Tag Archives: Childbirth

WHY have a postpartum doula? …

2 Oct

Postpartum doulas provide a much needed service for many new parents, however not all parents are able to pay for someone to come to their home, help them take care of themselves so they can take care of their baby, without judgment, and with a lot of compassion and really great tips for that “babymoon” time.

In today’s New York Times, reporter Zoe Greenberg writes about postpartum doulas in NYC and quotes Dr Christine Morton, one of the authors of Birth Ambassadors!

Birth Ambassadors mentioned in NY Times story: October 2, 2018

Everyone Should Have a Postpartum Doula

Because when a baby comes, friends and families don’t always know how to help.


Why doulas get no respect. It’s not the science, it’s the culture.

26 Feb

My social media feeds lit up two weeks ago after this New York Times story about doulas was published. At first it seemed that doulas, and the benefits of continuous labor support, had been validated by the paper of record.  However, it soon became apparent, from the many comments and later, responses from individual doulas,   the NYC Doula Collective,  a doula training organization, and Miriam Perez of the Radical Doula, that many doulas and their advocates were dismayed that the article failed to articulate what doulas themselves find valuable about what they do.

Slide2The main argument among the rebuttals mentioned above was that the NYT reporter neglected the research often cited as evidence that continuous labor support results in measurable beneficial outcomes for birthing women and their babies. Many also took issue with the characterization of doula support as a personal service, available to privileged women who can afford to pay handsomely for this luxury.

But there’s the rub.  Since doulas only attend about 6% of all births, according to Listening to Mothers 3, a nationally representative survey of women’s birth experiences, it’s hard to support the claim that merely adding more doulas to maternity care teams will make a measurable impact on birth outcomes like cesarean deliveries (currently ~32% in the U.S.).  In some areas, new maternity models of care are making an impact, by creating a “pregnancy care package,” with a continuum of team care led by a nurse-midwife and coordinated with an obstetrician, nurse, doula, pediatrician, social worker and patient navigator. But even those projects are difficult to scale up to meet the demand.

Doulas, working as isolated entrepreneurs, or even as collectives, may not be as effective, or as respected by maternity care clinicians, as they would if they were a recognized, legitimated part of the “team.”  My colleague Amy Gilliland has been writing about the issue of national doula certification, and recently cited the work of another colleague, Jennifer Torres, whose research comparing lactation consultants and labor support doulas found that “both filled a niche in maternity care practice that is not covered by nurses or physicians.  However, lactation consultants have been able to influence medical practice directly.  They entered through the “front door” and have been welcomed by medical professionals, because breastfeeding is seen as a medical event.  However, doulas are not recognized as having anything meaningful to offer to medical professionals, and as such are seen as entering through the “back door.” (see Amy’s blog for a full discussion).

In our book, Birth Ambassadors: Doulas and the Re-Emergence of Woman-Supported Birth in America, we argue that while doulas do provide several benefits to laboring women, the doula role itself is open to critique because of some fundamental contradictions in its definition.  Are doulas trained professionals, or “merely” caring women with a passion for birth? Do doulas unconditionally support women’s birth choices even as they hold strong views on the optimal management and outcomes of childbirth?   Can doulas advocate for their clients in the hospital labor room without being seen as interfering with the medical management or challenging obstetric authority? These various interpretations are clearly evident in the NYT story and even more so in the hundreds of comments it generated.

Our analysis of doula care in the U.S. maternity context, through a careful examination of its history, observations of training workshops and interviews with doulas and organizational leaders found that:

The reason why doulas are unable to gain respect from the press, the obstetric community and the public is that their primary goal of providing emotional support to women during childbirth is not valued by our culture.

