Very interesting bit on Woman’s Hour (22 June; it begins at about 24 minutes) discussing a scheme that offers birthing women in a hospital in Hackney the presence of a birth buddy, or doula, for their birth. The scheme began as a way of trying to reduce the number of emergency Caesareans and infant mortality occurring in women of Black African, Asian or Caribbean backgrounds. The programme was so successful, the service was extended to all birthing women.
Why is the programme so successful? As discussed on the show, fear associated with going in to hospital leads to tension in the mother. The presence of the doula helps to reduce tension, helping the mother to relax and go with her labour, leading to a better outcome.
From a physiological (i.e. hormones) point of view, the key hormone in labour is oxytocin. No oxytocin, no labour. However, the presence of adrenalin inhibits oxytocin, which is why it is so common to hear women say that their labour slowed down or even stopped when on arriving in hospital. (Adrenalin is released when mother is fearful, anxious…even something as subtle as being in unfamiliar surroundings can result in adrenalin being released!) Women may feel fearful during in labour if they are left alone…this may happen if the midwife has other clients to attend to, and cannot be with the labouring mother for the duration. A doula, who remains with the mother (and partner) for the whole of the labour, birth and appropriate time after the birth, can help reduce the level of distress associated with a lack of support. As stated in the programme, this results in a better outcome for both mother and baby.
Also, whereas a family member or partner might find it difficult to see mother in distress because of the pain of labour, doulas act as a “neutral” person, providing reassurance and reminding the couple that this is good pain, normal pain, and that it is bringing the baby closer to being born.
There is a clip from a birth that is aired at the beginning of the programme, which the midwife interviewed on the show commented on. She said she couldn’t recognise who was the doula and who was the midwife, as they both seemed to be coaching the woman to push. I also found this rather strange, as I would expect a doula to adopt a “quieter” role, encouraging the mother to work with her body and use her breath rather than coaching her to push. Indeed, the midwife commented that women shouldn’t be coached to push, as it is distressing for the baby and also may result in tears.
The key point here, though, was that doulas need to understand their role…they are present to provide emotional support to the mother (and her partner) [and I would add they are also able to act as an advocate for the mother and for the baby], and not to fill a gap in care resulting from a shortage of midwives.
Do have a listen if you have the chance; it’s quite an interesting piece!