Pod Insights Stuff You Should Know Selects: The Deal With Doulas About this episode The word doula in Ancient Greek might mean "female servant" but it's really not a great description of the 21st century job. Doulas are birth coaches who help women get through the process of childbirth as efficiently and painlessly as possible. They aren't midwives or nurses, but they can provide an invaluable service as advocates. Learn about the deal with doulas right now in this classic episode!
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1:06 Speaker 03 So what's the deal with doulas, everybody? That's my question to you on this wonderful Saturday morning. This one goes back to December 12, 2017. Doulas do great work. They're wonderful people, and they bring babies into the world. So I hope you enjoy The Deal with Doulas.
1:29 Speaker 04 Welcome to Stuff You Should Know, a production of iHeartRadio.
1:39 Josh Clark? Hey, and welcome to the podcast. I'm Josh Clark, and there's Charles W. Chuck Bryant, and there's Jerry over there. And this is Stuff You Should Know, the podcast.
1:49 Speaker 03 Childbirth edition.
1:51 Josh Clark? Yeah, we are traipsing into more territory.
1:56 Speaker 03 What does that mean?
1:57 Josh Clark? I don't know. I mean, we've done two on, you know, feeding babies.
2:00 Speaker 03 Yeah.
2:01 Josh Clark? Done female puberty.
2:02 Speaker 03 Yeah.
2:03 Josh Clark? This will, this will get into childbirth a little bit. So yeah, we're not afraid. I don't care.
2:10 Speaker 03 Yeah.
2:10 Josh Clark? I guess is what I'm trying to say.
2:12 Speaker 03 You can be a male doula.
2:14 Josh Clark? You can, although I, this is the only article I ran across that. And did you find anything about that anywhere else?
2:20 Speaker 03 No, I mean, it happens. It's just super rare.
2:24 Josh Clark? It happens.
2:26 Speaker 03 Because, I mean, we'll go ahead and spoil it. Generally, doulas are, well, let's just get into this. Generally, doulas are women who have already had a baby.
2:37 Josh Clark? Yes.
2:38 Speaker 03 Not even just women, but women who have had a baby. So they can really know how to help another lady have a baby.
2:44 Josh Clark? Yeah, yeah, and this is actually, so this is an ancient thing that's kind of come back around full circle. And even the name doula is a Greek term used way back in the classical Greek days when a woman giving birth would have female servants attending to her during birth, helping her with it, probably feeding her some grapes, waving palm fronds on her, that kind of thing. So doula means female servant or female slave, depending on who you're talking about.
3:17 Speaker 03 Right.
3:18 Josh Clark? And after, you know, ancient Greece fell, Rome and the Roman Empire fell, and all of civilization took this weird course, throughout it all, women were helped by other women while they were giving birth. Basically, up until about the first third, first half of the 20th century in the West, where hospitals entered, and all of a sudden, it was just the mom giving birth, surrounded by a bunch of nurses and doctors.
3:52 Speaker 03 Is that true?
3:53 Josh Clark? Yeah.
3:54 Speaker 03 Because I could see scenarios where there were women in the birth room helping along.
4:02 Josh Clark? I think once you started to get into hospitals and the physicians in the hospital starting asserting their authority more and more, especially through drugs, like I saw that... When hospitals kind of took over the birthing process or took responsibility for it from the family and from midwives and moved it into the hospital, they used to administer a lot of sedatives as part of the birthing process, as part of labor, you know. You could understand why they would, but then there were all sorts of complications from it, problems from it. So they stopped giving sedatives as much. And about that time, women who were giving birth started to like kind of come out of
4:46 Josh Clark? it and look around and say, whoa, it's just me and you guys in here. I need some family members in here.
4:51 Speaker 03 Right.
4:52 Josh Clark? And at the time, like if you were a dad, you were not in there. You were not in the delivery room at all. You were out in what was called the stork club, handing out cigars, maybe pacing. And the reason why was because to the doctors involved, it was just another medical procedure, right? So you're not going to have randos who have nothing to do with the actual procedure in the room during a procedure. They treated childbirth the same way. But women started to say, no, I need more than just you people who I've never met before, really, attending to the birth of my child. And so dads started to come in and then more family members. And then now, doulas have definitely kind of come back like they were originally. That's my understanding of the whole thing.