It is well known that facts alone are unlikely to change someone’s deeply held beliefs.  Doula advocates’ use of scientific rationale as the warrant for continuous labor support fails to address the underlying cultural belief among many that women’s birth experiences are not that important. Furthermore, unlike lactation consultants, whose goal is to facilitate successful breastfeeding with a client (something of value to hospitals now that The Joint Commission is tracking such rates), the doula’s goal is less clear and clearly less valued by hospitals.  On the one hand, doulas and their organizations cite benefits of continuous labor support such as fewer c-sections, yet caution that as individual doulas, the goal is NOT to ensure a vaginal birth, nor question the decision for a cesarean section for any particular client.  Instead, doulas typically say their goal is to enhance women’s satisfaction with their birth experience, no matter the outcome, wherever the birth takes place.

Changing the cultural meaning of labor support — the value of women’s emotional experience — is a much harder task than citing research on the clinical benefits of a doula.  Any occupation that includes emotional labor is relegated to a lower social status than a comparable one that does not (think school bus driver vs. city bus driver; pediatrician vs. neurosurgeon).  Much social science research finds, that in any organization, those workers who are expected to provide emotional care are less valued and less compensated than those who are not.

Doulas and their organizations need to communicate the fundamental value of emotionally supporting women through childbirth. 

And that may not be possible using economic or scientific rationales alone. It is challenging to communicate the value of emotional support in childbirth in a context where doulas who engage in entrepreneurial practice charge a higher fee than many obstetricians or midwives are paid through insurance.  Furthermore, as we pointed out in Birth Ambassadors, not all doulas speak with one voice, and there is not one organization that speaks on behalf of all doulas.  We can see that diversity in the various responses to the NYT article.  Interestingly we haven’t yet seen a response from DONA International, the primary doula training and certifying organization in the U.S. Without coordinated leadership from a strong, credible organization that can articulate it, the meaning and value of doula care is left up to anyone with the loudest platform.  If doulas don’t want to be compared to Amazon Prime, they need to provide alternative pull-out quotes for articles like the one in the NY Times.  And while you can’t always control what the press says, it’s important to insert your view into the cultural dialogue and not leave to others to have the final say.  In this case, by an obstetrician, no less, who says, “A doula is like a personal trainer. Not that you can’t do it yourself; it’s just nicer if you have a personal coach for it.”

Future directions in doula research

13 Apr

What else do we want and need to know about doulas and doula practice beyond the association with selected birth outcomes? By studying doulas, what else becomes important to investigate in the broader area of women’s experience of birth, the professionals involved in birth and the institutional contexts of birth? Here are some questions and ideas for continued research that emerged in the course of my study.

doula-conceptual-model Dekker 2012

Doula Conceptual Model (Dekker, 2012)

