Why do doulas claim they can reduce maternal mortality? Follow the money!

Chasing Money Concept

On Saturday I came across this tweet by one of the authors of the award winning ProPublica series on maternal mortality, Lost Mothers.

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Very excited to be speaking today at DONA International 2018 Summit to a group of women who have done so much to protect other women from becoming Lost Mothers: doulas.

What have doulas done to prevent maternal mortality? I could find no peer reviewed scientific evidence that doulas have done ANYTHING to reduce maternal mortality.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]How can doulas, who have fewer hours of training than some labors, prevent maternal deaths?[/pullquote]

But that hasn’t stopped the ugly effort of doulas to claim they can. And people are listening (although not applying any critical thinking). According to The New York Times:

Gov. Andrew M. Cuomo announced on Sunday a series of initiatives aimed at addressing a disturbingly high rate of maternal mortality among black women, who are four times more likely to die in childbirth than white women in New York State, according to a study released last year.

The plan includes a pilot program that will expand Medicaid coverage for doulas, birth coaches who provide women with physical and emotional support during pregnancy and childbirth.

Studies show the calming presence and supportive reinforcement of doulas can help increase birth outcomes and reduce birth complications for the mother and the baby…

We’re supposed to believe that doulas, who have fewer hours of training than some labors, can prevent maternal deaths?

I’m not exaggerating. Doula training involves only 16 hours of workshops. It is not unusual for the average first labor to last hours longer than that.

The leading causes of maternal mortality are cardiac disease, other chronic pre-existing disease and serious medical complications of pregnancy; how could doulas possibly prevent those? They can’t. It’s an especially puzzling claim when you consider that, as detailed in the Lost Mothers series, many women who die initially received false reassurance that the symptoms of their impending demise were merely variations of normal. Doctors’ chief complaint about doulas is that they offer women false reassurance in the face of high risk status and complications. So how are doulas, who are more likely to offer false reassurance, going to prevent doctors from offering false reassurance? They aren’t.

What’s this really about? Follow the money!

It’s yet another effort by “birth workers” to exploit tragedies to promote themselves. Doulas are desperate to have their high fees covered by insurance and Medicaid; they are expensive and most women can’t afford them. Insurance companies and Medicaid are unlikely to pay doulas to improve women’s birth experiences but they might be willing to pay to reduce deaths, so doulas pretend they can reduce deaths.

This cynical campaign comes from the Ina May Gaskin playbook. Gaskin is the grandmother of America’s homebirth midwives — a second class of midwife different from certified nurse midwives, who fail to meet international midwifery standards and are found no where else in the industrialized world. Gaskin came up with the “Safe Motherhood Quilt” as part of her campaign to receive insurance and Medicaid coverage for this second, inferior class of midwives.

Gaskin represented herself as shocked at the rate of maternal mortality. Yet as far as far as I can tell, homebirth midwives in general and Gaskin in particular have done NOTHING (no research, no education, no fund raising) to reduce the incidence of maternal mortality. They merely exploited the deaths to promote themselves.

Doulas are now doing the same.

But aren’t there studies that show doulas improve outcomes?

I couldn’t find a single peer review scientific study that shows that doulas reduced maternal mortality. There are studies that show that doulas can decrease intervention rates, but that’s a process, not an outcome. Moreover, most studies of doulas are riddled with confounding variables; even when doulas are offered for free, the women who choose doulas differ in important ways from women who don’t choose them and those differences are likely to impact outcomes.

What about the work of midwife Jennie Joseph showing that support improves outcomes?

Jennie Joseph is a British-trained midwife, a women’s health advocate, the founder and executive director of Commonsense Childbirth Inc. and the creator of The JJ Way®. She moved to the United States in 1989 and began a journey that has culminated in the formation of an innovative maternal child healthcare system, markedly improving birth outcomes for women in Central Florida.

What’s the JJ Way?

The key components in our health care delivery are: prenatal bonding through respect, support, education, encouragement and empowerment.

But there’s no evidence that the JJ Way has improved health outcomes for anyone. It’s never been the subject of peer reviewed scientific research. So why does anyone think it works? Because a paid “report” claims it does.

The “report” concludes:

Women who received maternal care The JJ Way® had lower preterm birth rates than women in Orange County and the State of Florida…

Women who received maternal care the JJ Way® had significantly better low birth weight rate percentages than women in Orange County and the State of Florida…

This evaluation of The JJ Way® model of prenatal care showed elimination of health disparities in preterm birth outcomes and reductions in low birth weight babies in at-risk populations.

