To Doula or Not to Doula

Week 32

Hubby and I have been on and off the doula train since we found out I was preggers. For those not in the know, a doula is a birth attendant/ labour coach separate from a mother's medical caregiver. A doula offers emotional and physical support to a woman and her partner before, during and after childbirth. DONA (Doulas of North America) explains it like this:

“Women have complex needs during childbirth. In addition to the safety of modern obstetrical care, and the love and companionship provided by their partners, women need consistent, continuous reassurance, comfort, encouragement and respect. They need individualized care based on their circumstances and preferences. The role of the birth doula encompasses the non-clinical aspects of care during childbirth.”

Doula support generally includes:

• Birth education and preparation
• Birth planning (including creating a written birth plan/birth preferences document)
• De-briefing previous births
• Massage and other comfort measures
• Optimal fetal positioning
• Suggesting positions and changes to help ease pain and facilitate a smoother, more effective labour
• Providing reassurance and encouragement
• Talking through emotional blockages which may come up in labour
• Maintaining Ambiance – aromatherapy, music, candles etc
• Assisting with negotiating with medical staff if what the mother and the hospital wants differs
• Photography and/or vide0

The etymology of the word, awkwardly enough, originates from the Greek term δούλη meaning 'female slave'. It was first used in a 1969 anthropological study documenting birthing traditions around the word. Historically, in most societies a cadre of women supported mothers through labor and birth. This was a role usually occupied by female family members or friends. Over time, as our birthing process (in North America at least) became more institutionalized and less community focused, our networks of women with significant birthing experience dwindled to the point where if we want skilled help now, we have to pay for it.

Part of me thinks that's kind of fucked up.

I mean, what happened? Did life get so busy that we forgot how to give birth? Why would I spend $800 - $1200 dollars hiring someone to speak up for me, rub my back, and give my husband a break when I'm off my tits on adrenalin during transition? Isn't that what family and friends are for? Surely we can light our own candles, create our own 'unique' experience, and not have to pay somebody to do it for us.

Theoretically, yes. My husband, family and friends are more than capable of doing all these things and more. However, labour can be-- and most often is-- an intense and personal experience, especially if we don't know what the hell's going on, which most women (especially with their first babies) don't.

Add to that the fact that the average labour lasts eight hours, and that a doula is there for support the entire time. Is it fair to expect my family and friends will reliably do the same, at any time of day or night, with little or no birthing experience, busy jobs, and busy lives? Will they happily rub my feet as I projectile vomit across the room during contractions?

To be honest, as much as my friends and family are happy to help (thanks guys!) I'd feel bad puking on their shoes, and I'd personally feel more at peace having someone else around with specialized birth experience to normalize the whole intimidating process both for me and my husband.

There is also a growing body of evidence that confirms concrete medical benefits to doula care. Studies (and reviews of the studies) demonstrate that working with a doula through birth and labour ends in significantly fewer caesarean sections, fewer incidences of forceps and/or vacuum assisted births, and fewer stitches in one's vagina (hurrah!), in addition to higher self-esteem and less anxiety and depression for the mother at 6 weeks post-partum. These benefits are significant enough for me to believe that a doula would be a worthy investment.

The bottom line is that I know my husband and I could survive the birth of our baby, but this isn't a process I simply want to 'survive'. It's an experience I want to enjoy and cherish as much as humanly possible.

We met with a doula yesterday who has a plethora of experience as a labour coach. She lived in Kathmandu Nepal for fifteen years and gave birth to her two sons in a small clinic there, where she also volunteered her labour services to friends and family. She has deep, beautiful smile lines and laughed freely with us about the fact that my cat attacked the last doula we interviewed, who neither my husband nor I connected with so much. She has experience in everything from emergency caesarians, to water births, to home births, to straight up old-fashioned hospital labour. She was very clear that her role in no way takes away from the father's role, or any other friends/ family that attend. Rather, as someone experienced in the ups and downs of childbirth, she can guide and reassure when needed - especially during the most intense times - so everyone can simply be present and make the most of the experience.

I liked her a lot, and would be happy to pay her very reasonable fee which includes pre and postpartum in-person visits, unlimited phone and email consultation, and in-person care through my entire labour.

She also works for this amazing program in Vancouver: 

http://scbp.ca/ 

The South Community Birth Program (SCBP) was established in 2003 to pilot a unique maternity care system in the under serviced South Community area of Vancouver. Family physicians, midwives, community health nurses, and doulas work together cooperatively (all covered by MSP!) in a community-based, culturally-appropriate, and woman-centered manner during pregnancy, birth and the newborn period.

It's the first 'shared care' program of its kind in Canada, and I hope it catches on. I've saved my pennies and am lucky enough to be able to afford a doula this time around, but I'd argue that most women can't. Should women suffer limited care and an increased risk of serious intervention during childbirth because they can't afford a doula?

I think not. Bring on the doulas I say.