  • One doula recommended that we look at countries where maternity care is sub-optimal. In these countries where social arrangements of childbirth support are inadequate or non-existent, can we find any correlation or causal relationships between rates of infant abandonment; declining birth rates; or illegal, unsafe abortions? What other social and reproductive practices and behaviors might be linked to poor maternity care?
  • To answer the question of whether doulas support the status quo or contribute to changes in social practices around their clients’ birth choices, it would be valuable to examine, what, if any influence doulas have on women’s choice of care providers or hospitals in their current and future pregnancies. How do doula messages about childbirth influence women’s plans for future birth interventions?
  • To answer the many questions emerging from these doula accounts about the current hospital management of childbirth support, and to tease out the relative impact of nurse and physician attitudes and practices, it would be helpful to have more systematic understanding of how doctors and nurses orient to labor pain in their clinical practice. Does labor pain have value in their view? How does dealing with labor pain affect their view of their patients?       Of their ability to do their jobs?       How does their medical training affect how they see pain and methods for its relief, including non-pharmacological methods, and labor support? How do they view doulas?
  • What motivates nurses and physicians to work in obstetrics? Have those motivations changed over time? Is the orientation of birth as the ‘happy event’ still current in today’s litigious culture where we see more physicians dropping out of obstetrics and fewer entering it? What does it mean for women-centered birth as more females are being trained as ob/gyns?
  • How has the sexual element of birth been incorporated and/or transformed in the medical setting?       How are power relationships negotiated and how are women’s bodies and subjectivities employed in these negotiations?
  • Many scholars have examined the motives of women choosing home birth. What motivates women who choose a doula for their births?       What are their experiences with doulas? It would also be helpful to learn more about how their partners and other family members view the doula’s role and actual support at the birth.       What reasons do women give for considering, but rejecting the idea of a doula at their births? How do they reflect on their experience and their decision after the birth?
  • What factors make it possible for women to work as doulas? It would be interesting to hear from the perspectives of others in the social networks of doulas. How do their male partners view doula work? How do they rearrange their lives when the doula is on call and at a birth? How is the work justified? What are other family members’ reactions to doula practice? Examining these questions would allow us to see how doula ideology is conveyed to others in their social networks.
  • We need more cross cultural research on doula care. How is the message of labor support conveyed to other cultural groups?       How is it received? What aspects of the doula ideology are specific to the American context of medicalized childbirth? What are the cultural assumptions underlying doula notions of ‘emotional support’?   How are issues of class, ethnic/racial identity, personal birth experience and age salient for doula practice?
  • How has the Internet influenced, affected, transformed the ways specialized interest communities can collectively share information and organize as social movements? Doulas embraced the Internet from its earliest days, gathering in local and international chat rooms, and offered their vision of birth on a playing field that gives them a platform to respond to mainstream views of birth.
  • How does a couples’ experience of birth affect their parenting practices and their marriage relationship (unasked in many studies of transition to parenthood).
  • How do doulas accomplish their goals within medical interactions?       We would benefit from observational studies of doula care, in addition to the accounts of doulas.       How have the related professions of nursing and social work dealt with the demands of professionalization and credentialization? What can we learn from the history of childbirth educators and lactation consultants about the fragmentation of care and information surrounding women’s childbirth and postpartum experiences?
  • As more hospital based doula programs are developed, it would be helpful to do a comparative study of doula practice in these settings with individual doula practice, especially with regard to information/advocacy roles.
  • How do community based doula programs work? What are their outcomes? How is doula ideology transformed and shaped in cultural contexts beyond white middle class frameworks?
  • How can we theorize doula care, doula practice and doula ideology?       Where do they overlap and where are they divergent?

What are your research questions about doulas?!

Chapter 3 Excerpt from Birth Ambassadors

14 Jan

Trained Professional or Caring Woman? Doula Dilemmas

A doula applies a cool cloth to a laboring woman as the nurse looks on

A doula applies a cool cloth to a laboring woman as the nurse looks on

Doulas assert specialized knowledge of the complex intersection of emotional, physical and medical aspects of childbirth, yet simultaneously, portray themselves as kind, caring women with a natural, intuitive ability to improve clinical outcomes in medicalized settings.  These claims are complicated by several factors.  First, a profession is technically defined as a group that controls entry into its own ranks and possesses specialized knowledge verified through credentialing and licensing. So admission to the profession is strictly controlled through organizational means. But anyone can call themselves a doula – as yet, an unlicensed occupation.   Further, the doula’s claim to specialized knowledge is largely experiential, and rests on the constructed, collective experience as women who have birthed socially, among women, since ‘the beginning’.

The dilemmas posed by this juxtaposition create challenges for individual doulas and their organizations.  Further, the effect of these viewpoints is that they obscure the real skills, talents and value of what doulas do accomplish. 

Midwife and author Pam England, creator of Birthing from Within, a Zen-inspired revisioning of childbirth education, argues that current childbirth education focuses too much on rational information and not enough on women’s intuitive knowledge of how to give birth.  Her prescription for this problem is to encourage doulas to come to births “empty-handed and open-hearted,” adopting a mindset she calls “birthing in awareness.”

