What is a doula and why do I need one? – Quality pregnancy, birth and postnatal support

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Like many other women in Australia, I don’t have the option to organise the perfect pregnancy, birth, and postpartum care that I desire. The local system that is presently in place simply does not support my individual needs. So I am planning to find a doula in the hope that her support will make my compromises feel a little less … well, compromised. I did not use a doula for my previous home birth, so this is new territory for me.

What is a doula and what does her training look like?

Historically, women worldwide have been attended to and supported by other women during pregnancy and for their birthing care. Unfortunately, in the 21st century, continuous support during labour has become the exception rather than the rule.

However families do have the option of engaging a doula. A doula is someone who provides physical, emotional, informational, and advocacy support to women during pregnancy, birth, and/or the postpartum period. But unlike a midwife, she is not a medical professional. Many doulas have completed a doula training, but there is not a widely-accepted standardised certification.

The use of a doula is gaining popularity throughout western countries. A survey in the United States found that about 5% of all women engage a doula1.

I haven’t met many doulas yet, but I imagine they must be very nice women. If they love babies, pregnancy, and birth so much that they choose to dedicate their time to supporting other women through this highly sensitive process, they just have to be amazing!

While browsing for doulas on the internet, I have discovered that many have other related skills These skills range from breastfeeding consultations and massage therapy to hypnobirthing and holistic health practices. Most of them are mothers themselves and many have studied at specialised organisations. The most popular ones for Australian doulas are as follows:

Birth Right (Blue Mountains):  “Inside Birth Practitioners” – 4 days face to face training in a small group, with an optional online component; and “Birth Right Doula” (birth/ postnatal) – combined face to face and online training. www.birthright.com.au

Birthing Rites Australia (Sydney): “Birthing Rite Doula” – comprehensive face to face training (over 300 hours). www.birthingrites.com

Australian Doula College (Sydney): Certificate IV in Doula Support Services – 20 weeks of nationally accredited doula training. www.australiandoulacollege.com.au

The International College of Spiritual Midwifery (Melbourne):20 half days of face to face Doula Foundation Training. www.womenofspirit.asn.au

Birthing Wisdom by Rhea Dempsey (Melbourne): 12 days (over 9 months) Birth Attendant training. www.birthingwisdom.com.au

Childbirth International (Singapore): correspondence (online) training for Birth Doulas (approx. 200 hours), Postpartum Doula (approx. 200 hours) and Advanced Birth Doula. www.childbirthinternational.com

Doulas pay between A$500 and A$5000 for their training. The organisations usually require their trainees to attend several births prior to formal completion of the program.

Why hire a doula?

In my case, I feel that a lovely doula can contribute to a wonderful pregnancy and birth experience. I currently live in rural Northern Territory, so my preferred option of care (a privately-practicing home birth midwife) at my desired birth location (my home) are unachievable to me. There simply are no private midwives in the NT, and in order to be accepted to the publicly funded home birth program, I have to travel to Darwin for the actual birth. Two midwives will be assigned to me as I do not have the option of choosing. I am sure I will still be able to achieve a great birth, but it does take a bit of effort for me to make peace with these circumstances. I believe that an understanding doula would be able to provide positive support through this process and create a bridge between my ideal birthing situation and my available options.

But there could be a lot of other reasons to hire a doula. She can provide continuity of care to families going through the hospital system and seeing different midwives for every appointment (and maybe another new one for the actual birth). Perhaps a woman might not be able to gain personal, emotional support during her pregnancy from her employed obstetrician. Maybe a woman seeks additional emotional support for the birth, feeling the midwives at the hospital may be too busy with medical procedures and attending other labouring women. Often when family and friends live far away, families look for some friendly support to help out after the birth. Or someone may have family and friends around, but they are just on a different page when it comes to pregnancy and birth; a doula can be there to discuss fears and worries without prejudice.

If you are planning to have your partner present for the birth, it might be great for him (and you) to know that there is someone else on the team. If it is your first birth, your partner might be too excited or nervous at times to provide the support you need. If you already had a previous birth, he might be busy looking after older siblings while you are in labour and can not be there all the time. A doula is not there to replace your partner, but to provide additional support for you – and him!

Is a doula for home births only?

Absolutely not. Doulas attend birth centre and hospital births. Generally, you can have your doula with you throughout your labour and birth, but it might be best to check the details of your hospital or birth centre’s policies in order to avoid a disrupting surprise. A doula can be invaluable, especially for a birth in a medical environment. She will be there for you throughout your labour and birth, no matter how long it takes. She can “hold space” for you and provide ongoing support. regardless of shift changes, or the possibility of the medical staff attending other women in labour at the same time. A doula will focus on you – not your medical record or the readings of a technical machine to which you might be attached.

Some doulas offer support especially for women who birth via caesarean section. If the caesarean birth is planned, they can help the family to prepare for the birth. In case of an emergency, they provide postnatal support and counselling.

Having a doula for my home birth helps to ensure I have a great support system in place even in the event that my midwives are late or unable to attend. In case a transfer to the hospital is necessary, a doula can support me through the transition. She can also help guide me through all the emotional challenges that would accompany it, and help me to refocus.

What does a doula actually do?

That depends greatly on the family’s individual situation and needs, along with the training, experience, and interests of the doula. There are doulas for the antenatal/postnatal period and/ or birth.

