Why a Doula?

I've mentioned my doula, Marika, and my backup doula, Bryoni, in several of my pregnancy update posts (which I post every week on a Monday if you'd like to follow the remainder of my pregnancy journey). I thought I'd dedicate a post to them today, mainly to explain why Boyfriend and I have chosen to work with a doula (or two) to prepare for Baby's arrival, to cover what a doula is and what she does and to signpost to some more information for anyone who needs it.
To me, a doula's work is so so important, I put them "up there" with midwives, in terms of the amazing improvement in birth outcomes that they can bring to a family, and I just wish that there were more doulas, so that this help could be made available to everyone.
 I feel strongly, for example, that we ought to have a system in place whereby caregivers such as midwives and obstetricians could recognise families who'd benefit especially from the services of a doula (women who'd experienced past birth trauma, couples planning a VBAC - vaginal birth after caesarean, couples planning homebirths, and also those suffering from social isolation, for example) so that this service could be provided for them. Yes it would be an expense to the NHS to provide doulas to families on a criteria based method of means testing, but when you consider the alteration in birth outcomes (fewer emergency sections, less pain medication, fewer incidences of assisted delivery and reduced rates of pre and post natal depression, with fewer babies requiring urgent treatment after birth) - I'm pretty confident that there would actually be a saving to be made.
So what is a doula, and why do I think they're so great?
The word doula comes from the Greek meaning "woman servant", and even in modern practice, this is still a pretty accurate description. We tend to think of servants as being repressed and poorly treated people, but most of us serve others in some capacity, either in our professional or personal lives. A doula is, quite simply, a woman whose role it is to serve a family in the most appropriate way during pregnancy and childbirth. Exactly what a doula does to fulfil this role, will vary from one family to the next. What help a single pregnant woman in an unfamiliar country requires, will differ wildly from the needs of a couple in their forties, expecting their first child after years of failed fertility treatments and multiple miscarriages, for example - and yet both of these pregnancies and births could benefit from the use of a doula.
We chose to look in to "hiring" a doula, because our homebirth plans presented several problems for which we needed to find a solution, and the solution was pretty simple to each of these concerns - we needed at least one extra pair of hands.
Here are some of the things we realised we would struggle with:
  • there is a possibility that five year old Seb will be present for the birth, but whose role will it be to comfort him and explain things to him, to make sure he has something to eat, drink, or play? If it gets late, who will help him to bed, and if the Sun rises, who will greet him in the morning? Of course Boyfriend would fulfil some of these roles where necessary, but it wouldn't get around the fact that he would be involved in the birth of his own child, and I'm going to need him, but I'll eventually become unable to attend to Seb's immediate needs.
  • Boyfriend is going to be in the birth pool with me (in theory) to best be able to support me and delivery our baby. This leaves a vacant position however for: someone to refill my drinks, someone to get Boyfriend a drink, someone to adjust the lighting, someone to change the tracks on the CD player, someone to answer the door to the midwives - the list goes on and on. Boyfriend would find himself constantly jumping in and out of the water!
As I see it, because we are planning our homebirth, my home basically becomes the labour ward. The problem is, I need to be able to run the labour ward, and be one half of the labouring couple - and that isn't going to work. I see hiring a doula as employing a ward manager, so that I can get on with being the birthing Mother!
This last week I set out a timeline of how I wanted my ideal homebirth to run. Each of the roles present (Me, Boyfriend, Doula, Midwife) has their "jobs" set out on the timeline in the order that they should happen, roughly, by means of colour coding. The doula probably has around three times as many "jobs" as anyone on that timeline, midwives included.
Here are just some of the responsibilities of my doulas on the timeline (if either of them are reading this it shouldn't come as too much of a surprise!)
  • Sort out Seb whether that's assist with handover to whoever is going to be looking after him, or setting him up for the duration and making sure he's happy - this could include on going childcare for the entirety of my labour and birth depending on the time of day! If I go to hospital, a doula will also stay at home with Seb.
  • Be in charge of the CD player. I'll be using both the Labour Companion and Birth Music CD's by Maggie Howell from Natal Hypnotherapy during labour and birth, and there are different tracks to be played at different stages or intervals, that the doulas need to be familiar with.
  • Keep an eye on the pool. Boyfriend will get the pool started whilst we wait for the doula to arrive, but by the time they get here, he's likely to be busy supporting me, so the doulas will finish off filling the pool, making sure the water is the right temperature etc.
  • Refreshments To ensure that Boyfriend is able to concentrate entirely on me, it will be down to the doulas to make sure everyone has a drink and snacks when needed, including making tea for the midwives and filling me up on coconut water!
  • Call the Midwife! I've asked that we hold off calling midwives until my labour is established and I'm in the pool. Boyfriend will be with me, so it'll be down to the doula to put in the call to the hospital.
  • Answer the door. When the midwife arrives, the doula will be on hand to let him/her in, show them where everything is, and make sure they have refreshments, as well as to go through the key points of my birth plan with them.
  • Lighting. Lighting plays a huge part in creating the ideal birthing environment (how many other animals would seek out bright fluorescent light under which to give birth?) so the doula will be in charge of adjusting the lighting as appropriate or as requested.
  • Breastfeeding support. Doulas trained by Doula UK receive training in helping women to breastfeed after birth. As I didn't breastfeed Seb, but am planning to breastfeed this baby, I'll be glad of their dedicated support.
  • Help with the tidy up. Once Baby arrives, the flat will need to be turned back in to the flat, the pool will need draining, protective covering will need rolling up and disposing off, there'll be washing up to do... thanks to our doula(s), Boyfriend and I will be able to snuggle up with our new baby whilst this is done (the midwives will take anything that needs to be taken)
Doulas also provide help after a baby is born, not just with breastfeeding, but as is seen appropriate. This might be visiting the Mother and looking after the baby whilst she has a shower and a rest, or providing advice on baby care in the early days. It can be as simple as coming over for a cup of tea and being an understanding ear in the midst of sleep deprivation, or helping a woman access help and support for postnatal depression.
The antenatal support that I've had from my doulas has been great. For the most part, I've just wanged on at them about what I want from my birth, how it differs from what I experienced when I had Seb, how and why I've come to the decisions I have, and so on and so forth. They helped me to put together my birth plan by bringing certain options to my attention, and bought a flipchart, marker pens, and even a pile of old magazines, to allow me to get creative with planning Baby's birth. What's more, they've taken time to get to know Seb, and Boyfriend, so that they can best provide for and support them both as well, which will make a huge difference when we get to the main event. They've researched local breastfeeding support groups in the area for me, and have made it their mission to track down suitable aromatherapy fragranced candles to compliment the oils that I've chosen to use during labour, and have recommended all-natural nipple creams (which I'd been after)... they are, quite frankly, my pregnancy PA's, and they're so so good at their job!

