Supporting role in making birth a positive experience

Concerns over a shortage of midwives and NHS cuts means more women are paying a doula for reassurance in the maternity suite. Nicky Solloway investigates.

Lesley Hilton is getting prepared for what could be a long night. One of her clients is in the early stages of labour and she could be summoned to the hospital at any minute. But Lesley isn’t a midwife, she is a doula.

Her “doula kit” is packed and ready by the door. The small, black shoulder bag contains an assortment of essential oils; clary sage, arnica and peppermint oil, drinking straws, water spray, massage oil, a wheat flower heat pack; and most importantly, her sandwiches. Part of the job of being a doula, or paid birth companion, is to provide non-stop support to a woman in labour. “I stay with the woman the whole time and this can mean for 24 hours,” says Lesley. “A doula friend of mine stayed in the delivery suite for four days.”

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It is this promise of constant care and one-to-one attention that is propelling doulas onto the must-have list for expectant parents. At a time of staff shortages and hospital cut-backs, many women are concerned they will not receive the attention they would like on Britain’s over-stretched maternity wards.

The Royal College of Midwives has reported a shortfall of 3,000 midwives for England alone, but says that to provide a “platinum” service the NHS should be taking on an extra 4,500 new midwives.

People are worried about not being supported and about taking pot-luck with the midwife,” says Lesley, who has worked as a doula for six years. “What I’m about is empowering the woman to have as positive a birth experience as possible and for her to get off to a good start with bonding with the baby.”

Research by the University of Salford has shown that three-quarters of deliveries where there is a risk of death or brain damage occur when too few midwives are on duty.

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Director of the Royal College of Midwives for England, Jaqui Gerrard says: “We are worried that women are finding themselves under a lot of pressure to engage a doula because they are recognising that there are not enough midwives out there to support them when they are in labour. If a midwife is so stretched she is looking after two or three or even four women at the same time then the actual quality of care will be a less positive birthing experience.

“I wouldn’t like to say that it’s unsafe but I would say there are risks involved if you don’t have enough midwives to give women one to one care in labour.”

If a woman doesn’t receive emotional support during labour, it can impact on her bonding and attachment with the baby.

“A woman might look back and think she expected the midwife to be with her all of the time but she was darting in and out of the room. The baby may be healthy but the woman may be left thinking there was something missing there and it can impact on her bonding and attachment with the baby.”

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Doula UK says hundreds of doulas are trained every year and the number has quadrupled over the last five years. New training courses are springing up to meet demand. The National Childbirth Trust has now teamed up with the University of Worcester to launch a nine-month doula training programme.

Doulas are not medically trained and are not able to interfere with clinical advice. However, a survey by Doula UK found that where a doula was present, the rate of caesareans halved, while the use of epidurals went down from the national average of 33 per cent to 15 per cent. The presence of a doula was also slashed the number of hours in labour by half.

A quest for a more natural birth is what drives many women to employ a doula. “I think women have lost confidence in their bodies,” says Lesley. “It’s part of this thing of birth becoming much more of a medical event, which it isn’t unless something goes wrong. It shouldn’t be a medical event; it’s a perfectly normal part of life. People tend to hire me because they have medical problems that are outside the straight hospital protocols. One woman told me ‘I hired you to fight my corner’.”

Lesley, who has three grown-up children and three grandchildren, says it is about “mothering the mother” and enabling a woman to feel in control during pregnancy, birth and the early days as a new mum.

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The 59-year-old, who also works as a freelance journalist, was inspired to become a doula after reporting on the subject for Radio 4’s Woman’s Hour. A few months earlier she had been concerned to watch the conditions in which her daughter gave birth at Leeds General Infirmary.

“Basically she would have had that baby in the bed on her own, if I hadn’t been there to drag somebody over. That was six years ago so hopefully things are better now, but it struck me afterwards how frightening and dangerous it would be if you were somebody who didn’t speak English and you were in that situation.”

Lesley also works with the Intensive Family Support Service at Sure Start to help vulnerable women such as single teenage mums, asylum seekers, or women who have been sexually abused. The doula service, which is funded by the Primary Care Trust, was due to be cut in April but has now been extended for a further six months.

A natural birth without medical intervention was what Vivienne Laidler, 35, had in mind when she employed Lesley as her doula.

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Her first baby was breech and was delivered through a caesarean section.

“I’d wanted to have a natural birth for this baby and we were having a bit of trouble negotiating that with the hospital,” says Vivienne, who works as a clinical psychologist at York Hospital.

“I didn’t like the idea that within the NHS you don’t know who your midwife is going to be on the day. It’s the luck of the draw. I thought it would help to have someone who we knew was definitely going to be there for the birth and who knew me and believed in my approach.”

Her second son was also breech and the hospital recommended another elective caesarean.

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“I think we’d have just gone along with that if we hadn’t had Lesley to support us in making the decision,” she says.

She is thrilled that baby Adam was born through a natural birth with no drugs.

“I didn’t have any pain relief at all,” says Vivienne. “At one point I was begging for drugs and Lesley said ‘you’re doing really well without them’.

“I suppose the most important thing for me was that she knew exactly what I wanted and she negotiated the whole way through.

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“The hospital was fantastic, I have to say, they couldn’t have been more helpful. They took on board everything we asked for and the midwives were superb.”

Lesley concludes: “If midwives could practice in the way that they want to practice there wouldn’t be doulas.”

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