Christine Morton’s research on the history and experiences of doulas in the United States shows how doulas respond to what they learn in training and later, from their doula experiences. One doula she interviewed (all names are pseudonyms), Maisy, is typical of new doulas who feel anxious and uncertain in their abilities to provide labor support while also aware of author and doula trainer Penny Simkin’s research on women’s long term memories of labor.  Maisy was referred to her first client, an Ethiopian Muslim woman, by an experienced doula needing back-up.  When she met the client prenatally, it seemed to Maisy that the mom-to-be “wasn’t interested in childbirth, she didn’t really care.” At this visit, Maisy mentioned that her care would involve touching the woman’s body wherever she saw tension, and the woman should then just concentrate on getting rid of tension in those places.  But the doula had little time to worry; she was called to the hospital soon after this visit.  She later recalled her feelings:

I was really nervous before I got there but it was good that I didn’t have a lot of warning because I just had to go and do it.  I remembered what they said at training was ‘All you need to do is be there—if you are just there it improves the outcome, anything you add on top of that is just a plus.’  Fine, I thought, I can be there.

Her dilemma about what she would do as a first-time doula gets at the heart of the contradictions within doula care.  The training is brief, there is no supervised student learning, the mode of care can be merely touching a body but the outcomes are said to be medically and emotionally consequential for the laboring woman.  Maisy made the commitment to just ‘be there’ and she described the birth as being very satisfactory for her client.  She labored after a Pitocin induction and gave birth to her first child without any pain medications. “Yeah, she did it,” the doula said. “She had no drugs, did the whole thing naturally, and I was amazed.  She thought it was great and she said she’d never in her life been as relaxed as she was in labor!”

Doula Lorie Nelson identifies the requirements of a good doula this way:   Unconditional love. You know, willingness to work with whatever judgment comes up inside of them. I think that is the key factor in a really good doula because I believe that exhibiting caring and respect for the woman regardless of what she’s going through or what she’s choosing is a validating force that that can change her perception of herself in a difficult situation.  It’s the most challenging thing for many us. It takes great physical stamina to be a doula.  I think …it also takes a high level of sensitivity/perception/ intuition to continually track the energy of the room, of the parties present, and what the woman’s needing.

Another doula in the study, Tiffany, sounds a cautionary note in terms of who is a ‘good doula.’  She stressed the importance of technical knowledge and education.  She considers it essential for a ‘good doula’ to know ‘one’s own strengths and weaknesses as a person and boundaries as a doula.’

Perhaps the greatest contradiction of the doula role is the leveling of expertise necessary for quality labor support to one common denominator:  being a kind caring woman.  The gendered dimension of this role is explicit.  Although there are some men who have certified as doulas, their numbers are low.  Doula trainers explicitly contrast women’s and men’s knowledge and behaviors at birth:  “We all know this intuitively, men don’t.”

Doula practice is explicitly considered ‘women’s work.’  The term doula is itself gendered, coming from the Greek meaning ‘woman serving woman.’  Although the term is often reframed to be more gender-neutral, (‘experienced labor companion’ or ‘labor support person’) in cases where a pronoun is called for, the feminine is used.  Doulas themselves see the work as uniquely female.

Although there are some situations that are unrewarding, doulas believe their job is to cope the best they can, knowing they are there, above anything else, to help this woman to the best of her ability.  The emotional support provided by doulas during labor is seen as one of the most fulfilling and rewarding aspects of the role. After her first birth as a doula, Christine wrote in her field notes:

I came away feeling so incredibly HIGH and exhilarated.  I don’t know how doctors or nurses can do this and do it so impersonally.  To me, birth is sacred.  There is a story surrounding each new life—connecting the story to the lives that will be responsible for this new one for some time.  I am in awe of the incredible leap of faith that goes into having a baby.  I felt like I passed the test.  I am a doula.  I can do this.