5:37 Speaker 03 Yeah, so doulas, we haven't even said what that is yet, and that would probably help clear it up if you don't know. Doulas are people, like we said, generally women, but not always, who are childbirth coaches. They coach you through the process. They will, depending on the service they offer, will come on before, obviously, you give birth and kind of prep you for what's going to happen. And this, I mean, it kind of depends on when your doula will come aboard in the process. But at the very least, they will help you in the delivery room and they are your advocate to kind of coach you through this whole thing. And that term actually started in an article in 1969 by a woman named Dana Raphael, and
6:21 Speaker 03 then later on in a book in 1973 called The Tender Gift: Breastfeeding. And that's when she brought this term back and said, you know, we're going to start calling these women doulas and it's going to be a real job.
6:35 Josh Clark? Right, and I think at first, what was the name of the woman who brought it back?
6:39 Speaker 03 Dana Raphael.
6:40 Josh Clark? So she had like a pretty good idea that was actually ahead of its time. When doulas really started to come into use and come into their own as a profession was in the eighties. And the reason why they came into wider use was because hospitals were going to C-sections a lot. C-sections went up from 1970, 4.2% of live births in the US involved C-sections. 16 years later, in 1986, a quarter of live births in the US involved C-sections. And there were a lot of complications with C-sections. And so you could have your husband in there, you could have your mom in there, you could have friends, but they're just there for you.
7:22 Josh Clark? One of the first services that doulas started offering was to say, whoa, whoa, whoa, does she really need that C-section? Are you sure about that, or are you just doing it because you can charge more money? I think that was overstating exactly the interaction they had, but that was the role they had, was to basically provide a barrier between a doctor who wanted to just give a C-section because he wanted to go home, and the mom who really didn't want a C-section.
7:52 Speaker 03 Yeah, and it's not just C-sections, they're your advocate, they're your birth advocate to make sure, or at least as best they can, to try to ensure that the birth plan that you feel best about is the one that you end up with.
8:05 Josh Clark? Yeah.
8:05 Speaker 03 Things always change, of course, and a doula would never put you in danger by insisting on something. In fact, they can't. But they are there to speak for you on your behalf because as a mother in labor, you're going through a lot on your own. So it's nice to have someone that is just there to do that job.
8:24 Josh Clark? Yeah, and is coming from a place of empathy and sympathy and, most importantly, experience. Like you said, most doulas have had children of their own, but they've also, after a while, attended other births too. So they know what they're talking about, they know what to expect, and they can tell you what to expect, which can make the whole process easier, I would imagine, for any mother giving birth.
8:47 Speaker 03 Yeah, it's definitely gained popularity in the 2000s. I think, I tried to find more recent statistics than 2012, but I couldn't. But in 2012, there were 6%, and this is in the United States, it's a... Has very much, I know it does happen all over the world some, but it's sort of an American thing. Six percent of people in 2012 used a doula versus 3% in 2006. And in that same survey, 27% of people said they would, they would like to use a doula. So, you know, at least they're, they're wishing or hopeful that they can.
9:26 Josh Clark? Yeah, that was question eight. Would you like to use a doula?
9:29 Speaker 03 Yeah.
9:30 Josh Clark? Yeah. 27% said. And so if you get the impression that like a doctor would not really prefer a doula to be in the labor and delivery room, you, you've kind of read between the lines there. Especially at first, the medical community saw doulas as they were starting to really kind of come into use in the eighties as basically meddling busybodies who could potentially put their patient's life in jeopardy, right? But then in 1992, doulas of North America was founded, Dona. It's like the first doula licensing body, certification and training and licensing body. And they were founded, it was founded by medical professionals, which kind of created
10:15 Josh Clark? a bridge. It bridged the gap or kind of got smoothed over the rough feelings between the medical community and the doula community. And it also added a real air of legitimacy to the profession of, of being a doula.
10:28 Speaker 03 Yeah, and the, the impression I get now is that if you have a good doula who is good with people, which is ideally what your doula is.
10:37 Josh Clark? Yeah.
10:38 Speaker 03 If your doula's not a people person, it's probably not going to be a good thing.
10:41 Josh Clark? No.
