good practice
Doulas: mothering the mother
“Knowing that Sue was happy to assist with anything I asked meant I wasn't left worrying if carers would say, &lquo;that's not my job&rquo;, especially when it came to baby care.”
Sue Searle, a disabled mother and trainee doula from Stevenage, UK, discusses how doulas can support disabled parents during pregnancy, birth and in the postnatal period.
Names have been changed to protect client confidentiality.
"Oh, isn't he a lovely baby. How old is he?" cooed the stranger, as I gently rocked the buggy in the café.
"Sorry, you'll have to ask his mum and dad," I said. Without taking my gaze off the little man I had been entrusted to push, I motioned to his parents who were next to me. John was tickling baby Archie's chin, and Vicki was checking the time of their appointment to register his birth.
The stranger looked at the couple next to me - John in his manual wheelchair, and Vicki in her electric one. A moment's discomfort passed across her face, before she started speaking to the proud parents: "Is he a good baby? … How much did he weigh? … Your friend is very helpful." John interjected, "That's our doula, Sue."
What is a doula?
A doula is an experienced woman who offers emotional and practical support to mothers and their partners before, during and after childbirth. A doula is employed by the family, and is not connected to a specific hospital. A doula believes in 'mothering the mother', enabling a woman to have the most satisfying and empowered time that she can during pregnancy, birth and the early days as a new mother. This type of support also helps the whole family to relax and enjoy the experience.Doulas are self-employed and all work differently. The services that they offer vary greatly according to the needs of the parents-to-be, so it should be possible for them to find a doula who is right for their family. A doula's role has to be flexible to fit in with a given situation. For example, a first-time mother will need different support to a woman who already has children. Every birth is unique and therefore every woman's experience is also unique.
How does a doula work?
Doulas work with midwives, being aware of their boundaries and respecting the midwives' knowledge. Doulas ensure that mothers and their partners are aware of what is happening. They empower mothers and their partners to ask questions, and if needed, can clarify anything with staff or re-explain in another way to ensure everything is understood. As they do not give advice, they are a safe sounding board for mothers and partners to use, without feeling guilty that they are taking away midwifery support from another woman.Birth doulas meet on one or more occasions with the mother and her supporters before she has her baby. They also communicate by phone and e-mail. They discuss anything about the birth that the mother may wish to talk about. Doulas get to know the family and find out about any fears, concerns and needs that they have.
As the expected date of delivery approaches, a doula is 'on call'. When a woman is in labour she can call her doula, who will go to her as soon as she wishes and stay as long as needed. If it is a hospital birth, the doula may first go to the woman's home and then, when the woman feels it is the right time, accompany her to hospital or meet her at the hospital entrance. For a planned caesarean, the doula may meet the woman at the hospital and wait with her until she goes to theatre. She may either go in to the theatre to support the woman or wait nearby and then stay with her until she is settled in the ward. For a home birth, the doula will go to the woman's home as soon as the woman feels she needs her. The doula will stay as long as the mother wishes - usually until the baby is born and has been fed, and both the mother and baby are comfortable.
This continuity of care has been proven by research to shorten labour, decrease the need for pain relief and the chances of caesarean section, and increase the chances of successful breastfeeding, as well as help the father to participate (Klaus, Kennell and Klaus 2002).
Disabled parents
The help of a doula can be invaluable to all parents. As a disabled parent myself, I feel that a doula can be particularly beneficial for disabled parents. Although still a relatively new concept, support from a doula is mainstream rather than disability specific. This means that they will treat people as parents first, rather than focus on their disability. However, as a doula gets to know the person and their family, they gain a much clearer idea of their abilities and needs than maternity staff who may not even meet the person before the birth.Doulas understand about parenting and focus on empowering parents, unlike maternity nurses who are employed to take over baby care. Some disabled parents may feel that family members and other people are less than happy about the baby, or worried about how pregnancy and birth will affect their disability. Doulas have no agenda other than to support the mother and those who support her to make informed decisions.
Doulas are not medically trained and are not a replacement for medical care. Doula UK (www.doula.org.uk), the leading organisation of doulas in the UK, has a recognition process for doulas, with a code of conduct. Costs for birth doulas start from around £200 for a trainee doula. Doula UK also has a hardship fund for parents who need it.
Amanda, a disabled mother-to-be who has recently booked a birth doula said, "I chose a birth doula as I wanted as natural a birth as possible. I really want to breastfeed too. Having a doula will ensure that my wishes are listened to." Her doula, Kate, says, "I don't see Amanda as disabled. I haven't even thought about it. To me, she's just another lady who wants my help and support, no different to my other ladies. The way I see it is, all my clients need me for different reasons, some because of previous sections, some for moral support, some for good information."
Working with social services
Postnatal doulas offer a flexibility of support, which can be difficult to find elsewhere. Vicki says, "Knowing that Sue was happy to assist with anything I asked meant I wasn't left worrying if carers would say, 'that's not my job', especially when it came to baby care. It was especially great as I received help in paying for a doula from social services. We also used our direct payments to pay for more hours. Because my doula empowered me to find my own parenting style and focused on my abilities, when the time came to find other support I was already confident in what I needed assistance with."Another parent said, "It was my doula who helped me say no to the queue of visitors wanting to see Charlotte. It was she who helped me stand up to the barrage of opinion from other people and who, with her quiet knowledge, showed me how to be with Charlotte and take my cues from her, instead of having my nose in a book. But most importantly, it was her who gave me the strength to follow my own instinct instead of battling with it. Quite simply, I cannot thank her enough."