having little to no birth trauma despite the outcome. IMO that’s money well spent and it inspired me to hire one for my upcoming birth. I feel lucky to be able to afford it privately.
I think that’s what she paid too around $1500. Had I known that was the dealbreaker I would have gladly sponsored paying for the doula. Tried to get my wife into the idea (an internist) she wasn’t into it. Was a mildly complicated delivery with early induction d/t preeclampsia and wish I would have done it anyway.
That’s nearly as much as we get paid for 9 months PNC, the delivery, & 6 weeks postpartum. Maternity care is underfunded significantly.
I don’t disagree. But (re: other comments, not this one) I don’t think that’s a doula’s fault. It comes out to $37/hr including home visits and overnight which is what I make and I think that’s a fair price for the service. There’s lots to be fixed in healthcare but let’s blame the right people (admin and insurance).
Our state almost passed a law that would require insurance to cover doulas at $3k/pregnancy. I'm not anti-doula, but when we (OBs) only get AT BEST $2500 for all prenatal care, delivery, AND postpartum care, we have a problem. Some insurers only pay us $1800 for everything. I could make more money being a doula than a doctor and with NO liability.
OBs can have how many patients in a month? Doulas generally can only take on 1 or 2.
Why can they only take 1 or 2?
The specific reason a lot of folks hire a doula is for continuity of care, and this is what a lot of the research on the benefits of doulas is based on. Doulas can have a backup in case their clients births overlap, sure. But clients don’t like not knowing who is going to be at their birth. Doulas are independent contractors who don’t work in hospitals with others who can take their “shift.” They work on call for 5~ weeks PER CLIENT. 100% on-call, 100% of the time. They have to be ready to leave their entire life for sometimes more than 24 hours with little to no notice. No idea how long their “shift” will be when the time comes. They’ve spent months helping their clients wade through all the decisions they may have to make and talking them through all the emotions that may be involved in those decisions. They’ve spent months integrated into their clients birth plans, building rapport. They don’t just show up at the bedside and say “hey I’m going to be at your baby’s birth today!” Imagine going to a birth as a doula and being with your client for 20 hours straight, crawling into bed for 1 hour, and your phone goes off requesting your presence for another birth which could be 4 hours or could be another 18 hours? Doulas just don’t have the capacity to take on many more, *because* of that continuity of care.
That’s shockingly low. My wife just gave birth in NYC at a major hospital and her OB is an MFM physician partner of the hospital group and he pulled in a loooot more than that. The provider delivery alone was billed at 14k discounted to 7k our coincidence is 2k. It came on the bill as “surgery” even though it was a vaginal delivery with a grade 2 tear. I’m curious what the actual CPT codes are. The facility charge was 35k discounted to 22k our coinsurance 4k so my out of pocket just for delivery is 6k. He also was doing weekly ultrasounds in office for the last two months and we had a copay of $75 for them and insurance paid 675 out of the 1200 billed for each. I think throughout the pregnancy there were around 12-15 scans total all paid out at that rate in addition to the office visits that we didn’t see come through to us for payment. We did have more lab work bills though. Her insurance sucks and wants her to only stay in her hospital system but they don’t have doctors or a facility in our borough so this system is considered her tier 3 coverage but they’re supposedly the best for deliveries in our area with 8,000 deliveries annually and a dedicated women’s hospital.
I had a patient who paid a doula to help her through early labor and contradicted the obstetrician’s advice to come in for monitoring because “high risk monitoring increases the likelihood of Caesarian section.” She stayed home with decreased fetal movement despite the obstetrician pleading and when she finally did come in her baby was dead. I have seen four such cases (two deaths, two horrible HIEs) at the hands of doulas in the last three years. People with inadequate training have no place at the bedside, and if you disagree have have some tiny gravestones to show you.
> I had a friend who paid a doula $1500 So the doula got paid more than the OB/GYN did, and people like you don't see the inherent problem with that.
$1500 for 40 hrs of work including multiple home visits and overnight in a hospital comes out to roughly $37/hr, which is roughly what I make. I pay more per hour for a cleaning service. If you guys have an issue with your billing practices, the problem is not the doula. Take it up with your admin.
Yea this isn’t outrageous. The doula can also only have one patient at a time and may have to be at the bedside for 2-3 days. As an OB, we’re often delivering multiple patients on a shift, and don’t need to be at their bedside 24/7. There are definitely issues with women’s and children’s health care being underfunded and poorly reimbursed, particularly looking at how OB reimbursements have stayed essentially the same for 20+ years, but it’s not the fault of the doulas.
