“Do I need a doula if…?”
I’m going to start by saying, you don’t need a doula. You don’t need a birth pool or a TENS machine. You don’t need gas and air or an epidural. You don’t even need a hospital or a midwife. All these things are options that you can choose or not choose. Yes really! Some of us want to prepare before giving birth by having these things available close by if we want them during labour. Some of us feel that we only need to call these tools into action as labour progresses and don’t want any prophylactic intervention. These choices are personal and should always be treated as such.
A doula is a tool for you to use during labour in a multitude of ways. In my previous article – What is the Secret to a Good Birth?– I talked about how doulas can reduce rates of unwanted intervention, reduce length of labour, increase parental satisfaction and good feeling about birth and increase the health check score of babies at birth.
Those are some of the reasons that you might want a doula, but of course there are reasons people choose not to have a doula (otherwise we all have on as standard!). While people are coming to their personal conclusions about whether they want a doula or not, the question I get asked frequently is “Do I need a doula if….” With various tails to complete the sentence, such as:
· I have a birth partner?
· I will have a midwife?
· I’ve done a hypnobirthing course?
· I’m going to give birth in hospital?
· I want an epidural?
· I am choosing a caesarean birth?
My answer is always the same: “Yasssss queen!!” and then I spin and walk away. (can you tell I’ve got half an eye on Queer Eye season 4 as I type this?!).
Not but really (and there is no twist ending here, you guys know I’m a doula so I’m pretty pro-doula…), all of the birth scenarios that include the situations above can be improved by a doula. Have you ever heard someone say they got too much great support? I haven’t. Sometimes they had the wrong support or bad support or not enough, but never too much. Plus, a good doula knows when to step back – when to let the people that you want to be supporting you up close in that moment be the one that is there for you.
Lets take a look at each of the situations in turn, if you’ll stick with me.
I have a birth partner, why would I want a doula?
Perhaps you are considering having a doula, but wonder if having your husband, wife, partner, mother etc. with you can do the same job? For some people it will only be right to have your most loved person there with you in your vulnerable, powerful moments of labour. For other people their partner could also benefit from some support; from knowing that there is someone else there that can take on the emotional and physical pressures of supporting a person in labour, stepping in when they need to sleep or if they aren’t sure of the best thing to do in that moment. Many people are just not the doula-type, and your partner might be one of them! I know that I really believed I could teach my husband how to be my doula (back before I really knew what it was…). He was so great; reading everything, asking questions, practising the hypnobirthing scripts with me almost daily. The day came and when it came down to it, he was my husband, he was in it with me and would have benefitted so much from someone to care for us both. That is not to say the same is true for you, that is very personal to me. People are often surprised when I say that I would have a doula if I were to have another baby; hell yeah I would! I couldn’t be my own doula.
I will have a midwife, why would I want a doula?
Oh my, this question makes me kinda happy because I get to be the one to tell you what a bloody brilliant team midwives and doulas are. Midwives are my hero’s; they are experts in normal birth, they have all the skills to care for your medical needs, and the knowledge to know when to use those skills. Some midwives have the time, space, energy and personability type to be your doula as well as your midwife, some don’t. In fact most don’t in the way that the NHS has cut costs so hard, they have to focus on safety, not security. That doesn’t mean that they are a lesser midwife, it might just mean that they are restricted and challenged by the NHS’s hobbling maternity system.
An independent midwife may have much more time to give you and perhaps a more holistic approach – but all the independent midwives I know prefer to work with a doula that without one which tells me that the skillset is just different and the care is better when everyone has their role with the birthing person at the centre.
I’ve done an antenatal, NCT, hypnobirthing course, why would I want a doula?
One of the things that a doula can offer is information and education; I personally come to antenatal sessions with about 10 hours of antenatal education, but I rarely complete it with couples and never from A-B, always a bespoke 4-8 hours depending on the individuals. Information and signposting is one of the big pillars of doula-ing; we say when we don’t know without shame and happily provide you with trusted contacts who can really help. I also blimmin’ love me some evidence based articles and if you are into that sort of thing you can expect WhatsApp messages pinging away with things you might find interesting or useful until weeks after you have given birth (never unsolicited I might add…).
One of the beautiful things about going to courses and having a doula is multiple perspectives, lots of interested and caring minds to ask questions of! Courses are often excellent places to make friendships that will keep you going in the dead of night and into maternity leave (if that is what you are choosing).
