“Birth rape”- a doula’s response
Doulas can play a vital role as part of a positive birthing experience.
Editor’s note: An article published recently on what has been called “birth rape” (traumatic births) provoked lots of debate. Melinda Rollinson,  vice-chairperson of WOMBS, an organization representing trained doulas in South Africa has been invited to publish her response:

Whilst it is undoubtedly true that the incidents described in the article [Dirty secrets of birth rape] do take place, in my experience as a doula, the far more prevalent scenario is often more subtle. Instead of a wholesale disregard for the pregnant woman’s wishes, medical professionals often undermine a woman’s belief that she can deliver without intervention, or worse, insinuate that attempting to do so is being reckless or unnecessarily endangering the life of her unborn child. Pregnant women, particularly first time mothers, are extremely vulnerable and are looking for guidance, support and advice from their doctors.

These professionals will often cite ‘informed consent’ as justification for the interventions used in a birth. But I question how informed that consent really is. The number of women obtaining obstetric care in private medical establishments in South Africa who are told that their unborn babies are ‘big’ is staggering. The clear inference? ‘Your body might not be able to birth a baby this big. You can try NVD but I wouldn’t’. It’s the first step in instilling the doubt in the already fearful pregnant woman that she’s not equipped to do this the way nature intended.

In response to this article, a Twitter user tweeted that it would be great if all women could have an advocate who could speak for them during labour. I agree, but it would be even better if women were able to speak for themselves during birth, having been educated and empowered by the person caring for them during their pregnancy. Doulas advocate for women in labour but not by speaking for them. If we did, we’d be just another person in the process taking the laboring woman’s power away. Doulas advocate by empowering the laboring woman and her partner with information throughout the process.

The intention of this response is not to indict all birth professionals in the private medical sector in this country. There are some exceptional professionals who very much put their patients’ birth experiences before anything else. I am also not passing comment on educated and informed women who, fully appreciating the increased risks to themselves and their babies, elect to have caesarian births.  I absolutely accept that caesarian births are life-saving surgeries which have their place, but the numbers speak for themselves. The WHO has previously recommended that Caesarian birth rates for any region should not exceed 10-15% of births.  I believe that the average rate of Caesarian births in the private sector is currently in the region of 70-80% of births. This phenomenon in South Africa is regularly referred to in international obstetric literature and it’s not a good look.

As doulas, we do what we can but in some respects our impact is limited. Despite indisputable evidence that doulas vastly improve the birth experience whatever the outcome, we regularly have to fight just to be allowed to stay with our clients if they birth in hospitals. Step out of line by explaining the alternative options to that suggested by the doctor involved and risk having that doctor attempt to block you the next time you meet in a labour ward.

Birth is remarkable, miraculous and breathtakingly beautiful. This life event should be facilitated by a team of birth professionals - doctors, midwives and doulas - working together to ensure the best possible birth experience for every woman we have the privilege of assisting.

Melinda Rollinson
Vice-Chairperson, WOMBS (Women Offering Mothers Birth Support)

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