I have a confession to make. I am also a doctor’s daughter. My father even won the gold medal in Obstetrics whilst at university, though claims he never actually delivered a baby and the prize was won solely on his ability to write poetry. Suffice to say he is now a Cardiologist not an Obstetrician.
But, just like the doctor’s daughter who runs this brilliant website, I have become increasingly interested in all things pregnancy, birth and baby related through my own experiences of motherhood. Despite a few paternally raised eyebrows I swerved off my career path to become a doula and campaigner on birth-related issues.
Today, as we are in the midst of World Doula Week, I wanted to tell you a little more about doulas. Who we are, why we exist, what exactly it is we do and don’t do and why new families come to us.
Doula is strange word and in ancient greek meant ‘female slave’. In the modern incarnation we are ordinary lay people experienced supporting new families throughout pregnancy, birth and the roller-coaster first few months with a new baby.
In the UK the majority of doulas belong to Doula UK who have around 600 members, all of whom have attended an approved preparation course, undergone a period of mentoring, committed to ongoing personal development work and signed a Code of Conduct and Philosophy.
Some of us work mainly through pregnancy and birth, helping women and their partners prepare, supporting them through the birth and coming back once or twice afterwards to settle them in to their new lives.
Other doulas focus more on the postnatal period, visiting new families regularly to help with feeding, signposting them to good resources, listen to how are feeling (without giving any unwanted advice), making tea, clearing up and allowing them to have a shower or a sleep.
Community and Support
For most of us, our journeys to becoming doulas started because we realised that women and their families need more much support than is currently available at this life-changing time. Unlike our ancestors, who tended to live in communities and saw their mothers, sisters, aunts and neighbours through their pregnancies, experienced birth first hand, saw breastfeeding often and usually had someone on hand to listen and help, modern women are much more isolated. Though, generally, we benefit hugely from societies advancements it’s more complicated when it comes to starting a family. We live further from families and often don’t know our neighbours. We hear about birth through highly dramatised media portrayals and horror stories. We often don’t hold a baby until we are presented with our own.
So as doulas we are filling a role that’s been around since women started having babies. A wise doula I know calls us the ‘second oldest profession’. We provide non-medical support that compliments what is offered by midwives and doctors. We don’t replace the medical professionals, and indeed usually have a really good relationship with them.
Instead we are a consistent presence throughout a pregnancy, birth and postnatal period, so that parents know they have continuous support from one person they have built a relationship with and trust. We listen, offer no judgement and no advice, though will signpost women and their partners to great resources if they need more information. We help them feel positive, confident and well-prepared and are also well connected with local birth professionals and Supervisors of Midwives should more support be needed.
We don’t replace a woman’s partner but instead work with them, building their confidence so that they feel able to support a woman in labour and positive about their parenting skills. I often feel it’s too much for a woman’s partner, who has often no experience of birth or babies, to handle all the practical and emotional support through a birth. He really benefits from a wing woman. Someone to give him a break, take on some of the duties (be it calling taxis, filling a birth pool or massage), smile at him to reassure him that the funny noise his partner is making is totally normal. We are there to support everyone and we find whatever gap exists in the team and fill it.
This can all sound a little touchy-feely, until the supporting evidence is brought in to play. There’s an increasing body of knowledge and some robust studies that show that this kind of support has a big impact on birth outcomes and breastfeeding rates.
A 2011 Cochrane Review of the effects of continuous support during labour, looking at trials that included over 15,000 women concluded:
“Women who received continuous labour support were more likely to give birth ‘spontaneously’, i.e. give birth with neither caesarean nor vacuum nor forceps. In addition, women were less likely to use pain medications, were more likely to be satisfied, and had slightly shorter labours. Their babies were less likely to have low five-minute Apgar scores. No adverse effects were identified. We conclude that all women should have continuous support during labour. Continuous support from a person who is present solely to provide support, is not a member of the woman’s social network, is experienced in providing labour support, and has at least a modest amount of training, appears to be most beneficial.”
In a Doula UK survey of over 1100 doula-supported births the conclusions were similar with only 12 per cent of doula-supported births required medical interventions, such as the use of forceps, ventouse or caesarean sections, compared to the latest national figures of 37.3 per cent. In addition the survey showed that 93 per cent of doula-supported women attempted breastfeeding, while 70 per cent were still exclusively breastfeeding after six weeks. The Department of Health’s latest national figures show only 74.1 per cent of new mums attempt breastfeeding, and just 47 per cent are still exclusively breastfeeding at six weeks.
The unconditional and continuous support doulas provide is not just popular and it doesn’t just make women and her family feel more confident; it actually positively impacts on their birth experiences and breastfeeding journeys.
Doula UK is the largest network of doulas in the UK and runs a ‘Find a Doula’ service on their website. Doula UK doulas will have attended an approved doula preparation course and will be undergoing or have already finished a period of working with an experienced mentor. Doula UK doulas will also have signed up to a Code of Conduct and Philosophy and there is a complaints procedure in place. These doulas will also provide you with a page to go in to your maternity notes to let your midwives and doctors know that you are working with a doula and explain a little more about about the role.
It’s always good to contact a few doulas and arrange to meet for an informal chat. There are some suggested questions to ask on the Doula UK website, but most people find their choice is governed by who is available and who they ‘click’ best with. Remember this is someone you’ll be spending quite a bit of fairly intense time with so the most important thing is to get on well.
How much will it cost?
Doulas set their own fees and these vary depending on experience and location.
If you are on a low-income you may be eligible to apply to the Doula UK access fund which provides a free birth or postnatal doula to those who would otherwise be unable to access that support. In celebration of World Doula Week, Doula UK has just announced a scheme working with Hestia‘s domestic abuse service providing free doula support to women living in refuges across 11 London boroughs.
Doula who are still going through the mentoring process at Doula UK charge at the lowest end of the spectrum and are encouraged to cover their expenses only. Though they will have less experience they will have undergone a doula preparation course and may well have worked with a few families already. This can be a great low cost option.
Postnatal mentored doulas charge around £10/h.
In London an experienced birth doula will charge from around £600-£1200. Outside of London you can expect to pay significantly less. It can seem like a lot of money, but do remember the hours the doula will be working before, during and after the birth and that she will often be unable to take on any other work during the four plus weeks that she is ‘on call’ for you.
Experienced postnatal doulas charge around £20/h.
Doula UK doulas will be happy to accept gift vouchers to cover all or part of their fee which means family and friends can treat you. Many will be happy to be paid in instalments and some are happy to accept bartering for all/part of their fee – with clients offering their time, skills or services as a swap for the doulas.