Still, receiving rebukes while at a birth from either the client or obstetric clinicians can be devastating to a doula’s sense of competency and personal worth.  At a doula retreat organized by local trainers, many women disclosed their own unexpected discovery that they felt unprepared to do the emotional support required of doulas.  It was, however, a revelation for them to share their feelings with others, and give it a label, “doula doubt.”  Many factors contribute to doula vulnerability: personal issues with birth, an insecure role within the medical hierarchy, and lack of experience are implicated in how individual doulas respond to the interactional demands placed on them to provide doula care, when it doesn’t come naturally.

Work that is defined as “caring” has been a rich source of feminist analyses that attempt to balance the humanistic underpinning of such caregiving with the economic devaluation of the work itself.  Caregiving work embedded within reproductive contexts also poses interesting challenges for theorists who explore work, gender and emotional labor.  Doula practice provides us with a unique case study to examine how the gendered and emotional meanings of work are “simultaneously expected and rendered invisible” in a newly emerging occupation.  It is especially important for examining how the emotional component of intense caregiving work can be seen not merely as an example of economic exploitation as well as an exploration of gender, but also as a motivating factor for the work, in its own right.

The caregiving dimensions of doula practice can be compared with the contradictions and tensions emerging in other types of care work, paid and unpaid.   Doulas experience this clash of value systems when the central definition of what it means to be a competent, effective doula also includes a personal identity as a caring, nurturing woman.  Contradictions around being ‘selfless’ and ‘of value’ are heightened at a time of socially recognized, ritualized vulnerability—childbirth.

Chapter 2 excerpt from Birth Ambassadors

4 Jan

What does it take to become, and to be, a Doula?

At the end of a training, doulas weave a star of connection, pledging to support each other and their clients

Doulas weave a star of connection, pledging to support each other and their clients

Doulas often consider themselves unique among women because of their strong attraction to birth and caring for birthing women. At the start of one training workshop, each trainee shared what she thought made her unique.  Answers included such things as deep-sea diving, gourmet cooking, parachute jumping, or being the eldest of ten children.  Then the doula trainer said: “I love to be with women who are having babies.  That’s not unique here in this room, but in the world you’ll find it is.  What’s unique is that we’ve been given this bug to be with women at this exceptional transition in their lives.”

Doulas understand themselves to be ‘special women,’ who have a deep interest and ability to care for other women during childbirth.  This interest and ability is often characterized as ‘uniquely female’ but doulas readily acknowledge that not all women are interested in birth.   Among the many factors that bring women to doula training are a long-standing interest in birth and an orientation toward caring for others.

Many women described their reaction to finding out about doulas and doula training as something they had always been looking for but didn’t know existed.  They did not want or were unable to become a nurse, midwife or physician, but they still wanted to be around births.

It takes much less time and money to become a certified doula than it does to become a certified childbirth educator.  An unlicensed occupation, there are no formal requirements for calling oneself a doula.  However, the steps to certification involve finding an organizationally approved training workshop locally (usually available within a day’s drive of most metropolitan locations), paying for the course and materials, reading some books and spending time at a training.  Attending the required number of births and doing the paperwork to become certified takes a bit more time and effort.

Women come to doula training out of an ideological commitment to caring for other women during birth, often shaped by their own experiences. Doula trainers say women come because “some have had good birth experiences and want to share that with all women, and some have had bad experiences that they need to heal from.” Sometimes, women become emotional as they share their stories.  Trainers encourage personal reflection:  “Think through why you’re here. Those stories matter, there’s a lot to be done in understanding your own story of what brought you here.”

During training, doulas learn the definition and parameters of the doula role, the medical and emotional impact of doula-attended births and in particular, how doulas accomplish their job of providing ‘physical, emotional and informational support’ to the laboring woman while protecting the memory of her birth experience.

