The Issue with Hospital Provided Doulas

Wednesday, October 13, 2021

The Issue with Hospital Provided Doulas

You’re sitting at a friend's table. Your ever expanding belly is, of course, the topic of conversation. “I’m thinking about hiring a doula”, you tell your friend. In the background the sounds of her own children serve as an unending, but joyful soundtrack. “OH!” she replies, “The hospital you’re delivering at provides a doula for anyone wanting them. They’re affordable, too. Maybe even free!”. Perfect, you think. Now, you can finally stop worrying about the money aspect. “Really? I’m impressed the hospital is providing them. That makes me feel so safe”, you tell your friend. “Isn’t it amazing!?”. You agree.

Pause a moment here and let’s consider a few things: Is it amazing? Or could it be problematic?

Let’s break down the conflict of interest before you grab the phone and hire that hospital provided doula. 

The Ethical Issue

The presence of a doula is supposed to ensure an unbiased, evidence based birth environment. When you hire a doula they work for you and you alone, but can this be true with hospital provided doulas? 

Honestly, no. 

Hospital doulas are often available for a small fee, or entirely free. This is because the hospital is paying them as a member of their staff, training them to follow hospital protocols, and as they receive this training they also learn their “DOs and DON’Ts”. Most likely those do’s and don'ts are vastly different from the ones followed by an independent doula. Hospital doulas don’t work for you and you alone. They work for the hospital. How often have you seen your labor and delivery staff stand up to your Dr. or call them out for practicing in a non evidence based way? It’s pretty rare, huh? This is the exact issue with hospital provided doulas. It is our job to follow your wishes as closely as safely possible and ensure that everything that goes on is 1.Consensual and 2. Appropriate care. How can hospital doulas truly do that when standing up for those things could get them fired, throw their family into a financial bind, and disrupt their career? Plain and simple- They can’t.

The Moral Issue

A doula is an extra set of eyes. A deeply-trained and highly-aware set of eyes that is watching and analyzing the care you receive as you labor and birth. We’re watching the pitocin level to make sure it isn’t being turned up too quickly (or without your consent), we’re watching for bags of Pitocin and making sure they aren't hung on your IV without your knowledge. We’re informing you that you don’t have to consent to a cervical check, we’re making sure you’re being asked before your body is touched. We are in all corners of the room, hearing the medical jargon and translating it within moments so that we can relay it to you in easy, digestible language. Our goal is ALWAYS to work in collaboration with your medical providers, but there are times when medical providers make moves that are not what you wish for, or in some cases not evidence-based suggestions for you and baby. In those situations we speak up. We have no obligation to your provider, hospital, nurses, etc… Our one and only job is to support you, advocate for you, and create an environment where you are in the driver’s seat of your birth. 

But what happens if your doula DOES have obligations to your provider, hospital, and nurses? Are they going to be as quick to speak up? Are they going to speak up at all? It’s unlikely. Speaking up for you, even when they 100% know they should, may get them in trouble. 

It might even cost them their job.

The Money Issue

While many doulas take HSA/FSA dollars, insurance companies don’t want to pay fair rates to provide their customers with doula support. Which means doula support isn’t accessible to parents with lower incomes, no HSA accounts, or parents who live paycheck to paycheck. Here is where the hospital swoops in to fill the gap and provide their patients with doulas that are paid through the hospital instead of paid privately. How wonderful that the hospital is providing this support! Sure, it looks good to the community. It looks so good, in fact, that it draws families in. 

Mother’s from all over the region are flocking to this hospital, and with them comes copious amounts of cash flow. Hospital doulas are not employed for your benefit--their position is a genius marketing ploy that fills the hospital’s pockets and fills you with a false sense of security. 

The Issue of Compliance

As we should all know by now, doctors, nurses, and other members of L&D staff are bound by hospital policies that are often not evidence based and/or overly restrictive towards physiological birth. 

Guess what! The hospital provided doula is no different. Here’s the best kept secret, hospital policy does not govern the patient body. Only consent does that. The hospital doesn’t want you to know that, of course, but one of the things I encourage my clients to do is get comfortable saying the phrase (or some iteration of) “My consent overrules your policy, and I do not consent to this”. I encourage my clients to get comfortable with it because my loyalty is to them and their wellbeing only. My wish is for them to bring their baby earthside safely and beautifully in charge. 