The report, produced by a sociologist and a mental health counselor, shows nothing of the kind. Why not? Because the authors failed to correct for confounding variables other than race. The women who participated in the program were a self-selected group. As such, they are likely to differ from the average women in the county and the state on demographics like income, pre-existing health conditions, substance abuse, smoking status and a variety of other characteristics.

Unless and until Joseph corrects for those confounding variables, she isn’t entitled to make any claims about her program.

The bottom line is that there is very little evidence that support improves outcomes as opposed to merely reducing interventions. And there’s no evidence that support prevents maternal deaths.

Of course, there’s nothing wrong with doulas; they can be very helpful to women. But there’s something very wrong with them exploiting maternal deaths to promote themselves.

  • Shawna Mathieu

    There’s a type of infertility “treatment” that does something like this. Practitioners’ sites are just littered with cutsey capitalized trademarked and copywrited words and phrases, along with “more natural” and “more effective” – without mentioning what they actually DO.

    You have to go to other sites by patients and former patients – where it turns out they do all the same stuff every standard infertility workup does – exams, bloodwork, charting, then timing suggestions, medication if needed and surgery if needed.

    Their effectiveness rate is based on a single survey done with self-selected moms who were able to successfully have kids. Individual practitioners will commonly refuse to divulge their own actual success rates. They’re pushing to be accepted for government insurance, too. In the meantime, I saw one doctor boasting about getting Medicaid to pay for treatment by putting false diagnoses down.

    The second I saw that “the JJWay” stuff above, I just clenched, because it’s the same damn stuff.

  • Thomas

    You can try paid softwares for free now.

    t2m.io/ESFbKBkS

  • westcoast

    has anyone looked at doula pricing!? it’s not uncommon to see $2000 for labor support. Nonrefundable in the event of c-section.
    Talk about the business of being born.

  • Sue

    Yep – as Dr Amy states in closing:

    “Of course, there’s nothing wrong with doulas; they can be very helpful to women. But there’s something very wrong with them exploiting maternal deaths to promote themselves.”

  • Guest

    Doulas can be useful. Individual doulas can be wonderful parts of a birthing team and collaborate well with physicians, nurses and family members. Absolutely.

    Doulas as a group of lay practitioners haven’t really done anything to improve maternal or neonatal outcomes – as they are claiming. Their collective reason for existence – so they say – is to improve outcomes for mothers and babies – but that is not what they are doing at all. Collectively, they promote a natural birth agenda.

    On individual levels, I have met and worked with all sorts of different types of doulas – from reasonable to extreme and everything in between.

  • The Bofa on the Sofa

    Doulas can be useful. There is a place for them if they understand their role and limitations.

    This sounds like what people say about chiropractors. They CAN be good, if they understand their role and limitations.

    Oddly enough, this is not what people say about most professions. Even professions that are generally despised, like lawyers, people will acknowledge there are some nasty and incompetent ones, but for the most part, the description will be as necessary evils. You don’t hear people say “Lawyers CAN be good, if they understand their role and limitations.” Nor are teachers or doctors described thusly. It’s always, “Yeah, there can be bad ones…”

    But for doulas, lactation consultants, lay midwives and chiropractors, it’s “There can be good ones.”

    In other words, “Not all doulas are bad.” At which point, I invoke Bofa’s Law

  • If staffing levels were what they should be, doulas would be unnecessary. There is nothing a doula does which a L&D nurse, or a nurse-midwife cannot do, and probably do it better, but the reality is that, instead of having a 1:1 [or maximum 1:2 patient] ratio, nurses are spread way too thin to constantly be in attendance with their patients. That saves the hospital money, and believe me, there’s nothing a hospital administrator hates more than to see several “unemployed” nurses sitting in the nurses’ station because it happens to be a “slow” night. Staffing levels are designed to be minimal, not for times of maximal labor and delivery unit utilization.

    • Dani G

      You are right, but the night I went to labor they were overflowing and I spent hours being triaged in a hallway (cervical checks in a bright hallway with only a basic privacy screen was not the best way to start my experience). The nurses were running around all night because they were so so busy. I had to wait a long time for my epidural. I definitely was dismayed that they don’t have a way to get more staff in there during overflow periods. But what do I know.