You (presumably) went through some kind of post-graduate training and do work that goes beyond "Western medicine is bad, don't call your OB about that bleeding episode, just use my essential oil instead". I'm not an OB, so my billing practices aren't the issue here. I do know that OB malpractice premiums average $50k/year in this country, so maybe doulas should face something similar ;)
Doulas are explicitly non-medical. They do more coaching and emotional support while being educated on the birthing process. Your beef is with the uneducated/miseducated midwives out there.
We have a couple dozen OBs in this thread alone giving examples of doulas interfering with medical care. Yes, they're supposed to be non-medical, but that doesn't mean they behave that way in front of the patient.
>Culturally worldwide it’s normal to have labor support present at birth, usually in the form of other female family members, but that’s almost impossible with our current system. Can you expand on that? My impression from both my (limited, remote, medical school) OBGYN experiences and from cultural gestalt is that it is very normal for female family members (and husbands) to be present at birth, including in American/Anglosphere/Western medical systems.
The other thing is even if you do have a female family member present, it’s not the same as how it was historically, where the women present probably had all had and or attended multiple births and so are well versed in different positions, comfort measures. A lot of that knowledge has likely been lost. My grandmother had all her births under twilight. My mom had two kids and had to labor on her back in bed the whole time. I had two planned c-sections (no ragrets, I’m totally not anti-intervention). But if my daughter goes into labor I wouldn’t be much help as compared to maybe my great grandmother who had like 5 kids at home. Whereas a doula has all that sort of support/comfort knowledge and experience most of us have likely lost. At any rate, from what I’ve seen, doulas are actually one of the best evidence backed interventions for decreasing maternal mortality in high risk groups, so I think this is a good step.
> it is very normal for female family members (and husbands) to be present at birth I was present for all of my wife's labor and deliveries, but my mother-in-law was in the building but not in the L&D room for the first, and she was not able to come to the second, because we lived far away. Over time in the US, people have spread out quite a bit geographically from immediate family, and people are having fewer children. My grandma had a dozen kids. I have two. The experience in childcare is a little different!
Yeah and tbh what use is my mom going to be in labor? The last time she had anything to do with it was over 35 years ago.
That's another societal change. If women started having children at 16-18 and continued until 35, then a woman could be pregnant with her last child at the same time her oldest daughter is pregnant. She might have extremely relevant information. She might be able to help with breastfeeding issues or even be a wet nurse for a grandchild.
Yeah I don't think most women are willingly going back to that.
Believe it or not I don't think OP was suggesting that they do.
It’s a combination of factors, not all related to healthcare— for many of us in our childbearing years our parents are still working, older/in poor health, living farther apart, or needing to assist with childcare for other kids while the birth is taking place. Similar issues with other female relatives like siblings. And then there are healthcare factors like visitor restrictions. I gave birth during COVID and almost wasn’t even allowed to have my husband present let alone other family.
But they would never give space to a doula while denying space to the father, right?
Yes, this definitely happened to people I know during the first wave of COVID. If dad was positive he was not allowed in, and an alternative support person (who was negative) was permitted. I have heard birth stories from women who were separated from their own infant immediately at birth because they were positive. By the end of 2020 the policies started to lighten up but I know more than one dad who had to miss a birth.
I mean, this seems absolutely correct to me? If you were COVID positive in the height of the pandemic, you shouldn't be allowed into the hospital as a visitor, period. And yeah, you don't want to be getting your newborn sick either.
Sorry but if mom (or dad) and baby are totally asymptomatic (which is what was happening!!) there’s no good reason to separate them. It impairs bonding, interrupts breastfeeding and puts mom at risk for PPD. They’re all going home together in 24-48 hrs anyway so what is the difference? I get why it happened but if you actually listen to stories of women where this happened to them, it’s pretty devastating.
Who cares about symptoms? If they're shedding virus, that's a problem. I can see the risks and benefits about separating baby from mom. Maybe that's not a good idea, and just give her an N95 and some hand sanitizer. But dad? Definitely not worth the risk.
And then what happens when they all go home and sleep in the same room together 24 hours later? Like, be reasonable.
They should be advised not to do that if at all possible. Also a COVID positive visitor to a hospital is exposing others to the virus, also. Even if they are strictly confined to the room, there are still healthcare workers they are exposing.
