Opinion: I was a doula before I was an OB-GYN. I wish the two professions understood each other more

I was standing in an operating room waiting impatiently for the abdominal prep to dry before an urgent cesarean delivery following a failed trial of labor after cesarean. The room was filled the quiet urgency that comes just before incision. The scrub tech was counting instruments. Anesthesia was checking the epidural level. In the corner, the NICU team was prepping the warmer. Everyone was focused on the same thing: getting the baby out safely. No one was talking about the patient’s birth plan anymore. A few years earlier, I probably would have been. Before medical school I worked as a doula. If I had been standing in that room then, my attention would have been on the patient whose labor had taken a turn she never wanted. The birth plan that had unraveled, the grief that can come with a delivery that looks nothing like the one someone imagined. Standing there as an OB-GYN resident, my thoughts were somewhere entirely different. I was thinking about how fast we could deliver. I was mentally preparing for hemorrhage, running through how I would manage a uterine rupture if that is what we found. It wasn’t that I cared less about the patient’s experience. It was that I had come to understand the urgency underneath it. Neither version of me was wrong. We were simply seeing two different births. That realization has followed me throughout residency. Whenever people learn that I used to be a doula, the reaction is almost always the same: “Really?” Sometimes it’s curiosity. Sometimes it’s surprise or excitement. Occasionally it’s followed by: “So … what changed?” As a doula, I spent a lot of time helping patients navigate a system they did not fully trust. Sitting beside laboring women, I translated medical jargon, encouraged questions, and reminded them that their voices mattered. I also carried assumptions about physicians: that they moved too quickly toward intervention. I worried that busy labor units left too little room to see patients as individuals. Then I became an OB-GYN resident and discovered how often obstetricians feel powerless. I watched reassuring fetal heart tracings turn into emergencies within minutes. I have watched severe hemorrhages develop after uncomplicated deliveries. I have watched healthy pregnancies become high-risk in the span of a few hours. The longer I practice, the more I think many conflicts in maternity care come from a simple misunderstanding: Patients, doulas, and physicians are often responding to different versions of the same birth. A doula may see a frightened patient who feels unheard. A physician may see subtle signs that a mother or baby is becoming increasingly unstable. Both may be right. One of the most useful lessons I carried from doula work had nothing to do with labor management. It was learning that patients remember how they were treated long after they forget the details of a labor curve. They remember whether someone explained what was happening. Whether they felt respected. Whether anyone stopped long enough to ask if they were OK. I still pull up a chair before I start to counsel a patient, a habit from doula work. Sitting down changes the tone of the room. There is no longer a rush. It becomes a conversation, instead of a physician issuing instructions. I also learned something else I didn’t understand as a doula. I used to be frustrated by how often physicians returned to fetal heart monitoring. Even when a patient was exhausted and grieving the birth she had hoped for, it felt like everyone was watching the monitor and no one watching the woman. Now I understand it differently: Fetal heart monitoring is imperfect, but when a baby is still inside the uterus, it is often one of the only clues we have about how that baby is tolerating labor. What once felt like fixation now feels like responsibility. That doesn’t mean the patient’s experience matters less. If anything, residency has convinced me communication matters even more than I realized as a doula. A patient who feels unheard becomes less able to process even the best medical advice. Communication is not separate from good obstetric care. It is often what makes good obstetric care possible. My attendings have picked up on my approach. When a patient has been pushing for hours, or a hard conversation is ahead, they send me into the room first. One night, the outgoing team warned me about a difficult dynamic with a patient’s doula. She was a fierce advocate, but nearly every interaction with the team had become adversarial — about consent, IV access, even the lighting in the room. By the time I came on service, the team felt they were constantly defending their recommendations, and the doula felt she constantly had to defend her patient. The patient was a Black woman, and I understood exactly where the doula’s vigilance came from. Too many Black women leave childbirth feeling unheard, and many doulas walk into labor rooms believing that vigilance is what keeps their patients safe. Their room was my first stop. I introduced myself and told them, before anything else, that I’d been a doula myself. I could feel the tension in the room soften. “I want us to be on the same team,” I told them. “Keep advocating for your patient. I also need you to trust that our team is trying to keep both mom and baby safe. My goal isn’t just a healthy outcome; it’s a positive birth experience, whether that ends in a vaginal delivery or a cesarean.” The rest of the labor felt different. The doula continued to advocate, and I continued to manage the medicine. We didn’t agree on everything, but we trusted each other’s intentions. The patient had an uncomplicated vaginal delivery. That night taught me the same lesson as the operating room where this story began. Years earlier, I would have stood beside a patient grieving the birth she thought she would have. That day, I stood at the operating table thinking about hemorrhage, fetal status, and getting a baby safely through delivery. Neither version of me was wrong. The doula in me understood the disappointment. The physician in me understood the urgency. It took becoming both to understand why every patient deserves both. Debra Eluobaju, M.D., M.P.H., is a maternal-fetal medicine fellow at Weill Cornell Medicine whose work focuses on maternal health equity, global health, and strengthening health systems to improve both maternal outcomes and the experience of childbirth.