10:42 Speaker 03 But the idea I get is that, that doctors and nurses like having doulas there now because they can just concentrate on, they don't have to be the ones providing emotional, empathetic support, although they can still do that if they want, they can just concentrate on the medical aspects of it. And they know that they have a trained, hopefully licensed doula, and we'll get into that later, on hand to sort of say, you know what, I don't have to deal with that part of things. You're in good hands with this doula and I can just concentrate on the medical parts.
11:13 Josh Clark? Yeah. Now all love doula.
11:17 Speaker 03 That's right.
11:19 Josh Clark? One of the other reasons or functions that doulas provide you kind of hit on is that they provide a service that hospitals used to provide through nurses, right? Where if you had a nurse in a labor and delivery room, they wouldn't spend as much time or give you as much attention as say like your mom would, or a friend, or your husband even. But they gave you a lot more early on than they did as surveillance of patients moved to electronics, right? To where somebody could just kind of sit at the nurses station and check on everybody and they didn't have to go into the rooms. And now you nurses were charged with watching even more people at once, right?
12:03 Josh Clark? So the personal attention dropped dramatically as electronic surveillance of patients increased. And the doulas kind of came in to fill that role as well.
12:14 Speaker 03 Yeah, like they're sitting in the room with you and hanging out. They don't get called in like 20 minutes before you give birth. They're with you, you know, sometimes days and weeks beforehand coaching you on what to expect and how you're going to go about this and what your plan is. And then on the day, like even if dad is in there and the husband is in there providing support, that's great. But the doula is just that extra step and that extra measure of support that is super knowledgeable about what it's going to be like, where the husband might not exactly, you know, be able to lend the most insightful ear there, you know what I mean?
12:55 Josh Clark? Yeah.
12:56 Speaker 03 So you want to take a break?
12:57 Josh Clark? Yeah, let's take a break and then we'll come back and talk about what to expect when you're expecting to work with a doula.
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15:57 Speaker 03 All right, so here's a misconception. Some people get, some people think that doulas are authorized or trained to give birth. That is not true. They don't deliver babies. They don't perform any sort of medical procedures. They don't put an IV in your arm. They don't work the heart rate monitor. Most times, they don't even work for the hospital. You have hired them independently. And again, they're just there to coach you. They're not even midwives. Midwives can deliver a baby.
16:28 Josh Clark? Right, yeah, they're not allowed anywhere near the medical stuff. But they need to know what the medical stuff is so that they can say, well, this is what they're about to do, or this is what they're suggesting right now, and here are your options. And then also, when they're administering the medical stuff, which can be pretty uncomfortable pretty frequently, I would imagine, the doula is there to kind of tell the mom what to expect and to comfort her in all sorts of ways.
16:57 Speaker 03 Yeah, and maybe not even offer advice. Like, I think the idea is that a doula will lay it all out there so you can make an informed decision.
17:05 Josh Clark? Right.
17:05 Speaker 03 And not necessarily say, well, if I were you, this is what I would do.
17:09 Josh Clark? Well, yeah, that's a slippery slope right there. Because then all of a sudden, if things go wrong, you can say, well, the doula told me to do that. And the doula is like, I'm toast.
17:20 Speaker 03 Doulas have to be great listeners. We already talked about the empathy piece. They have to be very empathetic. And they will, like I said, start meeting before birth to answer any kind of questions, come up with that birth plan, and really listen a lot to the wife and the husband. So, everybody is on the same page. And like I said, on the day, things can change. But going in, you generally want to have a pretty good idea of everything from medications you might want to use, if any, to where you want to have the baby. The doula can come on board and kind of explain, if they're knowledgeable, which hopefully they are, about the hospitals around you, and maybe even help you pick out where you're
18:04 Speaker 03 gonna give birth.
18:06 Josh Clark? Yeah. And I mean, if you already have an idea of what you want, the doula can, you know, kind of tell you how to make that happen. Or if you have no idea what you want, the doula can also tell you some other alternatives that you might not have thought of. And I saw a Parents Magazine article about doulas. They laid out what, basically what you can expect from the average doula for the doula's fees. One to two in-person prenatal visits, and then access to the doula for follow-up questions through email or phone calls. Their full attention and presence during your labor.
