As I look back at the last 12 years and the births I’ve been privileged to attend, I have come to realise that nothing teaches you about life the way birth does. It is the ultimate challenge where you come face to face with who you truly are and if looked upon as a way of providing insight into areas within that could do with some attention, it can lead to the freedom to lead a completely different life. Each and every woman and couple I have supported have taught me something new and I am forever in their debt and I am so grateful that they let me share what is such a special time with them. I have also witnessed the transformation that takes place in women and their partners and families when they have a good birth experience.
There are some births that had a bigger impact on me and that took me to a different level or should I say, started a transformation which was further cemented into my being in the births that followed. If you think about it, childbirth is an event in a woman’s life where there is nowhere to hide. It’s a forced transformation as you have gone from being a woman to becoming a mother. In the process of giving birth to your baby, you are not in control of what is going on in your body and you cannot change your mind or back out of the commitment you've made - to have a baby.
Whether you have a caesarean birth or a vaginal birth, you would have been on a journey during your pregnancy where you would have discovered and learnt a lot more about yourself, whether you wanted to or not. Just being pregnant and having your body being taken over by hormones and another living being. Having to perhaps slow down if you’re a very active woman, pregnancy hormones making you forget things and finding that many things in your life that you used to think was what you lived for, become unimportant.
Giving birth really pushes you to the limit of your being and every woman will give birth the best way she can. It’s not ‘just a day’ in a woman’s life, it’s everything she has experienced up until then and some would go as far as saying even from before she was conceived herself.
We are so attached to dichotomies in the world we live and everything has to be one thing or the other, good or bad, traumatic or ecstatic, beautiful or ugly. If we could accept that things are what they are and that each of us need to take responsibility for our own actions, feelings and thoughts, I don’t think anyone would feel that they have ‘failed’ at birth. If we could look back and discover what we can learn from that experience and also how we can heal from it, we can see every experience as something positive. It might not have been like we had hoped it would be but we can still gain something from it.
It just is what it is!
Women supporting women in labour and early mothering is an ancient and widespread practise. According to anthropological data reviewed and analysed from 128 non-industrialised hunting and gathering and agricultural societies, all but one offered support for the mother during labour and childbirth. In the animal kingdom, similar support can be found. When a bottle-nosed dolphin gives birth to a calf, other adult females in the pod will assist the new-born by keeping it afloat until the mother has regained her strength or until the calf can fend for itself. Similarly, adult female elephants that live in closely related family units of females with their young, are supportive of each other especially during labour and birth.
The word doula comes from Modern Greek and derives from a Greek dialectical word, meaning ‘servant-woman, slave’. The word doula appears in Biblical Greek as doulos which means ‘slave, bondsman, servant, attendant’. Some sources claim that the feminine form, doula, referred to the most important female slave or servant in the ancient Greek household, who probably helped the lady of the house through childbirth. There is no available evidence to support that specific distinction but this is what the word ‘doula’ has come to mean today, ‘a woman experienced in childbirth who provides continuous physical, emotional, and informational support to the mother before, during and just after childbirth’.
Doulas were first spoken about in a book written by anthropologist Dana Raphael (1976) called ‘The tender gift: Breastfeeding’ where the doula is referred to throughout the book as a helper, supporter and teacher for the new mother. Dana defines a doula as ‘a woman who goes into the home and assists a newly delivered mother by cooking for her, helping with other children, holding the baby, and so forth. She might be a neighbour, a relative, or a friend, and she performs her task voluntarily and on a temporary basis.’ Dana saw the role of the doula as crucial in the postnatal period to support and assist the new mother with breast feeding. She writes: ‘the doula’s help is crucial if the mother wants to breastfeed. Her care and handling could save the day. Her presence could save the mother’s milk.’
