The numbers of pregnant women hiring a doula to assist them through pregnancy and childbirth has multiplied in recent years, with high-profile mothers such as Nicole Kidman, Demi Moore and chat-show host Ricki Lake promoting the joys of having a professional birthing partner.
But yesterday the role and responsibilities of the doula were called into question by the Royal College of Midwives and an article in the British Medical Journal.
A doula, which translates from the Greek as “women of service”, forms a friendship with the expectant mother during pregnancy and is present at the birth to offer emotional and physical support.
Helping the mother move into different positions for the birth could be one role that a doula plays, as could offering a reassuring word for the father or just driving the couple to hospital so that they can hold hands on the way.
Doulas are also there to offer mothers information and advice through different stages of labour, and it is this area that has raised concern in some quarters. While a doula must never get involved in clinical decisions, some concern has been raised that they can sometimes overstep the boundaries.
Dr Abhijoy Chakladar, a trainee in anaesthesia, criticised doulas in the British Medical Journal following an experience on his watch, claiming that they could compromise patient care.
He said: “Hired birthing partners are unregulated, not part of clinical obstetric teams, and therefore should not be involved in making clinical decisions.
“As the trend grows here, a cynic might ask whether the doula business is actually necessary or whether it is exploiting – for profit – unspoken fears about NHS perinatal care.”
Doulas can cost anything from £200 to more than £1000 and tailor their services to the needs of the mother and any partner.
They are normally on call for two weeks before and after the birth, and assist with a “lying in” period when a mother gets used to their newborn.
Around 1000 doulas are currently thought to be working in the UK. Doula UK is the largest organisation in Britain, with some workers 450 registered, and it has been reported that 2500 children were born in the UK last year with a doula present.
Dr Chakladar added: “Traditionally, emotional support came from female relatives; more recently the modern father has stepped into this role. Partners, friends and family – those who know the mother best – should provide this support.”
Dr Chakladar made his comments after he offered a patient a top-up epidural and asked the woman to lie on her side. The doula “interjected”, asking if moving the patient was necessary. The doula then spoke to her client, and informed the doctor that she did not want to move.
Louise Silverton, deputy general secretary of the Royal College of Midwives (RCM), said: “There is no doubt that some doulas are performing a role that should be done by midwives. However, maternity services are experiencing rapidly rising birthrates, increasingly complex births and midwife shortages.
“In this climate doulas can have a place for women who do not have any social support, which is usually provided by their family and friends. Let me be clear about one thing – doulas should not interfere in any way in clinical decision-making.”
Strong evidence exists that continuous support from a non-health professional throughout labour results in better birth experiences and fewer interventions, such as forceps delivery and Caesarean sections.
Nicola Goodall, a doula and pre-natal teacher with the National Childbirth Trust (NCT), who is based in Edinburgh, said: “A doula can be a voice of reason and someone who is a little bit removed from the situation.
“We never say to mothers that they should do X, Y or Z, we should never be encouraging them to go in a certain direction. We just want them to be aware of what is going on around them.”
‘I was ignored … my husband was terrified’
Case Study:
Ruth Watt trained as a doula after becoming a mother for the second time. She wanted others to experience the joys of childbirth, knowing from her first experience just how difficult it can be.
Ms Watt, 43, of Edinburgh said: “The first time I gave birth, it was the busiest night in 15 years with 30 babies born in one night. There were no beds, no nothing and I was just a nervous first-time mum. It just wasn’t how I imagined it. There were a lot of people in the room and I was just pretty much ignored. My husband was terrified. I went into the pre-labour ward and I was saying ‘I just want to push’ and they told me I couldn’t, because there was no bed.
“When it came to the second one, I just felt that I wanted to be part of it and it was fantastic. It was a much quieter night and I had two midwives with me all the way. It made such a big difference.”
Ms Watt, who has two daughters aged nine and five and has been present at 13 other births, said that calming the nerves of first-time mothers was a big part of being a doula, with a relaxed mother making for a less painful pregnancy.
“The success of the birth is a lot to do with the work you do beforehand with the mum. If you are going into it a bit fearful, you will release a lot of adrenaline which can halt the contractions and the labour.
“As a doula, you are not there in any medical capacity at all, you are simply there to make sure that the mum, and her partner, have all the information they need.”
She said it was unfair that claims have been made that doulas are there to profit from childbirth or play on people’s fears of the NHS.
