Should Doulas Help Prevent Assault?

I’m having a discussion online right now about doulas, and their role in preventing or aiding in the assault of birthing women.

I remember telling my story to a mom who had a non traumatizing birth at home. Her answer was simply, “Next time, I highly recommend a doula.” Smug smile.

Me: “I did have a doula.”

Her: Jaw drop.

Yep, I did have a doula. I did have a birth plan.

I even had a part of my birth plan that was dedicated to “in case of emergency c-section”.

Here it is:

“If a c-section becomes necessary, I would like:

  • A second opinion
  • To make sure all other options have been exhausted
  • My partner and doula to remain with me the entire time
  • To have my headphones and music to self soothe (I am very afraid of surgery)
  • My hands left free so I can touch my baby immediately after birth
  • To see my baby and have skin to skin immediately after birth in the OR
  • I want to be able to hold and breastfeed my baby as soon as possible”

I also noted high up on my birth plan my history of being sexually abused and need for informed consent (even though informed consent is legally and technically every patient’s right…)

Guess how many of these bullet points were regarded? None.

That’s right. Exactly NONE of these points were heeded. Especially the most important bullet points, one and two, which would have easily resulted in a vaginal birth.

I know my OB read it, because she blatantly stated so when she told me that she and my nurse “read my birth plan, and just because I love doing c-sections doesn’t mean you’re going to get one.”

That means that both she and my nurse, over the course of the next three hours that I was under their “care” during labor (they both left me after sewing me up, without a word) blatantly disregarded my medical directives, even against medical indication.

It’s true, I did get to see my baby in the OR. My husband begged the anesthesiologist in the OR that she be placed on me after she was pulled out. The anesthesiologist had to take the baby out of the OB’s hands and put her on my neck before anyone could interfere. She was there maybe fifteen seconds before she was whisked away for several hours to be put on a breathing machine, while I woke up in a dimly-lit room with fluorescent lights. There was no nurse in there to tell me where my baby was, or how long it would be before I got to see her, or even if she was okay. Luckily, my doula was next to me, holding my hand. She had to be firmly assertive to even be allowed to be by my side in recovery. My nurse told her arrogantly that she was “lucky” to be allowed this privilege, as I suppose most new mothers had to wake up and recover isolated and alone, without any good reason.

But my point is, I had a doula, and against common sense and popular thought, she did not stop or prevent my unnecessary csection.

She did stand by me after. She did stand by me before. But she did not speak up.

When the nurse disconnected my bed and rolled me into the OR (all of 2 minutes), my doula tried to get into the hallway with me. She told me the nurse physically pushed her and my husband aside, so they were unable to follow.

My husband told me that my doula said, “Her oxygen was good. She would have been fine,” after I was rolled out. This did me no good. When my husband told me this, months after the surgery, I agonized about why she did not say it aloud in my presence. Anything that would have started a discussion, explanation – anything – that could have allowed me time to ask questions would have helped.

The heart rate also went up – as the OB admitted in the hallway – but she also said “But we need to do this.” What she meant was, she needed to do this. Not because it was medically necessary for me or my baby – in fact, it was medically unnecessary, not medically indicated, it was doing harm.

I was about to have multiple incisions and my body opened up, putting me at risk for infection, hemorrhaging, blood clots, temporary and profound short term disability rendering me unable to care for myself and my newborn, and reproductive and birthing issues for the rest of my life because she had an operating room full of people at the ready. Because she did not want to wait for the next twenty, thirty minutes, or hour for me to push out a baby by myself. Because the hospital was about to get paid three times as much for this unnecessary surgical birth.

None of these reasons were to protect my health or my baby’s health. This surgery would jeopardize and claim all of the triumphant, joyous health that would have been ours after a non surgical birth.

But, oh well, she must have thought. What’s this woman’s life worth, anyway?¬†Certainly not my time.

