Hi Marilyn, Thank you for your comments and thoughtful reply. I have some experience of the system in the US from presenting workshops there on several occasions, but I am glad to have your perspective as well, as you mave much more experience from working within the system there than I do.
Your suggestion to be cautious about doulas is very sound, and there are a number of issues to be cautious about. I've raised some of these in another Diary entry, which you can reach at: <http://www.birthinternational.com/diary/index.html>http://www.birthinternational.com/diary/index.html Whilst I agree that being a doula will never make much money, there is the implication that you could set up a business (from the material I have seen from the US) that is no doubt behind some of the hype that is going about. There is also the money-making aspect of the training courses etc that are being encouraged, when this may not be either appropriate or necessary. I worry that some wonderful women will find that working like this is not what they expected and get burnt out.... I think the interest in this phenomenon will pass.... Warm regards, Andrea At 06:33 7/09/2002, Marilyn Kleidon wrote: >Hi Andrea: > >I am going to bight on your controversy re doulas. I totally understand >your apprehension to yet another American phenonmenon and your inference >that it is just another way to make money. Though I have just returned from >the USA after almost a quarter century, I am hardly an advocate for the >prevaling free market capitalist culture that is so valued there. I really >hope it isn't further exported here (as it already has been in the >privatisation of so many public utilities, but that is another and not >midwifery debate). From what I have seen it is market based economics (a USA >import I think) is driving the health care system here. That is why is many >hospital systems, unless it is a slow shift most women in a birthing suite >wont get one to one midwifery care. Not enough midwives are being employed >to give quality care to women. Enter the family and friends. Even if friends >and family are available to give support, and even if, as you assert (from >the Klaus and Klaus articles) there is no difference in outcomes between >trained and untrained support people not everyone has good familial >relationships so not everyone will use their family or friends for support. >Also, because it has been several generations that women have been birthing >in hospitals, many mothers do not want to accompany their daughters in >birth, they don't want to relive their birth experiences and are more than >happy to show up once the baby is "delivered". Similarly with family and >friend support for breastfeeding. I continue to be amazed at women my own >age who tell me adamantly that the hospitals encouraged formula feeding 25 >to 30 years ago and that is why they didn't breastfeed. It wasn't my >experience but neverthless they feel helpless when it comes to supporting >their daughters with breastfeeding. Doulas are not pretending to be midwives >or lactation consultants they just represent the informed supporter, and >sometimes they are paid. > >I don't think any doula would place herself in the birthing room at the >expense of a family member and I haven't been in a birthing room in either >the USA or Australia where family members were not welcomed. Doulas can also >help with discouraging (gently) the exaggerated breathing techniques that >some of us used 20 or 30 years ago that well meaning aunties or mums may >inflict on the labouring mum. If the mom does have a c/s the doula is never >in the OR in place of a relative unless of course the mom/partner requested >it. > > Doula services do provide support to women who are removed from their >families for whatever reason. They provide supplementary support to partners >and they provide the woman with a knowledgable woman to just talk to. Some >women have had traumatic birth experiences, feel their partners or family >just did not have enough knowledge to explain to them what was happening and >hire a doula to fill this gap. Some hire doulas to be advocates for them: >this can be controversial. Obviously this is a gap in either midwifery or >obstetric care, the cold fact is it exists here as well as there. Most women >are not personal friends with either midwives or childbirth educators and so >do not have these people to call on. > > I personally do not know of any wealthy doulas. I do know people who earn a >modest living supporting women in birth. The schools that offer doula >training offer them, surprisingly, much cheaper that the trainings are here, >and they are much briefer. Experience as a doula is often a prerequisite for >direct entry midwifery education in the USA. > >At this point I just want to offer some info on the obstetric nurse versus >midwifve. USA trained obstetric nurses are not required to be >educated/trained as midwives, they are nurses with experience in labor and >delivery, they are usually extremely well trained/educated and I wouldn't be >without one in an obstetric emergency in a US hospital. It is not in their >job description to either birth/deliver babies, however they do everything >else including calling the doctor or midwife when the baby is on view. Many >are also great supporters and/or advocates for the mum (mom), however they >work in a hospital environment governed by protocols, guidelines, and >procedures. They are also incredibly understaffed and again while they will >do their best to provide one to one care during labor and birth if it is >busy the care will be less than supportive though competent. There are >midwives in the USA both nurse midwives and DEM's (of which I am one). Nurse >midwives (if working as a nurse midwife and not a L& D nurse) have their own >clients. They either have their own clinic, usually part of a group practice >of other CNM's and sometimes OB's and GP's or they are part of a hospital >clinic where they work similarly to team/group midwives at hospital >antenatal clinics here. Nurse