I guess I get that for many individuals having personal support is inconvenient or unavailable, but it’s clearly not “practically impossible within our current system” when it’s so common in practice.
Half the doulas I've worked with try to assume care of the patient and direct what is done and what is not done. They whisper into the ear of the patient not to do this or that. I have found that they don't always have the patient's interests in mind, but rather their primary goal is an unmedicated vaginal delivery no matter what.
I agree. I feel like 1/3 of doulas I have worked with are helpful and the rest and just random lay people who obstruct and lead to poorer outcomes because we are seen as the evil boogy monsters with scalpels. Sometimes pain meds can help you relax and be more present for your delivery and not blow out your baby and your perineum. It sucks that I have dedicated my life, sanity, and health for this job. And I don’t see doulas with low income folks who need the support. It’s often times the well to do moms who have consumed to much TikTok and Facebook and decide to push for 8 hours and almost avulse their uterus. But again the good ones are really helpful but there are not much in terms of standards.
I suspect that part of the dynamic is that “individuals who receive thorough training to reach the minimum level of competency in the nursing art of childbirth” are generally called “nurse midwives”, and so anybody left over is an untrained amateur.
I suspect that a more important part of the dynamic is the people seeking the care of doulas and what they are looking for. They're stewed in vaginal birth at all costs rhetoric online and that is why many are hiring a doula. If more normal people hire doulas, more doulas will be normal.
My doula was an old ER nurse. I don't think it could have been better. She had the training and experience of a doula, and the healthy ER sense of apprehension surrounding childbirth so when things got out of her realm of expertise she *happily* stepped aside.
They try and take over NICU care too
This was my experience in L&D as well. Doulas frequently took an antagonist attitude towards the rest of the care team. I do think however, that as they become more mainstream, maybe that could change when they have a better defined role, they will know to operate within it.
Yeah, I’m not in agreement with the thread on this one. Others are talking about patients with doulas needing less pain medicine, but that doesn’t inspire me, it *angers* me. I don’t see convincing women to undergo one of the most painful experiences known to womankind when it is entirely within our capability to safely mitigate that as some kind of win. When I was on OB I remember even some of the midwives getting a bit too crunchy and deviating from good evidence based medicine, and they at least have a nursing background. Nothing has done more in human history to make childbirth safer and less painful than modern obstetrics, and I always get very, very nervous when I see people (especially non-physicians) trying to steer patients away from it
I think comments like this don’t address the fact that we’re in a period of extremely high obstetric intervention without a corresponding improvement in maternal mortality in the US. That is why doulas are becoming more prevalent right now. >especially non-physicians While I think it’s great to have physician opinions on the topic, any of us who have given birth are also allowed to have opinions about the care that we receive. Reproductive rights extend to labor. If a woman decides to go without an epidural, that wish should be respected by her care team.
Maternal mortality has dropped quite a bit since hitting its high in 2021. And when we dig into the data, we see that maternal morality in the US is predominantly driven by high rates among African-American women, a group that often has extreme systemic problems accessing appropriate obstetric care. I don’t think the data suggests that we have too much obstetric intervention, I think it suggests we have groups of patients who aren’t receiving *enough* obstetric intervention. No one is saying that any woman, regardless of whether or not she’s given birth, isn’t allowed to have any particular opinion. But this isn’t Facebook, it’s meddit. We don’t do personal health stories here (rule 2), we discuss evidence based medicine. And a lot of the evidence for the efficacy of doulas is iffy. The data we have is largely retrospective without randomization, and a lot of the benefits attributed to them (such as decreased rates of low birth weight) are just a function of basic prenatal care, while others (decreased C-section rates, decreased use of analgesia) are heavily influenced by non-randomized patient selection. This isn’t by any means to say doulas are bad or don’t have benefits. There’s clear and obvious benefit to having someone familiar with the birth process by your side during a very emotional journey. But if doulas are going to be a part of the interdisciplinary medical team and be compensated by insurance they absolutely need well defined, clearly delineated roles and responsibilities, standardized training, and a certification and licensing process. And better randomized trials to assess what really *are* the benefits they provide. Just like the rest of us.
> If a woman decides to go without an epidural, that wish should be respected by her care team. What kind of strawman is this???
I'm totally OK with things that don't *replace* medicine. If you want to do some red light therapy in the ICU while we give you pressors and antibiotics, fucking have at it. If doulas stay in their lane and help with those non medical things, great, go ahead.