      Given all of this, my doula was a godsend.

  • demodocus

    They can, but sounds like a lot of them have trouble understanding their limitations.

  • Dani G

    Is there a reason why my comment was deleted? All I said was in some cases doulas can be useful if they know their role and limitations. I gave my own labor as an example?

    • Amy Tuteur, MD

      It ended up in the spam filter; I put it back.

  • MovingOn

    The only thing a doula ever did for me was tell me that my difficult induction and traumatic c-section were “unnecessary.” The hag did not tell me at any point that she was sorry for the pain and struggle, all she said was “you induced too early!” (At 40w3d? Really?) This total cow did not encourage me to seek help for the ensuing depression and trauma, she reinforced my feelings of failure and not-so-subtly implied that I had broken my bond with my son irreparably for having a c-section. All she has ever done for anyone at all is brag about her 2 home VBACs and push natural childbirth on them, spreading the same lies about epidurals, inductions, and c-sections as always. And because she’s a “birth worker” everyone believes her and doesn’t believe a word I say, because I couldn’t afford to finish my degree, which was in political science anyway. Never mind the fact she bailed on her criminal justice degree after only one year to marry a guy in the Air Force and become a human brood mare. Her only real degree is a diploma from Chucklefuck County High School in BFE, North Carolina. She is not a professional and if she was she would have been fired years ago for offering medical advice. All doulas do is argue with real medical professionals and bully traumatized new mothers. They’re supposed to be labor companions, but this idiot couldn’t even do that properly. I’m just glad I never actually wasted any money on her- she was a friend that I grew up with.

    Sorry for the tl;dr rant, that ended up being a lot longer and angrier than I intended! But I stand by it. Reading this blog has done so much more to help me heal from my PTSD than the doulas and other “birth advocates” of the world have. It’s helped me understand what truly happened, and let go of the notion that most inductions and c-sections are “unnecessary.” Turns out easing guilt and shame also promotes recovery from trauma! As much as doulas love to talk about birth trauma they sure don’t know a damn thing about it or how to deal with it.

    • Guest

      I’m sorry. There is a lot of fuckery in the natural childbirth world.
      I’m sorry this happened to you – and you’ve correctly identified that you were taken on an emotional ride that you didn’t need to go on at all.

      I hope others reading this blog, and comments, will start to see that, too.

      A lot of trauma could be avoided.

      • MovingOn

        Thank you. Really. It’s nice to finally hear, after far too long, that the victim-blaming was unacceptable- instead of insisting that the people who put me through all of this were “just looking out” for me.

        I honestly feel that if I’d been actually educated about childbirth beyond “pitocin is bad” I could have avoided a lot of this trauma, or at least gotten the right help much, much sooner than 15 months later. My son just turned 2 and I’m just now feeling like I’m getting past the worst of the PTSD and it’s because I spent far too long thinking I’d ruined everything for us and that I was completely broken and beyond help because I wouldn’t “accept” the brainwashing.

        • PeggySue

          Oh, heavens, how awful for you. She was not looking out for you and your baby at all–she was looking out for her own ego. Thank heavens you made it through, and went through the induction and Csection to give baby the best possible chances. I’m glad he has you for his Mom.

    • demodocus

      *hugs* What a horrible woman.

    • Sue

      Terrible experience!

      Looking back, is there anything about her you can now identify that might have given a clue to her attitudes? Your insight might help others avoid ones like her.

  • EllenL

    The big lie of the doula movement is that they can somehow change the trajectory of labor and delivery. They cannot. Your labor will be what it is going to be.

    The best you can hope for from a doula is emotional support for what is going to happen anyway.

    If you’re smart, you’ll recognize the limitations of doulas, and be open to help from the real professionals (physicians and nurses). This could save your baby’s life, and your own.

  • Guest

    And WTF is a “Certified Friend of Breech Babies” – besides a glorified doula?

    http://www.betterbirthblog.org/certified-friends-of-breech-babies/

    • The Bofa on the Sofa

      I have to admit, and maybe it is just a guy thing, but I don’t see the appeal or benefit of a vaginal breech birth.