midwives may also work independently doing >home and free-standing birth center births. They have usually had to have 1 >to 2 yrs experience as a labour and delivery (obstetric) nurse in a hospital >delivery suite before being accepted to nurse midwifery school. There are >some 8,000 CNM's in the USA. Direct Entry Midwives may or may not be also >nurses, usually have their own clinics and attend births at home or >free-standing birth centers, some also have hospital privileges which means >they continue to attend their women as their care giver if there is a >hospital transfer and also that they can attend women who for personal or >insurance reasons require a hospital birth, they will be assisted at the >hospital birth by the obsteric/labor and delivery nurse. > > >In a perfect midwifery world there would be no need for doulas or should I >say professional doulas, however it is not a perfect world and most likely >wont be for a while. The big down side that I see to the doula movement is >that hospital administrations may come to depend on them, and so pass the >cost of hiring extra nurses (in the USA) or midwives (Australia, UK etc) >onto clients/consumers of whom a certain percentage may be counted on (by >the admin)to hire their own private doula. So, I don't think we should be >antagonistic to doulas but maybe cautious. > >I had better finish before I write a paper. >regards >marilyn >----- Original Message ----- >From: "Andrea Robertson" <[EMAIL PROTECTED]> >To: <[EMAIL PROTECTED]> >Sent: Thursday, September 05, 2002 4:00 PM >Subject: Re: [ozmidwifery] Hello - Brasil here... > > >Hello Ricardo, > >Terrific to hear from you and to have you on the list. I hope you'll find >the midwifery scene in Austrlaia interesting to read about. > >As you know, I've been able to have a first hand look at what is happening >in Brasil and I am very excited about the work of REHUNA. Can I just say >that I think REHUNA should be careful of the "doula" phenomenon? Rather >than spending time on training a new team of people as doulas, why not put >your energies into re-shaping the thinking and up-skilling the nurses you >already have working in maternity and at the same time, open your labour >wards to family and friends of the labouring woman? The work of Klaus and >Kennell in the 1980's showed that in order to improve outcomes for >labouring women all that was needed was to provide a companion for her, and >one with no training was just as good as one with training. > >I've looked at birth in other parts of the world similar to yours and still >think that the first and easiest step to take is to find a way to enable >the woman to have her sister/mother/best friend with her during labour and >birth. This is cheap, easy, woman friendly and easy to implement. > >I hope to be able to get back to Brasil to do some more workshops for your >nurses on the basics of being "with women". In the meantime, I have written >a Diary entry http://www.birthinternational.com/diary/index.html >on doulas that you might like to read. A bit controversial but I think >these things need to be said. > >Look forward to seeing you again! > >Andrea > > >At 04:29 6/09/2002, Ricardo Herbert Jones wrote: > >Hello everybody: > > > >My name is Ricardo Herbert Jones > >I am an obstetrician from Brasil, and had the pleasure of meeting Andrea > >Robertson this year in a Congress about Humanization of Childbirth in S�o > >Paulo, Brasil. > >As an obstetrician I would like to share experiences with midwives and > >doulas all around the world, because I think that humanization of birth is > >an issue that has to do with every single person in this planet. Even thou > >only women deliver babies (yet - who knows where the tecnocratic paradygm > >will takes us?) all of us were once born, and lived during a limited time > >in a woman�s womb. Were we rescued from there by doctors and eletronic > >devices or were we cherished by mom�s tender body till we entered this > >world? These are different ways of looking to the same event. As I grew > >old (I am 43 now, and work with births from 20 years) I learned that women > >shall be treated with caress and gentleness. Birth in our tecnocratic > >society is seen as a mechanic phenomenon, and doctors usually see their > >patients as objects, and not as persons and subjects. That�s a terrible > >thing, because it�s a human�s right problem. > >I am one of the leaders of Rehuna (Humanization of Childbirth Network - > >Brasil) and our struggle now is to empower women in their decisions about > >chilbirth and force the government area to humanize the assistance to > >women in the public hospitals. The first step is a doula project, called > >"Friends in Light", to graduate doulas and doula trainners in Rio de >Janeiro. > >Ok, as u can see my english is not quite well, and I love to talk too >much... > >Hope I can get good advices from you all. > > > >Ricardo Herbert Jones > >Ob/Gyn and Homeopath > >Porto Alegre - Brasil > > > >__________________________________________________________________ > >Ricardo Herbert Jones > >Ric > >ICQ#: 1640612 > >Current ICQ status: 249cee.jpg > >( Home Tel#: 55 51 9981 0445 > >( Work Tel#: 55 51 9981 0445 > >7 Fax#: Ask me > >+ <http://wwp.icq.com/1640612>More ways to contact me > >i <http://web.icq.com/whitepages/about_me?Uin=1640612>See more about me: > >__________________________________________________________________ > > > > > >---------------------------------------------------------------------------- >---- > > > > > > ----- > > Andrea Robertson > > Birth International * ACE Graphics * Associates in Childbirth Education > > > > e-mail: [EMAIL PROTECTED] > > web: www.birthinternational.com > > > >-- >This mailing list is sponsored by ACE Graphics. >Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. ----- Andrea Robertson Birth International * ACE Graphics * Associates in Childbirth Education e-mail: [EMAIL PROTECTED] web: www.birthinternational.com -- This mailing list is sponsored by ACE Graphics. Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe.
