I love how Liz is thinking outside the box here. She truly shows the progress in her beliefs as life has shown her more. As doulas, it is pretty easy to become disenchanted with doctors -- on a surface level we see and hear things -- and often judgements are held. Liz's world shifted when she looked deeper into the issue to see what women physicians face. Think of what it might be like if these physicians were offered physical, informational, and emotional support during the child-bearing year? And how it could help to improve not only their health, but also the health of those they serve?
It is okay, stay with me. I know you are saying, what? Why would we talk about Doctors during doula month?!!? Doctors are the reason women need doulas in the first place! I would agree, wholeheartedly, that women need doulas, in part, to help navigate the maternal health care system. But I would also agree that part of the reason that women need doulas is that doctors desperately, desperately need doulas too.
I became a doula nearly 14 years ago in my twenties, and I’m not going to lie, I didn’t last long. I had some births that resulted in healthy babies and the mom was…not disabled at the end of it. Even with a doula, these moms did not receive mother-centered care. For a long time I thought I was just unlucky to get some bad birth situations, but now I know, they were all pretty routine. A male doctor telling me in the middle of a baby crowning that most women urologists would much prefer to have Cesarean births because it preserves the pelvic floor (is this really the time? While this patient is purple pushing her baby out in a lithotomy position that only benefits you?). That time the doctor was in tears because she had agreed to induce at 37 weeks because winter holidays were coming up, and no, to keep it short, it didn’t go flawlessly. I don’t doubt she was crying because she was tired, and maybe a bit raw, and dismayed that the baby needed resuscitation and extended procedures to make the transition to independent breathing. And yeah, her medical malpractice insurance was about to get tested. I certainly had views on the doctors in these births!
So in my thirties I went to school for a Masters of Public Health with the goal of changing birth outcomes through public health, and if that meant throwing the doctor out with the bathwater, so be it. It was no more than they deserved for being such out of date, out of touch jerks.
But now I’m in medical school in my forties. I see classrooms nearly half full of 21 year old women being called “Guys” by every lecturer and attending, being erased by every lecturer and attending. I see course curriculum that includes nothing on breastfeeding, and when asked a question about normal breastfeeding, an obstetrician says she knows that answer because she has breastfed for three months! Not because as an OB she has extensive and comprehensive training on breastfeeding (they don’t get any), but because she has beaten the odds as a breastfeeding physician (66% of physician mothers do not meet their breastfeeding goals, most don’t make it to three months). She is also the one that told the class vaginal delivery was a procedure done by a surgeon.
Physician mothers have nearly a two-times increased relative risk of birth complications, because they are doctors, and if anecdata is anything to go by, can anticipate having every medical intervention in the book -- evidence based or not -- thrown at them (perhaps accounting for that increased risk?).
After birth? For the 30% of women residents that are pregnant, they have minimal leave; it may be paid -- or not; they may get to finish the program on time -- or not. There is no required minimum maternity policy for residencies. Even if leave is allowed, many won’t take the whole of it because pregnant physicians are considered a burden on the residency program by attendings and male residents. Most are expected to return within six weeks, if not sooner. Maternity leave for practicing doctors isn’t much better. On paper they may have 6 weeks of paid leave, but in reality? Maybe their partners have made it clear that the business will not tolerate that much time away. Don’t even think about taking time to pump! Their employees and staff have better maternity leave.
So get to the point already, you say, why am I advocating doulaing the doctor? Because if ever there was a group that was high-risk for all the bad outcomes of birth and postpartum, while simultaneously seeming to have all of the protective factors, it is women doctors. They set out to become doctors when they are 18, start medical school at 21, and spend the next 4 years being erased as women and indoctrinated into the medical system's way of maternity care. They often have minimal exposure to safe alternatives to standard medical maternity care because of their training, and even if they want something else, the systemic pressure on them is nearly crushing. They are shift workers as residents, they have no protection under the law for breastfeeding because they are salaried, and sure, they have lots education but also lots of debt and not much income. If they are part of a private practice, they struggle to balance breastfeeding and bonding time with the need to go back to work immediately in order to become a partner and thus-financially secure.
And yet they do not utilize doulas, because they KNOW about birth, they’ve been TRAINED, their OB is the BEST, the nursing staff will help. The research is pretty clear on this too -- doulas improve birth outcomes, increase breastfeeding rates and reduce postpartum depression. Also, research tells us that doctors are frankly the worst patients in the world, because they are doctors. They literally refuse to ask for help because they shouldn’t need it, they have the training, THEY know what to do. So a high-risk group that would clearly benefit from doulas isn’t using them, doesn’t realize they need them, and I’d like to see that change.
Great, so I want to see that change. What is the big deal if they don’t use a doula? Most women don’t. True, although that is changing as doulas become more available and the research on their benefit expands. But the big deal is this: Women physicians have the highest suicide rate of any profession, 250% higher than the rest of the population (men physicians are 100% higher than the population rate), and 400% higher than women in other professions. We are doing something so profoundly wrong in our profession that women who should be healers and leaders and colleagues and parents are killing themselves.
