Are doulas working as lone wolves or as part of the pack?
Nikki Mather IBCLC is a Lactation Consultant and Doula specialising in support throughout pregnancy, birth and the early years of parenting. Here she discusses working alongside the NHS and helping families navigate their options.
With almost 800 independent doulas who are members of Doula UK, and more across the UK who choose not to be members, there really is a doula for everyone. Professional and personalised doula support both during pregnancy and birth or the postnatal period is becoming a more familiar scene in modern family life.
Doulas in the UK are primarily hired by parents-to-be to add an element of continuity on their journey to parenthood. As an additional layer of support during pregnancy, doulas can provide a whole variety of ways to navigate the process of birth, and support families in whichever preparation they believe will help them stay calm, positive and in control during such an unpredictable time.
Doula support often helps with informed decision making, birth plans or preferences, sitting together and working through the information they’ve gathered along the way from friends, family, antenatal classes and healthcare professionals to build a set of preferences their partner or doula may help advocate for when the big day comes along. Doulas also provide antenatal classes, with some offering mindfulness or hypnobirthing support and an understanding of the physiological processes of birth.
Postnatal support provided by doulas covers all eventualities from holding the baby whilst mum grabs a much needed nap, to infant feeding support and general support in the early parenting days as new parents work their way through what their baby needs from them. Batch cooking ahead so families have a lovely stock of food to reheat can be a lifesaver and timesaver in the early days.
Working as a doula as lovely and beautiful as it is, comes with challenges to navigate. Being seen as an “outsider” comes with our role at times. There may be questions from parents about how well doulas are accepted, or not, in their birth space due to a common presumption of doulas being unwelcome.
Doulas and parents have sometimes encountered defensiveness from healthcare professionals wanting to protect their status as primary care for families in pregnancy and exclude doulas from the team.
Occassionally, parents are eye rolled at when they excitedly tell their midwife or doctor they’ll also have a second birth partner – a doula. Leaving families unsure about their choice to hire additional help, and afraid to mention it again.
A deathly silence sometimes encompasses the room as I say I am the doula, when a midwife asks who I am.
Doulas are sometimes prevented from supporting their clients fully due to personal opinion being dressed up as “hospital policy”. Stories from parents also share how a healthcare professional may have a misunderstanding of our supportive role during their antenatal, birth or postnatal experiences.
Misplaced assumptions on how we only aim to divide a family from “the system” are few, but extremely challenging for parents and doulas to navigate. Despite extremely clear boundaries, there is still a misunderstanding of how we actually work alongside everyone, and not against them as the families we care for find themselves in situations unknown and as birth goes, in unpredictable outcomes.
“Out of bounds” areas like recovery or theatre may be tricky to gain access to, leaving us in rooms or corridors away from our clients and make it tricky to provide the service we promise due to hospital policy, visiting times or the opinion that doulas aren’t fit for purpose or trained enough to be in those environments.
I must emphasise here that in the vast majority of situations, Midwives and Doctors, Anesthetists and Paediatricians welcome doulas with open arms as a part of the team supporting families. Midwives will welcome families and doulas together as part of the team on arrival at hospital, or breathe a sigh of relief when they realise a doula is also around to help and support everyone at a home birth.
Over the years as I have supported families to navigate their pregnancy and birth journey, doula support has certainly been a challenge for me at times, as any doula will tell you and as with any job, there are ups and downs.
Different scenarios sometimes occur from the plan you have in your head. Perfectly laid plans for birth needing to be reevaluated with no notice at all. Birth preferences changed throughout the course of a pregnancy due to new information about the health of baby or of you. Last minute urgent decisions based on new information which needs an answer now and a consent form filled 5 minutes ago. Curve balls thrown at right angles, just to keep you on your toes.
When the unpredictability of pregnancy, labour and birth are navigated together, when parents aren’t left feeling unheard, unsupported and unable to express how they feel, positive experiences can be had, even when the outcome has been the least desired.
When doulas are part of the team, and not left out in the dark, when everyone works together to support a family’s needs in THAT moment, when everyone can be together and provide holistic support, when the landscape changes at the tick of the second hand, that’s when real teamwork occurs.
Working alongside a medical team in theatre is a much calmer experience for everyone. The family feel held and supported by somebody they know, somebody they’ve got to know together and feel safe. Doctors, anaesthetists and midwives appreciate the support so they can get on with their practical tasks, knowing parents are ok and can pop over for some reassurance when they get chance to.
When doulas are left out in the corridor or even escorted off the premises “because only one birth partner allowed now we’ve gone to theatre and visiting hours will be on the ward tomorrow”, it isn’t family-centred care at all. The hostility shown to doulas by some people, isn’t kind to anyone. Parents are left without their support and doulas are left stuck in Catch 22 – able to provide the support promised, sometimes even agreed previously by hospital staff, but being prevented in the moment it is most needed.
Parents can be left feeling unsupported, unheard and their needs unmet when their support network falls down due to the ignorance of our role.
Doulas, parents and healthcare professionals report a myriad of reasons for being asked to leave.
Visiting hours are over.
Parents are resting.
Theatre is cramped and one more person is dangerous.
Recovery has too many people in.
Mum is not conscious/asleep.
Only one person allowed in to visit.
The move to a postnatal ward won’t be until after visiting hours – come back tomorrow.
Mum needs to sleep, not entertain visitors.
Support is already being given by midwives/doctors.
The baby has been born, your support isn’t needed now.
Family only due to circumstances.
Parents, midwives, anaesthetists, doctors and doulas also report how the added layer of support works.
We were incredibly calm with our doula with us the whole way.
The doula provided much needed emotional support during a critical time during the spinal preparation.
The doula supported parents with hand expressing into syringes so the baby could be fed colostrum quickly.
The extra person in the room was no fuss at all.
Having the doula with the parents helped calm a critical situation.
Extra support for parents means extra support for me as a midwife – bonus!
We welcome students, so why not doulas?
Your presence has helped make this easier, thank you.
Wasn’t she (doula) brilliant in there! Not what I had expected at all!
As doulas we are available to support families in theatre, in recovery, in the birth room, and “out of hours” after visiting is over on the postnatal ward. This can only be achieved when our role is understood and the needs of the family respected.
In reality, and in the vast majority of situations, doulas and medical staff get along just fine. They support each other, working as a team to ensure parents are as comfortable as they can be. Their roles complement each others, often tag teaming the support element every role already holds. Nobody is more important than the family at the centre. And things work smoothly even when the ride is a bumpy one, and even with a doula on board, when we are accepted as part of the team.