18:44 Josh Clark? And then, sometimes, frequently, I get the idea, a follow-up visit in at your house after the baby comes home. Typically, if you hire a doula, this is about the average you can expect to them. There's definitely a lot of differences. There's, some will give you a little more, some will give you a little less. Some will charge more, some will do it for free. It's just all over the place, as far as, you know, what you're actually going to shell out and what you're going to get from a doula. But for the most part, you, the doula's going to have met you before you give birth, and then the doula will be there throughout the whole labor and delivery process.
19:27 Speaker 03 Yeah, and it says in this article that there are specialist doulas, like antipardum doulas, and postpartum doulas, and labor doulas.
19:37 Speaker 03 That if you want an antipardham doula to be, if you want more than those two meetings, you might want to hire someone who will be with you for several weeks beforehand. Or if you want someone postpardham to be with you to coach you through breastfeeding, or, you know, changing diapers, or just any of that kind of coaching, you can hire someone to do that. But I get the sense that doulas generally will sort of, uh, work with you on whatever kind of plan you want.
20:04 Josh Clark? Right.
20:05 Speaker 03 It may cost a little extra, but I get the sense that a doula wouldn't say like, "Nope, you get two meetings and that's it." They might be like, "No, I'll come in for a third and fourth meeting. It'll be an extra of this much money, and I can hang with you for a week or two afterward here and there."
20:21 Josh Clark? I found, I think it was through a BuzzFeed article, I stumbled upon a, there's a huge rift in the doula community, actually, between the typical, traditional approach to being a doula, which is, "I'll work with you on a sliding scale for how much you can afford, or this is my fee, but I'll throw in an extra visit just to, you know, make you feel like you're getting your money's worth, or I'll do it for free."
20:48 Speaker 03 Yeah.
20:49 Josh Clark? "I just want to help you." Because donas' mission is that, a doula for every, every mother who wants one, like every mother should have a doula, basically, right? And then there's this other group called Pro Doula, and they're, they can't stand doulas who, who charge less than like a decent amount for their services, or do it for free. They actually call doulas who do this for free oxytocin vampires, like they're just there to bask in the reflective glow of this, this amazing experience that the mother just went through, the parents just went through. And they're really kind of... Kicking other doulas around and they're kind of bullies.
21:34 Josh Clark? It's in a really weird way. But there's like this big debate over whether doulas are undervalued or underselling themselves.
21:45 Speaker 03 Huh.
21:46 Josh Clark? But I, I mean, I definitely get the idea that every woman who wants to have a doula should be able to have a doula regardless of her income, you know?
21:55 Speaker 03 Yeah.
21:56 Josh Clark? That makes sense to me.
21:57 Speaker 03 Like a pro bono for, for people that don't have as much money?
22:02 Josh Clark? Yeah. On the other hand, I also get that if you are a doula and you're doing your job really well, that yeah, you should expect to be paid. I think there's a happy medium. I don't think it has to be like, nope, this is the price and anybody who goes underneath it should be ostracized from the doula community.
22:17 Speaker 03 Yeah. The other thing about doulas, another misconception, a lot of people think is that it's just some hippie dippy thing that if you don't wanna, if you only wanna have like a natural childbirth, then you get the doula in there and they're not there for anything other than that. And that's not the case. They, they are there to support you in whatever kind of birth you want to have, whether it's a home birth or water birth, or whether or not you wanna get an epidural or be loaded up on every pharmaceutical they offer mothers in labor. They're there just to have knowledge of all that stuff, so you know what you're getting into.
22:54 Josh Clark? Yep. And then so during labor, this is where, this is where the doula shines, right? They're there to help with alternatives to, to pain treatment, right? So again, they can't administer any kind of drugs or anything. I would guess that they could even get in trouble for giving you an Advil. But they can do other things, like they can massage you in, in ways that you had not ever heard of before. That helps with labor pain. I, I came across this one technique where they pull on a couple of toes, specific toes, and it helps actually move the labor along if you're, if you have a slow labor. There's kneading techniques, there's stroking techniques, pressure on the bottom of your feet.
23:39 Josh Clark? There's all sorts of stuff they can do at various times throughout the labor and delivery process that can help alleviate the pain that you're going through. And that's one of the big roles that they played during labor.
23:50 Speaker 03 Yeah. When my kid was born, it was, I was shocked at how many people were in the room, first of all.
23:57 Josh Clark? How many?
23:58 Speaker 03 Oh, man.