Independent doulas are not bound to policies and protocols and therefore they are not complicit in the routine dehumanization of mothers that may, and will at some point, take place on every labor and delivery ward. The doulas that work within these wards are bound by a contract. This contract outlines what they can and cannot do for their clients, and herein lies the root of the entire issue. Sure, epidural use drops slightly and breastfeeding rates go up marginally when hospital provided doulas are present for birth, but the fact of the matter is that hospital doulas aren’t empowering you to have the birth you want, they’re preparing you to give birth in a convenient and policy abiding fashion.

So, what control do you have?

Hire an independent doula. This may be a wonderful question for when you are interviewing for birth support-- “Do you work for any hospital system or only for private clients?” Any person you are hiring should be honest and transparent with you about any conflicts of interests. 

Now, this places the financial burden of hiring a doula on the parents, so we brainstormed a few ways to help fund your birth support:

  • - Ask folks to put into a doula fund instead of buying a baby gift/baby shower gift
  • - Find a doula who offers payment plans
  • - Ask about cash discounts
  • - Find a doula who offers sliding scale pricing
  • - Barter with an offer that you can provide to your doula as exchange for their support
  • - Add it to your baby registry
  • - Ask your doula if they offer gift certificates for friends and family to purchase for you
  • - Reduce the baby gear and ‘extras’ you invest in and instead invest in a doula
  • - Save, Save, Save

The Bottom Line

Hospital provided doulas are almost always in this field for the right reasons, but unwittingly fall victim to the conveyor belt of birth all the same. They don’t take these opportunities to add to the ever growing birth trauma rate, but intentional or not, they are merely a pawn used to give patients enough of a false sense of security that they’ll flock from nearby cities and bring in more money. They’re used as a primer for medicalized birth so that you don’t come in informed, empowered, and aware of your rights. They’re used for good publicity and then bound by bureaucracy that impedes their ability to advocate, speak up, and do their job. 

Tie a person's livelihood to a contract that silences them and you’ll slowly see them become more and more complicit.

This is not a structure crafted to support physiological birth and achieve best clinical outcomes. This is a scheme crafted from hospital board rooms filled with (mostly) men that are more concerned with counting money in their pocket than they are counting the startling rate of trauma and deaths coming out of their labor and delivery wards. You are not a hospital provided doula’s boss.

That boardroom is their boss, and ultimately that is where their loyalty lies. 

How to Get Your Baby to Sleep Through the Night

Wednesday, October 6, 2021

How to Get Your Baby to Sleep Through the Night with Eva Klein

(Taken from The Birth Lounge Podcast with Eva Klein, Certified Sleep Consultant)

So I am a certified infant and child sleep consultant. I help exhausted moms get their little ones consistently sleeping through the night so that they can be functioning humans again. And I got into this business because of my middle child. So, um, I'm a wife and a mom of three. I live in Toronto, Canada and I, my kids are 10, almost eight and almost three. Um, and so it was my middle child that got me into this business because interestingly, I'm actually a lawyer by training. So my previous lifetime, um, which wasn't, which was you about 10 years ago now I was working as a lawyer. I basically finished law school, had my first baby. Um, that first baby was like this unicorn baby that made me look amazing and was just so easy and happy all the time and you know, slept amazingly. And then a couple of years later when I was done law school and got called to the bar and I was working, I had, I gave birth to my second daughter who unlike her older sister, you know, this baby was a very high needs, very difficult. 

I could tell from the second that she was born. When I say the second, I literally mean maybe 20 minutes after she was born. I could just tell that this baby was different. That her temperament was different. She was, you know, fussier. She was crankier. I have this image of my husband. It was probably four o'clock in the morning and he's walking around the postpartum ward, holding this baby, trying to get her to calm down. And, uh, that was never the case with my older one. And so naturally she did not sleep. She was waking me every 90 minutes all night long. You know, when she was four or five minutes old, I was so exhausted. I literally felt like I was going to die. I was not functioning. I could barely cope with life. And I should just mention that I was on maternity leave. 

I mean, I don't mean to rub this in the faces, any of your American listeners, but I mean, here in Canada, we get 12 months of maternity leave. Actually. Now it's technically you can take up to 18 months. Um, so I really, I hate mentioning this on an American broadcast because they feel so terrible. My sister lives in New York. I should just manage it. And she had her first baby about three months ago and she's going back to work soon and she's literally beside herself. So I, I know how hard it is, but it's relevant to the story here and that I was on maternity leave. I was dying from the exhaustion. I had no choice, but to open up the sleep books and figure out what to do. And I managed to make the situation a little bit better on my own, which gave me some clarity. 

