Guest post: "When I first became a doula, I wanted everyone to know how amazing birth is. Now, I'm more pragmatic"

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I'd finished having my own babies when I found out what a doula was. I was at a coffee morning with my twins and it was basic nosiness that led me to where I am now. I'm glad of it every day.

Another mother was telling someone about how she became a doula. My curiosity was instantly piqued, especially as I had already supported my sister at the birth of my niece, and a friend at the birth of her son some 8 years later. And so, despite this career path never being on the list of ambitions when I was at school - or any time after - I became a doula in my late 30s. I have been with Doula UK since 2006 and became co-vice chair in 2014.

So, what is a doula? The easy answer is a professional birth companion. It's someone, usually a woman, who visits the expectant mum a few times during pregnancy to get to know her and talk through her expectations around birth and the few days after. To my clients, I am there as their constant, whether they birth at home or in a hospital, no matter who comes and goes. They call, I go. They labour, I wait. They birth, I wait, support, hold, step back, encourage, smile, photograph. Whatever it is that my client wants, I provide - although I am not there to take the place of a partner.

Unlike midwives, doulas do not do anything medical or clinical. We do not perform sweeps or palpate babies or monitor foetal heart rates. We are there to signpost information and bring a sense of continuity and safety to our client. We are there to put a hand to the back of the partner that is suddenly scared. There really is so much to the role.

When I first became a doula, I was like an evangelist reborn. I wanted every pregnant woman, every human being to know just how amazing birth is and could be. The longer that I doula, the more pragmatic I become, not because I doubt the birthing process, but because I see how many different things can and do affect that birthing space.

Let me be clear, there are women and/or babies that need medical intervention to ensure their safety and health. I do, however, believe that birth is not to be feared and that it is a physiological norm. To watch a woman birth in an uninterrupted birth space is to be filled with wonder.

"The best thing about the birth pause is when everyone sits right back and mum, dad and baby fall in love with each other. You can feel the oxytocin rising and rising and a sense of the miraculous happening fills the room. The only sounds are of a new family forming. It is too precious to do anything other than stand in awe of its power" - these are my words, quoted in the book, 'Why Doulas Matter' by Maddie McMahon.

This birth pause and moment of wonder is, however, becoming harder to attain as we continue to make advances in medical care. Birth has become a medical procedure. Yet, despite this, there are many of us sharing stories and ideas about normality in birth - because normality comes in many, many guises. What is paramount to a good birth is respect for the birthing mother, her body, her dignity and her rights.

I believe passionately in good birth (that could be birthing in a field with a choir or a highly medicalised caesarean) - and that is what I want for all of my clients. A good birth, simply defined is where a mother can be listened to and heard, using informed consent with choices.

So, what can you do, being as each birth is so different? Be informed. Know your options. Ask why a lot. Ask about the risks of all the options.

Two clear births pop into my mind at this moment. Both were twin births classed as high risk. The first mother had had a physiological birth with her first child. Quick and easy. When she told me that she had been told she would need a caesarean, I asked why. She then spent some time asking why and working out what she wanted. The result was a physiological birth of twins on a labour ward that had never seen the like before.

The second mother had done her research and knew what she wanted - a physiological birth. Her labour started and the birth decided not to follow her hopes and plans. Using informed decision-making and consent, she went on to have a caesarean birth. Both women were happy with their births because they felt listened to and respected.

I love the work that I do, and I love working with my sister doulas, but mostly, I love the families that I work with. They make me smile every day.

Can't see why you get to decide whether birth is to be feared or not. It's a painful process for most women, and perfectly normal for humans to be afraid of pain. I would not want anyone as my doula who felt it appropriate to make broad, sweeping, unhelpful statements like that.

I didn't find it Unhelpful and if I was a 1st time mother I would love you as my doula. I have 2 kids 8 and 33 months. And both there births were very different birth shouldn't be feared but enjoyed because itz the most amazing thing to happen to a women is bringing there little baby into the world. The more you panick the more stressed you and the baby can get which isn't good a nice calm and peaceful atmosphere is what you want

You're another one who needs to stop making broad pronouncements about whether birth should be feared or not, then. Nor do you get to decide whether it's the most amazing thing to happen to a woman or not! These are things you only get to decide FOR YOURSELF. Not anyone else.

Why would you decide to be afraid though?

There is so much information out there that talks about the pain of childbirth, I think it's helpful to have a voice say that childbirth can be positive.
Once women understand what's happening to their bodies, the fear of the pain diminishes in my opinion.

