How Doula Care Enhances Your Birth Experience
By Julie Bell, NZRCompN, Doula.
“If there was a drug that could shorten labour by an average of two hours; reduce the likelihood of caesarian by half; decrease the need for artificial pain relief; increase a labouring woman’s sense of relaxation, comfort, confidence and overall satisfaction; and promote positive feelings that promote bonding of the mother, baby and father …. It would be unethical not to offer it.” 1
This quote really got my attention. It comes from a Medical Doctor named John H. Kennell.
The substance he is referring to is out there. It’s not a drug. There are no nasty side-effects. It’s getting rave reviews from people who’ve tried it.
It’s a Doula.
A Doula is a compassionate woman who knows a lot about birth and who stays with you right through your labour and birth.
How could something so simple make such a dramatic difference to birth outcomes? Those who have been conditioned to regard birth as a medical event that is highly likely to need close monitoring and active medical management in order to avert tragedy, may find it difficult to credit that a non-medical, non-surgical strategy could have more than a marginal effect on a process so fraught with difficulty and danger.
I heard about the Doula concept while I was pregnant with my first baby. I read all I could find on the subject of birth support and doula care. When I found out that there are Doula training courses right here in Australia, I thought, “That’s for me!”
During my training I had the privilege to meet many dynamic Doulas (put a few hundred of these remarkable women together and you won’t need electricity to light the room!) and got to see how Doula care in action.
I found that there’s a good reason why hiring a Doula to be part of the birth support team is growing in popularity. It works. Remarkably well! That is because Doulas trust in the natural process of birth, and understand that within an environment of privacy, safety, support, and respect, the majority of women will labour spontaneously and give birth to their babies under their own power. Professional Doulas have a high regard for the innate wisdom and instinct that guide a woman into assuming positions and employing comfort measures that support the progress of her labour. We are carefully trained to offer support, encouragement and comfort that will enhance this progress and not disturb it, take over from it, or get in the way of it.
Doulas are great for mothers because this nurturing care, known as “mothering the mother” empowers them to in turn nurture their newborns. In other countries, women choose their midwife themselves, who cares for them from early pregnancy through to the post-natal period. This allows a close rapport between the mother and her midwife. Such continuity of care is highly rated by both mothers and midwives and is a major factor in favourable birth outcomes – but it’s rare in Australia. Hopefully, in the near future, successful lobbying for maternity reform will result in continuity of care being standard for all Australian mothers. Until then, doulas and private midwives are filling this gap in Australian maternity services.
Doulas are great for babies because the Doula helps the mother feel confident and relaxed during the tremendous effort of giving birth. If the mother is distressed, the baby may well become distressed. But when the mother is cared for and supported, the risk of foetal distress is reduced. The Doula also sensitively promotes privacy and quietness at the time of birth, and encourages skin to skin contact during the important window of optimum bonding time just after birth, when the flow of bonding hormones peaks. This is ideal for promoting 'breast-crawl' in which the baby intiates the first breast feed - which is optimal for successful breastfeeding.
Doulas are great for fathers because they encourage as much involvement on the part of the father as both partners desire. The Doula is able to reassure a worried father and encourage him that his presence and care is having a significant positive effect. By taking care of many of the practical details involved in maintaining an ideal birth environment for the mother, the Doula arranges for the couple’s privacy, allowing the father to enjoy the emotional journey of helping his partner bring their baby safely into the world.
Doctors and Midwives are favourable to the presence of a trained Doula as part of the birth support team. That is because the Doula’s role in a non-clinical role and she is there only to provide continuous emotional and practical support. When Doctors and Midwives are unable to stay with a birthing couple for the duration of the labour, they know that the couple will not be left entirely alone, but have the supportive presence of the Doula throughout. This non-clinical support from a skilled Doula enhances and complements the efforts of the medical caregivers to promote the natural progress of labour and to ensure bottom line clinical safety for both mother and baby.
Doulas themselves benefit from attending births since we learn something from each woman we attend. Thus we grow in experience and hone our skills for helping other women in the future.
I love this work. It is a special honour to journey with a couple through such a special season of their lives. When I meet with a couple during their pregnancy, we take time to get to know each other. I listen to their birth stories and hear their hopes and vision for the up-coming birth. Every woman and baby is a unique combination, and I find that I learn a great deal from every woman and every birth. Despite our diversity, there are some things that every human female shares when it comes to our innate resources for giving birth.
