There is so much research and so many studies showing the incredible difference a doula can make to a woman’s and her family’s birth experience. There are a number of studies to look at here on the Doula UK website. Doulas are here to stay, and as the very highly regarded Cochrane Database of Systematic Reviews by Hodnett et al states:
“Continuous support from a person who is present solely to provide support, is not a member of the woman's social network, is experienced in providing labour support, and has at least a modest amount of training, appears to be most beneficial.”
This research is often quoted by midwives to argue their case for case-load midwifery and rightly so as the review is actually called Continuous support for women during childbirth, however, this particular line is often left out as it implies that it is not necessarily the midwife who is the most beneficial in terms of emotional support.
Don’t get me wrong, midwifery care is the best possible model for maternity services and case-load midwifery will not only provide the best service for women and their families, it will also bring midwifery back to what it should be like. What it does show though, is that women need support from women when they are in labour and giving birth. It’s not a new fad; it’s an ancient custom which provides so many advantages. As midwifery has become more clinical and the system midwives work in more risk averse, it has left a gap in the emotional support that women and their partners receive. This is not because midwives don’t want to provide this side of care but because they are often not able to as the trusts they work for have other priorities, such as record keeping and preventative measures. The fact that doulas exist and are a growing phenomenon shows that the system itself is lacking of something women find extremely important and therefore look for elsewhere.
I’ve been a doula for 14 years this year and I have seen how maternity services have improved in many ways and I see the stressful and extreme conditions that midwives have to work under. Often, I try and support them as much as I can and we all become one team, working for the best outcome for the mum and her baby. It’s a job I love but also at times, it can get rather frustrating. What I find more and more is that midwives, obstetricians and other care providers are becoming more women centred but the institutions themselves i.e. the hospitals often have very strict rules and policies that are a long way from putting the woman and her family at the centre of her care.
I accompanied a client of mine recently for an induction of labour. This woman had previously had a pretty rough time during the birth of her first child and was keen to have me there for support this time around. When my client, her husband and I arrived at the hospital 9am on the antenatal ward for the induction, we were told that only one person could stay with her until visitor hours started at 3pm. My client was beside herself and really upset. When her husband and I agreed to take turns, he was told that that was not allowed, which he actually totally ignored and we did take turns until we could both be there. As we all understand, an induction can be difficult at the best of times but to start the process full of fear, wanting to have someone there who you’ve built up a relationship with, is just not a great start.
It got me thinking about other times when doulas are often ‘denied’ or ‘prevented’ from being with their clients when the only reason usually is that a hospital rule says so. In fact, having the doula there would most likely make the women feel safer and therefore, any intervention would be more straight-forward.
Once, I was asked to leave the room during the citing of an epidural when the woman really wanted me to stay. The reason given was that the room was too small! However, they were able to accommodate the medical student! In cases such as this, should we not put the woman’s wishes first?
On occasions when my clients have been taken to theatre for an assisted or a Caesarean birth, the hospital rule of ‘one birth partner only’ tends to apply. At this point, the doula has very often been with her clients for over 24 hours and it is heart-breaking when the woman is holding on to you, wanting you to come with her and the partner, often pale with worry, wishing that you could come as well. It takes all the strength one can muster to stay optimistic, promising them that you will be there waiting when they return and remind them how exciting it is as they will soon meet their baby. This is the time when a doula will connect with one of her colleagues for support and it can feel pretty lonely. Most of the time, a lovely midwife will come in and offer you a cup of tea and promise to keep you posted on your client’s progress.
I had a rather nasty experience at the Queen Charlotte’s and Chelsea Hospital in London when at 3am in the morning, my client was taken to theatre for a Caesarean birth, they literally threw me out! I was not ‘allowed’ to stay in the room and I was not even ‘allowed’ to sit on a chair outside of the labour ward. I was told I had to leave the labour ward floor! There was no way I would go home without making sure my client was ok so spent the next two hours in the toilets on the ground floor, locking myself in as I felt unsafe to be in the hospital anywhere else. Hospitals are not nice places to be, on your own, late at night! I've only ever had this experience at this hospital and I have heard other doulas having been treated the same. It just doesn’t make any sense and it felt so unkind and harsh.
We all know that if a person feels calm and stress-free, they will generally do better at most things. The enormous amount of research into the effects of oxytocin clearly shows that children who have a massage before a maths test do better, cows that are stroked every day produce more milk and women that give birth do so quicker when full of oxytocin, hence the name which means ‘quick birth’. Patients bleed less and recover quicker if they are calm and well supported so to deny a doula access to her clients when they might actually need her the most, based on institutional rules from decades ago, could potentially be harmful to the woman and her baby.
Doulas should be allowed to be with their clients at all times, as long as the client wants them there. To restrict doulas access to their clients based on outdated institutional rules is wrong. When health and safety is quoted or lack of space used as an excuse in theatre, it’s a little bit suspicious when two medical students and a student midwife is allowed in but not the doula – the one person the woman wants there the most!
If maternity services in the UK want to become totally women centred, the hospitals need to look at their rules and policies and ensure that they put the woman’s wishes at the centre of everything they do. A doula has been chosen by the couple and should therefore have the same access rights as the woman’s partner. A woman and her partner have the right to have who they want with them during the birth of their baby. It is part of their human rights!
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.