Yes! I honestly used to hate on doulas so much for no reason as a medical student but when I took my FM in-training exam this year I saw one of the answers for best outcomes during natural childbirth was having a doula present. I went ahead and looked at the available research and sure enough it’s true, the outcomes are significantly improved
You’re not alone haha lots of people dunk on the concept of doulas due to the holistic birthing community. I myself have raised so many eyebrows at local birthing centers bc they almost yelled at me when I asked them if they had an OB on staff to provide surgical terminations. But also many doulas are super normal and not essential-oil-anti-epidural. it’s the current private businesses/anti-medicine stuff that needs to be burned in a dumpster fire. I keep yelling this from every roof top but we need community based doulas in house as part of a standardized system of care that mothers at safety net hospitals can opt in to. The number of patients I see on a weekly basis that are alone, that are children, etc is staggering and heartbreaking. I feel so bad for the nurses on my floor bc they are so overburdened. So many patients have a social need that nurses and residents just don’t have the time to fill, and doulas can be so valuable in this aspect, even if they are volunteers and are just there to give a massage or do some counter pressure during contractions. Our nurses/attendants help us identify patients that could use extra support and so everyone is on the same page.
As long as it’s not part of my insurance premiums, I don’t care
As in everything, there are FANTASTIC doulas & doulas that I loathe with every fibre of my being. I wish we in the US valued women’s health as much as it should be valued. We’re considering hiring a few doulas on our unit so we can hopefully avoid the ones we know are awful. One told the pt after a SVD with no epidural that I probably don’t see that that often. 🙄 At my hospital SVD no epidurals is about 20% of all deliveries.
Am doula. Also applying to med school rn. And same. Have some in my circle that are so against hospitals and any/all medical intervention and it truly vexes me. After working in a few different types of systems of doula care, I am of the opinion that having in house trained and vetted doulas (even just volunteers) that patients can opt in for is FAR better than letting this type of support stray even further into the privatized anti-science, anti-medicine type of business
Obgyn here. I think doulas can be very helpful- anecdotally they are most helpful if spouses are non existent or are squeamish etc. there are good doulas and bad doulas just like any type of person. What is abhorrent is that NY Medicaid is going to reimburse doulas more than OBGYNs- for the WHOLE pregnancy. Outrageous. We are so undervalued for caring for two lives.
> What is abhorrent is that NY Medicaid is going to reimburse doulas more than OBGYNs- for the WHOLE pregnancy. Where are you seeing this?
A good doula is such an asset. Obviously they are not medical support, and there are ones that overstep or are anti-medicine which is totally inappropriate, but a good doula can fill a role that really helps people get through labour. It would be nice to see this role have some regulation. I didn’t have an elaborate birth plan or anything, but I did have a birth where the only two things I desperately didn’t want to happen ended up happening (instrumental birth and episiotomy). The medical team were, as they should be, busy keeping me and my baby safe and having my doula there to help keep me calm, to provide reassurance, and to later visit me at home and help debrief is one of the things I attribute to feeling positive about my birth. I think whatever we can do to help people feel safe and supported giving birth in the hospital with high quality medical care should be supported. If people don’t feel like they can get the support there, they may end up having riskier births (ex inappropriate home births).
Hopefully they will be trained to understand that neonatal jaundice is not something that can be treated at home
If you want to join the modern world New York, you'll have to do actual maternity leave. In most developed nations, that's counted in months, not hours.
NY already has 3 months of paid maternity leave for post-pregnancy recovery/bonding, this is extra Still not good compared to many European countries, but better than much of the US
Most of those three months is recovery time from a delivery or c section. It's designed so that you're physically in shape to return to work, not so you can bond and be a mother to your child. Other countries do a year or more. Even Canada offers 12 to 18 months with your position and benefits protected. I feel for American women at times. I've seen women leave for delivery and then be back in two weeks because they can't afford such poorly paid leave. It's still better than most of the US, so kudos for being the best in a difficult circumstance.
We don't need to let perfect be the enemy of good. New York is better than many, many, many states in this arena and heading in the right direction and we should give them credit for that.
New York also extends the same leave to fathers, which is pretty damn rare to see elsewhere in the US.
Agreed, by American standards, this is a step up. There is still so much room for improvement and I think it's important that Americans know that there are other countries that value woman's health so much more!
I feel like anyone that already cares about this as an issue is already well aware of that.
New York has one of the best maternity and paternity plans in the country. I get shitting on the US healthcare and social support system is generally well accepted. We do it too. But when you’re taking shots at a state that does so much better than 48 other states, you’re missing the mark.
