Most prospective parents are familiar with what’s involved in preparing for a birth – attending antenatal classes, packing a hospital bag, perhaps writing a birth plan, and certainly bidding a wistful farewell to sleep. But something that’s less well known – although growing in popularity – is using a birth doula. So what exactly is a doula and why are more and more parents hiring one?
“A doula is a trained professional, experienced in childbirth who provides advice, information, continuous emotional support and physical comfort to a mother before, during, and just after childbirth,” explains Wicklow-based doula Anna Boch. “The word ‘doula’ is Greek in origin, meaning ‘female servant’ and a doula is literally ‘in service’ to the mother.”
Doulas provide non-medical support – they don’t carry out medical procedures or make decisions on behalf of parents. But they continuously support the mother; and unlike medical staff whose shifts may end during labour, a doula never leaves the mother’s side.
But with most births still taking place without a doula, what would prompt an expectant mother to hire one?
First of all, there’s research to say doulas have a positive impact. Information compiled by Cochrane.org shows that the presence of an experienced, trained person who is there solely to provide support, and is not a partner or friend, appears to be most beneficial to women in labour.
Many women turn to doulas after a less than ideal first time experience of childbirth. “My first birth was an induction, and ended up in C-section,” says Cork mother of two Geraldine Bøgetoft Power. ”It wasn’t a terrible experience – but different midwives and doctors told us different things at various times, and if a doctor tells you something, you just presume that it’s right – you don’t really question them. So looking back we felt we were pushed into things that maybe in hindsight we could have asked ‘Why?’ or ‘Can we have a chat about it first?’”
When she was pregnant with her second child, she and her husband decided to hire a doula. For Geraldine, a huge draw was the consistency. “In the Irish system at every doctor’s appointment you see someone else. Then when you’re giving birth, it could be a completely different doctor or midwife again. It would be nice to have a bit of consistency. A doula isn’t just there for giving birth – you meet with her before giving birth, and after too.”
She also liked the idea of having someone who was there just for her. “You get the extra support – you have someone in your corner. I remember at one stage I had doctors talking to me while I was in contractions – I was just looking at them thinking, ‘Stop talking, I’m in the middle of contractions!’ I had to have my waters broken – [the doctor] explained it, then left the room and said, “You guys have a chat about it.” I probably forgot half of it and my husband forgot the other half, so it was lovely to have our doula there – someone who knows what’s happening.”
Anna Boch agrees. “The biggest benefit is the continuity of having a trusted professional that you can rely on to be there for you – no matter what. And regardless of what your decisions are along the way – be it home birth, epidural, elective Ceasarean, midwife-led, or consultant-led – there is this one person who will support you.”
Nikki Walsh, a Dublin mum of two, also decided to hire a doula for her second birth. “I had a traumatic first birth and wanted the second time round to be different. Then I met the doula Amber Leipner. I instantly felt so comfortable with her, I knew it was the right thing for her to be there.” She found the experience to be completely different to her first birth. “It was amazing. The atmosphere was so loving and safe, I felt unafraid. And on a practical level, her breathing techniques and massage techniques made the pain manageable. And having her there prevented me from going to the hospital too soon, so I didn’t have to have a managed labour.”
Staying at home for early labour is one of the reasons couples decide to use a doula, says co-founder of doulacare.ie Mary Tighe. “Many like the fact that I will come to their home and offer emotional and physical support before they leave for the hospital. All current evidence finds that outcomes are better – especially for first-time, low risk mothers – if they can stay at home while in early labour. So having a professional birth partner with you can be a comforting presence.” Mary, who was Geraldine’s doula, says couples also find it comforting to have someone they know going into the hospital with them. “They may not have met their midwife beforehand or ever been into a labour ward. As I’m familiar with this environment I can offer a reassuring presence.”
Having a doula there also takes pressure off partners she says. “Partners like to know that not all the responsibility for supporting the mum lies with them and that there is someone there who is impartial and objective. The doula never takes over or replaces the partner – unless for some reason they cannot be there – we are there to support the partner as well as the mum.”
So how does it work in practical terms?
“I usually have an initial meeting to explain my services and then one or two more visits in their home, which last two to three hours, where any number of topics can come up,” explains Mary, who is based in Cork. “They also get to come along to one of my monthly GentleBirth weekend workshops so I get to spend time with them there as well. In between we will be chatting via phone or text or email, so by the time their labour starts we have built up a lovely relationship. I’m available to chat throughout the pregnancy and then go on-call 24/7 from 37 weeks until the baby arrives.”
The Doula Association of Ireland website (Doula.ie) is a good starting point for finding a doula in your area, and there are lots of virtual word-of-mouth recommendations in the form of Facebook parenting and birth groups. Indeed, social media may be partly responsible for the growth in popularity of doulas in Ireland. “Popular use of online forums has encouraged sharing of information in groups that pregnant mums can access, regardless of where they are based geographically,” suggests Anna Both. “So while in the past, you would learn a lot about pregnancy and birth from family and friends, you might not necessarily connect with others who share your personal birth preferences.”
Doula Jen Crawford (also a co-founder of doulacare.ie) is a DAI committee member and has witnessed the rise in popularity firsthand. “In the past ten years the DAI has increased membership by almost 500% – the first year we had ten members, now we have 47, with more applications pending. Ten years ago it would have been very difficult for a Doula to make it her sole career – now there are many who have their Doula work as their main income. The interest in Postpartum Doula care has increased also. Last year the DAI had two postpartum Doulas, myself included – now there are ten. Postpartum Doulas are shown to reduce the rate of PND and improve breastfeeding outcomes.”
Doulas cost between €600 and €1200 – are they worth the expense? Nikki Walsh thinks so. “I easily spent that on physio and osteopathy after the first birth so I figured I might be saving myself a few pennies if I hired one.”
Geraldine agrees. “First time around everyone said to me ‘Your baby’s healthy, you’re healthy, there were no major complications – be happy.’ But the journey to get there is important too. And the second birth was a completely different experience. Comparing the two births is as different as fire and ice.”
And personally, remembering my own three children’s births, I can see why having someone experienced there throughout, whose only function was to support me, would have been a huge comfort during the most vulnerable time of my life. My babies were healthy, but as Geraldine Bøgetoft Power points out, the journey is important too.
(This article first appeared in Mothers & Babies with the Independent)