Here are some examples of what services a doula can offer:

During pregnancy (antanatal):

  • provide information, education, and explanation about the various medical care options available in your area
  • provide support during emotional times
  • provide informational materials (books, dvds, etc.) suited to your needs and personal situation
  • provide support in creating your birth plan
  • explain and practice natural pain relief and relaxation techniques
  • support you during your emotional and mental preparation for the birth
  • help you to tidy up the house and with other responsibilities, such as cooking
  • refer you and recommend other therapists and practitioners if needed
  • provide bereavement support

During birth:

  • suggest position changes and support you physically during a change
  • supply essential oils
  • provide counter pressure and massages
  • employ affirmations and supportive encouragement
  • suggest natural pain relief techniques
  • help you with drinks, snacks, music and other things to make you comfortable
  • help tidy up and settle in after a home birth

Postnatal:

  • provide reassurance and emotional support in adjusting to your new role as a mother (and father)
  • discuss birth debriefing
  • help with basic newborn care
  • assist with newborn settling and sleeping techniques
  • provide breastfeeding support
  • provide birth trauma support/ birth story healing
  • help tidy up the house
  • assist with baby massage
  • provide bereavement support

 

What does a doula know about pregnancy, birth and newborn babies?

Through experience, training and studying, a doula is usually has an understanding of:

  • the various options of care for pregnant and birthing women.
  • the birth within the hospital system.
  • basics of a normal pregnancy, labour, birth, and postpartum period.
  • medical interventions.
  • related therapists and referral options.
  • breastfeeding support.
  • prenatal testing and screening.
  • caesarean births and VBAC.
  • household support.
  • postpartum education and supports.
  • newborn care.
  • bereavement support.

What is the difference between a doula and a midwife?

A doula usually has not undergone medical training. Whilst she might understand the physiological processes during pregnancy and birth, she is not qualified to provide medical advice or perform any medical checks (such as blood tests during pregnancy or vaginal examinations during birth). Her focus is solely to provide emotional and physical support to the family. It might be a good idea to let your midwife know that you will have a doula present at your birth. Some midwives might feel that doulas are taking on their role. If you explain to your midwife what additional support you are hoping to achieve with your doula, she might be able to better understand your choice.

What does a doula cost?

Doulas often charge “complete package prices” for a few ante and postnatal visits as well as attending the actual birth. These can range between A$500 – $1500 but varies depending upon the actual services demanded and provided. Greater expense can incur if there are a larger number of visits required, if the doulas has to travel a far distance, or if other services such as placenta encapsulation or hypnobirthing preparation is included. Training organisations often refer their trainees, who charge a lower rate.

How can I find a doula that suits my needs?

There are no official statistics on the number of practicing doulas in Australia. The online service findadoula.com.au lists over 90 doulas Australia wide, but most likely there are many others.
Most training organisations offer online listings and searches for their practitioners. There are also some general listings on the web. Another way to find a doula is to ask at your local birth or home birth support group for referrals. Many doulas have a webpage or facebook page where you can find some information about the doula and her training, experience, and qualifications.
Think about what exactly you are looking for in a doula. Do you have any specific needs or wishes? How often would you like her to meet with you and at what times? When first contacting a doula, find out if she is able and happy to provide the services you desire.
A doula is a personal support person, so it is most important that you feel comfortable with her. Trust your intuition. It is ok to keep searching for a different doula if you feel that you will have a hard time connecting.

Sounds great. But is there any research or evidence…?

I was surprised to find several studies related to effects of the support by a doula during pregnancy and labour. The Cochrane database provides a review of 21 published and unpublished randomized controlled trials involving 15,061 women2. These studies compare continuous support during labour with more traditional care. The review reports that women with the support of a doula were:

  • more likely to have a spontaneous vaginal birth
  • less likely to have intrapartum analgesia
  • less likely to  report dissatisfaction
  • experiencing shorter labours
  • less likely to have a caesarean birth or instrumental vaginal birth
  • less likely to receive regional analgesia
  • giving birth to fewer babies with a low 5-minute Apgar score

For example, one U.S. study from 20081 reports a caesarean rate of 13.4% for the women with a doula, compared to 25.0% for the control group, as well as 12.5% vs 58.8% for women with induced labour. The same study found that fewer women in the doula group received an epidural (64.7% vs 76.0%).

An update of this review3 further states “that in general, continuous intrapartum support was associated with greater benefits when the provider was not a member of the hospital staff, when it began early in labour and in settings in which epidural analgesia was not routinely available.”
Results from another U.S. study4 indicated that doulas were rated highest in terms of the quality of supportive care during labor when compared to midwives, family members or friends, husbands/partners, doctors, and nursing staff.

Remember, you are the one giving birth 

That all sounds wonderful to me; hopefully I will be able to find a great doula to attend my upcoming birth.

I think most women would benefit from using a doula – especially the women who experience pregnancy and birth care through a hospital system. At times the medical focus can overshadow a more individual personal approach. It is important to not only address the medical needs, but the emotional and personal ones as well. A doula is a great way to add some quality support to your experience. Ultimately the responsibility remains with you. You, the birthing woman, have to make decisions for yourself and your baby. You are the one growing and birthing this precious child. Make sure you have the support you need. But nobody else is as involved and connected and intuitive when it come to your baby as you (and your partner) are! Make it yours, own it, and enjoy the journey.

 

 

References

  1. Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2003, Issue 3. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.
  2. Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub2.
  3. McGrath, S. K. and Kennell, J. H. (2008), A Randomized Controlled Trial of Continuous Labor Support for Middle-Class Couples: Effect on Cesarean Delivery Rates. Birth, 35: 92–97. doi: 10.1111/j.1523-536X.2008.00221.x.

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