I cannot even remember the amount of times that I have been asked what does a doula do? Since I have been giving service to pregnant women as a doula, I have struggled to simply respond to this question with “well very little”. This is because in some sense it feels rude as I am paid my modest living doing this work but also because on some other level it is simply not true.
So why do I even mention to begin with a burning desire to say “well very little”?
Well this is because women are so cleverly designed that in the right environments with the right person or persons present, women simply give birth. Yes it is true that sometimes babies are born with no drama and after hours or many hours of very little happening.
In these scenario’s a doula may be seen knitting or in my case (because I do not knit) sitting in a place of mindfulness. Of course this is from the perspective of another person at a birth and for the mother there is a whole lot happening. The mother may need to outwardly share the experience physically or she may need stillness and silence to inwardly focus on her experience.
So why would she hire a doula?
Women accessing the NHS maternity system are mostly (there is a local trust starting to support continuity of care with homebirths) seen by many midwives in their pregnancy with no guarantee that the midwife that attends her birth is going to be a midwife that she has already met. For women entering hospital, it is guaranteed that it will be a midwife that she has not seen in the community.
In all the evidence-based books around childbirth (that I have read), there is discussion on how strangers in a woman’s birth space affects her production of the uterus stimulating hormone oxytocin. So many women access doulas to be a constant source of emotional, practical and for some spiritual support at a time when it is very necessary. Doulas are birth keepers protecting the mothers’s birth space.
Doula’s provide a lot of their ‘support’ antenatally as it seems to be hard for some women to plan a natural birth as the NHS focuses on risk in such a way that women often feel like they have very little choice. Risk is presented in a way that is often misleading. Even for those lucky enough to have the continual support of an NHS Midwife, the midwife is under a hugely restrictive political umbrella with the NHS and it is sometimes difficult for her to offer the woman truly honest support (options are often presented as limited within the NHS).
A doula walks alongside a mother in her pregnancy journey, opening up doors of possibility by listening to what the woman wants and presenting ALL the information. A doula will give the woman the space to make an informed decision as she has no vested interest in her decision.
This support is just as important for a new Dad as it is unlikely he will have attended many appointments with a midwife so having time and space with a doula to consider information related to birth is likely the main source of birth education he will have had. At births I have attended, I rarely see a midwife take time to explain to the Dad what is happening and this can be scary for fathers. A doula will keep a partner updated with all that is going on. When labour runs a long course, the doula will encourage the Dad to go for a rest and then she will go for a rest when the Dad returns with new energy.
A doula will see the mother and father after their baby is born. She may take a meal for the family or be able to help get some shopping in. She will most likely sit and listen to how the parents are finding this new chapter of their life. Often the birth won’t be fully debriefed for a while as mama is so focused and in love with her new child.
So doula’s provide a service that is missing in the conventional NHS maternity model of care. They provide continuity, emotional, practical and spiritual support. When I say spiritual, I mean doulas recognized that change happens after a mother has had her baby. This change can be ecstatic and life changing and or overwhelming. A doula focuses on the mother at a time when everyone else has started to move their attention to her baby.
Doula’s are sometimes asked to play a more active role in labour. It may be that the mother wants massaged and the Dad is caught up with something else or it is not his strength. But a doula should not be disrupting the flow of labour by distracting the woman and offering suggestions that she has not asked for. This undermines the mother’s confidence and does not help her transition as a new mother.
So a doula is a servant. A servant whose role is well researched:
So where does the humility and love bit come?
I started my doula journey in 2007 and was lucky to have a doula who reflected my birth power back to me and served me well. She has since blogged about it here:
Not once did my doula share my story as if it were her own. It is a privilege to be asked to be in someone’s birth space and I know from myself and the wonderful doula’s that I mentor that a great deal of love and passion goes in to supporting each mother to get the birth she wants. It is wonderful to share those memories and be thanked but we are not the reason their births are positive. Women own their births and we are merely servants with big hearts.