Early this March, several horror stories emerged in the media about pregnant women who were turned away from a Western Sydney maternity ward and had to give birth unattended by a health professional, one in the hospital car park and another one at home. These stories shone a light on the deficiencies of the hospital system, overworked midwives, a lack of staff and resources that leave some women frightened and looking at alternative options for giving birth. In order to receive the continuity of care they can’t find in maternity wards, some women choose to hire a private midwife and give birth in their own home, while others choose to use the services of a doula (birth attendant) to have a support at the hospital when giving birth, as well as throughout their pregnancy.
In ancient Greece, a doula was a woman’s servant who was very experienced in helping out with births, but there has been a resurgence of the doula in the last few years and the demand for their services is on the increase in Australia. A doula will meet the woman several times during her pregnancy to educate her and help her see what her options are and will accompany her during the birth, helping the woman with breathing techniques, massages, and generally bringing emotional support for her and her partner.
“It’s very rewarding, it’s a very special job,” 29 year-old doula, Romany Godson-King, says. After working towards becoming a chef (“I loved the creativity of it, but it just didn’t feel right”), she found her calling by answering an ad to help a first-time mother, and then went on to pick up more nanny work: “I was finding I was not only supporting the children, but also building this beautiful relationship with the mother and wanting to know about the birth, wanting to help her with the breastfeeding, explore all of that … there was something inside of me, I just felt so drawn to that.”
After more nanny work and travelling, she enrolled in an intensive course at the Australian Doula College and graduated in 2010: “It’s not just hairy-fairy hippie stuff! For a woman who is having her first baby, to have someone beside her during a pregnancy and birth, supporting her and educating her, is really valuable.” She says that it is even more true these days, in a society where people often live far away from their family and don’t necessarily have a mother/sister present to support them.
She says that having a familiar female companion all the way through the pregnancy and at birth has been shown to reduce interventions and give the woman a more empowering, easier birth experience. Romany also insists on the importance of education and doing research and says that a woman who feels in control of her choices during the birth, generally has a more rewarding birth experience, even when not everything ends up going as per her initial plan.
Romany explains that a doula does not compete with the midwife, but rather completes the midwife’s role, who doesn’t always have the opportunity to give continuous care: “A midwife’s focus is more on how the woman’s body is adapting and changing with birth, watching all the physiological things, helping the woman if she needs encouragement, and dealing with any complications.”
However, the collaboration doesn’t always go smoothly between doulas and health care providers, as each can have a different vision of what birth is: doulas see birth as a natural event, aim to avoid unnecessary interventions and have a holistic approach to it, whereas health care providers tend to see birth as a physical act, something that can lead to complications, as Romany explains.
Dr Hannah Dahlen, Professor of Midwifery at the University of Western Sydney and executive member of the Australian College of Midwives NSW, says there is a mixed response from the midwives who work with doulas: “Some doulas are fantastic, they know what their role is, but some overstep their role, and that can cause conflict. Some midwives feel threatened when they see that special relationship between the woman and her doula, but they shouldn’t feel threatened and should work as team.”
Romany also thinks that a doula and a midwife are a good combination: “It would be great for all midwives to have an understanding of how it is to be a doula too, because to incorporate all of that into being a midwife is a really wonderful approach to have.” It’s a belief that Romany puts into practice, as she is currently studying to become a midwife: “I want to have the ability to support each woman emotionally, intellectually and physically through her pregnancy, birth and postnatal period. Knowledge is power and I want to be an expert on the whole pregnancy, birth, motherhood experience so I can create positive change.”
While some hospitals do offer a continuity of care model, where women can receive one-to-one care through pregnancy, birth and postnatally at home by booking with a caseload (or group practice) midwife, not all hospitals can offer that option, and that is when some women turn to doulas. Romany hopes that in the future doula services will be offered through the hospital system, as is already the case in the UK. “That would be amazing to have that as an option in the hospital, it would show that it’s a worthy profession.”
Dr Hannah Dahlen also thinks we’ll continue to see doulas in the future: “There will always be a place for doulas to support women, but hopefully we’ll also see more and more continuity of midwifery care.”
