Duchess Meghan Markle has given birth to a baby, amid criticism from across the globe. That’s not unusual—as everything from her nail polish color and cradling of her baby bump to relationships with her royal in-laws has been scrutinized and pilloried.
But this time, a British doctor mocked her choice to hire a doula—a choice that has been rumored, but not confirmed. He did it at the annual conference of American College of Obstetrics and Gynecology (ACOG) in Nashville, and to a seemingly approving crowd. And that’s a problem, suggesting that disrespecting pregnant women is rampant in the profession and that some physicians themselves need a crash course in birth choice and what doulas actually do.
According to the Daily Mail, Dr. Timothy Draycott, a professor and envoy of the Royal College of Gynaecology, said, “Meghan Markle has decided she’s going to have a doula and a willow tree … Let’s see how that goes.” He continued, “‘She’s 37, first birth … I don’t know.”
Various media reported that Markle planned to birth at home, in Frogmore Cottage with midwives and a doula, though, according to unconfirmed reports, she delivered in a hospital in a posh special suite. Rumors that she wanted a home birth were greeted by a chorus of health-care providers pronouncing it a dangerous choice, particularly for a woman of 37, an age that is often considered “geriatric” in pregnancy years. And like many women, Markle was mocked for the rumored suggestion that she would like to deliver without an epidural.
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We can only guess at Draycott’s associations of doulas with willow trees—presumably, it was a bad joke that cast doulas as somehow connected to nature or “New Age” practices. Whatever he meant, it showed he’s unclear and contemptuous about the purpose of a doula or the reasons some people eschew medical management of their births.
One important point of clarity is that doulas (who are not medical professionals) do not deliver babies. Birthing parents do that. Medical providers, perhaps midwives in this case, assist with this process and ensure the safety of mother and baby, regardless of birth place. I have a great deal of respect for medical providers. As a doula, I’m aware that my training pales in comparison to years of medical school, and the average OB-GYN may deliver as many babies in a couple of days as I attend in a month.
But I understand the importance of doulas. Our purpose is to be by a family’s side for the duration of labor and birth, reducing the fear that many parents feel and providing information. Doulas do not determine a client’s birth plan, and many are just as comfortable with medical intervention as holistic techniques. And midwives do not exclusively attend to home births. Fully qualified health professionals who can manage labor and delivery if surgery is not needed, they often practice in hospitals as well.
So it’s unwise and ill-informed to assume Markle was making unsafe decisions for her pregnancy, if she chose a doula, a midwife-assisted birth, or opted for less pain management. And she’s not the only one making such choices in the United Kingdom, with an estimated 5,000 mothers per year choosing doulas, according to Doula UK, a nonprofit association of doulas in the UK.
Draycott would do well to take a page from doulas, who work to educate and empower people about their birth options. He should consider the true value of a birth plan—which might include searching for a doula or hiring a midwife—often is in the process: Here’s an expectant family or person being intentional and thoughtful about how their child will enter this world and how they will navigate this major life change.
By taking an active role in the process, Markle was combating what can frequently be a disempowering experience. Her desire for a doula may have been borne purely out of fear. But regardless of why, having an extra person to provide reassurance and support could only benefit her and her family no matter the eventual place of birth or medical outcomes. Many doula clients feel that by having an additional set of eyes and ears in the room, they are in fact safer.
Furthermore, choosing a home birth or an unmedicated one is not out of step with Markle’s adopted country’s norms. In fact, 2014 guidelines from the National Institute for Health and Care Excellence (NICE) recommend midwifery care for low-risk first-time mothers. And rather than dangerous and fringe, an unmedicated birth is recommended as the norm by NICE, a regulatory body in Britain.
Rather than make assumptions that a 37-year-old woman cannot have a low-risk pregnancy or safely consider a home birth, let’s remember that the Duchess’ providers—midwives or obstetricians—are the only ones who should determine if she is low-risk.
And Markle herself.
As a new mother in her 30s, Meghan Markle, Duchess of Sussex, is a grown woman. She has every right to arrange her own health care, and that of her child, without commentary from providers who’ve never met her. None of us needs to speculate on the state of this woman’s body, as if we knew her cervical dilation and gestational diabetes status from across the pond or across the street.
Rather than paternalistically laughing about birth plans, ACOG members should concern themselves with the growing sense among many health-care workers and families that many OB-GYNS are out of step with patients’ needs. The time spent laughing would be better spent finding out why people are making choices that make doctors uncomfortable.
The desire to have support beyond that of an obstetrician, natural (often meaning unmedicated) birth, home birth, and doula services is happening not out of some flight of fancy. People are turning away from systems in which they do not feel safe, heard, or respected.
The OB-GYN derision alleged by the Daily Mail is part of the problem and lends credence to some of these fears.
Lest we forget, Markle is a Black American woman. In this country, Black women are two to three times more likely to die in childbirth, and Markle’s former Hollywood colleagues are evidence that wealth and education do not diminish these frightening numbers. Serena Williams, Beyoncé, and others not in the spotlight have recently faced challenging childbirth or near-death experiences.
By moving to England, Markle entered a system with equally stark health disparities. Black women in the United Kingdom are five times more likely to die in childbirth than white women.
As a Black doula who primarily serves Black women and other women of color, I can imagine that she may have been aware of these statistics and felt concerned. Perhaps Markle wanted an environment where her desires and her bodily autonomy would be respected. This can be hard to come by, as studies show that the pain of both women and Black patients is often dismissed.
Some of my Black or brown clients are in mixed-race marriages. While having white husbands does not save them from fear and disrespect by the medical system, clients routinely share that their prenatal appointments are different if their white partners are present. One can imagine that, even without fame, the same might be true for Markle.
As such, who could blame Markle for wanting someone to coach her and her family through a process as humbling as childbirth, and being choosy about the medical team that was attending her childbirth?
How tragic that the media and obstetricians’ responses to her rumored choices prove that she was wise to be hesitant about accepting the default of a hospital birth.