The other day I was talking with a young woman I know who is living here temporarily, while her husband learns in yeshiva. She is nine months pregnant. I asked her if she were taking a private doctor for the delivery, a common practice among women in her community. She replied, no, that instead, they were hiring a doula. “Wow,” I thought, “times have changed.”
Way back when, 20 years ago, when I was pregnant with my oldest, labor support was delivering a baby at the birthing hospital, Misgav Ladach (now an outpatient surgery hospital for Meuhedet) or hire one of the few doulas working hard around Jerusalem. I chose option one with a twist; my husband turned out to be the best doula of all (he’s not for hire).
Fifteen years ago, in my zeal to try and change the system, a friend of mine, Sarah Goldstein and I, conducted a study to see whether women would want to give birth in a freestanding birthing center. The overwhelming majority said no, however, 70% said they would want to meet their midwife beforehand.
Chemistry is Important!
This statistic demonstrates that women wanted, and still want, to have a relationship with the person who helps them deliver their baby before they walk into the delivery room. However, in Israel, the system isn’t designed that way so women often choose to hire private doulas, a lady outside of the medical system, who they meet beforehand, know and trust to guide them through the labor process.
I have a close midwife friend and she and I are also arguing, in a friendly way, about the role of doulas in the labor room, what’s appropriate, and how doulas should and do behave.
So I decided to ask a few doulas that I know to expand on this discussion a bit.
But first, what exactly is a doula?
To quote Deena Jacobs, “The term Doula, a Greek word, translates directly to “slave woman.” Our names seem to imply that we are there to do anything and everything for those that we serve, yet most people aren’t really clear on exactly what we Doulas do. Part of the delicate balance of being a Doula is finding a way to guide a family to feelings of comfort in having their own preferences and expectations toward their birth and postpartum experience. We do this by helping prepare them with information, coping techniques, guidance, and our own vast experience of the birth world when its called for. We make it our business to be standing by their side, reminding them of their strength and their rights during the whole process.”
Says Sarah Goldstein, a longtime doula in Jerusalem, “As a doula trainer for an international organization, (DONA International), I can safely say that it is a doula’s role to provide resources for medical information as well as basic nutrition/exercise information. We are there to provide comfort measures, physical and emotional support and advocate for them in the hospitals.”
And what is the doula’s role, exactly?
Says Jacobs, “When speaking to expecting mothers, words like “Health Care Advocate,” “Medical Professional,” and “Childbirth Educator” are thrown around, when they tell me what they are looking for in a Doula. People these days seem very confused, and I honestly can’t blame them because I’ve frequently seen Doulas advertise themselves in all those ways. “
Sarah Goldstein brings another perspective. “Many women feel that they are hiring a doula to only help them through the birth process. They are not interested in neither prenatal nor postpartum care, unless they hire specifically, a postpartum doula (of which there are few here in Israel). Unfortunately, the healthcare system only treats the woman once a situation arises that needs addressing and then it is usually treated with medication.
Preventative care is not addressed enough, if at all. For example; Pregnant women should understand the crucial reasons to drink more (avoid premature labor, to avoid swelling, hemorrhoids and ensure help enough blood volume to bring vitamins and minerals to the fetus. Exercise during pregnancy, reducing stress and proper nutrition can avoid serious situations during pregnancy as well.
Most doctors do not share this information. If they are having a home birth with a midwife, they will get the information they need for a healthy pregnancy and a safer birth outcome.
If the medical system is not going to raise awareness, then the doula can guide them to attain the critical information that they and their growing fetus needs.”
There are those midwives, and doulas, however, who feel that the doula’s role is not during pregnancy or postpartum, but only specifically, to physically and emotionally support the woman during the labor process.