Yet another response to a Nature Nazi

It seems that I've hit a nerve with a Nature Nazi. She's a double whammy since she's not only a doula but a massage therapist. (I have a friend who refers to chiropractors and massage therapists as "The Hippies of Health Care"... but that's another thread entirely!) I have nothing against massage therapists. I love my excursions to the local day spa. My tired aching muscles are one thing, but my actual health care is another. But at least massage therapists are licensed.

Anyway, this particular lady and I have been going back and forth on my Nature Nazi post of Friday, Aug. 22nd.

I wanted to touch on her ponderings.

I. AllDoulas.com

Jennifer mentions my "suspension" from the AllDoulas board. I whole-heartedly believe that my "GatorMommy" account was suspended due to my pointing out the fallacies of many of the doulas on that board. From doling out medical advice to lying to hospital staff. I thought all along that if I went on that board and agreed with their tactics that I would not confront such B.S. ... and I was right. I tested that theory and still have an "open" account there even though I am not a doula. It all has to do with stroking the doula ego.


II. D.O.N.A.

Jennifer says, "you don't seem to know there's an international organization called DONA International which has put together training criteria. Yes, it does mean something, because many people with many years of childbirthing experience has put that together. They're not, let's say, one person with a blog."

I admit that I laughed at this. DONA, or the Doula Organization of North America is but one of the organizations that "train" and "certify" doulas. Back in 2005 when I was thinking about taking doula training, I considered DONA, as well as CAPPA. After reading their propaganda and hearing stories about doulas in action I nixed that idea. The final nail in that coffin was running into one particular DONA doula on a Momma's board. I began to jokingly call her "Dr. Doula" because of the way she, a college drop out, would dole out advice like a MD.

On the DONA website, it states that: "DONA International has the highest certification standards for doulas worldwide. When a doula proudly adds the letters CD(DONA) or PCD(DONA) after her name, it shows the world she has met all the requirements of our rigorous certification program." So? It's still not standardized nor accredited! That certification means less than the guy's who changes your oil or the woman who cuts your hair. (For a list of accredited organizations, go to the National Organization for Competency Assurance's site.)

Let's look at the "training" required to become a doula through DONA, shall we? There are three steps to becoming a certified doula through DONA:

--> 1. Join DONA. A membership costs between $29.25 and $80, depending on which level of membership/length of membership you chose. (a complete price list can be seen HERE)

--> 2. Within four years, you have to do a workshop and take a prenatal class (only 28 hours for a birth doula or 27 hours for a postpartum doula). For the sake of clarity, I found a workshop on the list and contacted the person for information. I will post their reply when I get it just so we are all clear on what these DONA-approved workshops entail.

In the meantime, this is straight from the DONA site at http://www.dona.org/develop/find_a_workshop.php:

• A Birth doula, must attend a 16 hour DONA approved birth doula workshop plus a childbirth education series (a prenatal class) of at least 12 hours. You may substitute a seven (7) hour DONA approved introduction to childbirth for doulas course in place of the childbirth education series. (more on birth doulas below)


• A Postpartum doula, must attend a 27 hour DONA approved postpartum doula workshop.

--> 3. Purchase a certification packet from DONA, which can cost anywhere from $22.75 to $35, with the application fee being up to $60

But, back to birth doulas. To become an almightly DONA certified birth doula, you have to (in no particular order according to their site)

• Attend a DONA approved Birth Doula Workshop of 16 or more hours in length. Certification must be completed within four (4) years of attending the birth doula workshop.


• Read five books from the required reading list and the DONA International Birth Doula Position Paper.


• Purchase a birth doula certification packet. Each packet expires within two (2) years of purchase.


• Complete one of the following: A. Training in Childbirth Education or Midwifery (see list of approved Childbirth Education organizations); B. Work experience in Labor and Delivery as a Registered Nurse; C. Observation of a 12 hour Childbirth Preparation series (not as an expectant parent) or "Introduction to Childbearing" class offered in conjunction with an approved DONA birth doula workshop. (he childbirth education component for section "C" must be taught by an educator certified through an approved organization.)


• Proof of completion of lactation consultant, breastfeeding peer counselor or community breastfeeding educator training.


• Proof of completion of an online study program. Lactation Education Resources offers a basic, “Complete Self-Learning Program” that is affordably priced. Learn more. A second option is Breastfeeding Basics. Click here for directions for accessing and registering for the Breastfeeding Basics Online independent study program. You can find their web site here.
  Proof of participation in a breastfeeding workshop offered to birth and postpartum related professionals, such as those offered at conferences and by local lactation consultants (three hour minimum).


• Provide doula service to a minimum of three clients after taking the training course and buying the certification packet. The births documented must meet the following criteria: They occur after you attend a DONA International-approved workshop of 16 hours or more. Labor support must begin before or at the onset of the active phase of labor. For certification purposes, active labor will be considered 4 centimeters.


• The three births combined must have the doula present for a minimum of 15 hours total. Your presence as the birth doula must be continuous. You must remain for the birth of the baby to provide immediate postpartum support. Every vaginal exam must be documented on the Birth Record Sheet’s Labor Progression Chart. Cesarean births may account for only one of the three required birth experiences.


• Document each of the three births for which you provide labor support with: A. DONA International Birth Record Sheet (pdf); B. A 500-700 word account of each birth; C. Client Confidentiality Release Form (pdf)


• Provide good Evaluations (pdf) of your doula services from at least three clients, three primary care providers and three nurses or midwives.


