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Hospitals are taking a proactive stance toward doulas in delivery rooms by training their own. Previously, doulas were, and still are, trained by outside agencies. However, while these organizations have standards that their doula trainees must meet, the standards of each organization do not necessarily match up with the standards of the other organizations. There is no one national standard that these doulas must meet, and there has been a problem with some doulas trying to advance their own agendas regarding childbirth and medical interventions, much to the chagrin of the mothers involved and the anger of the doctors trying to deliver the babies. To eliminate this conflict, some hospitals are now training their own doulas in an effort to allow the mother to have this extra coach available if she wants. Some hospitals have gone completely in the other direction and banned doulas because of the small, but vocal, group that has developed a bad reputation for the rest of the bunch. The training programs from hospitals are an attempt to standardize care to the point where the doctors know that the doulas understand why the doctors may want to do a particular procedure, and that the doctors and mothers know that the doulas are aware of their role in keeping the mother comfortable -- which includes not insisting she refuse procedures because of the doulas' own beliefs. Doulas are not necessary, medically speaking -- they basically function in a way that is similar to a lot of coaches -- but they can be very comforting for a mother who is trying to give birth. Having an argument break out between the doula, mother, and doctor is never constructive, and the added stress can be downright unhealthy for the mother. Doulas should be a part of the team, and not a soldier trying to protect the mother from an evil medical establishment. With careful interviewing and consideration, the mother can probably figure out which doulas would not be very cooperative if she has to find one who was not associated with the hospital where the birth is supposed to take place. It is much easier, though, to work with a doula that the hospital has trained. Still, most doulas that were trained by non-hospital doula organizations are just fine with letting the doctors handle the medical aspect of the birth. It is only a small group that has caused the reputation for friction. Doulas usually start working with the mother during the last few weeks of her pregnancy. A doula does not have much more to do than keep the mother calm and let her know how the birth is progressing, though that description can sound much less involved than it can be. The mother is likely in pain and just hoping everything goes well and ends quickly, and somehow the doula has to keep her mind off the pain but on the process of the birth so that she can follow any directions the doctor gives her. That is not always an easy task, and it is another reason why the training of the doula is so important -- anyone trying to keep a mother focused during a birth, especially a birth done without drugs, needs to know what they are doing and what sort of behavior might be inappropriate. It is also crucial that the mother and doula meet a few times before the birth in order to discuss how things should be done, what scheduling might be involved, and what might work to keep the mother on track. Proper preparation can lead to a successful experience in the delivery room.
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