19 Apr 19
(Picture: Ella Byworth for Metro.co.uk)
Meghan Markle’s birth plan has been much discussed throughout her entire pregnancy.
The Duchess of Sussex’s decision not to give birth in the Lindo wing, where all three of the Duke and Duchess of Cambridge’s children were born, or to use the Queen’s doctors, came under criticism – but like most mums, it is up to her to have her baby the way she wants.
With plans moving away from so called ‘protocol’, rumours have been flying.
One such rumour is that Meghan has hired a doula – someone who works with and supports parents-to-be before, during and sometimes after birth.
Of course we have no idea if it’s true but if so, she would be one of an increasing number of women to employ a doula.
Unlike a midwife, doulas are not there for medical help but are more like a childbirth coach, but sometimes they do face criticism for just being ‘expensive handholders’.
They help to devise a birth plan, advise them on preparing for labour and then are on call for up to four weeks around the due date. Throughout labour, they provide emotional and practical support throughout and once the baby is born, they carry out at least one more visit to support them as they settle into life as a new parent.
Nicola Wilson, a director for Doula UK explains: ‘I started as a doula over 20 years ago when it was a very new thing in the UK. The idea really grew from the U.S. and spread over here.
‘We now have around 700 registered doulas with Doula UK and that number has remained steady but there has certainly been a huge growth in people wanting to use one and a change in attitude since I started.
‘I think when I started, midwives and medical staff didn’t really understand why I was there. Now they recoginse the role of the doula and have started to embrace it as someone there who is able to help guide those new parents through all the little things, while they tend to their medical needs.’
(Picture: Ella Byworth for Metro.co.uk)
Although there is evidence that women who had continuous support from someone like a doula were less likely to use pain medication and suffer from post-natal depression, the benefits are not cheap.
A doula costs between £800 and £2,000 depending on the area where you live and their level of experience.
One of Nicola’s clients, Helen, had her first child in January and she says that having a doula made the birth easier.
She initially wanted a home birth and asked Nicola to help plan and guide her through it.
When she was admitted to hospital with pre-eclampysia, Nicola continued to help her in hospital.
‘I wanted to give birth at home and with a doula there to guide me, it felt much more likely that that would be possible,’ she says.
‘We decided a few months before I gave birth and we were able to get to know Nicola.
‘I ended up having to go into hospital and it was different to what we wanted but Nicola helped to make sure it was calm. I was napping between contractions.
(Picture: Ella Byworth for Metro.co.uk)
‘Even in hospital, she helped to get me into the birthing pool and she just helped to make sure we were able to follow through with our birth plan. She looked out for what I needed.
‘She organised things and I was able to concentrate on what was happening in that moment. For example, I didn’t want to use much pain relief and there was a moment were I faltered and was asking “What else can I do?” She was able to tell me how I had only had a little bit of gas and air and maybe I should try again. That was really helpful.
‘It just meant having some experience and guidance to make it as smooth as possible. It made a big difference to me.
‘It is expensive but for me it was worthwhile and I would recommend it to other people.’
With the rise in the number of people training to be doulas, accessing one is now quite straight forward.
There are a small number who work with the NHS so it is worth asking your healthcare team, but most doulas are privately and self-employed.
Some doulas volunteer through the Doula UK Access Fund. It covers the expenses of Doula UK doulas volunteering to work with local clients in emotional, practical or financial hardship.
Most doulas are members of and approved by the Doula UK organisation and you can use their directory to search for one that will suit your needs. Although doulas are not required to register with the organisation, choosing one through their directory means you can be sure they have completed a qualification and recognition process.
Many have trained as doulas after going through childbirth themselves and wanting to help other women have a positive experience.
Melanie with her children (Picture: Melanie Butcher)
Melanie Butcher, 38, from Solihull in the West Midlands, trained as a doula 18 months ago and started working as a doula seven months ago when her two children started full-time school.
She explains: ‘I realised that women are very much expected to comply and fit into the system when it comes to pregnancy and labour rather than the system working around their specific needs.
‘If you question or request anything that doesn’t fit into a particular hospitals standard procedure, you can come up against barriers which can be stressful and hard to navigate.
‘My care was not terrible but I had some interventions that I did not wish to have or were not clearly explained to me, and I felt afterwards that my voice had not been heard.
‘When it came to my second pregnancy, I was much more clued up on my rights, my choices and what I wanted from my birth experience. I, however, suffered with severe pre-natal depression which made it harder for me to effectively request the service that I wanted and getting support with my mental health was also a challenge.
‘With determination and the help of my husband and support of one of my community midwives, I did finally manage to achieve what I wanted – an unmedicated, water birth at home.
‘To be in control of my birth was hugely healing for me and made me want to help support other women in achieving a positive birth experience.’
After the experience of having children, Melanie wanted to work with other women to make sure they are empowered.
Melanie at the birth of her second child (Picture: Melanie Butcher)
Now she works with mums in her local area, through pregnancy and on call for the day of the birth.
Typically she has at least two pre-natal visits and is then on call for up to four weeks around a due date. She attends the birth and has a postnatal visit to talk through their experience.
She also offers support and guidance over the phone and helps to research and write their birth plan.
She explains: ‘I offer support with whatever a birthing parent needs. Tasks vary with each birth but include anything that helps mum to feel heard, cared for, safe, and fully informed and supported in her decisions.
