What is a doula?

“Mommy, there’s a dragonfly in the lounge,” my toddler announced very loudly in my ear as I dozed at 7am one Saturday. When his pleas became persistent, I staggered downstairs and released it into the garden. Even in my exhausted state, I marvelled at creation as its wings glistened in the sunlight of the new day.

I’m a doula, a childbirth assistant, and had returned home only a few hours earlier at 3.50am after a 14-hour birth in our local hospital. The Greek word doula means “woman who serves women” and in Israel, where I studied, it has become a household word in birthing circles. So what does a doula do and why? Why, I am constantly asked, do you need a birth assistant when most partners/fathers attend births these days?

Birth is a memory that lingers forever and, even though it may be painful and can be both physically and emotionally draining, it should be a positive experience. The presence of a doula means that the mother is provided with continuous physical, emotional and informational support before, during and after the birth. It’s not always easy for the father-to-be to be all things to the birthing woman. Not only is he physically and emotionally involved in the birth, he may become distressed at seeing his partner in pain.

Like the woman in labour, especially the first-time mom, he is inexperienced about what might and should happen. He may not, through no fault of his own, be the best person to help his partner in certain areas. The presence of a doula relieves the pressure on the father and gives the mom-to-be the confidence of having someone qualified with her at all times. Unless you pay for a private midwife to attend to your birth, midwives in hospitals (public and private) have other labouring women to attend to and cannot be with you all the time.

The doula can. She is experienced in birth. She knows what is supposed to happen and when and she will be with you – and only you – throughout the labour. The relationship between a doula and the mom-to-be and her partner usually starts when they meet at about 34 weeks. When I meet my clients, I discuss their needs and desires and help draw up a birth plan. We may meet again before the birth but at the very first twinges of labour, I am called and begin the nurturing process from my client’s home or, once labour is more established, we may meet at hospital.

Why use a doula?
Studies have shown the positive impact of having a trained doula present during labour:
50% reduction in Caesarean deliveries
60% reduction in epidural requests
40% reduction in oxytocin use (induction)
30% reduction in analgesia (pain relief)
40% reduction in forceps delivery
25% shorter labour time

The role of a doula

My doula career began in 2002 after the harmonious arrival of my second child, Inca. My first birth with my son, Teva, had been long and arduous. I had transferred from a proposed home birth to hospital in the very last stages of labour. I nearly birthed Teva in the hospital car park and, after a few minutes, he eventually came with his cord tightly bound twice around his neck. Those 40 hours were quickly forgotten but the brutal yanking out of the placenta darkens my memory to this day.

From that day, I firmly believed that a birthing space must be conducive to sensitivity and my studies with the National Childbirth Trust of the United Kingdom provided exactly that. Along with an exam in physiology and anatomy came our practical requirements and I attended a variety of births in water, at home and in hospital. I volunteered my services but it was actually after the birth of my third child, back in South Africa, that I found myself accompanying women to birth again.

That was three years ago and my understanding of the great diversity of birth options has grown widely. Each arrival is unique and I’m very fortunate to work along the Garden Route and do feel a sense of appreciation for the positive effect that my presence has in the labour wards.
The responsibility of the doctors and midwives is enormous and I have tremendous respect for their expertise.

Doula work is for those with lots of physical and mental stamina. There are many nights of skipped sleep and the spontaneity of baby’s arrival means that a due date is a mere circle on my calendar, demanding my flexibility for a fortnight on either side.

My work involves setting up of the sacred birth place, getting the father to participate in active labour techniques, using my reflexology and massage skills, the dosing of homeopathic remedies, photographing the event and recording the exact time of birth for astrological reasons. In home births, the adrenalin may race a bit faster as we connect up the birth pool to the geyser, boil up equipment, carry through hot towels and buckets, while the midwife and I share a giggle over where the birth may actually happen – in the kitchen, the bedroom or the bathroom.

I have experienced emergencies and my first stillbirth, which made me question why I’m treading on life’s thin ice but I continue to do it. I attended a course in Durban last year on advancing the doula’s skills in pain relief. There are some amazingly effective techniques that I have since applied. I am totally intrigued by the psychological input at birth and how it hinders or accelerates the labour process.

I find it a real privilege to bond with the women I accompany and often indulge in a very spiritual journey with them. I have found a strong emotional dynamic between mom, father and myself to be very beneficial to the outcome of a birth.

The presence of an experienced and trained doula goes beyond labour, too, and may encourage better bonding between mother and her newborn. Postnatal depression is often reduced. Many doulas assist with breastfeeding too. I usually write out a birth report at the time of labour, which the mom can elaborate on later, often in the comfort of home while marveling over this miracle of nature.

Some of my experiences...

The Caesar
May’s baby was in a breech position from 32 weeks. An external version (manual turning of baby) is seldom recommended and having turned my own breech baby at 37 weeks I informed May of all the tricks I knew to turn him. Despite all our attempts, we had to accept that he wasn’t moving around. I wiped away May’s tears when the Caesarean decision was made and explained the procedure to her.

On the set date, I was there to accompany her, went into theatre with her, was the photographer and then stayed with her for the completion of the operation while the father went with baby to the nursery. I stayed a few hours afterwards, answered their questions about the drugs and painkillers and helped her baby latch on. A few days later at home, I did a bath demonstration, a check up on baby and gave further breastfeeding advice.

May: “It was nice to have a professional opinion at the end of the line in the middle of the night.”

The home birth
Katrina’s wish was for a water birth at home. She had very particular requests about the decorating of the birthing space. We moved pot plants around, made her a shrine of candles, filled the birth pool, and so on.

When she felt restricted in the bath, I massaged her on all fours, she crawled that room for miles. She requested a written birth account in detail so I kept adding the progress report on my clipboard. When her baby surfaced I wrapped him in hot towels. We kept the placenta for her in an ice-cream box and a few hours after birth we had a tree planting ceremony to give thanks.

Katrina: “My birth was a team effort between myself, my partner, my midwife and my doula. Everyone had their own role to play.”

The hospital birth
Malia had experienced a stillborn baby three years before I met her. Luckily, we instantly connected and my role in her pregnancy and birth came from a “counseling” input. I drew up her birth plan with her at 36 weeks.

On arrival at the hospital after spending three hours with her at home at the onset of labour, she was 4cm dilated and her contractons were 7-10 minutes apart. Her labour progressed well. In the transition phase, she needed a lot of verbal coaxing and I gave her some homeopathic remedies for her rush of emotions. We did some exercises to keep her mouth and tongue loose, humming and chanting. She enjoyed the use of the mirror which I held for her to see in the pushing stage. Her daughter was born and there was such elation shared with all present.