23:59 Josh Clark? Baker's dozen?
24:00 Speaker 03 I mean.
24:01 Josh Clark? Twenty?
24:02 Speaker 03 Emily and I, birth mom. Uh, obviously. Our adoption counselor, who was a licensed doula, so she really served that function uh, for the birth mom, which was really a great, great plus.
24:18 Speaker 03 The doctor, uh, I guess the, uh, I'm not even sure what the roles are, what their technical titles are, but um, the doctor came in when it was go time and basically just checked things out and said, "Well, I think it's go time," and then he stepped out of the way and these two nurses came in there and ninety seconds later, there was a baby.
24:40 Josh Clark? Wow.
24:40 Speaker 03 So it was, and, and those were, so it was two nurses, there was probably like, there was probably at least twelve people in that room.
24:48 Josh Clark? Wow, that's a lot of people.
24:50 Speaker 03 It was crowded and fast and surreal and weird and amazing.
24:55 Josh Clark? Even, even weirder, they brought in Carrot Top to cut the cord, right?
24:59 Speaker 03 No, Emily cut the cord.
25:00 Josh Clark? Okay, cool.
25:01 Speaker 03 Emily actually helped sort of deliver in a way, cause you know, they, they like to bring in, uh, I guess, you know, in a, in a regular biological birth, it would be the husband probably, uh, in there saying, "Hey, do you wanna help hold the legs or do whatever?" In this case, it was Emily. And I just took a respectful position, uh, by the birth mom's head.
25:23 Josh Clark? Right.
25:24 Speaker 03 Sort of looking, looking down that way.
25:28 Speaker 03 I was like, you know, she was, she was like, "You can go wherever you wanna go," but I was like, "You know, I'll just hang right here."
25:32 Josh Clark? Right, and Emily's like, "That's right."
25:34 Speaker 03 Yeah, I just, I wanted to be there and, you know, I was, I was helping support her as well, uh, you know, holding her hand and patting her on the head and all that, all that nice stuff.
25:43 Josh Clark? That's cool, man.
25:44 Speaker 03 Yeah, it was, it was amazing.
25:45 Josh Clark? Did I ever tell you the story, uh, for when my niece Mila was born and, um, my sister-in-law was giving birth and she let everybody in the, in the labor room.
25:56 Speaker 03 I was surprised you can have a party in there.
25:58 Josh Clark? Yeah, and, um, when she really was going into, into, she was delivering, um, I stood back behind this curtain, right? And, um, the doctor comes in and walks past me and kinda gives me a nod and I hear him go to the crowd, he's like, "You know, there's like some guy standing behind that curtain, right?" I'm like, "Yeah, he's supposed to be there." It was pretty funny.
26:21 Speaker 03 He's the, he's the ward creeper.
26:22 Josh Clark? Right, exactly. I'm like, "Okay, I've heard enough here, I'm going to the next room."
26:28 Speaker 03 All right, well, let's take another break now that we've shared our stories. We'll come back and talk a little bit about how you become a doula right after this.
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29:23 Josh Clark? All right, Chuck, so if you wanted to become a doula,
29:27 Josh Clark? basically you start in training. At age three, you're sent off to Europe to apprentice at the one doula school in the world. And they make you eat a lot of magic cake. And then when you're 60, you get to actually start out on your own.
29:41 Speaker 03 That's exactly right.
29:43 Josh Clark? Okay.
29:44 Speaker 03 Well, before you decide to become a doula, you need to get a lot of thought on what you're going to be getting into. You know, the hours are long at birth. Childbirth is very stressful. And especially if there are complications, it can be super stressful in a matter of life or death. So you got to be able to deal with that stuff in the moment and hang in there and be the birth coach that mom needs, you know, in the most stressful of situations. But then, on the plus side, you get to see little babies coming out on the reg. And what's better than that, you know?
30:19 Josh Clark? I can't think of too many things.
30:21 Speaker 03 Talk about an oxytocin hit.
30:23 Josh Clark? Maybe magic cake.
30:25 Speaker 03 Magic cake? You do not have to have a college degree. You don't have to have a high school degree.
30:34 Josh Clark? You don't even have to be certified. It's not law that you have to be certified.
30:39 Speaker 03 Yeah, you don't. But it is, there are more and more programs now and more certification and licensing programs out there.
