The Doula Difference: mothering the mother during pregnancy, birth and beyond

- Himalee Rupesinghe

Written for the Sunbury & Shepperton NCT Autumn 2009 edition of 'Smalltalk'

So you may have heard or read about this special kind of birth professional and the benefits of hiring one. But what does a doula do exactly?

A doula (pronounced doolah, from the Greek word meaning woman servant or caregiver) is certainly not a new concept, women have been supported and cared for by women during pregnancy, birth and beyond for thousands of years. Asides that is, from a comparatively small period in time when the current medical model has challenged the usual female world of giving birth. The modern doula is a woman, trained and experienced in childbirth and provides emotional, physical and informational support to a mother and her partner, before, during and after the birth of their baby. Doulas are now more in demand than ever by women of all backgrounds, ages and means.

A growing body of research (1) shows that the use of a doula has clear benefits for families during childbirth and postnatally, with no known risks. Eleven studies showed the following effects of doula support on birth outcomes:

·         50% decrease in caesarean section

·         25% decrease in length of labour

·         30% decrease in assisted delivery (use of forceps)

·         40% decrease in the use of synthetic oxytocin to augment labour

·         60% decrease in epidural use

·         30% decrease in the use of narcotic pain medication

In addition, mothers who use a doula during labour have been found to be more likely than women who did not use a doula to:

·         Breastfeed exclusively and for longer

·         Respond sensitively to their infants

·         View their relationship with their partner to be better after the birth

·         Have a positive image of their babies

·         Feel closer and well-bonded to their babies

·         Have confidence in their ability to mother (2)

How a doula supports you is really dependent on you and your individual circumstances. You may be pregnant with your first baby and feel you would like someone experienced to be by your side, or you may have had a caesarean birth and feel this time you really would like to try for a natural birth. Or perhaps your husband or partner needs to care for your other children, or works away from home during the week and you want the reassurance that someone will definitely be there for you – day or night.  A doula provides you with one-to-one knowledge and experience of the birthing process with continuity of care from someone you know and trust, and most importantly someone you have chosen yourself.

There are two types of doula, a birth doula and a postnatal doula. A birth doula will usually visit you at home, or any place convenient for an initial meeting.  Your doula needs to be someone you can see yourself spending time with, so you need to make sure she is someone you and your partner both like and feel at home with.  Most doulas provide this initial meeting for free, and they may also know other local doulas you can meet with. Finding the right doula is really important and ideally you should speak to or meet with at least two or three doulas so you can be sure they are the right match for you.   

A good time to start looking for a doula is between your 5th and 7th month of pregnancy, though hiring a doula even a few weeks before you are due is still a possibility and will be of benefit.  Doulas can be booked months in advance, so it’s always better to book earlier rather than leaving it too late. From the time you hire your birth doula, she will available by e-mail or phone for any questions you have on pregnancy, labour and birth, or just want to talk to someone about something you have heard and concerns you.

Your doula will meet with you and your partner again usually at least twice, where she will get to know your thoughts on birth and how you see things going. A doula can provide you with unbiased information on pain relief options, Vitamin K, 3rd stage preferences and will usually have good knowledge on the protocols of your local hospitals. She will also know of support networks in the area such as breastfeeding clinics, or local complementary therapists. She will discuss your hopes, plans, expectations, any anxieties, techniques you may be interested in for managing labour, and will help write your birth plan. Your doula can be your best advocate on the day by getting to know you and your partner long before labour even starts.

From 2 weeks before your due date until 2 weeks after, your doula will be on standby for you and will be in regular contact and will join you as soon as you feel you may be in labour and need her support. Your doula will remain by your side throughout your labour, however long or short, and until your baby is born and regardless of whether you have your baby at home, in hospital or a birthing centre.  Besides helping you manage labour, she will often provide practical support like helping your partner with the birthing pool and making sure the midwives are fed and watered if a homebirth, or making sure you have all you need for a hospital birth. Your doula will also make sure that everyone remembers your hopes for the birth, by being your advocate if necessary and making sure your birth wishes are noted. For example that you want skin to skin with your baby as soon as baby is born. She will stay with you for a few hours following the birth, to help with early breastfeeding, and will ensure both you and your partner are comfortable before leaving you with your new family. Most birth doulas offer at least one postnatal visit where they will visit you at home to reflect on how you feel your birthing experience was, as well as help with any questions you may have on breastfeeding and all things related to newborns.