Doula care is presented as a return to the community-based, woman-centered care that existed prior to the shift from home to hospital births in the early part of the century.  In conveying this message, doula trainers emphasize collectively shared, community-centered support of women’s birthing experiences.  This focus asserts that birthing has been women’s work, that women intuitively know how to birth but our current culture has developed birth models that interfere with this intuitive knowledge and shared historical practice.  Doula trainers present an alternative model for how woman-centered support can reclaim a place within medicalized childbirth in Western cultures.

Trainees learn that their non-medical role is what distinguishes them from maternity care providers and this fills a gap within the current hospital provision of childbirth support.  Closing this gap takes two forms: first, the doula’s focus is specifically on the laboring woman’s emotional and physical comfort needs, rather than clinical issues.  Second, the doula provides continuous presence and personalized attention to one woman in contrast to the competing demands of the clinicians present, whether nurse, midwife or physician.

In addition to the focus on the non-medical aspects of their own role, doulas learn that pregnancy and childbirth are normal, non-pathological life events.  This notion is embedded in the midwifery model of care, described as a holistic approach; one that attends to the diverse aspects of pregnancy and birth: physical, emotional, spiritual, social, economic, cultural, and sexual. Trainees also learn the basics of childbirth physiology and other necessary information, but the emphasis is on birth as a natural physiological process occurring in healthy women, and the fewer medical interventions, the better the outcomes for both women and their babies.

Despite the emphasis on their non-medical role, doulas are nevertheless expected to be conversant with standard medical practices surrounding birth.  Trainees learn about pain medications used in labor, and the kinds of information they are expected to give their clients prenatally and during labor to help them make informed decisions.   Although critical of the unnecessary use of medical interventions, trainees are expected to be familiar with their indications.   Knowledge of anatomy and physiology of childbirth is encouraged in order to understand how to help labor progress in situations where the baby is not in an optimal position.

Doula trainers present the view that labor support should include unconditional emotional acceptance of women and their choices, practical physical assistance and as much information as women need to make decisions that are best for them.  Although trainers stress that birth is ‘not just another day’ in a woman’s life, and provide scientific rationale for continuous labor support, they also emphasize the importance of not judging women’s choices for their births or advocating one’s own beliefs on behalf of other women in medical settings.

Doulas learn that one of the most powerful ways they interact with their clients at births is by reframing what is happening from something that is negative or scary into something that highlights the normalcy of labor or the agency of the birthing woman.  Trainers communicate the value of reframing events in order for the woman to have a story to tell that places her decisions at the center.  Doulas are often present when the first telling of the birth story is announced to family members, especially when it occurs within minutes of the birth.  The injunction to ‘protect and nurture the birth memory’ is conveyed during training through a variety of means, including hands-on physical comfort measures.  But what the doula says is as significant as what the doula does in shaping the story of that birth for the woman, her partner and their families.

At the postpartum visit, trainees learn that the doula is there to see and admire the baby, and hear the woman’s story of the birth.  Trainers caution the doula to not assume that the woman will agree with the doula’s perspective of the birth.

Thus trainees learn that a large part of the doula’s impact on the woman’s memory of birth is accomplished through continuous presence, unconditional support, and reframing events, as they happen, so as to acknowledge and validate the woman’s effort.  In the event that the woman feels unhappy or disappointed about some aspect of the birth, the doula’s role is to validate her feelings about what happened, but reaffirm choices she made by reminding her of the factors affecting those choices. This reframing activity is a major part of doula training, designed to ensure a ‘positive birth memory’ for the woman, regardless of the doula’s opinion or experience of the birth.

Women who do not actively practice but intend someday to start or resume doula work still have a place in the doula world; they feel part of the community but are likely to have other family or life commitments.  No doula ever renounced the ideology, much like the phrase in midwifery, “once a midwife, always a midwife.”   As they continue doula work, many women move into allied childbirth fields that offer more professional status, better income and stable work.  Other doulas enroll in midwifery or nursing school to further their interest in technical aspects of maternity care as well as increase their earning potential.  Those who came to doula practice from another field, such as social work or counseling, continue to work in those domains but find their newfound experience working as a doula enhances their professional skills and empathy.