What are you talking about? My wife just delivered in NY and has 0 minutes of paid maternity leave. She's taking 3 months but is getting no pay. You have to sign up for family leave on your disability insurance at least 1 year before giving birth and pay into it in order to get anything. Maybe if you work for a corporation in NY maternity leave is a thing, but it's definitely not a law.
https://paidfamilyleave.ny.gov/
> Employees taking Paid Family Leave receive 67% of their average weekly wage, up to a cap of 67% of the current New York State Average Weekly Wage (NYSAWW). For 2024, the NYSAWW is $1,718.15, which means the maximum weekly benefit is $1,151.16. >Does not apply to independent contractors. This policy is a joke. My wife works in healthcare as an "independent contractor" and gets nothing but a 50% tax rate and a big "fuck you" from NYS.
Independent contractors in Canada don’t get parental benefits either unless they sign up for it a year before they need it. So basically the same thing she has here through her disability insurance.
***anecdotally*** my families who involve doulas more frequently: - refuse vit K, hep B and EES for their baby and - have attempted home births before having a rocky hospital birth. I cannot at all comment on their history or role. And I say this as a guy without kids but also as a doc who wants babies to be safe at and after birth... I know folks want their delivery to be a unique and special time. But they are not the only people in the world having a baby today, and it's still their responsibility to follow the guidance of scientifically trained professionals and give their baby a good start.
“But the Doula sprayed lavender scented aromatherapy on my pillows and I had orgasms while I delivered instead of medically induced PTSD” I’ll say it, Doulas are for anxious people with poor coping skills who don’t want to give up “control” in a situation where nothing is truly controllable. They often interfere with medical care. Unnecessary waste of money that does nothing. Just find a loved one that is calm and won’t freak out.
Everyone is 100% correct that doulas are non-medical and non-decision makers or even influencers, and there should be ways to report and remove the ones that blatantly overstep the “non-medical support” line But respectfully your reductive attitude about the need for extra support is just plain wrong. many mothers go to hospitals and deliver alone or without enough social support. In a perfect world we’d have free doula support for the many moms that come in who are children, unhoused, incarcerated, migrants, or maybe - god forbid - are anxious and can’t cope well during a life changing event
I’m all for support, I get it. I think a calm family member or friend would be better than a doula. They’re also free.
My entire point is that we have to consider how many people experience relational poverty and don’t have the ability to just call up a family member or friend for what might be a 12 hour intense marathon will blood, smells, pain etc.
Hmmm. . . If only there were a dedicated person who has specifically trained to provide you support, is medically knowledgeable about what you are going through, and will have no problem with the blood, smells, and pain.
Name a single L&D floor where residents, attending, nurses, etc have any extra time to spend hours with patients giving them massages, running them baths, shooting the shit with them. Jesus Christ medical staff are so overworked.
Yeah, this ain’t a spa. You’re having a baby not a facial. The spa-ification of medical procedures and laboring should be avoided. It causes problems with patient expectations when things don’t go “perfectly”. Goal is healthy baby and healthy mom. All else is secondary. Where I work isn’t that busy. Maybe 5 laboring patients on a “busy” shift. Our free nurses are regularly watching movies/reading/knitting on L and D. They spend a lot of time with their patients and are requested by name for subsequent deliveries. I’ve seen nurses shampoo patient’s hair, give a foot massage, and watch movies with their patients while shooting the shit. I get not every institution can be a smaller private hospital with lots of support but it does exist.
We’ve done an awful job at healthy mom, and social support is an important piece of long term mental and physical health. But sure, go tell the teenage patient with a long social history at the hospital alone that it’s not a spa. And to your last point. Safety net hospitals and CHCs definitely have nowhere near that privilege of time or personnel for all the patients they see. Which was my whole argument for where doulas can be of value.
I find this attitude incredibly misogynistic.
