Doulas: Why Bother?

Jo: “I first met Cathy at a Baby Show. She was calm, friendly and listened to me banging on about how she has the BEST job! When I organised an event with the La Leche League recently, Cathy was one of our stallholders and, again, her warmth and enthusiasm about positive birth experiences made me think she’d be the most brilliant addition to any woman’s labour and delivery.”

So, why bother with a doula?

Over to Cathy…

‘I remember being pregnant with my first and being told the benefits of having another woman with you in labour, such as your mum, but I couldn’t imagine being naked in the same room as my husband and my mum. Half way through labour I wished my mum was there. She was at the birth of my second and I never gave birth again without at least one other woman with me. Now I work as a doula, providing other women with that in labour support.

Woman to woman support in childbirth goes back to the dawn of time. We even get the word ‘gossip’ from it. In Medieval times when a woman went into labour her female family, friends and neighbours would come over and look after her, the house, the children, the husband and the animals, filling the house with chatter. They were called her siblings-in-God, or ‘God-sibs’.

This support was lost with the move to hospital births. In hospitals even dads weren’t permitted to support their woman, due to mistaken beliefs about infection control. Labour wards resembled factory production lines with women in rows of beds, and each midwife caring for several women. Birth became a medical procedure to be managed and endured, rather than a normal life event, or a biological function to be supported. Then, in one of the most over-medicalised experiments, obstetricians in Dublin found that their ‘Active Management of Labour’, where women were on a bed, continually monitored, given hourly vaginal exams and then speeded up if not dilating 1cm an hour, resulted in women’s labours being shorter and with fewer interventions. Naturally this idea quickly spread to the rest of the Western World, only to find that the opposite was happening. What was it, then, about the trial that led to the improved outcomes, when it obviously wasn’t the interventions that had originally been credited? In the trial every woman had a midwife with her throughout. It was the continuous presence of another woman that had led to the improved outcomes and shorter labours.

In the US, antenatal teacher Penny Simkin indeed noted that the clients who had her (or another woman) for labour support, experienced more straightforward births. One couple were researchers at the local university, and Penny suggested this as a research topic. They conducted a large study and again found that with the continuous support of another woman in labour, birth was shorter, less painful, and resulted in fewer interventions. It could be a midwife, a female friend or relative, or someone else. They needed a term for the ‘someone else’ and Penny Simkin used the term ‘doula’, a Greek word meaning ‘hand maiden’ or ‘house servant’. The research showed that the greatest effect was if the birth companion was not employed by the Health Service, and if she had had a positive experience of birth herself.

You should have been told all this. It’s in the national NICE guidelines (National Institute for Health and Clinical Evidence). “Women should be informed that continuous support during labour from women with or without prior training reduces the likelihood of CS.” NICE Guidelines on caesarean section.

So what does a doula do? Well, actually doulas try to do very little, especially in labour, so as not to interfere with your instincts. Our power is in our presence. By being there, calm and positive, we help to set the atmosphere, to ‘guard your space’, so you can labour well. We may move things around, fetch a chair for your partner or another pillow for you. We might rub your back or squeeze your hips, or lead you through a relaxation or guided imagery if that is what you want. Doulas have been known to sit outside the door to stop continual disturbance from medics checking this and that, which allows a couple some uninterrupted time. We do lots of fetching and carrying, for you, for your partner, for the midwife: drinks, food, flannels.

We do not do any of the medical stuff that the midwives do; we don’t do checks or monitoring. We don’t make decisions or talk for you. We might ask a doctor or midwife to repeat your options, or explain them more clearly, if we feel that would help you, or we might give you the opportunity to ask them some more questions or request time to think the options over. We can then go through the options with you. I often say that doulas act like interpreters, not just of words but of what is going on generally.   As a woman in labour, you are likely to be less aware of what’s going on around you, whereas your partner might notice the midwives talking in the corner or not pick up or understand something that the midwife has said quietly, perhaps after listening into the baby’s heartbeat. I have been able to reassure or explain so partners don’t worry unnecessarily.

Doulas are great for dads. We look after them too. And keep them company during the long wait for birth to happen. If it’s really long we can tag team and take it in turns to get some kip. I bring extra food and snacks in case they have forgotten theirs in the rush. One of my recent clients said his male boss was the one that suggested they got a doula. When men are recommending doulas to other men then you know they must find it good. Another client said this

“At first I was sceptical about having a Doula. I didn’t know what she’d do, I didn’t think it would be worth the money and I was worried I would be pushed out of the birth experience. In reality I found it very reassuring to meet with someone who has attended many births especially as we had a home birth after c section which is unusual. During the birth Catherine reassured us that everything was going as it should which was great and something that had been totally lacking from our previous experience. I didn’t feel pushed out at all. The whole experience this time was so much better than our first birth and Cathy was a large part of that. Definitely worth the money.”

Who has a doula? Often people assume that doulas only do home births, which just isn’t so. I’ve supported couples having planned caesareans, planned hospital births, birth in midwife led units, as well as those planning home births. Many of my clients have had a previous caesarean or difficult birth and they are looking for a more positive experience, and to avoid some of the pitfalls they had last time. I also have clients who are looking to give birth outside of hospital guidelines, such as a home birth with twins, older women or those with high BMI.

I also take care of first timers who have done a little research which quickly brings up the benefits of having a doula. Having a straightforward birth first time makes everything easier. Life with a newborn is easier, and so is the next birth. You don’t have the added stress and worry of being ‘high risk’ due to what happened with your first birth. With your first birth, having a doula can just help you and your birth partner relax. You have someone else with you who has been there; someone you know and trust; someone to reassure you that this is normal, you really are in labour; to calm your nerves; to help carry the bags; to help settle you into your birthing space; to make sure your wishes are heard; to help you cope with contractions; to support your partner; to help get breastfeeding going; and to nurture you both as you become parents.

Doulas do cost money. But many will accept payment plans or part payment in kind, and there is an Access Fund via Doula UK. Doulas can’t really do more than one or two births a month, and they are limited in other work they can do as they are on call. So in order to be able to feed their family they need to charge you. You are paying for their time, antenatally and on labour day, but much more than that you are paying for a personal service. For their dedication and care. For their experience and their personality. For their training and their skills. For being on call 24/7 for potentially four or more weeks. For the family arrangements. But above all, you are paying for difference it will make to your birth. Not all the births I have attended have been straightforward but I have helped women to avoid interventions, by helping them have more time, or have a voice, and I have helped women to feel positive and calm even when things weren’t going to plan… women have told me they think they would have ended up with a caesarean if I hadn’t been there. You are also paying for the company of someone who brings the focus away from the medical, back to the joyous addition you are making to your family.

One woman, working hard pushing her first baby out, in the pool on hands and knees, during a very intense and fast labour, looked up at her partner and said, “This is so great. I love it.” He replied “Really? Is it joyful?” “Yes” she said. (‘Joyful’ was the word they wanted to describe their birth.) Another, who had been in labour for three days, transferred from planned home birth at 8cm because of meconium, and was being continually monitored (but still upright), said, during the strong pushing stage, “This is the most empowering experience of my life”.

“If a doula were a drug, it would be unethical not to use it.” John H Kennell, a US paediatrician.’

Cathy, writing for The Mother Side xx

Cathy is a doula and antenatal teacher based in Bedfordshire. She runs antenatal and postnatal workshops, and relaxation retreats. Do find her on social media and tell her your stories, or ask her questions. In fact, you can ask her questions on the Tales From the Mother Side Facebook page, or in the comments section below.

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