People ask pregnant women a lot of questions. What names are you considering? When are you due? Do you know if it's a boy or a girl? Are you planning a natural childbirth, or do you want an epidural for the pain?
That last question hints at the controversy that surrounds childbirth in the United States. There are two major schools of thought about childbirth in this country. One camp, which includes the American Medical Association and the American Congress of Obstetricians and Gynecologists, holds that the best place for a woman to give birth is in a hospital with a doctor present. The other camp believes that women gave birth for centuries without hospitals or doctors, and that childbirth shouldn't be considered a medical procedure but rather a process controlled by the woman herself, with the assistance of a midwife or a doula. Midwives oversee the medical parts of the birth, including the actual delivery, while doulas provide constant emotional and physical support and comfort to the mom-to-be.
For centuries, all births were attended by midwives and doulas, women who had learned their trade through decades of experience or through apprenticeships. In Europe, midwives and doulas still assist in the majority of births. In the U.S., however, midwives and doulas lost their status at the end of the 1800s, when doctors took over the job of childbirth. With knowledge about hygiene and the latest medical procedures, doctors had a better success rate of a childbirth that kept both mom and baby alive than the midwives did -- and they took to the press to make sure the country knew that. Medical interventions such as aesthesia, cesarean sections and episiotomies became commonplace.
But in recent decades, women have been embracing more natural ways to give birth. These women were influenced by second-wave feminists, who urged women to take control of their bodies, as well as books such as "Spiritual Midwifery" by Ina May Gaskin. "Spiritual Midwifery" was a widely read work that explained that birth would be better without a doctor or an epidural; by giving birth naturally, women were simply doing what their bodies had been made to do.
As a result, women began forgoing medication, giving birth at home and employing the services of midwives and doulas rather than shopping around for an obstetrician. So what exactly do midwives and doulas do? What's the difference between them? And why are they still so controversial?