So, information is important, and it allows you to have choice; but it isn’t the only string to a doula’s bow. I find time and time again that the thing that is most important to families that I have worked with is also one of the hardest to pin down; having someone who is totally there for you (and your partner) to emotionally and physically support you no matter your choice or the direction birth goes. The simple (yet sometimes not so simple) presence of a doula during your birth is sometimes the only bit that matters.
I’m planning to give birth in a hospital, can a doula still help me?
Most of the births I’ve attended as a doula have been in a hospital and I think the same is true for many other doulas. I do not have an agenda for how you give birth; I don’t want you to give birth in a certain way or in a particular place. Home, hospital or birth centre; I really have no preference, as long as you are treated well, respected and listened to.
A doula can be lots of help in a hospital, providing much of the same types of support that would be provided in another setting; doing everything we can to get as much oxytocin flowing in you as possible. Some things your doula might do for you (and your partner): giving you physical relief with massage, hip squeezes, holding your hand, giving counter pressure, setting up the room to be better for you (darker, quieter, louder, friendlier etc.), getting/offering food and drink to you and your partner, giving your partner some time to step outside for a few moments or perhaps a sleep, breathing through each contraction with you, helping you to understand what midwives and doctors are asking you or advising you do…and lots more.
A big thing about hospital birth is that a lot of it (perhaps the largest portion for many women) happens at home first! This is often a time when another pair of (experienced) hands come in useful.
I think I want an epidural, how can a doula support me?
Interestingly, my last two birth clients had both planned to have an epidural during labour. In the end, one did have one and one decided she didn’t want one and both got what they would describe as a positive birth.
It comes down to your reasons for wanting an epidural (or any particular pain relief for that matter); what are your goals for what it will give you or allow you to do? Once we know that we can look at how you can get the support that is right for you with the pain relief you want, when you want it. All of the options are here for a reason, it is just best if they are used at the right moment and not applied to everyone without individualised care.
I am choosing a caesarean birth; I want support but how could a doula help with that?
For some people an elective caesarean birth is a positive choice and they look forward to it, for others it is a route they have been forced down by medical circumstance. For the latter it can be a nerve wracking thought and preparing for it ahead of time can do so much to reduce anxiety and stress.
Doulas can help you with creating the closest to nature birth environment that you can get in theatre (if that is what you want). We can support you with protecting the things that are important to you like optimal cord clamping, skin to skin, help to get breastfeeding initiated and keeping calm and in control throughout what can be quite a scary thought for some people.
A caesarean birth has a built-in recovery period as necessity (I would also argue that all birth does, but our culture doesn’t always allow or prepare us for that). Those first few hours to the few days after birth can be a bit of a bamboozlement to the senses and having someone there who knows the ropes and can let your partner rest without guilt (not that they should fee guilty, but many do), can be a big relief.
Hopefully that has given you some food for thought if you were considering a doula but thought it wouldn’t work. Sorry to be so boringly pro doula – I just really wish everyone who wanted one could and would have one. I know there are people like me out there that thought it wouldn’t work with my circumstances and that I could do it all myself and I will always be looking to speak to the old Ruth, or people like me and say, it is OK to ask for help, you deserve it.
A note on “wish everyone could have a doula”; I’ve got the guilt today, and I want to mention that I am not purposefully ignoring that this is a paid for service that not everyone can afford. I, and many other doulas I know, volunteer for families that cannot afford to pay. Many of us, me included, ask you to tell us if you can’t afford our fees and we will consider reducing it for you. There has been some backlash about the fact that doulas are a paid for “exclusive” service and I get it. I didn’t do this job to make a lot of money (good job too, frankly), but I don’t have the luxury of not bringing an income into my household. It seems a strange criticism; people pay an average of £27,000 for their wedding day in the UK without dressmakers and caterers receiving criticism for charging a fee for their valuable service.
If you enjoyed this you might like to read What’s In My Doula Bag?
I’m going to recommend a (or some if I get carried away…) book at the end of each of these articles, take a look at my whole library and some short reviews of more birthy books. Book Recommendation today: Your No Guilt Pregnancy Plan by Rebecca Schiller
Ruth is a birth and postnatal doula supporting families across Kent and South London. Come and learn more about Ruth and doulas by exploring these links: Website, Instagram, Doula UK, Facebook, Kent Doula Collective.