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Hazel from TwinningitUK, talks to the moKee Birth School Online about being a Doula.

WHAT IS A DOULA?

A Doula is a trained person (non-medical) who is brought in to help support the woman and family at the time of birth and post-birth. The Doula’s aim is to do whatever is possible to make the whole family have the best experience when it comes to birth and to enjoy those precious moments. Since the lockdown , the majority of the work is carried out virtually as Doulas aren’t currently allowed into hospitals or people’s homes during labour or in the postnatal period.

The old saying goes, “it takes a village to raise a child” so now in lockdown it’s harder than ever. People are having babies and all they have is the person that they live with to support them. There are no visits to the clinics, no baby groups. I am finding that more than ever, people are needing that extra support.

A Doula is not medically trained and doesn’t give medical advice, they are not there to deliver the baby. They offer evidence-based information to families and help cut through things that are not evidence-based, such as people basing information on experience rather than evidence.

As an example, a Doula will give you evidential information about the facts around having a vaginal birth after a c section or they can signpost you to relevant information that may be needed. They’ll look at the facts rather than what happened to a friend.

When it comes to birth, lockdown aside, Doulas can be present at the birth of your baby. The role of a Doula is to help and support the mother and to support the family. The role of the Doula is not to take away anything from your partner. If the partner feels worried about being pushed away during the birth, reassure them that a Doula is there to enhance their experience too.

Doulas are trained in relaxation techniques, massage techniques and setting the mood in the room and holding the space. Having a Doula present means that they can enhance the experience of the mother and her partner. A Doula can do simple tasks such as go and get refreshments so that the woman is never left alone and the partner can stay present with her. It’s a key thing and back to lockdown, women are going to the hospital on their own and lots of hospitals say that the birth partner doesn’t come until the woman is in established labour which is really tough.

If it’s your 1st or 10th birth and you have worries, the Doula’s role is to signpost you where you can find the information about your birth. A Doula can help you plan your birth wish list and during labour (with your permission) they will tell the Doctors and Midwives what you’d like if you’re unable to communicate.

Post-natal, Doulas may visit the first day a family is back to help them find their feet within their new family dynamics. It’s a big change. A Doula’s role is not to look after the baby, that’s for a maternity nurse or the parents. A Doula is there to empower you, show you how to do something, make sure everyone is comfortable and sometimes they’ll even cook for you! They’ll help you navigate feeding the baby, changing the nappies, etc... but remember that they are not there to do it for you, they are there to empower you.

Doulas are usually on call from 38 weeks and right up to 10-14 days overdue. You draw up a contract on expectations because generally when you go into labour you want to know all of the details before and what they’ll be doing to help you.

QUESTIONS AND ANSWERS

How expensive are Doulas?
Doula’s start from around £500 for attending a birth and some postnatal support may be included in that but postnatal support is usually extra but this is all written into the contract. Doulas can charge more, depending on their level of experience and what they’ll be doing for you.

When should you start looking for a Doula?
Start doing research around 5 months into pregnancy. Arrange interviews with them. There are some excellent Doula websites, for example, Nurturing Birth or Doula UK, go on their website and go through Doula profiles. You need to gel with that person. You will remember that person forever so ensure that you connect with them. Meet up with a few, even if for a 30-minute coffee to see if you can both work together.

Do Doulas only assist hospital births or can they do home births?
Doulas can help with hospital births and home births. Doulas never deliver the baby, that’s the job of a Midwife or Doctor. In the States and Europe, Doulas are very common for someone to have. It’s quite new in the UK still but is certainly much more talked about in the past few years and the value of a Doula is beginning to be really recognised.

Can you have a Doula for the first two days at home?
Normally you’ll have a Doula for a few hours after birth. A Maternity Nurse is someone who can stay with you 24/7 and look after the baby. However, some Doulas may be willing to stay for longer periods of time with you. This is something you should try and discuss before the birth and have drawn up in your contract.

From your experience, what would recommend to have in your hospital bag? (Must have's) there are a lot of different views.
Snacks for yourself are very important. In warm weather have a cool spray. Something that you like the smell of that is comforting. Your favourite music, a book because labour can be long and boring! A pillow from home is the ultimate essential!

What if my baby is late?
You’ll be on call up to an agreed time after your due date. It is worth considering having the option of shared Doula support. This means that if you go well beyond your due date and beyond the time that was agreed with your primary doula, then you could have access to another Doula to support you.

What if the Doula doesn’t make it to the birth? Do I still pay?
Some babies come really quickly and you can’t get there in time. When you sign up, a retainer fee is paid. ALL Doula contract agreements are different so you may still be liable to pay the balance. However, it may be worth discussing if the doula can offer you some additional postnatal support in place of being unable to attend the birth (for reasons beyond anyone’s control).

Can they give feeding advice?
Yes, Doulas will have basic feeding knowledge and can help advise on feeding. However, if you are having feeding issues then they will likely refer you to a breastfeeding specialist if it is not something that can be quickly addressed with doula support.

I’ve heard doulas reduce the risk of intervention. Is this true?
Yes, research shows that having a Doula present can reduce the risk of Caesarean/instrumental birth. Research has also shown that it can reduce the need for painkillers or epidural and also a reduced rate of induction of labour. Research also shows an increased likelihood of successfully establishing breastfeeding. There are a wealth of benefits of having a Doula. Not just for emotional support, but for physical benefit also.

Can I have a Doula for my c-section?
Yes, absolutely. Doulas can definitely be present for a caesarean (so long as the hospital are ok with this). A Doula will be up to speed with caesarean research so she can be there to ensure that you have the best c-section experience. More and more options are becoming available now for C-sections, such as gentle caesareans, delayed cord clamping and much more which has shown to have benefits to both mother and baby. A doula will be able to advise you where you can find more information on this and what questions you may need to ask.