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reports and press releases
Report adopted on June 10, 2008
Doulas : an emerging Profession ?
Bull. Acad. Natle Méd, 2008, Tome 192, Juin-Juillet, No 6, p. 1237:1252
SUMMARY
The term ‘‘ Doula ’’ was coined some three decades ago in the United States, after pediatricians showed that a continuous presence and support for women in labor improved the conditions of the delivery. The word designates women who accompany future parents throughout pregnancy until the postpartum period, as a complement to normal medical care, and who act as a go-between with the medical profession. Their knowledge is empirical, being usually based on their personal experience of pregnancy, delivery and breast-feeding, plus expensive theoretical education and very limited practical training. The emergence of this new activity is not difficult to explain. Indeed, it coincides with societal upheavals, including more fragile family ties, the growing popularity of ‘‘ coaching ’’, and changes in childbirth conditions (closure of small maternity units, ‘‘ medicalisation ’’ of childbirth, and earlier postpartum hospital discharge). As their popularity grows, Doulas are demanding a specific professional status as ‘‘ labor companions ’’ or ‘‘ birthworkers ’’, separate from the medical profession and outside the sphere of voluntary work, but with a degree of medical training. The results is a somewhat ambiguous situation, and numerous reservations have been expressed. Controversial issues include Doulas’ neutrality (they participate directly in the birth project, and sometimes in potentially risky choices) ; possible delays in hospitalisation due to incorrect interpretation of clinical signs ; the possibility of psychological pressure being placed on fragile young women ; the risk of infiltration by religious sects ; and an increase in home births. The French National Academy of Medicine, wary of the involvement of persons with insufficient training in the process of pregnancy and delivery, warns against official recognition of Doulas’ training and function. The Academy would prefer to see more posts for midwives, who are ideally placed to accompany women during childbirth (especially in rural areas), as well as more welfare staff specialized in mother-child protection, and more home helpers.
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