The following response appeared in the January 6th, 2007 edition of the National Post. It is reproduced here verbatim, in the event that the National Post article link goes stale.

RE: article in National Post Aggravated at Birth
Virginia Collins, director, Antepartum Doula Program, CAPPA, Toronto.

In your article describing the relationship between doulas and other members of the health care team I am struck by your omission of what is surely a most pertinent piece of information. The doula is the only person involved with the facilitation of the delivery who is in the service of the parents. All the others involved are in the service of the facility where the delivery is occurring. They may have a great range of autonomy and responsibility but they are ultimately constrained by the circumstances of their facility.

A doula has likely been involved with her clients pregnancy for a significant length of time prior to the delivery and has likely had many discussions regarding the expectations for labour delivery and postpartum. The client has chosen to work with that doula because she and her partner feel that their needs are best met with this person.

The health care team that is assigned to a woman at the time of delivery is largely composed of complete strangers to her and her partner but who enjoy an intimate relationship with their co-workers. There is a team-mentality espoused by the obstetrical medical profession, but make no mistake, the labouring woman and her partner are not a part of this team, rather they represent the opposing team - with the unborn child the ultimate prize.

In being charged with facilitation of a safe, healthy delivery, health care providers can adopt a belief that they know you better than you know yourself and that they have a better understanding of what you need. This is the type of assumption that leads to the stories of disempowerment often heard post partum. This assumptive knowledge is not based on an understanding of you, your partner, your history, your lifestyle or any other personalized measure; these assumptions are based on the health care provider's own career experience, accepted protocols and supported research of others like you. Individual circumstances don't have much of a place in this equation.

The ultimate goal is for a healthy mom and baby; "at any cost" is the unspoken collateral. With this, it is possible to justify intervention in almost any situation that can arise, and the team's support can be biased in that favour. An example is that of the successful delivery by Cesarean section of a baby whose heart rate was dropping after a prolonged, unsuccessful failed induction. This is viewed by the profession as a justifiable rescue. Yet there is no acknowledgement or ownership of a risky intervention that created the circumstance that necessitated the rescue. While certianly rescues do save lives, there is a case for the Doula's advocation of a low intervention delivery - one that is less likely to create need for the rescue in the first place.

Cesarean rates are on the rise, as are inductions and, with failure to progress in labour as a leading cause of Cesarean section, one really has to wonder why doulas - with their evidence-based success at reducing the Cesarean section rate and shortening labour - are not in demand by the medical team.

I have attended births as a doula for 18 years at a variety of facilities in the GTA and I have observed examples of all types of behaviours from all those involved with birth. It seems to all come down to one thing and one thing only - respect. As long as it is tolerable to show disrespect for one another there will continue to be friction. This friction is not limited to doulas coming onto the health care team; this problem exists across the board.

In recognition of this the SOCG has worked hard to promote its MORE ob program, an element of which deals with the friction and subsequent communication issues that exist between the various members of the health care team as it exists today. Everyone is jostling for recognition of their important contribution to the safe delivery of our most precious resource, and in doing so, I believe they are forgetting why they came here in the first place. There is more than enough room for all of us and we all are better off to perform our unique services in concert with each other creating harmony and eschewing discord.

Read the original NP article >