I’m 24-years-old, lying flat on my back in a stiff hospital bed. I’ve been forced here by a nurse who told me that regardless of what my doctor had said, “it’s hospital policy.” I’m entangled in wires, attached to monitors. Gray machines are beeping at me. I’m growing more uncomfortable, being held like a hostage in my own body, and I haven’t even begun to feel the force of my contractions.

“Am I having one now?” I ask naively, when a gentle tightening comes across my belly.
The nurse shifts her gaze to the screen next to the bedside.

“Yeah. You’re having one.”

Within a few hours, being on my back is unbearable. I’m twisting and turning, tying myself in knots. I am not being pounded with one contraction after the next, like I anticipated. I am in constant, unrelenting agony. I am blindsided by it and at a loss for how to manage it.

I sense everyone is angry with me for thrashing wildly, tearing at the bed sheets. But I don’t care because I’m angrier. I’m thinking of the time I spent reading pregnancy books that emphasized how important it was to move during labor, how birthing on your back could make for a longer, more difficult delivery, how your pelvis can’t open when you’re laying flat, and how the risk for cesarean birth increases. I did my research, and here I am, suffering at the hands of someone else’s ignorance. Someone who should know better.

My daughter finally emerges, in the early morning, but not before a doctor picks up a knife a slices me from underneath without warning. I almost yell out “Don’t!” I want to command him, but something, a fear of authority perhaps, holds me back. I don’t yet realize that it will be months before I can sit down without wincing, that my nerves have suffered permanent damage from his deep cut.

The advocate I wish I had

It’s been eight years since my first birth, but I’ll never forget how it felt to be so utterly unsupported on one of the most important days of my life. Yes, my then-partner, now-husband held my leg and said encouraging words. But he’d never attended a birth before. How should he know how to offer labor support? Everyone made it out alive, yes. Is this the only standard by which we measure the experience of giving birth? Escaping death?

No one had seemed to care about my choices, my feelings about my body or my baby, or what my recovery would look like as a result of how my body would be manipulated. There had been no one in the room to help me manage my pain, or to be my advocate when policies that lead to riskier birth were forced upon me. From laboring in bed to the episiotomy I received (a procedure that hasn’t been routinely recommended in over a decade), most of what happened during my first birth wasn’t evidence-based. I knew it at the time, but advocating for yourself while you’re in the throes of labor is practically impossible.

It would be years before I would become pregnant again. When I did, I learned there was a profession called a “doula,” a designated person who provides non-medical support during labor and delivery and in the immediate postpartum. I learned that doulas have the power to drastically improve labor outcomes, from decreasing the rate of cesarean birth by a landslide, to making sure women feel supported, empowered, and comforted during delivery.

Personally, a doula could’ve helped me to achieve an evidence-based birth, rather than one that felt convenient for everyone in the room, but torture for me. A doula could’ve saved me from hours of back labor (the most excruciating pain of my life) by letting me know I had the right to informed refusal (as any patient, even a mother in labor, does). A doula could’ve helped my partner be a better support, or spoken up to hospital staff if medical treatments I didn’t want were being pushed upon me.

A doula could’ve been the light when everything seemed dark and terrifying.

The case for doulas

There is no denying that giving birth in the US has become astonishingly dangerous. From having the worst maternal mortality rate in the developed world, to high rates of unnecessary interventions, to women experiencing birth trauma (PTSD-like symptoms post-delivery), supported birth is not just a luxury – it is a complete and utter necessity. Where you give birth is now the biggest predictor of what kind of birth you will have, and your care provider’s preferences and bad hospital policies dictate outcomes, rather than science.

Why shouldn’t they? A traumatic birth can lead to greater cases of postpartum depression, anxiety, and PTSD. Not to mention, the day a woman becomes a mother is a day she will likely remember for the rest of her life. Only too many of us don’t want to.

Women shouldn’t have to learn the hard way that when it comes to giving birth they need to arm themselves with an experienced person whose sole job is to support her, because often times no one else is (or even knows how). It’s why every single pregnant woman deserves a birth doula. It’s why they should be accessible and covered by insurance without question. And because black women are more likely to die in labor than white women, we especially need to make sure women of color have access to doulas, too.

Research also shows that women’s feelings about their births have more to do with labor support and having choices than specific details about the birth. So doulas shouldn’t be brought on board for one specific type of birth. Rather, they should be a standard for every birth. Whether a home birth, a hospital birth, a planned cesarean, or a VBAC, making doulas the new norm can make women feel comforted and supported no matter what type of birth they plan on having – or end up having.

Regardless of positive outcomes demonstrating the importance of labor support, mothers-to-be are routinely subject to messages that tell them that their choices about their own bodies aren’t important. They are told if they plan for their birth at all they will be mocked by the care provider. The narrative of calling women “controlling” or “unreasonable” for wanting to make choices about their own bodies might be centuries old, but it’s certainly not gone. We hear it all the time, and yes – some providers still hold onto the paternalistic attitude that tells women to lay down and be quiet. We should be pushing back against this harmful narrative, not accepting it so easily. These are our births, our bodies, and our babies, after all.

Supported birth is not our normal. We don’t see it or hear about it often enough. And while hospitals and care providers need better policies, training, and an attitude that seeks to protect women’s choices, we still have far to go. Too often, birthing women don’t receive the care they expect. Labor support can help bridge that gap for every birthing person and every type of birth, too.