What is a doula?
A doula is a birth companion, she accompanies a woman from the start of labor until after she gives birth. In some countries where doulas have more privileges, they can help the woman at home postpartum. In our region where the role of the doula is still new, her role is limited so it ends at the hospital when the baby is delivered, and starts breastfeeding.
A doula receives excessive training in childbirth education and is accredited and certified through different boards around the world, a doula can be certified in The Bradley Method, Lamaze Method to name a few, that encourage natural pain-free and drug-free delivery. And in the Arab world, there are a few boards that train and certify doulas such as Amani Birth in Saudi Arabia, where I received my certification from.
Doula’s training includes birth education courses, in addition to birth companion courses, there are different types of certifications offered to doulas, some are only licensed to offer birth education, others are only certified to be birth companions, and sometimes, like in my case, a doula can be licensed to do both roles.
I highly recommend that any lady deciding to have a doula as a birth companion only, to still attend childbirth education classes before delivery. These classes have a positive role in preparing a woman for labor and delivery, in addition to easing the stress related to this experience.
When the doula is accompanying the expecting mother through her education and preparation for delivery, she will be aware of any difficulty she is facing and to any fears she has, to help her overcome them to have a stress-free delivery. This education will empower the expecting mom to be in charge of choosing the place of her birth, the type of birth she prefers, and whether she wants a natural delivery or not, in addition to the extent of medication intervention she wants.
When to contact a doula?
Unlike other professionals involved in labor and delivery, a doula can’t tend to more than one lady at a time. So, it is imperative to book the doula early on to ensure her availability. Usually, a doula’s schedule doesn’t have more than 3-4 expecting mothers each month, and only one is expected to birth a week. Because doulas are present through all stages of labor, this ensures her availability as long as the birth takes. I always make sure that I am available at least one week before my client’s due date. And if a woman has a history of early labor, then I am available at least a week before.
When the moment comes the doula is contacted and her work starts by reminding her of her preset birth plan. Then she starts doing the breathing and relaxation exercises with the expecting mom to ease her labor, and she is there in every step. Doulas have special kits where they keep the tools that help with easing the pain and stress of delivery. Like hot water bags, massage oils, essential oils, dates, and a birthing ball in case, it is not provided by the hospital.
What does the doula do?
It is essential to highlight that those steps taken by the doula to support the lady in labor, differ depending on the doctors’ recommendations. If there are no medical limitations this is what the doulas do to support women during labor and delivery:
– Remind the expecting mother of the breathing exercises and encourage her to do them while in labor.
– Gently massage her back to reduce the pain.
– Assist her in doing squats to smooth delivery.
– Reduce noises and disturbances and make sure unnecessary people are not disturbing the quiet in the delivery room, that the mother needs to relax and focus to control the pains successfully.
– Guiding the husband into providing the needed moral support the mom needs. In case the husband is not present the doula provides the needed support as if she is a mother, a sister, or a friend.
– Encourage the lady going through childbirth, if the medical protocol allows, to eat at least a few dates.
– Encourage her to practice comfortable birthing positions.
– Reminding the mom to pray or practice any relaxing religious ritual.
– In certain societies where the doula’s role goes beyond the hospital, she helps a lady who just gave birth at home by taking care of her other children, cooking for her, and even cleaning, to be true “The woman who serves”!
It is important to highlight that the doula doesn’t do any medical practices unlike the Midwife and the OBGYN. Her role is to support a woman going through childbirth morally, psychologically, and physically. In addition to pre-birth education. Occasionally she would help after birth as well.
Challenges and limitations doulas face
Maternity hospitals are often classified either as baby-friendly hospitals or mother-friendly hospitals or both at the same time. When the hospital is classified as a mother-friendly hospital the job of a doula is made easier and her presence in the delivery room is something normal and everybody is used to it. While in other hospitals especially in our region, there is still a lot of red tape around the presence of a doula in the delivery room. We are sometimes forced to pose as a family member or a friend to be allowed to accompany a lady while giving birth. It is essential to know exactly the hospitals’ policy concerning the presence of non-family members during delivery. And the presence of the doula must be mentioned and the birth plan.
Why doulas are important?
1- Promoting natural birth
Promoting medication-free natural delivery is in the core role of a doula, this starts during the childbirth education phase. It is important to highlight that proper education during pregnancy helps in making delivery much easier and in avoiding unnecessary medical interventions like episiotomies and c-sections.
2- Encouraging movement during labor
Mother-friendly hospitals encourage women in to move around while in labor and not to be confined to bed if there is no medical necessity to it. One of the roles of the doula is to support an expecting mother while moving and to encourage her movement to improve her birthing experience.
3- Reminding the expecting mother to eat
If there isn’t any medical restriction one of the doula’s roles is to encourage the expecting mom to eat at least a few pieces of dates to get the energy she needs during these crucial hours.
4- Boosting mother’s confidence
Doulas offer mothers an immense amount of moral and psychological support, in addition to educational support before, during, and after labor. This support generates the confidence and positivity needed to overcome this experience. It is important to highlight that the educational support a mother gets from the doula provides her the confidence to put the birth plan that suits her to make educated choices that would allow her to be pleased with her birthing experience even if it will include medical intervention.
5- Reducing the possibility of postpartum depression
Any experienced doula will work hard to increase the mother’s awareness and education about everything related to pregnancy and birth, so she is well prepared. This education in addition to the moral support provided increases the mother’s self-confidence during labor. This empowerment has been shown to alleviate the levels of happiness and relaxation hormones which are key elements in reducing the possibility of postpartum depression and baby blues, in addition to encouraging the husband into taking an active role in supporting his wife to reduce the possibility of postpartum depression.