30:48 Speaker 03 So if you want to be a doula, my advice is to go that route. You probably just get more work that way.
30:53 Josh Clark? Right, so when you're, when you're starting out, you would go to, if you wanted to get certified, you would go to one of the certifying bodies like DONA or what are, what are the other two that are mentioned in here?
31:04 Speaker 03 There's one called CAPPA.
31:06 Josh Clark? Kappa?
31:07 Speaker 03 Sure.
31:08 Josh Clark? And then the American Pregnancy Association, all three of those certify and train doulas. DONA, from what I could tell, is the oldest, obviously, it was the first one. And it seems to be the most respected, but I would guess if you get your training from any of those three, you're probably doing pretty good. They'll offer online classes, in-person classes, self-paced study. And you typically need to go take a birthing class, a breastfeeding class. Because again, you need to know, like, you need to be current on all the stuff that's going on with labor and delivery, right?
31:46 Speaker 03 Yeah.
31:47 Josh Clark? If you, if you took these classes 10 years ago and then did it again today, you would probably find some real differences and new stuff that's been discovered in the last 10 years. So you would need to be pretty current, even if you've had kids of your own before.
31:59 Speaker 03 Sure.
32:00 Josh Clark? And then you also need to attend at least one, I have the impression that multiple births under the apprenticeship of another doula who's already certified or trained or experienced before you really go off on your own to become certified.
32:17 Speaker 03 Yeah.
32:19 Josh Clark? And that's, I mean, that's just, I would, I would say, how many births have you been a part of, you know, already before I hired a doula? That's a pretty big question if you ask me. So they would want to say, well, I've been, you know, I've assisted in like three or five or however many, but you're going to be my first solo.
32:39 Speaker 03 Your first solo flight?
32:40 Josh Clark? Yep.
32:42 Speaker 03 You will, it depends on where you live on how much you're gonna pay. If you, if you live in a big fancy city like New York City, you're gonna be paying top dollar for your doula. If you live in Los Angeles, you're gonna be paying top dollar for your doula.
32:55 Josh Clark? I saw like thirty-five hundred at least for each of those cities.
32:58 Speaker 03 Yeah, but that, that scale can go all the way down to.
33:02 Josh Clark? Zero.
33:03 Speaker 03 Well, sure, all the way to zero, but if you're paying a doula, that number can go all the way down to six hundred to eight hundred, a thousand dollars in, you know, in, in the flyover states.
33:15 Josh Clark? Right. But again, I mean, like if, if this is the doula's first time on their own, you're probably not gonna be paying top dollar. And if you say, look, I really, really, really want to have a doula at my, at my child's birth, but I really genuinely don't have this money. I actually got a Lyft once from a doula, and she was talking about having to deal with this family who clearly was very well off, but was pleading poverty. And she was like, I'm the one who's a doula and driving a Lyft here, and these guys are trying to like shortchange me.
33:52 Speaker 03 Interesting.
33:52 Josh Clark? So she said, she told them no. She said she tried to work with them, but they wouldn't, they wouldn't budge about whatever they thought her services were worth, so she had to just walk on. But I.
34:05 Speaker 03 Why would a family that's well off not pay eight hundred dollars?
34:08 Josh Clark? I don't know. I don't know, because I remember thinking like, wow, that's, that's all it costs for a doula. She might have even been quoting them less than eight hundred dollars.
34:16 Speaker 03 Jeez.
34:17 Josh Clark? Yeah, so there is definitely like, there seems to be a tension between the desire to have a doula and the, um, the sense of non-obligation to pay a doula a decent wage, which I think is where that pro doula, um, uh, group pulls their hair out.
34:35 Speaker 03 Right.
34:36 Josh Clark? You know?
34:37 Speaker 03 Well, you may get it covered by insurance. There are more and more cases and insurance companies that will let something like this be covered, but it never hurts to ask. This article points out, you can always ask, you can always file a claim and just see if you'll get a little assistance there.
34:55 Josh Clark? Yeah, if you live in Oregon and Minnesota, though, Medicaid will reimburse your full doula expenses for a certified doula, which is pretty awesome. Like, that's huge and groundbreaking that those two states have that.
35:08 Speaker 03 For sure.
