Somebody to lean on

By Emily Board

I am something of a doula evangelist. Since experiencing the birth of my son, tirelessly supported by Sydney doula Lucy Perry, the first thing I have said to any pregnant friends (especially those planning a hospital birth) is “don’t give birth without a doula!” And it seems I am not alone. I was introduced to the concept of doulas and birth attendants by a friend who gave birth in the UK, who was the only mum of her ante-natal class to have a natural birth – this she entirely put down to the support of her doula. It seems that women love having doulas at their birth and are encouraging each other to try them… For me the proof for the need of the doula lies with birthing women: if they find them invaluable at their births then they will continue to ask for them.

So who exactly are the doulas, these miracle-working wise women steadily infiltrating birthing rooms across the Western world? They are simply birth attendants, trained to offer non-medical support to birthing women. The word doula is an ancient Greek word meaning “to mother the mother” or “woman caregiver”. A doula is a professionally trained birthing support partner who is there to offer emotional and physical support as well as unbiased information to the birthing mother and her partner. A doula does not replace the role of a midwife or doctor and is not there to deliver the baby. She is there to “hold the space” for the woman and to be attuned to her emotional and physical needs.

The doula, then, does not offer medical care, but supports the labouring mother in the way that the mother chooses. For me, Lucy’s support in the delivery suite ranged from the physical – massage, aromatherapy, holding drinks, directing hot shower hoses to just the right spots on my back and belly during contractions – to the emotional: coaching me to remain focused and positive. I vividly remember her saying, just after transition, “you’re going to want to push soon. Pushing sucks – cos it hurts – but you can do it!”

Having such an experienced, relentlessly positive and creative birth support person enabled my husband Ben and I to adapt to and cope with each phase of labour as it unfolded. For example I would never in a million years have planned to be reliant on having an egg shaker beat out a rhythm in my ear during contractions – but it worked for me! I was able to entirely withdraw into my instinctive self; I didn’t have to try and use the rational part of my brain to remember things I had read or learned in ante-natal classes, I didn’t have to worry about Ben and whether he was getting tired because I knew that he and Lucy could look after each other as well as me. I could just get on with dealing with each contraction.

With a hospital birth, a doula bridges the divide between that otherworldly plane inhabited by labouring women (necessary for a natural and instinctive birth), and the white-coated world of bright lights and monitoring numbers which all-too-often brings women out of their primitive labouring state. Sarah Buckley reminds us that disturbing a birthing mother (for example by expecting her to hold a rational conversation or make snap decisions) does not only cause her stress and distract her from her task, but biologically can slow or temporarily stop the birth process by inhibiting the timely production of key hormones such as oxytocin, endorphins, adrenaline, noradrenaline and prolactin.

Furthermore, in a hospital birth, any such slowing can be labelled ‘failure to progress’ and open the way to further interventions which may in themselves cause complications- the feared ‘cascade of intervention’. Something as simple as asking a doctor to leave the room so a couple have time and space to discuss whether to proceed with a particular intervention, or reminding a well-meaning chatty nurse to keep quiet in the birth room, can make a huge difference – but a birthing woman and her partner might not have the assertiveness to act in this way, especially during their first birth. Having a support person who knows your wishes and can act as your advocate therefore enables you both to remain in control of your birth and to meet and adjust to each challenge that arises.

Doulas will generally want to meet before a mutual decision is made to go ahead, and then several times before the birth to talk things through and make sure that you are in tune with each other. After all, you need to feel completely comfortable with each other given the intense experience you are going to share. For me, Lucy’s counselling and reflective role began even before I moved to Australia at 30 weeks pregnant (I found her online and emailed her from the UK ). She offered to be our ‘digital doula’ until the move, we renamed her the Didgeridoula and she helped us to choose a hospital and ante-natal classes that would support us in our preference for an active natural birth. Lucy asked me hard questions, like “what are you most scared of?” which forced me to prepare myself mentally for labour. Talking to her was different from talking to friends, because she was trained and well-informed, yet different from talking to doctors, because I knew that she would always give me unbiased information without being restricted by hospital policies. After the labour, too, we talked the experience through. A post-labour discussion during the first few weeks after birth can be a vital in giving closure to your labour experience, perhaps coming to terms with events that didn’t go entirely to plan (and what labour does)?

A criticism that has been directed at doulas is that they displace fathers from their role as support people. This is a misconception – doulas support both of you. They not only enable the father to support his partner more effectively – how can new Dads be expected to know what a labouring woman needs? – but remind us that Dads need someone to lean on too! Ben was initially sceptical about our need for a doula (“isn’t that what midwives are for?”) but supported my decision to hire Lucy, seeing how important it was to me. Since the birth, during which they worked superbly as a team, he now is as positive about the impact of doulas on labour as I am. He has already met Di who will be supporting us during the birth of our second child in May now that we have moved too far away from Lucy!

There is a wealth of scientific evidence to support the positive impact of doulas on labour. A study published in the Cochrane Review in 2003 involved over 12,000 women, and concluded, “Continuous labour support reduces a woman’s likelihood of having pain medication, increases her satisfaction and chances for ‘spontaneous’ birth, and has no known risks.” A 1999 study in the US found that, “Emotional and physical support significantly shortens labour and decreases the need for caesarean deliveries, forceps and vacuum extraction, oxytocin augmentation, and analgesia. Doula-supported mothers also rate childbirth as less difficult and painful than do women not supported by a doula.”

For me, all I can say is that it worked. In the midst of the scary delivery suite paraphernalia I was able to turn down the lights and experience the rollercoaster ride of a hormone-fuelled natural labour.

Having prepared us mentally for the birth, Lucy enabled my husband and I to stay focused and positive throughout labour including the toughest moments. She showed me my own strength, and so empowered me to face my new role of mother with joy and confidence – and therein lies the lasting value of a doula.

Where labour is an active, empowering experience rather than one in which the woman is a “patient”, the impact on her feelings about her child and herself as a mother is significant and enduring. Doulas help women to experience labour their own way and so gain confidence in their instincts: there is surely no better preparation for the amazing journey of motherhood that follows.

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This article was originally published in Nurture, the quarterly journal of Natural Parenting Melbourne, www.naturalparentingmelbourne.com.au.

Postscript: Emily gave birth to a baby girl named Angharad in May 2007 after an intervention-free four-hour labour. “You would have been very proud of Ben, as a graduate of Beer and Bubs. He ran the show and was an amazing support person. Our doula commented that he was the best male midwife she’d seen!!! He was amazing,” said Emily.

References

S. Buckley, ‘Undisturbed Birth’ in Gentle Birth, Gentle Mothering, Brisbane, 2005

http://www.cochrane.org/reviews/en/ab003766.html

Scott KD, Klaus PH, Klaus MH (1999) quoted at http://www.nurturingbirth.co.uk/c_medical_views.html