Do you want an easier pregnancy?

A review of 15 research trials involving nearly 13,000 women presented in the Cochrane Library shows the ongoing care of a female support person, such as a doula, radically reduces the chance of caesarean, the length of labour, forceps deliveries and requests for epidurals and oxytocin use.

Because they bypass medical and clinical tasks and work independently, a doula is there exclusively for you, offering guidance, support, reassurance and information.

Traditionally, to achieve an optimal birth outcome, other practised women guided and supported the expectant mother through her pregnancy, labour and postnatal period. Most western cultures, however, lost the philosophy of women assisting women during birth, when industrialised societies emerged. In Australia, a woman’s experience of childbirth is likely to find her labouring in a bustling hospital ward with an overwhelmed partner, in the care of a rostered midwife or obstetrician.

Enter the doula. They have re-established the role of a woman as a support person during this momentous — and sometimes daunting — life transition. Translated from Greek, doula means "female slave for the childbearing woman". This has transformed to "one who mothers the mother" — the modern-day meaning of what a doula offers. Because they bypass medical and clinical tasks and work independently, a doula is there exclusively for you, offering guidance, support, reassurance and information. Recent years have seen doulas flourishing in the US and the UK, and now they are gaining popularity in Australia, as word is spreading of the benefits of their holistic approach.

Birth buddy

Townsville’s Debbie Holland recruited doula Philippa Scott, co-founder of Birth Buddies, following a traumatic labour with her first baby, Cate. "It went for days — I had every type of medical intervention and ended up having a caesarean," she explains. Pregnant again 13 months later, she instantly became apprehensive about the impending labour. "I had reached a point where I decided I would just ask for a caesarean, simply to get it over with," says Debbie.

An acquaintance who saw her distress recommended Debbie meet with Philippa. They bonded immediately and Debbie hired Philippa as her doula. "Even my husband, Andy, who is quite the macho stereotype, not at all new age, was all for the idea of having a doula after he met Philippa," Debbie says. The first childbirth experience had troubled Andy, too, but Debbie says the second time around he was relaxed and supportive, offering her massage and other pain-relief remedies. She learned afterwards that it was via Philippa’s subtle coaching that Andy had garnered his confidence.

With baby Anastacia only three weeks old when she spoke, the birth was fresh in Debbie’s mind and she was on cloud nine. She credits much of her bliss to Philippa’s facilitation. "She was there as my advocate. She knew what I wanted as we had drawn up a birthplan. She knew I didn’t want to be offered drugs and if I did want them, I would ask."

The diversity of the doula

Honey Acharya, Philippa’s partner at Birth Buddies, tells of the range of their clients. "Here in Townsville we have a large defence force community. They are often stationed here without family or close friends nearby. Townsville also has many people who work in the mines, flying out for weeks at a time." Because they are often isolated, Honey says she plays an integral role in the postnatal period. "We offer help around the house or provide information or emotional support."

Doulas all seem to have a propensity for the entire birth procedure, and Honey is no exception. Her impetus to become a doula began at just five years old. "I’ve always been interested in pregnancy, women and babies, and planned to go into medicine and obstetrics until I realised it wasn’t really what I wanted to do. Childbirth education or midwifery were more along the lines of my passion." While still pondering midwifery, Honey enjoys being there solely for the mother and not tied to the hospital’s rigorous schedule. "As a doula I am not focused on routine tasks. I don’t have to leave because there is another woman in labour down the hall or my shift is over," she explains.

Birth Buddies is so devoted to helping women, Honey and Philippa have made a commitment to provide support for those who may find the cost prohibitive. They usually ask for a small exchange in return. "This can be as little as some muffins or paying the cost of our taxi fare." Usually, the cost of a doula ranges from $300 to $800, depending on the type of care required.

Scientific recognition of doulas

Dr Sarah Buckley, a Queensland general practitioner with training in GP-obstetrics, says the one-on-one care with a chosen midwife is the gold standard for pregnancy and birth care, but laments this choice is only available to a minute number of Australian women. "For the 99 per cent of Australian women who are unable to access this safe, satisfying and cost-effective model of care, I recommend taking their own doula into hospital with them. A doula can provide the personal and loving care that labouring women have traditionally enjoyed in all cultures, and that is the foundation for a safe and satisfying birth," says Dr Buckley.

She also praises the emphasis the doula puts on your partner and adds her perspective on the rising childbirth intervention rates. "A doula can help to create, and more importantly to protect, the birthing space so the labouring woman can feel private and safe — these are core requirements in birth for females of all mammalian species. Conversely, the lack of attention to these basic needs is, I believe, a major reason for the difficulties that women have in giving birth under medicalised conditions."