      1) Breech is demonstrably riskier than non-breech, with a relatively high chance for a bad outcome for the baby. Meanwhile, breech is generally considered irrelevant when it comes to c-section, so no more risk than a c-section for standard presentation
      2) In addition, accounts I have heard are that breech is also more damaging to mother. An oft-stated benefit of vaginal birth over c-section is that recovery is easier. Yeah, maybe that is true, on average, for normal delivery, but that is less true for breech

      Granted, a lot of my insight into breech vaginal delivery comes from my MIL, who had two of them, but that’s not because she chose to. If she could have avoided it, she would have (especially after the first).

      The risk for the baby is enough for me, but combine that with increased risk for the mother and you come to the question of, what’s the upside?

      • guest

        I can understand why people want to avoid surgery.
        Some people are afraid of surgery – just like people are afraid of blood draws and experience extreme anxiety in medical environments.

        There is a rabid movement in the NCB crowd to glorify vaginal birth and villify surgery and life-saving medical and obstetrical interventions, which clouds and confuses decision-making – even for people without a pre-existing aversion to surgery.

        I don’t believe everyone gets a clear set of facts when it comes to risks and benefits of cesarean vs vaginal birth – and I have little confidence a “friend of breech babies” doula is the person who will provide accurate information.

        • There is an ethical dilemma about “full disclosure” of risk. Tell some women all that could happen and you’ll have a hysterical woman in high anxiety for weeks or months. But I doubt a doula has the necessary education to even know all the risks.

          • seenthelight

            And see, I wonder if I had been made to sign a full disclosure of possible risks and their instances in the general population, their instances in the center’s population, and the action plan for each risk event, if I would have had second thoughts about the freestanding birth center. I would have probably started googling things like shoulder dystocia, which I had never heard of until I read about it here, which means I was certainly unaware of its possibility as I was going into a post date spontaneous labor, at a freestanding birth center, of a baby whose recent sonogram had predicted a ten-pound birth weight. Fortunately she was in the seven neighborhood. But Mary, mother of Jesus, what a thing to have gone into not understanding the what-ifs! Hindsight is a mother on this one, pun intended

      • Mel

        I was curious about vaginal breech births in a “huh, how did they do that prior to surgery” way so I found the Canadian guidelines on delivering breech births and techniques with pictures.

        I got as far as what I summarized as “the kid’s APGAR score is going to be lower since they will be deprived of oxygen from cord compression while the head passes through the cervix” and I was done.

        My single anecdote isn’t data – but even with something like major blood loss from HELLP syndrome – I was sore for 3-5 days after my C-section followed by a 2-4 week recovery from anemia. The anemia was far more problematic than the C-section incision area. By comparison, my mom and mom-in-law both had 4-6 week recoveries from 3rd or 4th degree tears after having large term babies involving bringing donut pillows everywhere.

        • MaineJen

          You’re pretty much guaranteed an episiotomy, correct? With a vaginal breech birth, I mean.

          • Mel

            Unless you have a very roomy vagina or a provider with tiny hands, yup.

          • If the baby is term, absolutely yes. But that may the least difficulty. As the body is born, the umbilical cord is trapped between the pelvis and baby’s body, and the oxygen supply is cut off. The baby will begin to be hypoxic in 4 minutes unless the head can be born to the point where the nostrils are free. But delivering the head too rapidly can cause cerebral hemorrhage, and delivering it at the wrong angle can break the baby’s neck. Also, the body, smaller than the head, can be born BEFORE there is complete cervical dilatation and the head can be trapped.

            Vaginal breech delivery, even in a multip with a large pelvis and an ordinary-sized baby, requires a very skilled operator — and a lot of luck. In fact, usually, in hospital, a breech delivery is usually done in the OR, with a complete team, so that the delivery can be converted to a C/S immediately if necessary, and the baby can be resuscitated and transferred to an NICU, if needed, very rapidly.

          • MaineJen

            Wow um….no thanks. I would take the c section 🙂 But then again, I didn’t want 10 kids.

          • The Bofa on the Sofa

            Apparently a torn up pelvic floor and otherwise ripped up private bits are a small price to pay for 10 kids.

          • Mel

            Not to mention the stress of having a child with disabilities due to prolonged hypoxia.

            It’s one thing to focus on keeping a woman’s reproductive tract in optimal condition having a large family – but that’s going to be a grim joke if the vaginal breech birth hurts the baby badly enough that the family’s time and energy is shunted to providing medical care for the kiddlet.

