​“I’m planning to get an epidural so I don’t need a doula.”

This is unfortunately the primary thought among birthing women today, particularly those who plan to choose medication for their births. Obviously, doulas have historically done a very poor job of educating the public about the role of a professional doula. To further muddy the waters, many “doulas” that have made poor impressions on society at large about doula support. They have cheapened the meaning of the words “I’ll support you” by following it with the word “if.”


I’ll support you IF you choose not to circumcise.
I’ll support you IF you want (my definition of) a natural birth.
I’ll support you IF you labor at home as long as possible.
I’ll support you IF you decide to have a home birth.
I’ll support you IF you don’t get induced.
I’ll support you IF you don’t get an epidural.
I’ll support you IF…. You do things my way.
Not yours.


And most of the time, these “doulas” want to see only one kind of birth: an unmedicated one. They leave once their client asks for an epidural. Beware these “doulas.” That is not a doula.

That is a birth activist posing as a doula to use a woman’s birth for her own agenda. It’s no surprise that women choosing to have medication feel like they don’t need a doula. It’s as if to say that an epidural can replace everything that a doula does. But friends, an epidural is no substitute for a professional doula.

An epidural cannot meet with you during your pregnancy, spend personal time listening to your thoughts, fears, expectations, and apprehensions about your upcoming birth.

An epidural does not personally know the care providers in your area. Therefore, it cannot get to know your personal situation and make appropriate recommendations for who may be a good match for you.

An epidural cannot help you process and discuss your previous births as you prepare for another one.

An epidural is not connected with a network of birth related support professionals to provide you with extra support prenatally and postpartum.

An epidural does not have lending libraries of priceless information for you to look through as you prepare for labor, birth, and life with a new baby; it cannot know your personal situation or preferences and make recommendations accordingly.

An epidural cannot talk you through all of your birth and baby care options, help you from your birth plan, or answer questions as you put it all together.

An epidural cannot provide reassurance that your experiences and emotions in pregnancy and are normal and it cannot sympathetically encourage you to hang in there as you wait during the last few weeks.

An epidural does not go on call for you 24/7 in the last weeks of your pregnancy to answer questions, offer physical or emotional support, or help you understand what may be a confusing and inconsistent early labor phase.

An epidural can not support your labor at home before you get to the hospital, and it cannot help you decide when is a good time to go.

An epidural cannot watch you as you labor to help you understand what stage of labor you may be in, which is sometimes a general guide for when to leave for the hospital.

An epidural cannot support you as you labor until the pain medication takes effect.

An epidural can provide you with one option for effective pain control.

An epidural is not an expert in positioning during labor in such a way that the baby has the best chance of moving through the pelvis.

An epidural cannot support your partner.

An epidural cannot communicate about your labor to other family members.

An epidural cannot help you understand the medical language that may be used around you and about you as you labor.

An epidural cannot reassure you that any medication side effects you may be experiencing are completely normal. It cannot offer you options for managing those either.

An epidural cannot massage your feet, brush your hair, or gets something to drink for you and your partner.

An epidural cannot help coach you through the pushing phase.

An epidural cannot take pictures of you, your new baby, and your partner during or after the birth.

An epidural cannot help you get into a comfortable position after the birth.

An epidural cannot help your baby achieve their first latch.

An epidural cannot follow up with you days or weeks after the birth to see how you and baby are doing.

An epidural cannot provide you with ongoing postpartum support or resources.

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​The “birth community” has a rather unfortunate reputation that precedes us. Some tend to come across as harsh and judgmental toward western medication, not unlike this childbirth educator in the 2008 comedy, Baby Mama.

We rather giggle about this interaction as Amy Poehler’s character makes it very clear where her decision lies. And yet, we all know that, especially when it comes to all aspects of childbirth, the media has a reputation for being woefully inaccurate. This includes the education and support personnel in the field of childbirth, namely birth doulas and childbirth educators.

As a doula who has attended all kinds of births, let’s clear the air about medical birth a bit.

When it comes to birth, women have many medical options. Some of these options are what we call “interventions” because they intervene in the normal birthing process. These can be natural interventions (such as natural induction) or pharmaceutical interventions (such as epidural anesthesia for labor and birth).

There is, fortunately, a lot of readily available information about the risks and benefits of interventions. Women have more knowledge available at their fingertips than ever before in history. It’s true that evidence shows that most of the time, interventions do carry more risks than they do benefits.

That does not make them bad. Or evil. Or unnecessary.

And it doesn’t invalidate the women who choose to have them for their birth. It simply says that there are risks associated with them.

But, there are also benefits.

So let’s talk about some benefits to interventions. The most obvious benefit is that some interventions can be life-saving. Birth is rarely complicated, but when it becomes so, western medicine is very good at handling acute care situations for both mothers and babies.

There are many interventions used in modern obstetric units, but for the sake of simplicity, we’ll stick to 3 of the most well known: Induction, Epidurals and Cesarean section.

Induction is a great benefit for when it’s really necessary. Evidence supports induction in 3 cases. 1: Preeclampsia. 2: When the waters have been broken for 18 hours and labor hasn’t started yet. 3. Being induced past 41 weeks is supported by evidence – not because going past 41 weeks is dangerous, but because induction is likely to be successful at this time.

When induction is successful (meaning that it leads to a vaginal birth), it keeps a mother from having to go through a cesarean. It can save a mother and baby who are headed toward toxemia which can be very dangerous. Waters being broken for extended periods without labor starting can cause infection. The benefits of induction are obvious in these cases.

Epidurals (pain relief that is injected into the dura part of the spine) are being hailed as either Heaven’s gift to women or the devil’s invention itself. Emotions and opinions aside, when is it useful? One of the side effects of an epidural is that it causes a drop in blood pressure. It’s so predictable for this, actually, that nurses are required to give women a bolus of fluid to prevent that drop. However, for a woman with out of control high blood pressure in labor, an epidural’s blood pressure lowering effect may be of tremendous benefit.

What about sexual abuse survivors? Sometimes their bodies can respond in a similar fashion to labor and birth that they did to their abuse: by closing up and pulling away from the situation. This is not helpful in childbirth since a baby needs to come down and out. This reaction can be subconscious and out of an abuse survivor’s control. An epidural’s numbing effect on that region can allow a woman to open her body for birth.

Epidurals are also popular because they are generally a very effective form of pain relief. This can be important to many women for many reasons that go beyond just not wanting to experience pain. The way that epidurals are given today, most women are numbed enough that they feel pain relief, but they are also left with enough sensation to push. Birth doulas as very helpful to mothers that have epidurals as well since they can help explain what is happening, keep the mom comfortable, and help aid in the laboring process to keep the baby moving down.

What about the exhausted mother who has a baby that is perhaps malpositioned and causing labor to go longer than the range of normal? Or the baby that simply caught the birthing mother in a completely exhausted state? An epidural can allow for some much-needed rest from what is surely the biggest physical job a woman will ever have.
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It’s true that cesarean section is nothing to shake a stick at. It is major surgery and a mother should only go into a cesarean if the situation truly warrants it. But it does save lives. And the ones that have been saved by surgical birth are grateful for it.
Interventions are tools and nothing more. They are neither good nor bad. They simply carry risks and benefits. Which risks and benefits are important to a birthing mother are solely up to her. Sometimes the benefits outweigh the risks. In those situations, mothers, doulas, and providers are grateful to have them.

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