Doulas aren't just great for helping you get stuff done though. More and more and more research has pointed to "continued care" being one of the most important factors in improving birth outcomes. Basically, those who receive on going care from the same care providers, generally have the best birth outcomes. If you see the same midwife throughout your pregnancy for example (as I've been lucky enough to do) and then that same midwife attends the birth of your baby - chances are, you'll have a better birth experience than someone who has missed out on any consistency in their antenatal care, and delivers her baby surrounded by strangers. Unfortunately, in the UK, with most women under the care of the NHS throughout pregnancy, a continuity of care is very difficult to achieve. The NHS provide a wonderful service, but it can be logistically difficult to provide a woman with the same midwife throughout her pregnancy, and even harder to have those community midwives present at the births of the babies they've monitored. In busy labour wards and midwife lead birthing units, it becomes almost impossible to provide anyone but a stranger - and with caesarean rates in the UK now reaching a somewhat staggering 25%, many births will include staff in unfamiliar roles, such as paediatricians and anaesthetists, as well. By hiring a doula, a couple can provide themselves with this continuity of care, alongside their medical care. A doula can be a constant, and familiar face throughout pregnancy, and guarantee their attendance at the birth - much like an independent midwife but without the medical provision. This has been proven to dramatically improve birth outcomes, by providing the same benefits as the continuity of care which is missing from the NHS model of pregnancy and childbirth.

Image courtesy of Wendy Kenin "Green Doula"

Those couples who hire a doula are far more likely to have a birth which closer mirrors their prepared "ideal" birth plan, are less likely to have an assisted delivery or emergency C-section, use fewer modes of pain relief, and have a generally more positive outlook - there is a notable decline in pre and post natal depression in women who have the support of a doula, social isolation during and after pregnancy is dramatically reduced, and those women supported by a doula are significantly more likely to breastfeed successfully, if the Mother wishes to breastfeed her baby.

Doulas are especially ideal for those deemed "high risk" in pregnancy, for a number of reasons. For one, they can attend appointments with pregnant couples and help them to make sense of the information provided, or suggest questions that the couple may not think to ask at the time. Informed couples have a far better experience of pregnancy and birth, and are significantly less anxious - so having someone there to get to the bottom of what's being suggested, can be really helpful. High risk pregnancies are also more likely to require the sort of emotional support and encouragement that a doula can provide. Doulas will also act as a couples advocate. It can be very easy to say that you will say no to induction, but just as easy to become intimidated when faced with an apparently knowledgeable and convincing hospital consultant - your doula will increase your confidence, and prevent you from feeling "ganged up upon" to agreeing to a treatment that you're not comfortable with. These supportive services can make a huge difference to the birth outcomes of women who naturally feel pessimistic, anxious, or doubtful about their birth choices.

If you feel you'd benefit from the services of a doula I would urge you to check out Doula UK. Nobody needs a set qualification to act as a doula in the UK (to be honest, your best friend or sister could decide today to be your doula, and you'd probably see great benefits - depending on who your best friend or sister happens to be!) but Doula UK provide on-going support and training for their registered doulas, which comes with a number of benefits that these women can pass on to the couples they work with, this includes, for example, expert training on helping women to breastfeed.

You can use the Doula UK website here to find and contact registered doulas in your area, or contact Doula UK for a list of mentored doulas, who've completed the training but are now spending a year "in practice" before they are awarded their full registration (these ladies will usually charge significantly less than registered doulas for their services - our doulas are mentored and still provide an outstanding service and have the backing of full Doula UK training). If you are in receipt of certain means tested benefits, or your income is less than £16,000 per annum, you may be eligible for the Doula UK Access Fund, which will cover a doulas expenses so that she is able to provide you and your family with appropriate care at no cost to you. The access fund is very easy to apply for, and could help a lot of families who've found doula fees impossible to find.

Marika and Bryoni work together as Divine Doulas, are based in Canterbury, and will travel to provide doula services to families throughout East Kent. You can check out their website here.

Marika and Bryoni are mentored by Rebecca Schiller of The Hackney Doula, who is based on the Isle of Thanet, and will travel throughout Kent and East London to provide doula services and private antenatal classes, she also runs the Thanet Homebirth Support Group (which Boyfriend and I attend) and chairs Birthrights, the only charity in the UK dedicated to defending the rights of families in childbirth.


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