To try and improve my running speed (which is in 'granny with a hangover' territory), I go to a group session. On last week's run I was chatting to a straightforward Aussie engineer while trying to keep my expression from showing how much I was hurting - his excited description of his wife's homebirth plans was a great distraction for me.
'We're meeting our doula this week!' he told me. Even through the pain of running (remind me why I do it again?) I had to grin at his enthusiasm.
I'm not sure I would have been having the same conversation ten years ago. Doulas are becoming more common and as a student or qualified midwife you've probably worked with them or are going to come across them soon. This post is on the basics of their role - thanks, doula Charlotte Holloway for providing me with your information and experience!
The word 'doula' means 'servant' in Greek and that's a good description.
The role is non-clinical but includes emotional and practical support for mothers and families. There's good evidence to show that continuous support for labouring Mums, from someone who's not clinical staff or a family member or friend, helps with satisfaction and improves outcomes. This is the role that doulas fulfil.
Midwives are shouldering an epic workload at the moment in the UK, which in practical terms can mean they get called out of labour rooms sometimes. A doula can provide stability and certainty by being that one constant support person that's there throughout labour and birth.
This is a controversial thought for some midwives. The criticism I've heard includes that the roles conflict, doulas can 'take over too much' and that if the support from NHS midwives was adequate the role wouldn't be necessary.
(I disagree wholeheartedly but it's important to explain the criticism that's out there!)
Different doulas offer different packages of care that can cover the antenatal, intrapartum or postnatal period, or any combination of these times. Some follow Mums throughout childbearing.
Though the role of midwives in the UK extends to 28 days after birth, if everything is going well, it's more common for Mums and babies to be discharged after 10 days. Support from a doula for a few weeks postnatally can, therefore, be very welcome for some women.
The profession isn't regulated which means anyone can call themselves a doula.
However, the vast majority of doulas will have taken a course and a mentorship process either through Doula UK or through another well-recognised company such as Nurturing Birth. This is because the role of a doula is more complex than it appears.
Many doulas have their personal birth experiences which may interfere with how they support a family. They may also be antenatal birth educators, yoga teachers, breastfeeding supporters and even midwives. It’s important for doulas to be clear on what role they're fulfilling when they're working in that capacity.
Doulas don't offer advice on any part of clinical care. This is specifically forbidden by the Doula UK Code of Conduct.
In Charlotte's experience, this is where conflicts can arise, as doulas can't 'back up' medical advice unless that option is what a woman has chosen. Doulas are in a powerful position of trust and must not break this by pushing a personal or hospital agenda onto a family.
Instead, the role is about helping women with all their options and then advocating and supporting them in that choice, even if it goes against guidelines.
A good doula will aim to work in harmony with midwives and the woman's informed choice, even when there are complicated ethical circumstances.
In a postnatal position, doulas do not take care of the baby. Their role is to care for the family in a number of ways from light housework, cooking, walking the dog, caring for other children, and generally providing the time and space for Mums and Dads to care for their new baby. Many doulas also have breastfeeding peer support experience.
It's all about wanting to create an atmosphere conducive to birth and making the postnatal period enjoyable.
Should midwives have a conflicting experience with a doula (or have worked with a doula that was brilliant for that matter!), if that doula is part of Doula UK they can be contacted to be given feedback.
Just like in midwifery, reflection and ongoing learning is a huge part of a doula's role.
The cost of a doula can vary greatly depending on their experience and location. A recognised birth doula can charge between £500-1500 (or more) and postnatal support from £20 an hour upwards.
It's typical for doulas to be employed by families independently.
However, there are some doulas who work within the NHS and some charities that provide the service. Doula UK have an access fund to help families from less affluent backgrounds access the support.
You can see a survey from 2013 which looks at some of the benefits of doulas here.
Though this is not 'high level' evidence, the results are encouraging and suggest doulas can help reduce the risks of instrumental and cesarean birth, reduce the length of labour, the need for pain relief and increase rates of breastfeeding after birth and at six weeks postnatally.
I've met some amazing doulas in my time. I was particularly impressed by Rebecca Schiller, who as well as being a doula is the director of Birthrights, an important charity dedicated to protecting human rights in childbearing.
Now I'd love to hear from you on the subject of doulas! Leave me a comment:
- Have you had experience with doulas, either as a midwife or a Mum? What was it like? Any insight you can offer?
- Do you have any research to share on the efficacy of doulas?
- Do you think the role of a doula can conflict with the role of a midwife?
As always, thanks for reading and for your comments and input. I know how busy you are and I'm always blown away that so many of you take the time to read these posts.
I hope life is good for you and yours right now, at work and home,