I think I know why my OB did what she did. Her goals were diametrically opposed to mine. She wanted a viable fetus and to look good while extracting it, like a champion, at whatever the cost. In her mind, my baby’s birth was about her. How she felt about herself.

But to me, and in real life, my daughter’s birth was about me and my daughter. It was about me bringing her into this world, as her mother.

My doula, of course, was on my side. A doula’s purpose is to stand beside and support a laboring mother. She knew birth was powerful for a mother, that it was not only a physical, but emotional and spiritual journey.

So in the nights following the birth, when I woke up sweating, screaming and in between nightmares and flashbacks of being on the operating table, I couldn’t stop thinking about why she hadn’t said anything. Just one little thing.

I went through the birth, start to finish, in detail, over and over. I imagined where she could have inserted herself.

I remember the meetings we had together, alone and with my husband. I remember telling her that my greatest fears were feeling like I wasn’t being heard and that things were happening too fast for me to have a say. Those worst fears were the pillars of my daughter’s birth. I remember her telling me ways that she would prevent this from happening – that she would tell hospital staff I needed time to think, pray, or make a decision. She would ask if we could delay the decision for just a couple minutes. She would say to Mike and me, do you want to hear the risks and benefits? Knowing she would say these things, believing she would, helped put me at ease. I knew I would have an advocate in my corner when I was too in pain and focused on laboring to advocate for myself.

But during the labor and birth, she said none of these things.

Before the big unnecessary surgery, she didn’t ask for more time.

Because of this, I was confused.

Surely, especially, I thought, if she didn’t think it was an emergency, she would let me know. Surely,

But she didn’t. She knew it probably wasn’t an emergency, but she didn’t say anything.

After the birth, I felt somewhat betrayed by my own advocate. I did some research. And I found that many doulas don’t believe preventing abuse or speaking up during abuse is within their scope of practice as doulas.

But I think that’s bullshit.

Just on a human level, I think if anyone sees another human being being assaulted or abused, it’s your duty as a human being to intervene. If you are being paid to be any kind of support system, such as a doula, I believe it’s your professional duty as well. So to see so many doulas turn a blind eye to this abuse is infuriating and heart breaking.

But this is most important:

It also minimizes the birthing mother’s experience as abuse.

Because my doula said nothing, I thought, my husband thought, and most likely my healthcare providers thought that what they were doing to me against my consent was acceptable.

Why? Because if it was abusive, surely someone would say something, right?

Surely, the person I hired as my support, my own husband, somebody who actually cared for me would say, “Stop!” or at least, “Wait! Slow down!”

But that’s not what happened to me, and that’s not what happens for many, many women experiencing birth abuse and assault at the hands of their providers.

There are many reasons why. Husbands and partners are scared. And when they are scared, they revert to old, deeply entrenched if incorrect belief systems like, the doctor knows what they are doing. Birth is scary and unpredictable. The doctor will only do what’s best for my significant other and child.

The doula might think, I want to support more clients in this hospital again. I have to be careful what I say so that I don’t ruin my reputation. So that I don’t get kicked out. So I can support my client after her surgery. Or, she might be triggered and stunned into silence herself.

But these reasons, while very valid, can not be our excuses not to stand up for the very women doulas claim to support. How can you be truly supportive of someone if you stand by and watch as she assaulted? Bearing witness to an assault and not speaking up in my mind makes someone complicit. Like not calling police during or after a crime. And assault and battery is a crime.

I’m not here to blame doulas for the widespread abuse done by providers in L&D units across the US.

But I am here to ask them to think about what responsibility they bear in preventing and interfering in an abusive situation, one that involves a client under their emotional care. I’m here to ask them to think about what responsibility they bear after witnessing an assault, a crime.

And I’m here to ask them to think about what it might do to a woman emotionally when they turn their back on them during and after an assault.

What does a doula have to lose by speaking up for a woman who is about to be assaulted, except that woman’s trust should she choose not to speak up?



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