Mothering The Mother-To-Be

17th August 2018

Childbirth is a natural and exhilarating process, but for some women it can also be a scary and difficult one. It’s claimed that having a doula at your side can help women have a shorter, easier and less painful birth, with less chance of intervention.

So what exactly is a doula? And how can they help in such a significant way with no formal medical training? Lisa Botwright finds out more…

Seventeen years ago, a thin blue line appeared on a white plastic tube and changed my life. It was to catapult me into a brave new world of pain, anxiety, sleeplessness… and utter elation; but I didn’t know that yet. The realisation that I was to be a mother was too awe-inspiring to comprehend; surely only other people gave birth?

I was lucky in that I had an equally dumbfounded, but loving husband, and close family around to support me. Yet the process of becoming a parent was still scary and bewildering. I felt like I was being pushed into a pitch-dark tunnel, taking tentative steps forward without having a clue what was ahead of me.

Maddie McMahon has been a doula for fourteen years, and explains in her book, Why Doulas Matter, that for many women, ‘pregnancy is a place where they don’t speak the language, where all the rules seem different, and the only option is to cling to any life raft that is offered’. Maddie isn’t a recognised health professional; she is, however, one of approximately 700 women supporting up to 5,000 births a year*. ‘It can be comforting to be led by the hand through the corridors of pregnancy and birth,’ she says.

The word ‘doula’ comes from ancient Greek, meaning ‘woman who serves’. Nowadays, it means someone willing to serve the physical and emotional needs of women before, during, and just after childbirth – perhaps fulfilling the historical, now redundant, role of ‘village wise-woman’. Some women specialise in offering support through labour, others offer a post-natal service. It’s a nurturing, rather than medicalised role, sometimes seen as ‘mothering the mother’.

Lauren Mishcon from north London, an experienced practitioner (fromtummytomummy.co.uk) and editor of The Doula magazine, explains that a doula’s role has to be flexible to fit in with the given situation. “The type of support will differ for a first time mum to that of a woman who has children already,” she says. “Every birth is unique and therefore every woman’s experience is also unique”.

Women choose to hire doulas for all sorts of reasons. They might be anxious about a particular aspect of labour, and be seeking someone who will act as a mediator for them. They may have lost their mothers, or their close family may live overseas, and so they’re feeling nervous and isolated. Lauren tells me that she’s worked with a significant number of families from the US, where it’s standard practice to go through pregnancy with the same obstetrician. Over here, where there’s rarely an opportunity to build up a relationship with a familiar midwife or medical professional, they ‘feel like a number’ in the NHS system.

“British midwives are under a huge amount of pressure,” says Lauren, when I ask if there’s ever any tension between the midwife and doula in the same labour room. “They have a job to do, and I have a job to do; our roles are completely different. Mostly there’s mutual respect – they’re relieved there’s another pair of hands.”

Midwives go through years of medical training with an emphasis on high academic attainment. ‘They bear the clinical responsibility for the wellbeing of mother and baby, while doula preparation is almost entirely about self-knowledge, self-development and the practice of social and emotional intelligence,’ clarifies Maddie in her book.

“I wanted a doula because I wanted someone there to support me, especially if the hospital was busy,” says Sam, a mum of two from Edgware. “The most positive aspect was having someone in the room all the time. It was a very long labour and my doula was very reassuring, and helped me to relax, especially once I had the epidural. She was also able to ‘fight my corner’ if I needed anything but was too tired to keep asking.”

Hannah, who lives in Watford, sought a doula during her first pregnancy because she felt it would help her have ‘as calm a birth as possible’. “I had done my research,” she explains, “and seen that doulas are associated with a better birth experience for mothers.” In the end, she reflects that one of the most positive aspects was “having her support at home when I was in labour before we went to hospital. Our doula helped us to remain calm and helped us decide when was the right time to go into hospital. We didn’t want to go to early in case we were sent away, but I know I might have panicked and gone too early if she hadn’t been there.”

