SAUSALITO, CA (ASRN.ORG) -- Like any other conscientious, organic-fruit-buying expectant mother, Pamela Myers knew what she wanted from her childbirth experience. And, as is the case with growing numbers of women, that meant hiring a doula — the word means “servant” in Greek — to help during labor.

“I wanted a natural, unmedicated birth,” said Ms. Myers, whose daughter was born in 2011. “The doula was supposed to be my advocate at the hospital and help us carry out our birth plan.”

At first, Ms. Myers, now a 36-year-old mother of two in Glencoe, Ill., was thrilled with her doula, who doubled as a prenatal massage therapist. “She was earthy yet grounded, and really knowledgeable,” she said.

Then labor began — and went on and on — and Ms. Myers’s opinion took a nose dive. Though the doctor recommended that Ms. Myers receive intravenous fluids to hydrate her, the doula, eager to avoid medical intervention, insisted that Ms. Myers ignore the suggestion, causing her contractions to spike.

Then “she urged my husband and me to take a shower to ease the pain,” Ms. Myers said. “I told her I didn’t want to, but she was adamant.”

Dripping wet, freezing and in bone-shattering pain, Ms. Myers said she seethed in silence. When she ultimately chose an epidural, her doula walked out. “She was so set on my having a natural birth, she offended me, she offended the nursing staff, she offended my O.B.,” Ms. Myers said.

In an era of nurse shortages and high Caesarean rates, doulas and lactation consultants can be godsends for many women. Indeed, multiple studies show that a doula’s presence during childbirth leads to shorter labor, less medical intervention and a happier experience.

Similarly, lactation consultants are often necessary for mothers having difficulty breast-feeding. Overwhelmed nurses don’t always have the time for one-on-one instruction, and because formula use peaked in the 1970s, a mom’s own mother may be ill-equipped to offer advice.

But the increased popularity of doulas and lactation consultants has also led to more conflict — not only with parents but doctors and nurses as well.

There are no national statistics on the phenomenon, and few women readily admit to doula discord. But according to a 2006 study of women who used doulas in Alabama, 44 percent of women described the relationship between their hospital nurses and doulas as hostile, resentful and confrontational.

At Reston Hospital Center in northern Virginia, disputes became so common that in 2005, the hospital banned doulas. “From a nursing standpoint, too many crossed a line and interfered with my job,” said Sarah Baxter, a registered nurse and director of labor and delivery at Reston.

The American College of Obstetricians and Gynecologists has issued no official statement on doulas. Dr. Sarah Kilpatrick, chairwoman of the academy’s committee on obstetric practice, said in an interview that doulas can be helpful, but “occasionally you have someone who attempts to interfere with the medical aspect of delivery.”

When 33-year-old Melissa Malka’s twins were in the neonatal intensive-care unit after being delivered at 33 weeks, a lactation consultant urged her to have tubes delivering formula through her babies’ noses removed in favor of an intravenous feed to deliver nutrients, against the advice of her neonatologist. Intravenous feeds carry a high risk of infection for premature babies, but some lactation consultants fear that babies will develop a taste for formula and then reject breast milk.

“She was so intent on avoiding formula,” said Ms. Malka, from Olney, Md. “I was very upset with her, but that’s their standard — breast is best.”

Pumping around the clock with no milk to show for her efforts, Ms. Malka sought the help of four lactation consultants, but they couldn’t remedy the problem. When she consulted her obstetrician, she finally learned that she was unable to produce prolactin, a hormone vital to milk production. “You would hope that L.C.s would be well versed in this type of thing since they’re focused purely on the breast,” Ms. Malka said, using the shorthand for lactation consultants.

The breast-only mentality can also put off today’s participatory husbands. Kenneth Cain, a 42-year-old writer in New York, said his wife’s lactation consultant was “a nightmare.” In December, after he and his wife decided supplementing with formula for their one-month-old baby might not be such a bad thing, they turned to a lactation consultant for advice. “All we got was this ideological diatribe on the merits of breast-feeding,” he said. “It was like talking to a Marxist about an international trade deal.”

Doulas can be equally doctrinaire. “There are doulas who really do not appreciate when women get medication,” said Mary Beth MacKinnon, a doula based in Falls Church, Va. “I know some doulas who will not take on clients who are thinking of having an epidural.”

Mary Beth Harris, also a doula in Falls Church, has turned away two clients for precisely that reason. “I choose to work with women who are striving for a natural birth because that’s where my passion and training lies,” said Ms. Harris, whose training was as a Bradley-method childbirth instructor, which emphasizes natural birth with intensive support from the husband.

“I’m a firm believer in the natural process,” she said, “and in my idealism as a birth worker, I see this as my contribution to helping change the world.” In both cases, Ms. Harris referred the women to another doula.

Doulas contend that doctors and nurses aren’t always cooperative. Penny Simkin, a founder of Doulas of North America, has been a doula for 40 years, but she says, “When I walk into a hospital where the nurse doesn’t know me, I still experience dismissal: ‘What is she here for? Why does the woman think she needs someone else to protect her?’ ”

For Mary Sanderlin, a doula who became a labor and delivery nurse in St. Paul, Minn., problems usually arise when doulas act outside the scope of their practice. “As a doula, I certainly felt there were times when the medical staff weren’t being transparent about their wishes,” she said. But a good doula “can force the medical staff to come clean about certain interventions.”

One major source of conflict is an absence of standardization and oversight, said Maureen Corry, executive director of Childbirth Connection, a nonprofit research and advocacy group that promotes maternal care. Between 1994 and 2005, the number of doulas certified by Doulas of North America grew to 5,842, up from 750. But a doula requires no certification — anyone can be a doula, regardless of training.

Similarly, since 2003, the number of lactation consultants certified by the International Board of Lactation Consultant Examiners, which requires 2,500 hours of practice and 45 hours of course work, has increased 15 percent to nearly 9,000. But most consultants are not that well trained. Dozens of groups offer certification after completion of one- to five-day courses, and there are at least six different acronyms signifying lactation credentials. How can a sleep-addled mother differentiate among a C.L.E., a C.B.E. and a C.L.C.?

Though childbirth and breast-feeding seem like the most natural of acts, the complexities that arise — from emergency C-sections to inverted nipples — demand a great deal of training and experience. “People laugh when I tell them I’m going to a weeklong conference on breast-feeding,” says Angela Love-Zaranka, a lactation consultant also certified by the board. “But a mother may have had breast-reduction surgery or a baby may have Down syndrome, and you need to know how to deal with that.”

As Jessica Sacher, a registered nurse and lactation consultant at a Los Angeles Medical Center, said: “I don’t think anyone is out there deliberately trying to deceive mothers out of malice. But parents have to do the same amount of due diligence as they would when seeking a pediatrician.”

 

 

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