So, we've established that there are two types of doulas, birth doulas and postnatal doulas. Some doulas chose to fulfil both roles whilst others concentrate on providing just birth support or postnatal support. However, the function of a doula varies in different cultures and can include support before childbirth with education and information for the couple, support during the birth of the baby and help with cooking, washing, bathing and other baby care after the baby has been born. Whatever the doula does, it is actually less important than the fact that she is there!
A doula’s true value is her presence as a calm and kind influence on the new parents and not her qualifications.
I’ve always loved using Penny Simkin’s Road Map of Labor with my clients as I found that the colourful and informative yellow brick road really helped parents approaching childbirth to get a good understanding of the process. Penny’s illustration shows three different pathways and as I wanted to be able to show what a physiological birth might look like, complete with a ‘rest and be thankful’ stage and third stage of labour, I decided that I was going to try and design a version of my own.
I spent some time drawing and adding the things that I wanted to include and after seeing my cousin, Annika Langa, posting her wonderful illustration on Facebook, I thought that I should ask her if she would be interested in drawing it for me. Annika went to South Africa as a young journalist to report on the Apartheid regime coming to an end. She later married Paul Langa who is an ex-political prisoner who spent time with Nelson Mandela on Robben Island. You can read more about that here on Annika’s blog. She also has a shop on Etzy where you can find her other creations.
Annika agreed to produce the Path to Birth and after many months of hard labour, my Path to Birth was born. The illustration is not a ‘map’ of how to get somewhere but rather a colourful way to hold discussions with pregnant women and their partners about what a physiological birth looks like. As well as discussing the different ‘stages’ of labour and the importance of keeping well hydrated and energised, you might also want to talk about things that are not on the drawing. The pool and birth ball could initiate a conversation about other types of pain management that are not depicted. The woman is naked giving birth, is this something that worries the woman you are working with? Has she thought about what she would like to wear? There is a mention of how often contractions are coming and how long they are. Is that important to know? Should they be timed or will you notice anyway if they’re coming closer together. Are there other signs that labour is progressing?
The third stage of labour is seldom discussed, unless it is covered in the antenatal preparation that the couple attends. That is why I wanted this to be included in an illustration of labour and birth as the birth is not completed until the placenta has arrived. As we doulas like to say, “we meet and greet the placenta”. I felt the syntometrin injection (which by the way can be spelt with an “e” at the end or without) had to be on there as many women believe that you need to have this injection for the placenta to come out, just like many believe the cord needs to be clamped and cut immediately. Those of us working around pregnancy and birth know that the scissors used to cut the cord does not look like a normal pair of scissors so this is another point for discussion. Who cuts the cord? What other options are there? Do you need to have an injection? What is the injection? Some hospitals now use only syntocinon for the expulsion of the placenta whilst others still use it in combination with ergometrine.
Oxytocin is featured a lot on the path to birth because the release of this hormone is so important in a physiological birth. Oxytocin means “quick birth” in Greek and the more of it you have in your body during labour, the quicker it will be. Endorphine actually means “the morphine within” so if women understand that labour is manageable by nature, this might alleviate some of their fears. It’s all very cleverly designed but the environment has a huge impact on how easily these hormones are released by the woman.
As a woman follows the path, climbing upwards, reaching new found levels within herself, there are points when adrenaline is injected to remind the woman that she is having a baby and that she needs to be in a safe place. These are old warning systems from our early ancestors who needed to make sure they were back in their cave when the baby was going to be born. If women know that they are feeling the way they do because of physiological changes in their body, the can feel safe knowing that this is normal. I often see the ‘mini-transition’ around 4-5 centimetres and then, of course, the transition as the woman is approaching full dilation of her cervix.
So, my Path to Birth was designed as a complement to Penny’s great Roadmap of Labor, which I hope that you can all see. I hope you find it useful for preparing couples for the life-changing event of childbirth and that in some small way, it will contribute towards making their experience a good one! That is my one and only reason for creating this illustration. To help women have good birth experiences, what ever that may be!
Kicki Hansard is a member of Doula UK, however any opinions expressed on this blog are personal views and not necessarily the view of Doula UK.