Scientific evidence also reveals the positive outcome a doula can implement. A review of 15 research trials involving nearly 13,000 women presented in the Cochrane Library shows the ongoing care of a female support person, such as a doula, radically reduces: the chance of caesarean, the length of labour, forceps deliveries and requests for epidurals and oxytocin use.

Doulas support all types of births

Many women’s interest in becoming a doula is spawned after supporting the births of close friends or family’s babies. They progress to doula training or childbirth education classes, which teach them the physical, mechanical and emotional aspects of the natural birthing process. Of additional importance is the necessity for a doula to understand the need or want for medically intervened births.

Denise Love, founder of Doula Express, a doula training school in Sydney, says when meeting with a new client it is imperative for the doula to "know how to leave her own belief systems at the door". The whole doula-client relationship focuses on your satisfaction. Denise, who held the first Australian doula conference in Sydney in 2004, has attended many births, including those of women who choose an elective caesarean. She says, while most women find the birth process a little daunting, some have a deep-rooted fear that goes beyond the norm. These women can be particularly vulnerable and a doula is an excellent advocate, ensuring they are aware of all aspects of any procedures. Furthermore, they make sure mother and baby are able to bond as soon as possible.

Denise describes how following a caesarean she likes to guarantee the mother has the instant opportunity to hold her baby skin-to-skin. This creates the beauty of the tactile responses often vacant following a caesarean. She emphasises, a doula aims to engender a sense that your baby’s birth was a supreme achievement — regardless of how they entered the world.

Postnatal benefits

The first book to be written on doulas, Mothering the Mother (Klaus, Kennell, and Klaus, 1993), indicates a doula’s assistance can help combat postnatal depression (PND). The authors say that both the physical and emotional outcomes of birth have long-lasting effects on the new mother — with a negative experience potentially exposing the woman to PND.

Some statistics note that around 14 per cent of Australian women suffer PND, however other surveys challenge this. In particular, a poll conducted early in 2004 by the University of Sydney found that 53 per cent of new mothers in Coffs Harbour suffered from the disorder. In contrast, there is no evidence of PND in non-Western cultures, where community and family members nurture and prevent the new mother from any duties other than mothering her child. While a doula does not endeavour to change our societal practice, she can offer to alleviate some of the stress incurred in those vital early weeks.

Jo Hunter, has been a birth and postnatal doula for a little over seven years and supports, on average, two women per month. Jo operates a 24-hour telephone service and lists the ways she has assisted women in the postnatal period: "I have looked after older children while the mother cares for and bonds with her new baby; I have stayed overnight to help exhausted parents; I have brought the new family dinner; I have cleaned their house; I have gone to the woman’s homes every two to three hours to assist them with positioning and attachment when there have been breastfeeding problems; I have taken older children and the new baby for a walk to the park so the mum can have a much-needed sleep; I assist with comfort and settling techniques, help with the bathing of a new baby, talk women through baby massage." The extensive list is not complete without what Jo notes is a key factor to her services: "I listen to the women, acknowledge their feelings, fears, apprehension, joy and happiness, and I hope that I have assisted a new family in any way that I can."

Ali Maegrarth, from Cranebrook, west of Sydney, employed Jo after researching birth options for her second son, Jonah. She says, although her previous labour with son, Jebediah, was quite straightforward, it was vacant of guidance and assurance that all was progressing smoothly. Ali and her husband Richard felt that they were left to their own devices. "I just wanted someone to wrap their arms around me and say ‘Come on keep going you’re almost there’ — just the verbal encouragement that can give you the motivation to get through."

After employing Jo, Ali says they communicated regularly and a close friendship blossomed. She was so ecstatic with the encouragement and advocacy Jo provided during the birth that she and Richard were soon discussing baby number three. Of course, the sleep deprivation that followed brought swift reconsideration, but Ali affirms, when the time does come she will undoubtedly choose a doula for birth support. "It’s the most obvious way to have a baby … just having an experienced woman there to help you through — it’s very simple." She adds, "The overriding thing Jo provided was to give me faith in myself to birth my own baby."

To find a doula in your area see: www.australiandoulas.com.

The doula’s philosophy:

She believes in the process of birth and the impact it has on parenting.
She is a great listener.
She is respectful.
She does not impose her own thoughts and beliefs.
She trusts the woman’s instincts.
She acknowledges the power of birth.
She believes the father is the most important team member if that’s what the woman wants.
She recognises birth as a non-medical event, unless the woman asks for assistance for her or her baby
She understands that the fewer people interrupting the woman and the process, the quicker the birth will be.
She knows that dim lighting always makes a difference.
She offers continuous support to the woman and her birth team.