So, we discuss such topics as “the Physics of Birth” - how you can work with your pelvis, using movement, gravity and positions to alter the dimensions of your pelvis and become familiar with your body’s strength and cleverness. We practice exercises to strengthen your muscles and encourage the baby to lie in the anterior position which is optimal for a straight-forward labour. We talk about the care of your perineum: the benefits of perineal massage, pelvic floor exercises and soothing remedies for the healing perineum after birth.
Then there is “the Chemistry of Birth” – how your body releases exactly the right hormones you need to birth your baby. The special cocktail of hormones released by the pituitary gland of your hypothalamus is remarkably similar to the ones released during sexual intimacy. The hypothalamus is also known as the primal brain, old brain or ‘deep brain’. It is the part of you that is responsible for emotions, feelings, intuition and conditioned reflexes. It activates the ‘fight or flight’ response to stress. Birth is a time to chill out, let your instinctive self rise up and let your thinking, analytical brain slumber for a while. Birth time is not Maths time! It’s similar to other instinctive activities we do like sex and toileting.
Imagine if you were having a warm, intimate moment with your beloved and suddenly you hear, “By the way – we got the quote for the renovations – it’s going to be about 30% more than we budgeted for.”
Right. Thanks for that, sweetie.
Talk about a mood killer!
During birth, monitoring, measuring and questions can do more than just kill the mood – they can inhibit the progress of labour and give your uterus ‘stage fright’. Interruptions can trigger your fight/flight mechanism, causing you to tense up, which may make labour more painful and protracted.
If a birthing woman hears talk of how many centimetres dilated she is, what the foetal heart is, what her blood pressure is, how many hours she’s been there, what station the foetal descent is at, etc, such constant stimulation of her cerebral brain can make it hard to relax and sink into the deeper, instinctual part of her being.
You need a “Baby-Friendly Environment” – one that is conducive to conceiving as well as birthing babies. Then you can maximize the release of your natural oxytocin, relaxin and endorphins, and minimize the release of stress hormones, so you can relax and your body can work beautifully. Your doula will talk with you about your preferences for such things as soft lighting, warmth, peace, privacy, mood music, gentle words, warm water, massage and touch, a sense of safety, and respect.
And then there’s “the Art of Birth”. During pregnancy, birth and mothering, the mind-body connection is clearly evident. In our culture, fear, risks and problems tend to surround the business of birthing. Our thoughts produce fear, which triggers the fight/flight response and makes it harder to relax and move into the dreamy, intuitive place of deep relaxation. Fear is a natural part of life – fear helps us make smart decisions when we are driving. So the goal is not to eradicate fear, but to confront it, be real about it – and then manage it. As you gain skills, grow in confidence of your strength and abilities to give birth, and practice deep relaxation, fear gets put into perspective – as a tool - but not an overwhelming thing. I work with my clients to explore beliefs, feelings and memories of birth. Through relaxation, breath work, meditation, prayer, breathing, visualization and affirmations, you are able to get in touch with your inner strength and get your inner dialogue working for you, not against you.
During labour, it is all about you. Doula literally means, ‘servant’, and she is employed by you (not the health care system) to be in your corner and serve your best interests. After listening to you during the pre-natal visits, she understands your requirements and preferences, and supports your choices. She is simply there for you, from the time you call her to come until when you are cuddled up safe and sound with your new baby and tell her ‘goodbye’.
Doula care continues after the birth with breastfeeding support, and practical help such housework or minding the baby while you sleep. Sometimes I arrive in the early evening and support the mother through that ‘interesting’ time of settling and soothing a tired baby. And mother! Many doulas will do overnight stays to give the new parents a much-needed unbroken night’s sleep. Photography and birth stories or scrapbooks are extras some doulas offer with their services. I give each of my clients a year’s subscription to the Australian Breastfeeding Association, which includes a free book called “Breastfeeding Naturally”.
How much does it cost to hire a Doula? A full package typically costs from $600 to $1000. This includes 10 hours of pre-natal consultation, attending the birth and usually 4 hours of post-natal visits. Doulas are dedicated women who do it for love not money! $1000 might seem like quite a large bite out of your Centrelink Baby Bonus – but a positive birth experience, with the support for optimum bonding and confidence in breast-feeding and mothering that results is surely a great investment. The benefits of having a compassionate Doula at your birth may be felt for months and years ahead in the way you approach parenting with confidence and belief in yourself.
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