Knock-knock. Who’s there? Do. Do-who? DOULA (this is why we’re podcast hosts and not comedians). This week we’re discussing the origins of doula care. Best known for their growing role in providing laboring mothers during childbirth, doulas have been around for decades in an official capacity and even longer in an unofficial one. Closely intertwined with midwifery, doulas have evolved alongside the changing world of labor and childbirth, ultimately ending in the place we are today. We dive into that history as well as their role on the birthing team in hospitals, homes and birthing centers now. Then we discuss the medicalization of childbirth, share some of our own experiences as medical students on the labor and delivery floors of hospitals and unpack how doulas, support and caregiving play into those spaces.
- How can we reconcile the medicalization of birth with the role of doulas and the health of the mother?
- How do you think doula work could be made more accessible to pregnant people?
Listen to the episode, discuss these questions with friends and family, let us know what you think!
The word doula is a Greek word that translates to “female slave of the child-bearing woman.”
Today, doulas assist people, mostly women, with births at home, in the hospital or at a birth center. They are loosely described as being non-family members that help ease a family through adjustments and changes a new baby brings by emotionally and physically helping the family.
A key difference: midwives are essentially obstetricians, or people who deliver babies and care for pregnant people in labor, but for low-risk pregnancies. Midwives are medical professionals where doulas do not.
History of Childbirth in America
Midwifery has existed, as we know, for thousands of years and of course, so much of this work was done by Black women. Even before then, midwives were often enslaved women who survived the Middle Passage to come to America and were the main source of birth care throughout the country.
In the second half of the 1900s, doctors became a more established medical field and childbirth became this way of demonstrating advances in technology and medicine.
Out-of-hospital births, which were nearly 100%, went to 44% by 1940. Some birth workers adapted to this change, taking it as an opportunity to care for their patients and also enjoy formalized training programs.
From 1939-1948, better regulations and medical advances like antibiotics, oxytocin and safe blood transfusions helped bring down maternal mortality rates but the problem was that moving towards birthing in a hospital actually changed the perspective of childbirth from this natural thing to an illness. That is called medicalization.
Doctors began relying very heavily on intervention methods like c-sections, induction, breaking women’s bags of water and the episiotomy. As a result of this medicalization, the home birth movement arose in the 70s as well, which created an alternative health belief system that stressed normalcy and non-intervention.
Actual birth doulas became popular in the 1980s where women began to invite dedicated female friends, childbirth instructors and obstetrical nurses to join them in labor. In 1992, the non-profit org Doulas of north america (DONA) which was later renamed DONA international. It is the first org to train and certify doulas.
Doulas today–views of pregnancy
Today, doulas have been found to positively impact childbirth outcomes worldwide, but they are most prevalent in the US. Professional doulas are often hired by individual mothers/families to be a part of their birth experience. The average cost is anywhere from $800 to $2500.
The training to become a doula has multiple levels–there is a basic level in which you attend a 2-4d training and you can practice as a doula. Then there’s advanced doula care where you have to see a certain number of births that are unmedicated and labor with a certain number of moms. You can also get more certifications in prenatal massage and postpartum care.
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