Are Doulas a Form of Complementary and Alternative Medicine?

Last week we discussed medical pluralism and complementary and alternative medicine (CAM) in an anthropology course. CAM is hard to define, but basically brings to mind chiropractors, acupuncture, massage therapy, homepathy, Reiki, dietary supplements, yoga, meditation, traditional chinese medicine, etc. The 2007 National Health Interview survey found that approximately 38% of adults use CAM. Alternative medicine is used instead of conventional medicine, while Complementary medicine (or therapies, treatments, etc) are used in conjunction with conventional (bio) medicine.

Kaptchuck (2001) writes “any therapy deemed unacceptable by the mainstream can find a receptive home in CAM,” all that is required is that they can be described as alternative (202).  Harvey (2011) builds on this point, also emphasizing that “it gathers or is granted meaning from what it is not (Western) as if having no meaning-making, capabilities or significance of its own” (48).

As we were discussing CAM, one of my classmates asked me to talk about being a doula. When asked, I was a little bit thrown off. Is a doula really a CAM practitioner? Doulas are non-medical. I don't consider myself "medical" but could certainly fit into a form of "therapy," as I provide psychosocial support. After all, is yoga and massage medical? They're definitely therapeutic. And am I "alternative" or am I "complementary"? Well, no one really uses a doula INSTEAD of biomedicine, generally in addition to it, so perhaps doulas are complementary.

So, I agreed to speak about these thoughts I was having about being a doula and perhaps being complementary medicine. It's true that many people who hire doulas do so because they feel they haven't received appropriate care from biomedicine/conventional medicine. Often, CAM is sought because biomedicine is not meeting some health need. Alternative therapies attempt to “address what orthodox biomedicine seems both unable and unwilling to address” (Nairandas 2011:69). Also true is the fact that people who hire doulas also tend to be into massage, yoga, acupuncture, chiropracty, and other forms of CAM.

I struggled with this topic, though, because I had never considered myself a CAM practitioner before. This was what my professor found the most interesting. Perhaps I hadn't thought of myself that way because I do get hired mainly by people who, even if they desire a natural birth, are still birthing in the hospital and are not the hippie crunchy granola new age people one associates with users of CAM.

I think after considering this for a while I have come to the conclusion that yes, a doula is a form of complementary medicine. It is a form of mind-body therapy. Like acupuncture, for example, it doulas are seeking legitimacy by proving their worth and efficacy through randomized control trials. Further, doulas can on occasion be paid by health insurance, also a fight that CAM undergoes.

The only place I could find a clue about doulas as CAM was at this Integrative Medicine blog where the blogger mentions doulas and health insurance.

To many, it might seem obvious that doulas are CAM, especially if they've never heard of them. But to me, because I work in biomedical settings, it seems hard to separate what I do from conventional medicine. Perhaps a midwife and/or doula at a home birth seems more alternative.


What do you think? Is a doula a complementary and alternative health practitioner?



Our CAM and medical pluralism readings:

Baer, H. A., C. Beale, R. Canaway, and G. Connolly 2012 A Dialogue between Naturopathy and Critical Medical Anthropology: What Constitutes Holistic Health? Medical Anthropology Quarterly 26(2): 241–256.
Baer, H. A. 2002 The Growing Interest of Biomedicine in Complementary and Alternative Medicine: A Critical Perspective. Medical Anthropology Quarterly 16(4): 403-405.
Harvey, T. S. 2011 Maya Mobile Medicine in Guatemala: The “Other” Public Health. Medical Anthropology Quarterly, 25: 47– 69.
Kaptchuk, T. J. and D. M. Eisenberg 2001a Varieties of Healing. 1: Medical Pluralism in the United States. Ann Intern Med 135(3): 189-195.
Kaptchuk, T. J. and D. M. Eisenberg 2001b Varieties of Healing. 2: A Taxonomy of Unconventional Healing Practices. Annals Of Internal Medicine 135(3): 196-204
Micozzi, M. S. 2002 Culture, Anthropology, and the Return of "Complementary Medicine". Medical Anthropology Quarterly 16(4): 398-403.
Thompson, J. J. and M. Nichter 2012 Complementary & Alternative Medicine in the US Health Insurance Reform Debate: An Anthropological Assessment is Warranted. Topic paper prepared for the SMA 'Take A Stand' Initiative on Health Insurance Reform.
Barnes, L. L. 2005 American Acupuncture and Efficacy: Meanings and Their Points of Insertion. Medical Anthropology Quarterly, 19: 239–266.
Green, G., H. Bradby, A. Chan, M. Lee 2006 “We are Not Completely Westernised”: Dual Medical Systems and Pathways to Health Care among Chinese Migrant Women in England. Social Science & Medicine 62(6): 1498-1509.
Kaptchuk, T. J. 2011 Placebo Studies and Ritual Theory: A Comparative Analysis of Navajo, Acupuncture and Biomedical Healing." Philosophical Transactions of the Royal Society B: Biological Sciences 366(1572): 1849-1858.
Langwick, S. 2010 From Non-Aligned Medicines to Market-Based Herbals: China's Relationship to the Shifting Politics of
Traditional Medicine in Tanzania. Medical Anthropology 29(1): 15-43.
Naraindas, H. 2011 Of Relics, Body Parts and Laser Beams: The German Heilpraktiker and his Ayurvedic Spa. Anthropology & Medicine 18(1):67-86.
Thompson, JJ, and M Nichter 2007 The Compliance Paradox: What We Need to Know About "Real World" Dietary Supplement Use in the United States. Alt Ther Health Med 13(2):48-55.
Yuehong Zhang, E. 2007 Switching between Traditional Chinese Medicine and Viagra: Cosmopolitanism and Medical Pluralism Today. Medical Anthropology 26(1):53-96.