      • Bofa, it’s not a “guy” thing. In certain communities, where women want extremely large families [like the Amish or ultra-Orthodox Jews], and therefore would prefer not to have C/Ss, which might limit the number of children they ultimately can have safely, there is a measure of sense to a MULTIP breech vaginal birth. But for a first birth, never! It’s just not worth the risk.

        It’s an anecdote, I know, but it just so happened that my daughter’s first baby AND three of her friends who were due to deliver their first babies around the same time, all turned out to have breech presentations. All four of them were offered the possibility of external cephalic version. I told my daughter to opt for an elective C/S, and she did. All three of her friends opted for the ECV, and all three wound up being rushed to the OR when they experienced complications, and had quite traumatic experiences, and two of the babies had to spend 48 hours in NICU on “observation” for respiratory difficulties.

    • Mel

      I’m willing to bet that a “Certified Friend of Breech Babies” is a person who has bought the “Professional” level shit the sight is hawking.

    • LaMont

      This sounds like “friend” in the ironic Shakespearean sense, where a “friend” might “help” you – by sending you to heaven.

  • lawyer jane

    One of the scary things I hear about doulas in my area (NY-Phila-DC) is how they are hired purposefully to help women “labor at home” until the very last minute. I understand that showing up in very early labor at the hospital is not necessarily a great idea idea; but these doulas seem to have the goal of not sending the woman to the hospital until she is in transition! That, and the one group of crunchy hospital-based midwives around here who purport to be able to tell how far a woman is in labor by listening to her on the phone. I’ve heard more than one story about near-unattended births due to that practice. Perhaps not coincidentally, they also require their patients to have doulas.

    • Chi

      There seems to be a LOT of nepotistic back-scratching that goes on in that industry. Midwives ‘recommend’ certain doulas, acupuncturists. chiropracters etc etc – not because they’re any GOOD but because they are their friends.

    • EmbraceYourInnerCrone

      Let see, wait in labor at home until the baby is practically crowning so that any problems can not be detected until it’s too late to prevent them, what could possibly go wrong! /snark
      Gee ask my mom, 2 boring normal pregnancies/deliveries followed by a third in which EVERYTHING went pear-shaped.

  • Mel

    Ina May thinks she can drop maternal mortality rate?

    Her goons’ care totally worked for Joey Feek who got a lovely home birth followed by a moving funeral two years later.

    She had midwife/doula coverage from the Farm when she was pregnant with her only daughter. She gave birth to a daughter with Down Syndrome who didn’t see a pediatrician for 4 days after birth; thankfully, Indiana didn’t have a cardiac or gastrointestinal issue that needed immediate attention.

    When Indiana was a few months old, Joey was diagnosed with cervical cancer. The cancer was thought to be totally removed, but it recurred when Indiana was 18 months old and had metastasized. She died a few days after Indiana turned two.

    An OB/GYN would have done a Pap smear during the pregnancy which would have caught the cancer a year earlier.

    • Spamamander (no mall bans)

      O.M.G. No cardiac or GI scans?? I admit I am still upset with some of the things that happened after my daughter’s birth, but after they gave her an I an hour of bonding time (I think so that when they did give me the dx, I had already spent time with her) the military hospital not only had the head of pediatrics involved, but had called in cardiac specialists from Children’s Hospital to review the echocardiograms they were performing. I didn’t know any of it was going on, but at least they DID it.

      • Mel

        Spams – there was no prenatal diagnosis in spite of Feek being 37 or 38 at the time Indy was conceived! My insurance company is notoriously stingy but they covered NT testing for my pregnancy with Spawn with no questions asked since I was going to be 35 by the time Spawn was born.

        I’ve known quite a few people who had a prenatal diagnosis who had a baby with a trisomy; advanced knowledge saves so much stress on the day of birth! Mom and Dad get a chance to understand why the doctors need to do cardiac and GI scans – and most were super grateful that they had a chance to repair damage rather than have the baby die.

        Her husband wrote a post about how “judgemental” the doctor was about them being anti-vaxx….but he missed how freaked out the pediatrician was once he took a good look at Indy and realized that he had a 4-5 day old baby with Down Syndrome who might decompensate in front of him in real time.

        • I think parents need to have the option of knowing antenatally if a child will be born with a life-threatening condition or major defect. Some parents will decide NOT to do testing or want to be informed — “Whatever God gives” is something I hear a lot from very religious women. But you are right, some couples need to have, and want, the knowledge in order to come to terms with the eventually difficult situation.