35:09 Josh Clark? The reason why they would pay anything for a doula, rather than just being like, just burn some sage or something and, you know, spend five bucks, is because there has been studies about doulas and they have come out quite positive in some pretty good peer reviewed studies and peer reviewed journals, right? Have you seen any of this?
35:32 Speaker 03 Well, yeah, I saw the one, 15,000 people, that's a pretty decent study size. And they said, in this study size, there were some women who had doulas and some women who did not have doulas or any kind of support like that. And then outcomes for women with continuous support were better than those without, meaning their labors were shorter by about 40 minutes on average, their babies had higher APGAR scores, which, APGAR are these tests they give your baby, like, the first thing your kid has to do is take a test.
36:05 Josh Clark? I know.
36:06 Speaker 03 Seconds later, they're giving your kid their first test.
36:09 Josh Clark? Yeah, activity, pulse, grimace, appearance, and respiration.
36:13 Speaker 03 That's right.
36:14 Josh Clark? Yep.
36:15 Speaker 03 And so, higher APGAR scores, fewer negative feelings about childbirth, like, this is the emotional component, they required less pain medication, fewer uses of forceps or vacuum assisted interventions, C-sections. Across the board, doulas helped. And what was really interesting was, there was basically nothing that could point out that said having a doula was a negative in any way.
36:41 Josh Clark? Yeah, and even when they look just at doulas, rather than just all types of continuous support. Just at doulas, the doulas, they held up too. There was less use of pitocin, less C-section, more spontaneous vaginal deliveries, less of a risk of being admitted to a special care nursery. Four times less likely in one study to have a low birth weight child, two times less likely to have complications, and they were significantly more likely to initiate breastfeeding when cared for by a doula, right? So there's all these like demonstrably positive outcomes. And then you hit upon the other thing too, that they, they, they make the harsh hospital environment, there's something called harsh environment theory.
37:25 Speaker 03 Yeah.
37:26 Josh Clark? Where the bright lights and the people you don't know coming in and out and treating you like a piece of meat that they need to get this thing out of. They can actually produce a traumatic experience. I suspect in more women than, than you would think, having birth or giving birth in a hospital is kind of traumatic. And for some women, from what I read, it's like, like deeply traumatic. And that's, that's been a huge reason that doulas have really come into use lately is because they mellow everything out for you a lot more. And there's actually, I read there's a group of renegade doulas who are acting as midwives out in the pot growing country of Northern California.
38:09 Speaker 03 Oh, yeah?
38:10 Josh Clark? Mm-hmm.
38:12 Speaker 03 What's the relationship there to the pot growing?
38:17 Josh Clark? Ah, I would guess they probably do both. They grow the pot and deliver the babies.
38:21 Speaker 03 Nice.
38:22 Josh Clark? I think it's kind of like a whole back to the earth, to hell with the, the man's establishment hospitals. Apparently it's illegal to give birth like this without like a certified, someone from the medical community being there to assist in the delivery.
38:38 Speaker 03 Yeah.
38:39 Josh Clark? They're saying nuts to that, which I would guess is pretty dangerous, but also illegal. And if there's anything that screams Northern California more than dangerous and illegal, I don't know.
38:50 Speaker 03 Yeah.
38:52 Speaker 03 If you want to use a doula, and, and I'm officially endorsing this, I say, don't say don'ta, say doula.
39:01 Speaker 03 Sorry, couldn't resist on that one.
39:03 Josh Clark? It was worth it.
39:04 Speaker 03 You just get online, you know, the doulas are easy to find in your area. Do a little Google searching, get a reference, a personal reference if you can, would be great. Get online, find a friend who has used a doula, they can recommend. I mean, that's really the best way. I don't know if I'd go on Yelp or anything like that, or Angie's List. Although, maybe, who knows? But it's better if a good friend says, "Hey, I use this doula and she's great."
39:33 Josh Clark? I think also the certifying bodies have directories of certified doulas in areas, too.
39:40 Speaker 03 Yeah, I mean, you want it to be a good personality match, too. So you should talk to your doula on the phone at the very least. But ideally, have a little in-person meeting to make sure, like, is this someone I want to, I want to jump into the foxhole with? Because they're going to be around a lot, you know, and you have to have a good personality match there.
39:58 Josh Clark? Well, yeah, and your husband or co-parent needs to like them, too. You don't want weird tension between those two in the delivery room.
