Doulas: pregnancy carers that go the whole nine months… and beyond

March 19, 2010 at 10:31 am 1 comment

by Sarah Gillinson

Doulas are far from being a new concept – the word derives from ‘woman servant’ in ancient greek – but they are in increasingly high demand. Doulas are women who offer support and encouragement to mothers during pregnancy, birth and in the early weeks of a baby’s life. They build on the age-old tradition of older, more experienced women ‘mothering the mother’ throughout the whole process of having a child. In the past, these women were mothers, sisters, aunts or friends, part of the family’s community. Today, doulas are accredited professionals.

Doula UK – the professional network run for and by Doulas – attributes the explosion in demand for their services (their membership has risen from 28 in 2003 to more than 450 today) to three main factors: the ‘medicalisation’ of birth in hospitals, which has led to the withering away of non-clinical support for mothers; the likelihood that women will no longer live close to their extended family; and the constant cut-backs faced by midwives, which mean they are increasingly strapped for time and staff.

In this context, Doulas are sometimes accused of trying to usurp the midwife, offering a poorly trained alternative. In fact, Doulas aim to empower all the people involved in pregnancy, birth and the early days of a baby’s life – from midwives, to partners and the mother herself – to make the best use of their resources in creating a more ‘enjoyable’ and successful experience for all involved. Doula UK argues that far from being a replacement for midwives, Doulas should be a powerful complement that helps improves outcomes for families.

Doulas empower mothers themselves to feel more confident in their instincts and choices, and to relieve some of the stresses of day-to-day life. They are explicitly focused on the mother and her needs as a whole person, not as a ‘patient’. Doula services are therefore highly flexible, depending on the person and their experience – they can involve anything from doing the shopping, to looking after other children, to talking through options for the birth.

Doulas can also build new parents’ confidence, as this new mother found:

It was my doula who helped me say no to the queue of visitors wanting to see Charlotte. It was she who helped me stand up the barrage of opinion from other people and who, with her quiet knowledge showed me how to be with Charlotte and take my cues from her, instead of having my nose in a book. But most importantly, it was her who gave me the strength to follow my own instinct instead of battling with it.

This kind of moral support and understanding is possible because the Doula can stay with the mother throughout the whole period of pregnancy, birth and early life of a child – they can build an enduring relationship.

This does not only apply to mothers: much of the testimony on Doulas describes how they have helped fathers to feel more confident in their role in the birthing process for example. It also describes the role of postnatal doulas in helping the whole family settle into their new life.

Doulas, at their best, can also support midwives to make their job easier and more effective. They help women to be better prepared for and more confident in the birth process and can provide crucial support and encouragement on the day. The Royal College of Midwives recently hosted a fascinating conversation about doulas on their blog for members. The dialogue illustrates highly variable opinions about doulas – and their quality. Some midwives see them as meddling and a burden – questioning their authority and contradicting important medical advice:

It seemed that she had very fixed ideas that all hospital midwives were nothing but obstetric nurses…Her questioning would have made a barrister proud! It was not helpful for the woman to see her caregiver being treated like a snake oil salesman either.

Others see them as allies and a crucial partner in the birthing team – helping to calm mothers and make the choices that matter to them:

I feel that doulas are extremely valuable in that they help build confidence in the woman’s own ability to give birth prior to labour. Women I have supported with the assistance of a doula have been far better prepared and more relaxed during labour.

Doula UK would uphold the complaints of the midwives who feel their advice is being undermined. They state explicitly that the job of their members is never to offer advice – the clinical job of the midwife – it is to create the environment and offer the support that makes the birthing process easier and more effective.

Doulas are an interesting new breed of professional – their role is less to offer their own product or service, and more to liberate the resources of all the other actors in the birthing process, from mother to midwife. They are much more like the concierge service, TenUK – offering you the ability to delegate the tasks not requiring your personal attention, and allowing you to focus on the aspects of your life that require your energy and expertise – than they are a doctor, nurse or midwife. The impact can be remarkable. Research has shown the presence of a doula shortens first-time labour by an average of two hours, decreases the chance of caesarean section by 50% and decreases the need for pain medication. All of these have a financial, as well as physical and psychological impact.

We believe Doulas are an example of radical efficiency: different, better, lower cost public services. As described above, they offer a whole new paradigm of service to mothers, not merely tweaking or adding a new dimension to the old system. By truly understanding their users, they help to clarify and remain true to the outcomes they want to see, whilst liberating the latent resources already in the system, to make them happen.

Entry filed under: Innovation Worldwide, Radical Efficiency.

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1 Comment Add your own

  • 1. theideasguy  |  March 21, 2010 at 2:15 pm

    As a writer and parent of 4, I understand the importance of confidence when learning anything. The first taste of anything in life can make it or break I have found. Think about it. what are you good at? I bet you had a pleasurable experience of it at your first sitting. The is a great innovation and clearly address confidence and the content of the knowledge to be imparted to new parents.


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