It’s important to note that a birth doula does not replace your husband or partner. In fact a doula supports both you and your partner and allows your partner to be there as the father, rather than take on a variety of roles that a single birth partner would have to. Most fathers, however hesitant before the birth are often quite vocal on how much the presence of the doula helped them enjoy the experience. A woman in labour needs as much support and nurturing as possible, and having both your partner and a doula forms a complementary team, with each bringing unique skills to the labour and birth.

Hiring a doula does not automatically guarantee you the perfect, natural birth and remember birth is not an exact science, but a natural, physiological process that involves both you and your baby, and things can change at any point along the way. The doula's role is to provide you and your partner with ongoing emotional, physical and informational support so you can make the right decisions for you, leading to a safer and empowering experience regardless of the method of birth.  Even women who have chosen to have medical intervention or a caesarean birth value the additional support and reassuring presence of another experienced woman who knows them and their wishes. A doula will never judge or try to convey her own beliefs on to your labour and birth, she is there to support and facilitate your experience as you define it. And women choosing a VBAC (vaginal birth after caesarean) often find the support of a doula invaluable, as do couples planning a homebirth.

So why hire a doula when you will have a midwife present?  A midwife performs actual medical care and delivery of your baby.  A doula is there to support the mother and meet her needs and provides constant reassurance and 'mothering of the mother'. This is largely emotional support but can include massage, the use of aromatherapy oils or homeopathy, as well as physical support to keep your labour progressing well.  It is not the role of the doula to offer you medical advice or carry out medical procedures or in any way replace your primary caregivers.  They can however provide an atmosphere of trust and continuity when your midwives may have to go through a change of shifts, or perhaps tend to a few women in labour. Your doula can help your partner communicate with the medical team, leaving you to labour in peace and without distraction. A doula can help protect the overall birthing environment, helping you to keep those oxytocin levels nice and high!

A postnatal doula may be your birth doula, or you can hire a postnatal doula just to support you in the weeks following the birth of your baby. Again the role of your postnatal doula really will be dependent on your own situation and the kind of support you would like.  Postnatal doulas work flexible hours to suit the family, offering practical and emotional support to the new mother and father in the home following the birth of their baby. In many cultures women are confined to bed and rest for a period of up to 40 days. This may be impossible in our society but with the help of a postnatal doula, a mother can enjoy some of the benefits of a prolonged "lying in" period. This will help her bond with her baby and spend extra time with any older siblings. A postnatal doula’s role is about empowering a family to take care of itself, by helping around the house, with older siblings, and supporting the new mother both emotionally and practically, or caring for her newborn baby while she gets some well earned rest.

Research (3) has shown that 88% of women who hired a postnatal doula were still breastfeeding at 6 weeks and 67% were still breastfeeding at 6 months. This compares with 48% at 6 weeks and 25% at 6 months according to the Infant Feeding Survey of 2005 (Bolling et al 2007). Women with postnatal doula support are less likely to suffer from postnatal depression (4), especially important nowadays when family and friends may not live close by to support you in the transition to motherhood. A postnatal doula can visit you for 3 hours every day or a few days a week, or even up to 8 hours a day for as long as you feel you would like her support.

So how do doulas charge for their time and experience...Birth doulas recognised by Doula UK, the non profit association of Doulas in the UK, generally charge between £500 to £900 for the full birth service, dependent on experience and where you live and up to £20 an hour for postnatal doula support. Trainee doulas working towards fully recognised status charge no more than £200 for the full birth service, and a maximum of £10 an hour plus expenses for post natal doula support. Hiring a doula who is a member of Doula UK ensures you they have attended a recognised doula course, and abide by a code of conduct. Most doulas are fully insured.

So, ready to look for your doula? The best way is to first ask friends, family and colleagues if they can recommend someone. Alternatively the Doula UK website www.doula.org.uk has a handy ‘find a doula’ service where you can search for both recognised and trainee doulas in your local area.

The unwavering, reassuring presence of a doula goes back to when women were helped and supported by women they knew and trusted. It is unfortunate that midwives these days are often unable to provide the kind of support that they would like as they just do not have the time. A doula aims to build that trust and confidence in your body, to allow you to have a safe and supported experience, regardless of where you choose to have your baby - at hospital, a birthing centre, or at home - and how any previous birth experiences may have been. Allowing you to have an empowered and satisfying experience when welcoming your new baby to the world...just ask anyone who has hired a doula to tell you about the doula difference!

 

(1)    Mothering the Mother by Klaus, Kennell and Klaus, 1993

(2)     Klaus, Kennel & Klaus, The Doula Book, 2nd Edition

(3)    Goedkoop V. MIDIRS Midwifery Digest, vol 19

(4)    The obstetrical and postpartum benefits of continuous support during childbirth. Scott KD, Klaus PH, Klaus MH