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Slave Labor

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Child birth can be one of the most stressful of human experiences. But even with the most advanced of technological breakthroughs in medicine – KUNC commentator Dr. Marc Ringel says the human factor may still be the best way to keep both mother and newborn calm and avoid unnecessary risks.

Here’s the scene:  The surgeon’s lounge.  Morning.  I’m drinking a cup of coffee.  I’ve just assisted a surgeon colleague in removing my patient’s gallbladder.  I’m listening in on the conversation of a couple of obstetricians.  One says to his comrade, “Not only was the labor prolonged [meaning the doctor had had to spend the whole night at the hospital], but she [the mother] had a doula!”  His colleague groans and rolls his eyes in commiseration.

A doula is a non-medical person whose job is to support a woman through labor and delivery.  The term is derived from the Greek word for female slave.  I never had the opportunity to work with a doula myself.

Why should that obstetrician have objected to a doula being involved in his patient’s labor?  What could be bad about a woman getting extra support during labor and delivery?

As a physician who used to deliver babies myself, I do understand that doctor’s reservations.  One more person in the mix with patient, family, doctor and staff could complicate communication and decision-making during the sometimes stressful, high-stakes drama of labor and delivery.  While doing her duty to advocate for mother, baby and family, a doula must walk a fine line between being supportive and being intrusive.  And I imagine not all doulas are able to pull off that balancing act.

I can see where an obstetrician, who spent seven years after college acquiring the education and skills that led her to the delivery room and operating suite, might resent opinions expressed by someone whose certification, according to DONA International, a body that trains and certifies doulas, amounts to at least 16 classroom hours, reading five books, and a certain amount of exposure to childbirth (not including her own).

Nevertheless, there are things doulas incorporate into their practice that many doctors don’t, at least not so intensely.  These things arise out of the close connection that develops between a woman in labor and the woman there to support her through it.  There are understandings that can only be acquired by shared experience, the sorts of matters that technology-obsessed modern medicine tends to undervalue.

We ignore the interpersonal and subjective at patients’ peril.  Labors are, in general, not only more pleasant for the mother and her family if there’s a doula involved, but outcomes are better.

A study published in 2008 in the medical journal Birth reports on the rate of cesarean section delivery (as opposed to normal vaginal delivery) among 420 women, half of whom were randomly assigned a doula and half of whom (the control group) weren’t. 

Overall, delivery by c-section was 13% for the doula group and 25% for the control group.  For induced labors, the difference is downright astounding, 13% for doulas, 59% for controls.

Avoiding c-sections is a big deal because in childbirth, as in most things regarding health, natural is better.  All else being equal, delivering a baby in the old-fashioned way beats a surgical delivery, in terms of pain, complications, rate of recovery, cost and, most importantly, wellbeing of mother and baby.

I can only make an educated guess as to why doulas appear to have such a big impact on cesarean rates.  It probably has something to do with reducing the mother’s (and maybe even the baby’s) level of stress.  Outcomes for just about everything medical are better at lower levels of stress.

Whether the baby finally arrives via vagina or surgical wound, a doula can make a big difference to a mother and her supporting cast.  After the delivery, the doula is likely to feel great satisfaction as she sits back in the break room with her cup of coffee and reviews the intense experience it’s just been her privilege to have shared, her pleasure diminished just a bit perhaps by the burning she feels in her ears because they’re talking about her in the surgeon’s lounge.

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