Suicide has many causes, but here is one I think we haven’t talked about enough: physician mothers are providing care and getting none. Maybe if we nurture our physician mothers through their intense times of change and challenge, support them during their births, help them bond with their babies, meet their breastfeeding goals, maybe we could change that suicide rate. Birth can be transformative, or traumatizing. Doulas can help shift the balance for women, and women physicians need this as much as any other high risk group. Time to doula some doctors and change the world.
Liz Langthorn, Master of International Maternal Child Health from Tulane University, current medical student at University of Oklahoma College of Medicine. Once a birth doula, always a birth doula.
I heard a doctor say once, when presenting a pivotal intervention to the family I was working with, "If you were my wife, this is what I would do." It truly does offer the feeling: "He really cares about me." This is actually a fallacy -- faulty emotional appeal. It isn't based on science, or evidence, or the unique needs of mother and baby. It is simply an opinion said with feeling, and it can be swaying. Maddie McMahon hits the nail on the head here, and she offers sage wisdom to those of us who work with families -- families who may be vulnerable to the words we say and feel with emotion, that may not exactly be the truth.
These are the kinds of things I hear parents saying quite a bit, and they always remind me that being kind is just not enough. Meaning well is just not enough. Smiling and speaking gently is just. not. enough.
There is a lot of talk in health care about compassion. And so there should be. It should pretty much be a core quality of anyone working in a caring role. Compassion means having a deep understanding and sympathy for another’s suffering. It also means wanting to do something to fix that suffering and take it away.
The problem is, compassion on its own can be a problem. If we believe we can make this all better, if we believe we know better, if we can’t bear to see present or potential future suffering, if even the idea of risk is frightening, then compassion can be dangerous.
Compassion needs to be tempered and balanced with empathy. The ability to enter into another person’s feelings, to see the world through someone else’s eyes. It is this ability that allows us not to get caught up in our own emotions and not get swayed by our own assumptions as to what might be right of wrong for this person. It is empathy which allows us to step outside of ourselves, just a little, and make space to really listen – and more than listen, understand WHY someone might feel the way they do.
So my plea to you wonderful, compassionate practitioners out there, whether you are doctors or midwives or nurses or lay supporters like doulas: Please try not to coerce with your kindness. Is this mother doing as she’s told because you’re so kind and she doesn’t want to upset you, or is she making a fully informed decision? Are you laying YOUR stuff on her or are you truly holding the space while she looks at the benefits and risks of all her options then follows her heart? True kindness and care means trusting that those we care for can make safe, appropriate decisions for themselves, even if we disagree with them.
My New Year resolution this year is to pour a cup of Alongsideyou Tea and strive to listen harder and longer and deeper, whenever I can to everyone I meet and give my empathy muscles a workout.
Maddie has been a doula since 2003. She is a Doula UK Mentor and runs Developing Doulas, a Doula UK approved doula preparation course. She is a founder-trustee of Cambridge Breastfeeding Alliance and also a Breastfeeding Counsellor with the ABM. She recently achieved her childhood dream of being a published author with the publication of Why Doulas Matter in 2015.
She enjoys blogging on her site for parents and birthworkers The Birth Hub.
Mum to boy and girl teens and stepmum to one all-grow-up boy, she lives and works in Cambridge.
This week we celebrated IBCLC Day...
to recognize those amazing, top-level lactation professionals who have gone through the difficult steps to becoming International Board Certified Lactation Consultants. IBCLCs are at the forefront of breastfeeding difficulties -- or at least they should be. What seems to happen, though, is when breastfeeding problems arise in the early days after birth, many families turn to their doctors for breastfeeding help. It is natural to assume this provider who cared for you during pregnancy would have the skills to treat sore nipples or inadequate weight gain, right?
Liz is a friend of mine in medical school, and I am so glad she set her sights on becoming a doctor. I know she will do a world of good, absolutely A WORLD OF GOOD, because of her knowledge base and her passions. Liz gave a "Breastfeeding 101" presentation last weekend at Take Root: Red State Perspectives on Reproductive Justice conference. Spend 10 minutes watching this and you will gain understanding of why lactation knowledge is so lacking among our doctors, and why we should be shouting from the rooftops the value of IBCLC help and support.
Unfortunately, the end was cut off, so I let me add Liz's takeaway points:
The last point in particular is one of interest to me: What if all residents received the same three-hour lactation education required by physicians when a hospital is working toward Baby-Friendly Hospital Status? That three hours could be a consistent way to provide lactation education to new doctors.
Three hours -- many of us would be happy if doctors received just three hours of education. Think about this: I just finished 90 hours of specific lactation education as I work toward becoming exam-eligible to get to IBCLC -- 90 hours! And there is something busy doctors out there can do to add to their skills in an easy, effective manner -- today, without even one minute of extra education: Get to know local IBCLCs, and refer to them often!
♥ four young boys and a boy dog (offspring)