It isn't about deciding to be afraid, its about other people deciding for a woman how she should feel. There is no possible way in which that can be ok, but that's what people do when they say birth isn't something to be feared. You just don't get to make pronouncements on other women's views and experiences like that. By all means state your own feelings, but don't universalise them (which incidentally is what you do when you say women fear pain less if they understand what's happening- that depends entirely on the woman).

Liesel, I understand what you are saying. I decided I would not (and have not) use a doula for that reason. Horses for courses.

I am very happy with my scheduled medicalised birth, for which a doula would have been utterly redundant, for me anyway.

Thanks. I wouldn't mind a doula provided she was a bit more of a sciency type, rather than one who thinks birth is beautiful and wants to impose that view on me. Having read Mars Lord's website, she also offers placenta encapsulation and buys into a load of daft claims about the benefits. So I think it's safe to say she would not be the type of doula I'd be looking for. Horses for courses, as you say.

Doulally.

Liesel I couldn't agree more with what you are saying. I feel that some ways the efforts to "rebrand" birth as a unilaterally positive experience for every woman if they could just get over their fear is a kind of anti-feminist movement which ultimately can be as oppressive as what came before. Each birth will be unique for each woman, and there's a huge sense of guilt and blame for the women who bought into self hypnosis and still found birth frightening, painful and the rest. We need to understand that accepting difficult feelings around birth is a huge part of the process of coming to terms with it all.

I had two medicalised, intervention births (my liver failed both times, necessitating induction). The first one was scary - the illness wasn't picked up until very late, so it was all a bit emergency. I felt bewildered and out of control. I had planned on a doula but sadly her own father passed away that very night, so it was just me and DH.

The second birth was less emergency as the medics were looking out for the illness well ahead of time. It was still a driptastic induction with epidural, theatre on standby etc - but my doula was there, helping in all sorts of ways (not least because we had a babysitter fail and DH had to be home with DC1 for the latter part of labour). It turned into a really positive experience, despite the medical nature of it all, and I believe I have my doula to thank for that.

I agree, Liesl and Turning. I'll decide how I feel about birth, thank you very much, in the same way as I'll decide how I feel about having an appendectomy. I don't need a hushed, reverent and coercive rhetoric of birth about birth pauses.

Plus I have a vision of every woman who has given birth in history before the advent of modern medicine snorting with incredulous, slightly scornful laughter at the rebranding of birth as the ultimate in beautiful experiences, awash in oxytocin and love.

I had doulas for all 3 of my births (same one for the first two and a different one for the third as we'd moved area). They were great, and there's a huge amount to be said for that calm, continuous, reassuring presence throughout the birth experience. My births were amazing experiences - there was pain and intensity and oxytocin and love. The doulas really helped with giving the very medical hospital rooms an atmosphere of peace and calm. I can see how it is easy to ridicule if you've not had one, but I would definitely encourage my DD to have one - mind you, she's only 3, so hopefully not any time soon!

Very good posts turning and potato!

JonSnow, personally I'm not ridiculing doulas per se. They clearly help some women, and I wouldn't be opposed in principle to the idea of one for myself. But only if she didn't feel compelled to force her ideas of birth on other women, and understood enough about science not to be posting a load of drivel about the benefits of placenta encapsulation. This particular doula would clearly not meet my criteria, because actually she is peddling shit that is deserving of ridicule, but that's not to say no doula ever could. SlipperyJack's sounds alright.

I was a fully paid up member of the Birth is a Wonderful Perfect Experience Not To Be Feared for both my births - hypnobirthing, the lot. Both times I was in agony, only relieved by epidurals. Both times I had wonderful, fabulous bonding experiences, despite "medicalised"births. The whole Perfect Birth is Wonderful mentality nearly destroyed my postnatal mental health, giving me an unbelieveable sense of failure.

We should focus on helping women who require or want intervention in their births to have positive, empowering experiences, not on some rubbish saying that birth is coughing a baby out your fanjo with a whiff of patchouli oil.

My experience of doulas is that they don't force opinions on you. With hindsight (and from getting to know her more afterwards) my first doula has political/social etc. opinions and values that are diametrically opposite to mine, and in fact I must represent a class of people that she considers to be oppressive. I never got an inkling of that during her time as my doula - everything she did or said was entirely supportive of my choices.

It is a very personal thing - in my case, DH and I met several doulas before deciding on the one that was the best fit - it came down to a gut feeling of being comfortable with them.