‘Some specific examples include massage to help with pain, suggesting birthing positions to help baby’s decent, helping mum to eat, drink and empty her bladder, asking that the family are given some private time to make key decisions, and generally helping to keep a mother in her ‘zone’ so she can just get on with following her body’s lead.
‘Doulas will often talk about this as ‘protecting the birth space’. Low lighting, minimal conversation, aromatherapy and playing music that mum has requested can all form part of this – as can rearranging the furniture in a hospital room if needed.
‘I also support any other birthing partners helping them to feel confident in their role, explaining any procedures, or simply giving them the opportunity to rest and refuel during a long labour.
‘After a baby is born helping to establish breastfeeding, assisting an exhausted mum to shower, and supporting her through the delivery of the placenta is common. Mother’s can be really vulnerable emotionally and physically during this time and it’s vitally important that their care doesn’t end at the delivery of the baby.’
Charlotte Holloway, 41, also from Solihull, has worked as a doula since 2010 and has supported over 100 births.
Like Melanie, she was inspired by her own pregnancy. She says: ‘I had a very traumatic first birth, a lack of support from busy midwives; NCT classes just hadn’t prepared my husband and I for the long hard slog of labour.
‘I had a huge amount of anxiety from watching birth programmes designed to frighten you to death about labour and birth and the complete helplessness my husband felt as I fell apart with fear.
‘My birth ended in an emergency C-section that could have been avoided had I had support to keep me calm and remind me that I had choices.
Charlotte with her child (Picture: Charlotte Holloway)
‘Had I had support in someone I trusted to reassure me in early labour that what I was going through was normal and not to be frightened of, that could have encouraged me to stay at home in early labour and kept the oxytocin flowing in my body to help my birth become shorter and easier.
‘When I became pregnant with my second baby, I still did not know about doulas, but I did realise how important a good birth team was, how important having continuity of care was.
‘My mum stepped up to help, along with my consultants. I had the most amazing VBAC (vaginal birth after caesarean) with people that believed in me, even when I had a huge panic attack and begged for a C-section.
‘They calmed me, mopped my brow, held my hand, kissed me and let me know I was loved, and I was doing the most amazing job. I can still remember the elation I felt when I got to hold my baby girl in my arms immediately after birth, it was so very different to how I felt with my son.
‘During my maternity leave, I decided to have a complete change of career and trained firstly as a childbirth educator and antenatal/postnatal yoga teacher. During this training, I found out about doulas and eagerly signed up to train as a doula. I then went on to join Doula UK as a mentored doula and become recognised in 2014.’
(Picture: Irene Palacio for Metro.co.uk)
Charlotte explains that there is a misconception that we don’t need doulas because we have midwives, but they play very different roles.
She says: ‘I get asked if a doula is like a midwife. My answer is absolutely not! I have no medical training and my role is not clinical. It is supportive.
‘When a client goes into labour, I’m often called before the need to go to hospital arises or a midwife is called out to the home.
‘I will support clients in early labour, I can encourage them to rest, eat and drink, I can encourage partners to get some rest, being with clients, we see how their labour changes via body language, breathing and noises made and can suggest when it might be a good time to head to the hospital or call out the midwife.
‘I don’t leave my clients until they’ve had their baby, they are settled, have given their baby their first feed and are ready to rest. This means I can be with a family anywhere from a few hours to a few days, which is very different from a midwife, who has clinical care of their birthing women and will only stay as long as their shift.
‘I will then support the clients with a postnatal visit where I can help with anything from feeding, cooking, light housework or just being a friendly ear to listen and chat about the birth.
‘I know from personal experience how having a good support team around you can make a huge difference to a birth experience. I hear from clients that they couldn’t have done it without me or that I have special powers. None of that is true, what I do is have full belief in my client’s ability to birth.
[metro-fact-box title=”How do you become a doula?” colour=”pink” icon=”exclamation”]
There is no requirement to complete any particular qualification to become a doula but to join Doula UK, the biggest membership association, you must complete their recognition process.
You can attend an introductory workshop with Doula UK to get a better idea of what a doula does and what involves.
Doula UK provides a list of approved preparation courses. You can choose a course in your area that suits you. Most courses are flexible and involve a number of training sessions, as well as studying at home.
You can join Doula UK and find a doula mentor. You will then work with them to complete the recognition process.
‘I help partners to get involved as much as they want and feel comfortable to. I can help create space to make decisions and encourage dialogue between my clients and the health care professionals looking after them, we always work best as a cohesive team.’
Katy Hemus, 35, from Birmingham has been a doula since 2016. Like Charlotte and Melanie she was inspired by her own birth but she had a very positive experience and she wanted to empower other women.
She says that there is a feeling that doulas are working against the medical system. For her, it is about working with the women’s team to improve the experience but she is completely led by what her client wants.
She says: ‘There is a misconception that doulas have an agenda to go against the medical system and advice, and that they advise their clients of this – which is simply not true.
‘What we want is for women to be given information and evidence so they can decide what is right for them. We want them be given the information in a way which gives them choice and doesn’t involve scaremongering women into consenting something out of fear.
‘Supporting women to have positive birth experiences helps with parenting and our own emotional state of mind.’
Working with a doula is costly and down to personal preference but if Meghan wants someone there to help her give birth for the first time, we absolutely don’t blame her.
Pregnancy and labour can be terrifying. Anything that makes that easier for women seems like it might be a good way forward.
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