          • Well, yeah. I would not abort a kid with Down Syndrome, but I’d sure like to know before the stress of giving birth, and have any medical interventions needed lined up without delay.

          • Especially as one of the complications of Downs is that there can be cardiac problems.

          • Mel

            I’m always in favor of patient autonomy. If a patient (such as Ms. Feek) is aware that she’s at higher risk for a baby with a trisomy, and that prenatal screening testing of varying levels of invasiveness and accuracy are available and she decides not to pursue testing – I support her decision just as I support my own decision to pursue testing.

            My concern was that the untrained Farm midwives failed to discuss some of the issues surrounding AMA that testing is available for.

          • What it boils down to is that every patient is entitled to maximum PROFESSIONAL care, not some amateur with inflated opinions instead of education.

          • seenthelight

            Yeah, they’re like southern women who decorate whole rooms in the see no evil, hear no evil, speak no evil monkeys. If you just don’t talk about the bad things they don’t exist and that’s that. It’s intentional delusion. The problem is that they string along suckers like me without informing us of the real risks that we’re facing, like me, overdue with a ten-pound sono delivery weight prediction, yet unaware until I found this site, years later, that something like shoulder dytocia even existed. Happy to report we’re all fine, but goodness.

          • Who?

            I interpret the meaning of those monkeys as see with your kind eyes, listen with your kind ears and speak with your kind lips.

            Which puts a rather different complexion on their message than the one you describe.

  • Mel

    The “report” is a great example of small sample size causing some drift.

    Yeah, the 256 women in the study had lower preterm and low birthweight babies than the rates for all of Florida and all of the county – but that’s a pretty good bet for most samples of 250 women drawn randomly from the total population regardless of if they have a doula or not.

    Don’t believe me? Their pilot sample from 2015 managed to have NO preterm or low birthweight babies for African-American or Hispanic moms. In 2016-2017, the rates of preterm births in those two groups skyrocketed by 860% and 400% when the sample size doubled. Either the program completely messed up how it handled women of color in less than a year – or we’re just looking at random fluctuations due to tiny sample size.

  • mabelcruet

    I honestly think you’d be safer with a lay family member or even a man off the street than someone who has had a modicum of training-someone totally inexperienced is more likely to listen to the mum (and to any professional advisors like proper midwives or doctors) without jumping to conclusions about what they think the woman is saying or complaining of, or in need of-my interactions with doulas has been limited, but there is definitely a strong Dunning-Kruger effect going on there.

    • The Kids Aren’t AltRight

      Not to mention the fact that many doulas are committed ideologues, who will be more concerned about naturalness than your health, safety, and desires.

  • PeggySue

    One teeny typo… Sentence “But aren’t their studies….” Their should be there.

  • demodocus

    Doulas, bless them, seem to have an exaggerated view of their importance. They’re substitute friends who’ve done this before, not really any more of a medical professional than someone who took a cpr class.

    • PeggySue

      This, absolutely. I was arguing on twitter about breastfeeding with someone who said she had been a birth professional for 30 years. Looked her up: a doula.

    • EllenL

      “Substitute friends” – exactly!

      The only reason I can think of to have a doula is if there is no one else to show up for your labor – no partner (unavailable for some reason), no relatives close by, no friends close enough to call on. In my experience, hospital nurses don’t have the time to sit at the bedside of each patient for every moment of labor. They tend to pop in and out, and stay when things get serious.

      A doula could be that “sitting by the bedside” person, someone who can reach out to staff if the mom needs someone to do that. They certainly aren’t experts in any way that I can discern.

      My daughter hired a doula for her first birth. Afterwards, she felt the doula was useless. There wasn’t anything the doula could tell her she didn’t already know, and the doula couldn’t administer pain relief (an epidural was the solution to that). She already had her husband there, and relatives in the waiting room who could be called on. She skipped the doula for her second birth – and saved a lot of money.

      • demodocus

        I saw my nurses a lot, but they were concerned about my bp. Never bothered with a doula, even though the 2nd hospital had some on staff.

      • Merrie

        Yes. A friend hired a doula because she didn’t think her husband (otherwise a great guy) would do well in the role of labor support person and she wanted someone there with her who had done it before.

        • demodocus

          I was worried about my boyo, but he did surprisingly well. He only fell apart once our baby was safely delivered. Then he had to be helped to a chair to cry for a little. The nurses thought he was rather adorable.