The typical practicing doula, then, is a woman who has been drawn by passion to provide care to other women during their births.  She has adopted a belief in the transformative and empowering effects of unmedicated, low intervention childbirth but also in the right and ability of women to make their own choices.  She strives to provide education and information to women that will give them an open mind to experience whatever lies in store for them at their births.  She networks intensively with others who share her beliefs and help her attain her goals.    Ideology, rather than professional status or economic reward, keeps her going, with the conviction that she is changing the world, and making a difference.


Birth Ambassadors Contributors

18 Oct

Birth Ambassadors Contributors


College Students’ Views of Childbirth

7 Oct


Top 3 words associated with childbirth provided by about 30 undergrad students at a guest lecture by Christine Morton in September 2013.  (All students were born vaginally!)

Birth Ambassadors, a New Book from Praeclarus Press, Describes Why Doulas Are the Ambassadors for the Midwifery Model of Care

2 Oct

Women who give birth the U.S. often find that it is very difficult, so many are hiring doulas to provide continuous labor support. A new book from Praeclarus Press, Birth Ambassadors: Doulas and the Re-Emergence of Woman-Supported Birth in America, describes the work of doulas, the dilemmas they face, and why they have become the ambassadors for the midwifery model of care in the U.S.

An increasing number of American women are hiring doulas to attend them during labor and provide continuous labor support. For many women, this a way to counter the highly interventionist births they are likely to encounter in American hospitals. Rates of cesarean sections are at an all-time high. Almost half of American women described their recent childbirth experiences as “traumatic,” with 9% meeting full criteria for posttraumatic stress disorder.

Doulas provide individual attention, information, and support to their clients. But this role does not come without dilemmas, as Christine Morton and Elayne Clift describe in their forthcoming book, Birth Ambassadors: Doulas and the Re-Emergence of Woman-Supported Birth in America, new from Praeclarus Press.

One dilemma doulas face is how to advocate for the woman in hospitals, where they may not be welcome. Another dilemma is what doulas should do when hospital policies or clinical practices violate their core beliefs that women have the right to plan for their birth, to be active participants in their care, and to be treated with dignity and respect. This core belief can be at odds with the structural care models currently in place at most U.S. hospitals. Thus, doulas sometimes find themselves in awkward and emotionally charged interactions with health care providers.

While egregious cases of obstetric maltreatment do occur, more common are cases in which a woman’s desire for an unmedicated birth is not respected, or when interventions are proposed without allowing for a full discussion of risks and benefits. Women may feel coerced into intervention because clinicians implicitly–or explicitly– convey the idea that if a woman does not comply, she will harm her baby. Knowing how to handle situations like these is often difficult for women working in hospitals as doulas.

Women often become doulas because they want to support women in childbirth. But to continue, they need to find ways to navigate the challenges inherent in their role. Birth Ambassadors summarizes results of the first scholarly study of the role of doulas and the dilemmas they face. It is a fascinating and readable volume destined to become a classic in women’s health.

Christine H. Morton, PhD is a research sociologist whose research has focused on women’s reproductive experiences and maternity care roles. Since 2008, she has been at Stanford University’s California Maternal Quality Care Collaborative, where she conducts research on maternal mortality and morbidity.

Elayne G. Clift, MA is a writer, journalist, and Humanities adjunct professor. She has worked internationally as a health communications and gender specialist, and is an educator/advocate on maternal and child health issues. A volunteer doula and Vermont Humanities Council Scholar, she has edited anthologies and published fiction and poetry collections, a novel, and a memoir.

Praeclarus Press is a small press founded by Dr. Kathleen Kendall-Tackett and specializing in women’s health. It features books, webinars, and products that support women’s health throughout the lifespan. Praeclarus Press is based in Amarillo, Texas, USA.Image


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