What does 'sleeping through the night' REALLY mean?

For my purposes, I do like to use one definition of sleeping through the night and that is baby sleeping 11 to 12 hours uninterrupted. Now, when is a healthy baby able to consistently do that? In my experience, definitely by eight months, but I've definitely seen babies younger than the eight month period be able to pull that off. However, there are just as many babies in that four to seven month mark that might still need that one feed around, let's say 3:00-4:00 AM. So it's definitely a little baby dependent, but I would say for the most part, if a mom comes to me with a five month old baby who is waking her up multiple times a night to eat, we can absolutely get that baby sleeping significantly better than the way that baby is right now. I can tell you for a fact that when you get a baby who is waking up four times a night down to one night waking, it is a game changer when it comes to mom's mental health and ability to function on a day to day basis. 

The number one thing you want to make sure is that your little one is never over-tired.  Over tiredness is a massive sleep stealer when it comes to babies of all ages, right? It's going to cause them to fight sleep, fight bedtime, wake up more  unnecessarily at night, and give you short naps. It can also cause early rising as well. So from day one, I suggest making sure that your baby isn't up for too long throughout the day. That's really the key here is to be looking at their periods of wakefulness. 

How long can your little one be up for before they need to go back to sleep for newborns? The answer is not very long.  It is really important to stay on top of the appropriate wake windows for their age.  Most importantly, understanding that what goes on during the day directly impacts what happens at night is really, really crucial. 

As the day goes on, naps tend to get trickier and trickier for these babies because external homeostatic sleep pressure gets weaker. Basically there is this external force that basically just describes this buildup of sleep that helps babies fall asleep when they need to fall asleep. But as the day goes on, when that external sleep pressure gets weaker, that means that the baby is going to rely more and more on you to help them fall asleep. And that's okay because they're really little- and they may need your help here.  That may mean your last nap of the day before bed time is on a parent, in a stroller, or in a carrier.

Sleep Regression

So let's chat about the four month tip that I have for parents starts back in the early newborn days: to try to get your little baby down sort of awake half awake, drowsy, but awake. In other words, not completely asleep, maybe once a day. The reason for that is because it's a very important skillset that your little one is going to take with them throughout the next months and years when they are learning how to sleep like a champ.  When babies reach the 'regression' stage, what happens is that their sleep cycles undergo a permanent neurological change where they are now cycling in and out of deep and light sleep similar to the way that adults do.  

Now, the reason why I don't like calling it a regression is because the term regression implies that it's this temporary phase, that baby is going through and that all you have to do is just wait it out.  Your baby is not going back to being a newborn. Your baby's not going back to sleeping like a newborn. And they are now sleeping like an infant, which resembles that of an adult. So the solution at that age, if the baby relies very heavily on something like feeding or rocking to fall asleep, then we need to begin teaching that baby how to put themselves to sleep on their own without any help. By putting babies to bed drowsy but awake from day one you may be able to avoid being hit hard by this 'regression'.

It's definitely multi-faceted in that part of the solution needs to involve teaching that baby, how to sleep independently, right? Sleep, training, sleep, coaching, etc. There are many different approaches here. This doesn't just have to involve cry it out. If cry it out is outside your comfort zone, where you know you put the baby in the crib and you leave and you don't go back in- you don't have to do that. There are many other approaches that you can use, but part of the solution does need to involve teaching that baby to sleep so that they can connect their sleep cycles. 

At the same time, the sleep training is not going to work if that baby is overtired or under-tired. The daytime has to have proper structure that is biologically appropriate. We have to make sure that we've got those puzzle pieces in place first. And so that's why in my signature method that I use to help these moms get their little one sleeping, it's a four stage process for sleep training. A lot of parents don't even know that there is stage one or stage two.  These stage involves looking at the sleep environment, routines, schedule, the nap times the daytime, etc. That all has to be down pat first in order for stage three- the sleep training to work well. Check out my free masterclass for more information about these stages:

How to Get Your Little One CONSISTENTLY Sleeping 11-12 Hours at Night so You Can Be a Functioning Human!

Want to connect with Eva? Check out her website here! Or her Instagram here!

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