It was massively reassuring having someone constantly there through the whole process who was focused on nothing else but me (without being in any way obtrusive and definitely not taking DH's place). It helped me feel I could let go and get on with the process without having to have any awareness of what was going on around me - I knew the doula would make sure that I knew anything I needed to know.

She was indeed liesel. Very non-woo, very reassuring, but without projecting any particular birth philosophy.

DH missed the actual birth by 15 minutes - but he said that when he arrived, I was sitting up with DD, drinking tea and smiling, the midwives were still high-fiving each other (tricky crowning that they sorted out without a doctor), and the room was awash with good feelings. Bit different to first time around!

I'm not ridiculing doulas at all, either. Friends have had them, and I think I considered one myself at one point. What I have an issue with is the compulsory rebranding of birth as if it's some kind of 'memory-creating' New Age experience holiday. The NCT, which is now the default antenatal experience for large swathes of women, does much the same, and the ultimate effects are toxic and profoundly anti-feminist under a rhetoric of 'choice'. I don't need to have my medicalised birth cooed over or regarded as an unfortunate but forgivable aberration from an ideal 'uninterrupted birth space' in which I labour in beauty and without fear.

YY PotatoGun I also find deeply patronising the assumption that somehow we are all terrified of birth, which is the only reason births deviate from some wondrous experience.

I don't understand this 'birth is a wonderful experience ' thing. The wonderful bit is that you get a baby at the end of it. Of course certain things can make it less painful (drugs and non-medical things too) but ultimately you're still forcing a large thing through a relatively small place and it hurts more than anything most women will have ever experienced. Making them feel like they ought to be actually enjoying it is just another way of minimising women's actual feelings and making them feel like they are doing it wrong. Incidentally, my midwives were calm, reassuring etc, so I don't think I'd have needed a doula. What does a doula do that a midwife doesn't?

If anyone actually READ the post, they'd see that the author also mentions a Caesarian birth as being a success because the mother felt listened to and respected

I wish people would respond to what someone is actually saying, not just what they think she is going to say and which they feel annoyed by.

Oh I did read the post ohmyeye. That's why I have a problem with these words that Mars uses:

I do, however, believe that birth is not to be feared

Because that is not a call she gets to make for other women. It simply isn't her place to decide whether an individual's fear of birth is legitimate or not. That's a direct quote, something she presumably wrote herself, and it's what I'm judging her by. I'm also judging the bilge on her website about placenta encapsulation, although it's true that isn't in the post and everyone posting in this thread may not have seen it.

Looking at it cynically, preying on women's 'fears' is one way of drumming up business for the doula. If women did not 'fear' it, why would they even pay for support?

It may not occur to some women to 'fear' birth until someone puts that thought into their head.

Blueshoes has a good point. There has sprung up (almost overnight) a huge industry based on selling women a narrative that birth was once easy and painless and successive patriarchal civilisations have effectively convinced women that it is painful, hard and frightening.

we are a product of both evolution and cultural influences. Trying to "erase" millenia of shared female experience in which birth was referred to as potentially dangerous and often hard work by imagining your fanjo as a rose unfurling is pretty daft.

What is cynical and sad is that doulas and hypnobirthing is an expensive means of filling a void which is left by the lack of honest dialogue amongst women, mothers & daugters, sisters etc about the reality of giving birth and adjusting to life with a baby.

I wish I'd feared my last birth more (3 weeks ago). Then I might not have had a such a shock at how horrific the entire thing was, I might have been better prepared for it all.
We fear things that scare us. And frankly, lots of births are very bloody scary. Mine was terrifying. Why wouldn't you fear that?

ohmyeye I read the post. Yes, the OP mentions c-sections and 'medicalised births' as a side-issue, but saves her enthusiasm and high-flown prose for what she clearly considers the 'real deal' eg 'To watch a woman birth in an uninterrupted birth space is to be filled with wonder'.

My birth space was highly 'interrupted', not because my fear of birth (a fear I think is perfectly legitimate) made my body 'go wrong', but because my baby was all caught up in the umbilical cord. Without the 'interruption' /CS, we'd both have died. My consultant suggested it. If I had bought the 'birth experience' rhetoric, I would have been putting my desire for the 'uninterrupted birth experience' above the considered advice of medical professionals, who had my life, and the life of my baby, at heart.

And only having a certain kind of birth dubbed 'physiological' is monumentally irritating - all births are bloody physiological.