The research that Hannah refers to is certainly persuasive. One survey published by Doula UK – a national body that offers all aspects of training and ongoing professional development – gathered data from 105 doulas and their 1,106 birth clients across a range of critical birth-related areas. The most dramatic figures relate to breastfeeding and birth interventions. ‘Women who used doulas need significantly less medical intervention in the birth process and had greatly increased breastfeeding success compared against the national average,’ it states.

It’s a myth that doulas are opposed to medical intervention; they’ll gladly advocate for pain relief if that’s what the mother needs, but they do believe that by keeping their client calm, they can boost the body’s own chemical reaction to dealing with discomfort. ‘Endorphins and oxytocin are the yummy feel-good hormones that keep you serene and drive your labour’, writes Maddie, who points out that high levels of adrenaline, exacerbated by fear, can cause the dreaded three Fs: “This makes you want to fight, take flight or freeze, none of which are particularly fun or conducive to a smooth labour.”

Another misconception is that in hiring a doula, women are potentially sidelining their partner. On the contrary, Maddie believes the father ‘has an essential role to play… If they are a loving couple, the oxytocin they can produce together, as they gaze into each other’s eyes, kiss, cuddle and touch, is more powerful than any artificial hormone drip.’

Lauren has found that some men feel responsible when they see their partner in pain, and want to ‘fix’ the situation, yet feel helpless to know how to do so. “They’re expected to be the perfect birth partner, when they’ve never done this before,” she recognises.

Sharonie from Hendon, who hired the ‘wonderful Nina Forman’ (ninaforman.co.uk) for all three of her births, says her motivation to find a doula arose from “being very conscious that my husband does not deal well with blood or injections, or more importantly, someone suffering in pain, and I thought it would be fairer on him if I wasn’t solely reliant on him.”

“People think that it is weird [having a doula] and that the partner gets pushed out of the birth experience,” says Hannah, who’s also keen to fight misconception. “The doula is there for both you and your partner. Mine built a relationship with both of us before the birth, and during the birth she supported my partner to support me.”

Meeting the couple before the birth is an important part of the process, to ensure that both sides ‘click’. ‘A birth package’ typically includes antenatal sessions, telephone or email support, a postnatal visit and that all-important ‘on-call’ period from weeks 38 to 42 of the pregnancy, when the doula can’t make plans, take holidays or drink alcohol. “A client may pay anywhere from £600 to £3,000 for a birth package and between £15 and £30 per postnatal hour,” Lynsey McCarthy-Calvert, a spokesperson from Doula UK explains. The organisation, which is non-profit and mainly run by volunteers, also fundraises to be able to offer women access to support, regardless of circumstance. “The fee is a sacrifice,” admits Hannah. “But for us it was worth it.”

And how do doulas themselves find the strength to cope with such a demanding role? “My job is amazing,” says Lauren, “but it’s never about me. The women we care for need us to be fully present, so it doesn’t matter if we’re tired or hungry… It’s important not to get burnt out.” For Lauren, this meant finding a fellow doula with whom she practises ‘shared care’. She and her partner provide joint ante-natal sessions so the clients get to know them both equally. They both go on-call and one of them attends the birth. In the event of a very long labour they are able to swap-in to relieve each other, meaning the client is always accompanied by someone known to them, whom they trust.

The role of the doula still remains a rather mysterious one, but Lynsey tells me that she has observed “a growing understanding of what a doula is and what a doula does”. The number of women choosing to train for the role is on the rise too, albeit slowly. “We are seeing many new doulas train each year, but in turn others will step away from the work due to family commitments or other reasons. That said,” she continues, “for an organisation that started off with a handful of women in 2001, we have seen incremental growth year on year.”

“I encourage all my friends to get a doula,” enthuses Hannah. “Ours had a way of just having a quietly calm and reassuring presence. She didn’t tell us what to do at any point, but she was skilled at weighing up the pros and cons of things where appropriate. She encouraged me to relax, breathe and trust my body.”

Why Doulas Matter’ by Maddie McMahon is published by Pinter & Martin, £7.99

*Figures from Doulauk.org.uk – a fantastic source of information, including how to find a doula near you.

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