A friend and fellow doula once told me she was going to stop attending hospital births because women needed to have a challenging hospital experience in order to find their path to empowering birth. At the time, my friend's proclamation shocked me, but as I struggled to write a review of The Doula Guide to BIrth by Ananda Lowe and Rachel Zimmerman, her words bounced around in my head. Does Ananda believe women should birth without doulas? Indeed not! But I suspect she would agree with what my friend was trying to say, that doulas shouldn't try to save people. The Doula Guide to Birth doesn't try to convince people they shouldn't have unnecessary interventions, it provides information on topics (the option of refusing vaginal exams, pushing with no added force, and walking epidurals) that have had little coverage in other birth books and it fully explores what a doula is and does and how one might work for you. The authors of the Doula Guide to Birth tell us that no matter how you birth, you need support, and gently encourage you forward on the path toward empowered birthing.
Die-hard natural birth junkies might find themselves wondering (as I initially did) why this book doesn't use stronger language when they discuss subjects such as being a guest of the hospital or in their sample birth plans. When I read the section titled "Being a Guest of the Hospital" (15) I thought, wait a minute! It is your birth, take back your birth! But then I realized that hospitals are private institutions and they have the right to create policies that we may not agree with and it will take a lot more then simply a line in a birth plan to change those policies. And then it hit me, maybe, by reminding readers they are the guest of the hospital perhaps, the authors are saying, if you buy the hospital ticket, you will take the hospital ride (which might, of course, be the perfect ride for you), but saying it in a way that respects women's choices.
The Doula Guide to Birth provides many tips (backed by solid research) that will make the hospital ride smoother. They gently remind you that if your provider isn't open to the birth experience you desire, perhaps you should change providers. And they suggest that there is an alternative: "if you want the most control and the least restrictions on your behavior...learn about the option of giving birth at home or in a freestanding birth center (16). The authors make it clear that you cannot hire a doula (or use a birth plan) to save you from all interventions, especially at hospitals with high medical intervention rates. When unplanned interventions do happen, this book has some wonderful ideas about how to reflect back on your experience (as well as an excellent form, The Evaluation of Your Birth (Appendix) to help you start processing the experience).
The Doula Guide to Birth has something for everyone, the lesbian couple, grandparents, women birthing with disabilities, moms who will be placing their baby for adoption... and some fantastic book recommendations. I loved the focus on pushing "with your body's own rhythm." It reminded me that pushing is often left out of the birth plan. As a VBAC mom I definitely approved of the VBAC section. I also loved the practical stuff, some of my favorites are below:
How to have a frank conversation with your provider about doulas
When to really go to the hospital (moving beyond the 311 rule)
Twelve alternatives to a vaginal exam (another topic that gets fantastic and much needed coverage)
What to do when your water breaks (finally, a mainstream childbirth book that questions the 24 hour rule!)
Real talk about birth plans (i.e., just because it is in the plan doesn't mean it will happen)
If I had to change one thing about this book, it would be the section on walking epidurals. While I agree that moms absolutely should know about the position changes possible with an epidural and be supported by hospital staff so that they can squat with an epidural, I have yet to meet a mom who has actually had a walking epidural. Perhaps if more moms would discuss this option with their care provider before the birth (as the authors suggest) "walking" epidurals would become more prevalent.
So who should read this book? When I first heard the title, my thought was, is it for doulas or moms? My answer is both! I think this book has lots of tips for newer doulas (including a section on insurance reimbursement for doulas). It is a great book to suggest to clients who aren't sure about whether they will hire a doula or a partner who thinks he/she will be replaced if a doula is hired. I do think moms who are planning a hospital birth will get more out of this book but ALL moms will take something away from this book.
It wasn't just my friend's comment about doulas and hospital births that was floating through my head while preparing this review. I recently made a decision to attend the Birthing from Within Introductory Workshop. As preparation for the workshop we are required to come up with our deepest question and we learn what our deepest question is not. On the CD "Mentor's Introduction" that we must listen to before attending the workshop, Pam England notes that our deepest question cannot be, for example "how can I save clients from interventions." Did I want Ananda to use stronger language so that her book would "save clients" from unnecessary interventions? I think the honest answer to that question is yes. But the reality is books that use strong language have the potential to turn away moms whose journey includes planning for the epidural, and surely that would not be a good thing because all moms can take something away from this book.
Ananda Lowe and Rachel Zimmerman, The Doula Guide to Birth, Secrets Every Pregnant Woman Should Know, New York: Bantam, 2009.