• Sami Zanfagna

Why I Quit Doula Work for Good

As my own daughter's birth gets nearer, birth is even more of a consistent topic in this house than it was before. But the tone, the opinions, the approach - everything about how I talk about birth has changed.

I became a doula when I was around 20 years old because I wanted to help women; one of my very wise friends suggested it to me, which is how I first heard about the profession. I went into it with curiosity, and I quickly became addicted to the literal chemical experience of birth - the secondary oxytocin release that anyone who is privileged enough to witness birth often experiences, which is (usually) intended only for mother & baby.

I also went into it already having strong distrust and dislike of the modern medical system, and I thought somehow doulahood would be a way to make change happen from the inside.

But from my very first doula experience - through Mass General's volunteer program with a teen mom who lacked other family and community support, which lasted 5 days and ultimately ended in a Cesarean - nothing about being a doula felt satisfying or 'right'. I would get home from every birth exhausted, feeling relatively useless and ultimately pretty irritable and frustrated. But I ignored this feeling, and only recently have I been able to put words to why this was my experience.

When people hear you're a doula, their reaction is usually "Ooooh cool! You get to work with babies!" - but that reaction always seemed funny to me. I probably spent about 2% of my work hours actually snuggling newborns. 98% of it I spent looking at terrified moms, shaking my head, trying to remain calm and to instill calmness in her, all the while masking my internal thoughts : "This is so fucked up".

I have done two doula certifications with two very different organizations. In any doula training, you will likely find language that instill this message in you: as a doula, you are obliged to be unopinionated. It's an ultimate form of political correctness. For fear of offending your client or influencing any of their choices, don't tell them how you really feel - don't even tell them about your knowledge based on past experience. Just support whatever decision they make - even if you know their well-intentioned but misinformed choices may ultimately lead them to regret or to an outcome they desperately are trying to avoid. Doula, from Ancient Greek, means "a woman who serves", and in modern times in the US we've really taken this meaning towards literal servanthood. As a doula, you have no power.

Part of this is because you are not deemed a 'medical professional', because witnessing hundreds of birth experiences is somehow not enough evidence that you might know a thing or two. It's not 'science'. You are not obliged to be subservient only to your clients, but also to their every care provider: nurses, doctors - obstetricians who have likely never, in their training or profession, witnessed an undisturbed (truly 'natural') birth. You are inferior, and you are treated as such - usually with condescending or even outright rude comments from skeptical hospital staff.

The expectation of a doula, as we understand it in the modern sense, is someone that will witness a mother's pregnancy and birth process, without influence, gently providing back rubs and getting her water, unable to stop the inherently traumatic 'cascade of interventions' that is ubiquitous in hospitals and results in poorer outcomes for both mother and baby. Just a witness: to trauma, pain, fear, and often, sanctioned abuse. And it's definitely false advertising, from where I sit now .. to have a woman to hold space to witness that and provide some semblance of comfort and support absolutely makes the whole situation more bearable for the birthing mother. But the misconception that having a doula will somehow stop these unwanted outcomes from happening is simply not true.

When we took our Hypnobirthing class in my second trimester, I figured most of the couples in our group would be birthing at home - after all, Hypnobirthing is all about how to birth peacefully and meditatively, trusting in your body's innate wisdom and physiology, without intervention or pain. But to my utter surprise, we were the only home-birthing family. Every other couple expressed how they would be birthing at this or that hospital, but how they didn't want anything the hospital has to offer: no drugs, no tests, no monitoring, no interventions, no people in the room, no C-sections. In fact, one whole block of our class time was dedicated to guiding them through how to 'successfully decline' or avoid each of these almost-standardized interventions.

To me, the equivalent of this expectation is going to an Italian restaurant expecting to be able to order sushi. It's just not going to be part of the experience; it's not what they have to offer. Being in a hospital is a perfect place for a birthing mother who wants help: epidurals, surgical birth ... and there is absolutely no judgment around that. But for mothers who desperately want to avoid these outcomes, why is the hospital still the place they seek a comfortable birthing experience?

We get trapped into the idea that a hospital birth, in only the locational sense, is a 'safer' birth. But the reality is that anything that interrupts the hormonal physiology of birth - down to the most 'benign' disturbances, like someone you don't know entering your hospital room - inherently makes birth less safe. This is why dangerous complications, like hemorrhage, are more likely to happen in the hospital setting than in truly undisturbed birth. When these instances arrive, and modern medical intervention 'saves' us, we get trapped into believing it was good that we were there at the hospital. But we can never say whether these complications would have happened in the first place - if we hadn't been in that environment, which is inherently at odds with the physiological birth process.

There's more to say on that, but that's for another time. For now, this is my confession of why I've decided to leave the doula world for good. I realize now that if we are to make true change in birth ... if we are to truly separate ourselves from an abusive system to step into our power as birthing women ... it can only be done without the watchful eye of Big Pharma and Big Medicine. It can only be done when we are not in the confines of their standardized and impersonal system, being dismissed and manipulated, while in our most vulnerable states - and with only a doula, a silent witness, to support us.

I am still an immense advocate for women supporting women in the birthing process, the way it has always been done, cross-culturally, the world over, from the beginnings of humanity. Having wise women for guidance, to share their knowledge, and to hold space for uninterrupted, physiological birth is a privilege most birthing women don't get to experience. We need more wise women, more birth-keepers, who are willing to exit the system and protect the sanctity of birth. If you are passionate about supporting women in birth, there are many of these alternative trainings available to you, which I am happy to share more information on. Leave a comment below.


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