• Read and sign the DONA International Code of Ethics and the DONA International Standards of Practice.


• A type written essay on the value and purpose of labor support(500-1000 words).
  Payment of certification processing fee.


• Verify that you are a current member of DONA International. Join now.

Boy! That really compares to the years and years of intense college classes, clinicals, and internships REQUIRED to become a nurse or obstetrician. And cost-wise? Wow! For less than a fraction of the cost of medical school, one can become a birth EXPERT! (note sarcasm)

Buy a membership and a packet, attend a 16-hour workshop, attend a birth class (commonly taken by expectant parents), learn about breast feeding, read five books, and write some essays. Damn. Forget the years and years needed for my PharmD (Doctor of Pharmacy), or the six-digit price tag! Where do I sign up? Oh yeah ... I have to buy a membership first. I suppose letting the hair grow out on my legs and armpits is optional.

III. The questioning of the woman's story about having Cytotec forced up her vagina by a L/D nurse:

I responded to this in my reply to Jennifer, but it should be noted that everyone has the LEGAL right to refuse treatment.

Even in an emergency situation, the hospital has to make every effort to obtain consent from either the patient, the parent, or the nearest of kin before doing anything. If the situation is critical and consent cannot be obtained before the person would expire, they can only do what they have to stabilize the patient until further consent CAN be obtained.

Since late 1991, FEDERAL LAW has required that hospitals ask if each adult patient has a living will so that if the patient cannot make decisions for him or herself, there is someone who legally can. If the patient does not have a living will, the hospital HAS to give information on making one. Furthermore, under Common Law, any medical treatment given to a patient against their will/consent is considered battery.

It seems that a good text on Health Care Law isn't a part of the doula reading list!

For those reason, I question the story. No, not did it happen, but HOW it happened. Did the woman really agree to the Cytotec treatment and then, after an adverse reaction, need to blame someone? If it happened the way she said, did she sue? If not, why? If it did happen 100% of the way she states, she should have no problem listing the name of the hosptial and the nurse that forced Cytotec up the the patient's vagina so that we all may be aware and know to steer clear of said hospital and nurse.


IV. Allowing/Not Allowing Doulas in a Hospital Room:

Well, each hospital has a RIGHT to determine who will or will not be allowed into any room or ward. Try telling a hospital that so-and-so WILL be allowed in the room for your cholecystectomy or for your MRI. Only in Labor and Delivery are the rules more lenient on non-hospital persons being in the room during all aspects of care. Doulas are banned by many hospitals/doctors in charge for one reason: their actions. Anyone who impedes care can, and should, be asked to leave, doula or not. It's illegal to impersonate a doctor, so I can't understand why many of these self-righteous doulas aren't arrested and charged for doling out medical advice.

If you don't like the policies of your OB/GYN or of your hospital, don't use them. Waiting until you're admitted to the hospital and in labor is NOT the time to take issue with the policies. Lying is NEVER the answer. Furthermore, no one has a *right* to do as they wish in a hospital. It's a hospital for crying out loud, not a hotel room! Acting like a toddler having a temper tantrum is not going to make a hospital or a doctor change their views or policies ... it's only going to make them dig their feet in the sand.

V. Drugs:

Jennifer stated: "Doulas are educated about the drugs mothers are given during birth--it was covered in my doula class, it's in several of the required reading texts."

Oh, really? LOL ... I am simply dying to see a list of the "required reading" concerning medication during antenatal care, labor/delivery, and postpartum recovery. I mean, really. There is not ONE pharmaceutical book on the DONA required reading list. ;)

A chapter on drug is not sufficient to claim "knowledge" on medications! How can you completely learn about the chemical make up of a medication, its pathophysiology, its mean(s) of affecting the body, its interactions with body systems/preexisting disease states, whether or not it crosses the blood brain barrier, etc. in a chapter or two of a book? You would need a good pharmacotherapy text at the very least to even beging to skim the surface of the topic!

VI. Finally, this question: "So why the big grudge about doulas, since you're so ignorant of what they really are?"
LOL ... It seems that I know more about doulas and their training than you do, Jennifer. Not only have I interacted with many doulas, I considered becoming one. Why are you so angry? (Most doulas seem to be, though.)

As I told one doula with whom I was corresponding via email:

"You state that you take pride in what you do. Good for you. And I do not mean that in a snide manner. I take pride in what I do, too. That pride should mean that you take issue with, and get angry at the women who do overstep their boundaries thus causing the stereotype of all doulas.

The old addage 'one bad apple spoils the bunch' is true. Why are you angry with those who point out the faults of the fundie movement within your occupations? Don't shoot the messenger -- shoot the persons responsible for the stereotype.

I have never been kicked out of a hospital for impeding emergency aid to a laboring mother. I have never adjusted a Pitocin drip. I have never used scare tactics to get someone to deliver their child according to my preferences. These are well-documented actions of doulas with an agenda. And that agenda has been appropriately named the Nature Nazi movement.

A nazi is defined as "a person who is fanatically dedicated to or seeks to control a specified activity, practice, etc." In the case of women who abhor medical interventions in pregnancy and will go to any lengths to keep women out of hospitals during their birth, this terms is perfect.

You can kick and scream at my opinions, but they do nothing to further the view of doulas. Instead of kicking in my back door, you should take care of those in your own yard that are causing the problems."