Is there a place for Doulas?

I was invited to attend a meeting of midwives recently to give them some information on how doulas in the local area are supporting women.
I met some lovely ladies, obviously very dedicated in their role of providing care to women using their maternity services.
One of the midwives present commented that she felt that doulas were unnecessary as SHE builds relationships with the women in her community role, and offers them all the support and information they need. This has certainly got me thinking....... what is it that we, as doulas offer that a community midwife doesn’t?
Well, I suppose the best angle to look at this from is in fact the expectant mum’s one, and as a mother of five children I think this is the way I am going to consider it.
I would like to say that I have had wonderful support from the community midwives who have offered me care throughout all my pregnancies – this has always been the best professional medical care that the NHS could offer, (according to the protocols of the particular area I have lived in at the time) and these midwives have shown unfailing support within their abilities.
However...
I had my first four children, following religiously any advice or intervention ‘offered’ I say this with tongue a little in cheek because at the time, in my total ignorance, I was not aware that any of these ‘offerings’ were in fact ‘choices’!!
During my 4th pregnancy I became very depressed and frightened of ‘procedures’ that would be done to me, yet again without really understanding WHY they needed to be done, and how the results (or interpretation of these results) may alter the care being offered to me.
I have a wonderfully supportive husband, but his ability to support me through this journey was limited, he had had a very sad experience himself within a previous relationship where his partner had given birth to a stillborn son, therefore my husband was himself frightened and powerless to support me very much at all.
During my 3rd and 4th pregnancies I had made it absolutely apparent that my husband would need extra support during my labours as I knew he would suffer emotionally, and would be unable to support me adequately due to his fear of losing another baby. Our community midwife had made a ‘note’ of this so I had felt confident that come Labour day this would be of utmost importance to my caregivers. I could not have been more wrong... he had no significant support at all. One of my husband’s biggest fears had been the machine that continuously monitored the baby’s heartbeat (I was never told I had a ‘choice’ to be connected to this machine at all) and he would freeze while watching and listening to baby’s changing rhythm. I have to say he was terrified! I would explain to the present midwife what his problem was, and can we have the monitor sound turned down and the machine turned away, which she happily did... then the next midwife came in and turned it all back again, so we asked again for it all to be turned around... then the doctor came in and turned it back again!!!!
THIS is where I would have paid in gold for a doula to be with us!!
She would have supported my husband, and helped protect our space, reduced my stress levels and she would have given my husband the support he needed and the tools to support me.
I never knew any of the midwives who helped me while I delivered my first four children.. they were all labour ward midwives this is all I know, their names and faces were never really absorbed in the short time they were part of my care team, and never remembered – yet these women were the first to touch my new born baby, and the first to make decisions for the immediate care of my children – my husband certainly doesn’t remember anything of these births we shared which he considers traumatic and a medical procedure (even though they were ‘normal’ births)
I can remember going home after my stay in hospital after each birth, shaken, traumatised and with strong feelings of disempowerment.
THIS is where I would have given my left arm to have a doula!
She would have been a continuous presence for me, available to support me, my husband and the rest of our family as needed.
Throughout my maternity care with these first four babies I had never been given clear information that may/or may not have altered my choices in childbirth.
I had never been told that it was my choice to homebirth
I had never been told that I had choices in 3rd stage management
I had never been told that it was my ultimate choice what tests and monitoring I had throughout my maternity care including labour and birth.
Considerable pressure was put on me to comply with consultants wishes for my care, despite my weak protestations. I was vulnerable, frightened for my baby, concerned for my husband and felt very, very alone..
THIS is where I would have cried in the arms of a doula!
She would have given me emotional support that would have made me feel not so alone and frightened. She may have given me skills and information to help me make informed choices for my care. She would have given me the confidence to believe in myself and the choices I made.
I DID NOT KNOW ABOUT DOULAS!!!!
Until a friend told me about them not long before I became pregnant with my 5th child.
And that’s when I trained to be one!
Again, I had the care of a wonderful community midwife, she was very helpful, and seemed pleased that I was aware of the choices I could make, and was happy to support them (as she didn’t really have much choice herself I suppose!)
We spent long appointments discussing homebirths/hospital births, tests, managed V physiological 3rd stage!!! What a difference a bit of information can make! But she admits it would never have been information she would have given freely.
I felt empowered to trust my own body; I no longer feared the process of childbirth!
A Doula could have helped me achieve this! And it was only the fact that I was NOW a doula that helped me achieve it this time.
During pregnancy a doula meets with parents several times. She puts in place a support package which includes information, and birth preparation sessions to help both parents understand the birthing process and how to prepare for it, physically, mentally and emotionally. At no time should she offer any ‘advice’ or interfere with the relationship between midwives and parents.
My 5th child was born at home. I was attended by community midwives who were lovely, but still unknown to me or my husband as neither of them were my ‘regular’ midwife. This potential situation had been a concern for me as they would not have understood my husband’s fears (and if they did i was unaware of it) but my regular community midwife could not guarantee that she would be available to be called to me in labour, and it could have been anyone within the community team..
But my doula would have been available 24/7 to be with me – and I would know I could depend on having someone familiar who understood my wishes and needs. She would not be going off shift either, but would be dedicated to stay with me throughout the time I would need her, whether at home or hospital. She would NOT offer any clinical care, but just to know she was there and knew me would be plenty.
This was the only birth of our children that my husband actually remembers with any clarity! It had been an empowering and healing experience for both of us.
A doula would understand what this meant to us.
A doula is NOT a replacement for a midwife, she does not offer support instead of a midwife, she does not attempt to obstruct the relationship of parents and midwife.
A doula offers additional emotional and practical support, and at all times is focused on helping parents to achieve a more empowered, satisfying birthing experience whose main caregiver at all times will be a medical professional, whether it be a midwife, doctor or other.
It can be easy to consider birth as a small part in a woman’s journey to becoming a mother, and we often stumble through the experience with our eyes closed. A doula believes that whatever a woman’s childbirth choices are, as long as they are HER choices, will ultimately produce a more confident, satisfied mother and woman.
Doulas are women who have been ‘through the system’ as pregnant, birthing women, and KNOW how it feels... and we recognise that there is a need for more personalised support. We have not just woken up one day and decided that we will carve a place for ourselves, whether there is a ‘need’ for us or not, we haven’t decided that we will force ourselves on women, and convince them that they need us! We ARE those women! We recognise the need for doulas and have become them due to our own experiences. WE are a product of the very system that cannot provide all the support some of us feel we have needed in our birthing journeys, and we feel passionately about providing it to others so they don’t have to feel the same loss and disempowerment that we have.
I know there can be intolerance and suspicion from midwives directed at doulas, but I would beg you to realise that we are the very same women that you support throughout pregnancy and birth, and by questioning our service as doulas you are also devaluing our choices as women in your care. Instead of telling us that you don’t think doulas are needed, because you feel you offer all the support that a woman could want, please consider this: - if that were true, why are we here? And where have we come from?
On a positive note, well done and thank you midwives!! Especially the ones working in challenging areas – you’re doing a wonderful job and you are invaluable to our care in this country, birth wouldn’t and couldn’t have the opportunity to be a great experience without you! xxx