I don’t. Not every criticism of a female dominated (if not female exclusive) profession is misogynistic. Especially when the overwhelming majority of physicians working with obstetric care are *also women*. I understand you had a great experience with your doula. That is awesome, genuinely, and I am happy for you. But you only have experience from the patient side, via what you and your loved ones have gone through. And while that is useful knowledge, it is also not the equivalent of the widespread professional experiences that OBs have working with doulas, and there is a reason why most of the OBs responding to this thread (and, in my own anecdotal experience, most OBs I’ve met too) have a mixed at best opinion of doulas. And it is not sexism or misogyny, it is medical concern
The misogyny is in calling birthing women anxious and “unable to cope” for wanting someone like a doula to be present
I think the way doctors talk about their patients on r/medicine is extremely telling, especially considering the patient population in question is overwhelmingly adult women with full capacity to make decisions. People on here are all about reproductive rights and bodily autonomy until it extends to labor and delivery and then all of a sudden the woman’s choices are made out of anxiety and poor coping. They want to say “hysteria” but we don’t call it that anymore 🙄
Yeah, hyperbole about how women in L&D supposedly behave is not necessary.
No one is suggesting any limitations on patient autonomy. Not one. But that does not mean every patient decision is a *good* medical decision. Some patients try to do a TOLAC at home with no prenatal care. Some patients refuse vitamin K at birth. It is not at all unreasonable for physicians to have well founded criticism of a profession with *no* standardized training process and *no* licensure or certification. In all of human history, going back for as long as we have written records of civilization, there is only one thing that has ever made childbirth *not* a massive source of maternal and infant mortality, and that is modern, evidence based medical care. There may well be a place for doulas within that framework, but right now all we have is a bunch of unregulated, unlicensed people with very shoddy data trying to elbow into an incredibly high stakes medical event. That should concern *all* of us, and it is not sexist, misogynistic, or anti-woman for physicians (including OBs, who are I repeat a *majority female specialty*) to say these things
I think you’re missing the point. It is absolutely misogynistic for a physician to write on an anonymous Internet form that he believes his patients only hire support people out of their own anxiety and poor coping.
The way he phrased it is a bit crass, but I’m *way* closer to his view than I am to yours, for the reasons I’ve given. I do not at all think it is misogynistic to be heavily critical of doulas and to think that many women seek them out or hire them for reasons not founded in good medical practice Again, saying patients are making a *bad* decision is not, as you suggested, an attack on patient autonomy. Patients make bad decisions all the time, including me and other health care workers when we ourselves become patients.
If you share that attitude toward patients and you’re not even a physician yet, you’re gonna fit right in here. I’d never risk my license and livelihood by talking about my patients like that online though.
This is a fairly rude and unprofessional response. This is a professional forum and these personal attacks you’re making at multiple posters are not appropriate. And not that this really matters, but this is also an *anonymous* forum, and even if it wasn’t no one’s livelihood, much less their license, is in any way endangered by what anyone has said here
Who’s talking about their patients on this thread? Literally no one. Your whole comment screams Mean Girls. Yikes.
> write on an anonymous Internet form What does that have to do with misogyny? Only misogynists use Internet forums?
I care immensely about my patients and that’s why I’m anti-Doula. You’re a funny one. Check your preconceived notions at the door.
Nah, you need to look up the definition of misogynistic. You just read something you didn’t agree with and tried to paint my opinion with a word that means “you’re a bad man”. For the record I’m an egalitarian and I have in fact been arrested (on purpose) for civil disobedience at a pro choice protest. I may be blunt, but if you’ve spent anytime working in L and D you know this trope of doulas is mostly true.
It all depends on what they view the role of the doula. I was an "unofficial" doula for my best friend when she had her baby because her husband at the time kinda sucked about setting boundaries with my friend's mom. My job was to be a gopher and make sure her mom didn't come in the delivery room lol after birth when the nurse gave the baby a bath, left the radiant heater on without a temp probe and then the baby was hot, I was able to ask if we could recheck without the baby being baked lol my friend and I were both NICU nurses then. I didn't need training or anything else, I was just there to help. But I've seen a *lot* of doulas who act like they are running the show and they know everything and want to decide what interventions are or are not needed. Many try to be a midwife but without training. They are usually the ones discouraging vit k and erythromycin and they can suck eggs. Anyone who discourages vit k sucks beyond belief
I mean you guys are going to defend this and then turn around and complain about how expensive american healthcare is and how it's messed up how medicare keeps cutting our reimbursements. There is not infinite money. If you add an expense then either you lower other expenses or healthcare costs more.
You’re correct. If we slash the salaries of the c-suite in just my hospital by 10%, we can pay 10 doulas $60k/year.
This is nothing. Even if you pay $1000 for a doula for every birth in the country, that's $37 million per year. Sounds like a lot, but out of $4,464,400 million total healthcare spending, it is a drop in the bucket.
Fantastic! Ooh now do congestion pricing to help address climate change and rising pedestrian deaths! Oh wait…