This article was first published in the November/December 2015 edition of the BCT’s Small Talk magazine.

doulas

By Emily Gold

If you are pregnant and have begun looking into options for your birth perhaps you’ve came across the term “doula”. Or maybe you had a doula at your last birth or heard about the benefits of a doula from a friend. Doulas are a relatively new addition to the Brussels birth community but employing a doula could be a great addition to your birth team.

What is a Doula?
A doula is a birth companion. The word “doula” comes from ancient Greek and literally means “woman who serves”. A doula works with pregnant women and families during pregnancy to prepare a birth plan, discuss options for medical and non-medical interventions and pain relief and discuss other questions and concerns. During labour a doula works with the labouring woman and her family. She will provide non-medical pain relief support, such as massage, breath coaching and encouragement and support for moving and position changing and will work to advocate for the birthing woman.

After birth, doulas can provide emotional support for women and families as well as breastfeeding support. Unlike a midwife a doula’s main goal is to ensure that the birthing woman is as comfortable as possible and feels empowered and respected while giving birth. Doulas are not health professionals and unlike midwives or doctors they don’t give health advice.

My partner/sibling/parent/friend/etc. will be at my birth, why would I want a doula?
Doulas are a great addition to a personal support team. Births are often very emotionally charged and having a doula present allows other members of the support team to take time and space if they need it. A doula can ensure that your partner has time to grab a cup of coffee or go to the bathroom without you, the birthing woman, being left alone. Some partners want to be very involved in the birth and having a doula there can help in this process. The doula can remind the birthing woman of effective comfort measures and ensure that two people are present to support optimal birthing positions. Other partners prefer to be more hands off and having a doula means they can be sure their partner is still supported. No matter what the comfort level a doula means extra support while giving birth.

As doulas attend many births, their intuition leads them to know just what a woman needs, whether it is a sip of water, some chapstick, added pressure on the back, etc. Sometimes the woman doesn’t even realise that she wanted it until it is offered, and then her face will light up with relaxation and a bit more comfort. A partner or family member is wonderful support but unless they’ve attended previous births they may not pick up on the subtle cues a birthing woman often gives.

A doula’s experience often helps bring some calmness, for the birthing woman and her partner. Often when she gets the call to attend a birth she can hear nervousness and fear in the voice of the birthing woman or her partner. When the doula arrives, this tone often changes, as the presence of someone who both knows what a “normal birth” looks like and is also a familiar face can be amazingly calming.

What exactly does a doula do at the birth?
Every birth is different and every doula is different. Much of this depends on what the birthing woman and her partner want from their birth, as well as the setting for the birth. In my role, typically I speak to the client on the phone as soon as she goes into labour and offer her reassurance and encouragement. If she wants I will spend time with her, though I often encourage my clients to rest if things are going normally. As I am not a medical provider, if they are worried about ANYTHING I also encourage them to call their healthcare provider or go to the hospital, but if they are doing ok I do my best to encourage relaxation, an important ingredient for birth!

Whenever they decide to go to the hospital I join them there. At the hospital my main job is to “hold space”, encouraging the birthing woman to identify what she feels she need (physically or emotionally) and to help her get it. Physically I provide massage and physical “counter pressure” to help relieve pain. Sometimes I am reminding the partner of how they can best do this, and I am acting as a secondary support person.

Often I provide reassurance. Especially for first births, or births in a new culture or setting seeing a comforting face, having a hand to hold and hearing a reminder to breath and an acknowledgement that what is happening is normal can help foster relaxation.

I also am an extra pair of hands, and that can be useful. Sometimes I go on a coffee or food run, getting some caffeine for a tired partner or something light to eat for the birthing woman. Sometimes I stay while the partner steps out, to get something to eat, or just to take some time to process everything that is going on, knowing that their loved one isn’t alone and has someone nearby she knows and trusts. And if, for whatever reason, baby needs to be taken away after birth, for more tests or additional procedures, partner can go with baby, again knowing their loved one will have someone to comfort and reassure her in what may be a scary time.

Isn’t this just a bunch of hippy stuff?
Not at all! While I love the miracle of birth and its demonstration of the strength a woman holds inside her, I have a Masters in Public Health and I believe in scientific evidence which confirms that doulas can be beneficial to both mother and child. The World Health Organization recommends continuous support for labouring women by doulas. A Cochrane Library Review(1) found women who received support had lower risks of C-sections, shorter labours and their babies had higher APGAR scores. The continuous support of a doula can lead to a more positive birth experience.

I don’t want any medical interventions, how can a doula help me?
No matter where you are planning to give birth having a birth doula can enhance your birth experience. Having a doula has been shown to shorten labour. If you are hoping for a less medicalised birth in a hospital, doulas have been found to reduce the risk of a variety of medical interventions and can work with you and your health provider to try to reach your birth plan

I am not sure if I want to have a “natural birth”, why would I hire a doula?
We are very lucky to live in a society where we have access to a variety of medical interventions, some of which are life-saving. You have the right to decide what interventions you do or don’t want and you have the right to change your mind at any time. Doulas work with women and their partners so you can make informed decisions to make your own choices.

Further reading
The Birth Partner by Peggy Simkin
One of my favourite books about what doulas do and how they can enhance your birth experience, and it is a great, non- fear inducing read, laying out what happens during all the stages of labour and even includes sections written for the partner.

Reference
1) http://apps.who.int/rhl/pregnancy_childbirth/childbirth/routine_care/cd003766/en/index.html

A note from our BCT prenatal teachers:
In our experience not all Belgian hospitals welcome doulas into the birthing rooms. If you are considering having a doula with you during your (hospital) labour and birth, do seek support for your decision from your gynaecologist or hospital. This is also the view from Vlaamse Federatie van Doula’s vzw. They have also told us hospitals who are part of the UNICEF Baby Friendly Hospital Initiative (BFHI) will allow doulas. The hospitals with this label can be found here: www.health.belgium.be/nl/bfhi-ziekenhuizen

To find a Doula:
www.doulas.be
www.doulasite.be/vind-een-doula

Emily Gold, MSPH, RYT, (www.birthbreathbeyond.com) is a birth doula and yoga teacher, originally from New York and now based in Brussels. In the past, she gave a talk to BCT members about her role as a doula.