40:06 Speaker 03 True.
40:06 Josh Clark? They need to fit into your jam pretty well.
40:09 Speaker 03 Yeah.
40:10 Josh Clark? Or else it's just going to be, especially if you're one of those people who can't stand conflict, that would be awful to have a doula who your husband or co-parent or wife or whoever doesn't like and butts heads with in the delivery room. That would just be bad. And then you have to pay them afterward, that would just be terrible. So, yeah, you want to vet them pretty well ahead of time.
40:31 Speaker 03 Yeah, and while you, while a doula's there, a doula's there to support you. So while they may have their own opinions on what they might do in a given situation, their childbirth philosophy is, your childbirth philosophy as a mom is what matters.
40:49 Josh Clark? Right.
40:50 Speaker 03 You know, so a good doula will get on board with that. Or if they aren't on board with that, then they probably shouldn't be working with you.
40:58 Josh Clark? And, yeah, I could see them being like, "Look, I can recommend a couple of other people who are more in line with what you're looking for than me."
41:04 Speaker 03 Mm-hmm.
41:05 Josh Clark? You know?
41:06 Speaker 03 Yeah.
41:07 Josh Clark? Instead of wrong, wrong, wrong, this is all wrong, this is how we're going to do it.
41:11 Speaker 03 That's right.
41:12 Josh Clark? You got anything else on doulas?
41:14 Speaker 03 Just this little bit on death doulas. We may have covered this in our... Geez, in our dying episode?
41:22 Josh Clark? Yeah, that's what I was thinking.
41:23 Speaker 03 I feel like we've talked about it, but it is a job. If you want to help a family or a person or both through end of life care, there are people you can hire just to do that. And it's not the same as, they can work in concert with hospice care, but it's not like a hospice nurse. It's someone just like a birth doula who is there to really just emotionally kind of coach you through, through the dying process with a family member.
41:50 Josh Clark? And also to very concretely hold your hand, make sure you're comfortable.
41:55 Speaker 03 Yeah.
41:55 Josh Clark? Move you around a little bit, listen to you talk, tell you stories, whatever you're looking for to make the whole thing better.
42:02 Speaker 03 That's right.
42:02 Josh Clark? Pretty, pretty neat.
42:04 Speaker 03 Up with doulas.
42:05 Josh Clark? Yeah, Up with doulas, agreed. If you want to know more about Up with doulas, this new organization that Chuck and I just now founded, you can, I'll just wait a little while, we need to get to work on the website. And in the meantime, let's listen to some listener mail.
42:23 Speaker 03 All right, I'm going to call this flu shot clarification because that's what the subject line says.
42:27 Josh Clark? Okay.
42:28 Speaker 03 Hey, guys, avid listener, wanted to comment on the flu episode. I'm a graduate student and a few months away from completing my degree to becoming a physician's assistant. Well, never mind then, buddy, I don't want to hear it. No, I'm just kidding. I spend a lot of time seeing patients answering questions about things like flu shots and who should receive them. The CDC now recommends that everyone over the age of six months receives a flu shot, even those who are perfectly healthy, even those who are allergic to eggs.
42:58 Josh Clark? They're cuckoo for flu shots.
43:00 Speaker 03 The new flu shots are now being designed to be egg free. So they're egg free, gluten free.
43:09 Speaker 03 What else? Dairy free.
43:10 Josh Clark? They, they contain 10% quinoa.
43:13 Speaker 03 And there's no evidence to suggest flu shots in recent years could cause a reaction in those allergic to eggs. All right, that's interesting. Did not know that. He said the benefits of the flu shots far outweighed the risk, in his opinion.
43:27 Josh Clark? In this guy's opinion?
43:28 Speaker 03 Yeah, and it sounds like it's an informed opinion, at the very least.
43:31 Josh Clark? Sure.
43:33 Speaker 03 So that is from Devin from Philadelphia. Go Eagles!
43:41 Josh Clark? Do you think so, really?
43:42 Speaker 03 No, I mean, why not? They're doing great.
43:44 Josh Clark? Okay. Well, thanks a lot, Devin. I appreciate writing in. That was nice of you. And if you out there want to be like Devin, you can hang out with us on email at [email protected] . And as always, join us at our home on the web, stuffyoushouldknow.com.
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