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"A doula is a person who supports women through labour and birth, and/or after she has her baby." Mander, 2008; Doula UK, 2018
There are loads of statistics out there about what a doula can bring to your birth experience – less chance of medical intervention, lower rates of unplanned caesarean birth, less perceived need for medical pain relief, greater birth satisfaction – and whilst these stats can be helpful in guiding your decision to invite a doula on to your birth team, they reflect population level trends, not individual experience.
Some people with a doula on their team will have an unplanned caesarean birth. Some people will choose medical pain relief. A doula is not a guarantee that you will have a birth experience that unfolds exactly to plan… though overall when we look at whole groups of people, it does increase your chances.
So why does a doula have the potential to unlock a more positive birth experience then?
What is certain for YOU as an individual, birthing with a doula by your side, is CONNECTION. Connection is powerful. It brings that sense of safety… and we know a sense of safety is KEY in birth.
A doula can make you feel safe by bringing that connection to your birth space in so many ways.
Physical Presence
We are in a strange situation in the UK where the reduction of risk is the focus of maternity systems…yet the system is grossly underfunded, overstretched and most maternity units have huge staff shortages, particularly of midwives. This means staff supporting your birth are physically stretched – though the ideal is to have a constant companion through active labour, your midwife may not able to be fully present with you and dipping between different rooms. Or if you are choosing to birth at home, you may find you are told there might not be enough staff available to come out to you.
A doula will be physically with you from when you decide you need them….until you decide you are ready for them to leave. A doula will rarely dip out of your birth once they have come to you (except for wee breaks!), so no need to worry about staff changeovers as shifts end. This knowing that you have a constant supporter removes any fear of being left alone, any doubt about who will witness the birth. Certainty brings safety.
Continuity of Carer
Many studies, and frankly just common sense, reflect how important continuity of carer is in birth. Having a known person who knows YOU supporting you through birth. This has been shown time and again to affect mental and emotional well being (no brainer really) and also actual physical safety of both mum and baby (maybe more surprising?).
If you are pregnant in Bristol, it’s likely you’ll be assigned to a team of midwives and you may see the same one through pregnancy and a different one at birth, or you may see different midwives from that same team in each midwife appointment. And then someone different post natally. Or, very rarely, you may get the same midwife for birth as you’ve seen thorough pregnancy – this is far more likely if you home birth.
A doula will support you through pregnancy, birth itself and the post natal period. A doula knows your back story as intimately as you want them to, so you remove the need to reshare past experience or individual preferences over and over again – they will already know it. Some of the stress and anxiety about who will be there on the day can be removed by knowing it’s the familiar face of your doula there again. They’ll get to know you and your family closely so that they know how you respond to stress, how they can support you best and the type of communication that works best for you. Familiarity brings us safety.
Personalised Care
A doula’s role is not to provide the medical care you may need or choose in pregnancy or birth, but it is to centre YOU in your experience, however it unfolds.
The NHS maternity system is a system and it has to be set up in a way to deal ‘efficiently’ with the huge numbers of people that access it every year. This results in midwives and doctors feeling under pressure to meet hospital targets and bound to their Trust guidelines, whether they personally believe in them or not. This is their job to do, in the way the system currently stands. However, it does often leave the feeling that you being processed, or managed. That you have ‘ticked a box’ (literally!) so your path is this way… with little regard to you maybe wanting a path that is that way.
“Safety is not the absence of threat, it is the presence of connection.” Gabor Mate.
A doula will always bring the focus out of the tick box and back to you. My favourite questions to ask my doula clients are:
How does that feel to you?
What do you think?
Do you need anything else to decide?
Doulas aren’t governed by policy and have no target to meet – other than supporting you – so you will always be their focus. Autonomous decisions (over tick boxes) brings safety.
Birth is a hugely transformative experience, however it unfolds, and it’s ramifications are felt probably for the rest of your life. It deserves honour, time and respect and you do get to choose what is right for you.
Your doula can remind people around you, and in fact you yourself, that you are the centre.
Author: Kim Mousley
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Kim is a doula, pregnancy and post natal yoga teacher, and Hypnobirthing teacher. She is based in Bristol, offering classes in Hanham and Keynsham, and her doula-services around the greater Bristol/Bath area. She believes there’s no way right way to birth... But that everyone deserves to recognise their power, be treated with respect, and have a positive experience of what will no doubt be one of the most special days of their life.
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