Wednesday, 7 November 2012

Our questions for...

Regular WIer and mother of two, Fiona is a local birth worker supporting women and families before, during and after childbirth.

She is passionate about supporting women in their choices around birth and has kindly answered some of our questions.

Q: I have heard the term doula but am not really sure what this is, please could you tell me more?

A: The term ‘doula’ comes from a Greek word meaning ‘woman servant or caregiver’. A doula’s role is to support the mother during her pregnancy, birth and early postnatal period with practical and emotional support – this ‘mothering the mother’ will help support the whole family. Traditionally, the women supporting a mother during birth would be members of her family or friends, but these days we tend to live separated from our loved ones, and we have lost that circle of support. Doulas fill that gap.

Q: Why did you decide to become a doula?

A: I’ve been involved in women’s health for about 20 years. My own journey with supporting women began when I first fell pregnant when I was 19. I unfortunately lost my baby, and I started looking into healing myself with traditional Chinese medicine, homeopathy, yoga, and Ayurvedic medicine. I studied Shiatsu and acupuncture, and worked in drug and alcohol services for a while and supported women who were in recovery during their pregnancies. A Shiatsu friend and colleague of mine asked me to be at the birth of her first child, so I did a post graduate diploma in Shiatsu in maternity care with Suzanne Yates. This deepened my knowledge of women’s health and birth, and I was very privileged to support my friend through her birth. She had a long labour, but said that the only pain relief she needed was my support and the massage of certain acupuncture points. I was hooked! The moment that my friend and her baby looked into each other’s eyes was just magical, and I knew that supporting women and babies is what I am meant to do with the rest of my life. It’s my calling and my deepest joy.

Q: What sort of training do you have to do to become a doula?

A: There are several training courses here in the UK that are recognised by Doula UK, the voluntary umbrella organisation for doulas. Learning doesn’t stop there; it’s a lifelong process of self development, debriefing, and staying well informed about women and children’s health.

After a new doula has completed her course work with one of Doula UK's Recognised courses, she then works with a personal Doula Mentor through a process that involves reflection and supplying documentation to support her experiences as a doula over a period of not less than 6 months and preferably not more than 2 years. This then leads to a formal assessment interview with the Doula Mentor before the doula herself is Recognised. A minimum of 4 birth and/or postnatal experience records are submitted for review by the Doula Mentor during the process.

A condition of Doula UK membership includes a commitment to life-long learning and continuing personal/professional development.

Q: How do you work with midwives/HCP/the families during labour?

A: The relationship with the mother begins during pregnancy. It’s important that the family trust and feel comfortable with the people that will support them during the birth, so I meet the mother regularly during pregnancy to start building a relationship. I am also available for her to call or email with any questions that she may have. The parents and I usually meet up for birth preparation sessions about how to be actively involved in the birth process, and I will share with them some tools for how the birth partner can support and assist the labouring mother. These sessions may include simple Shiatsu techniques, acupressure points for pain relief, birth positions, themes from Active Birth, breathing and visualisation, and techniques from Birthing from Within (a wonderful book by Pam England) such as using art to explore feelings and ideas around birth. Themes that can be discussed during these antenatal sessions include homebirth / waterbirth, breech / optimal foetal positioning, vaginal birth after a previous caesarean (VBAC), how to have a positive caesarean, pregnancy loss and grief, and previous birth experiences.

For the birth itself, the mother calls me when labour has started, and I go to her home or the hospital when she feels like she needs me to be there. It’s important not to go too early as it may interfere with the flow of hormones during early labour as women generally need privacy during early labour. I do whatever the mother needs me to do, and that may include massage, fetching food or drinks, helping with the birth pool etc.

Midwives that I have worked with have said that they appreciated having an extra pair of hands to help out, and felt that I was an extra support for the whole family. Midwives are often so overstretched these days that they don’t have time to do the things that they’d like to do to support women, which is a real shame. I see it as my role to help hold a peaceful space, so will work towards building a good relationship with the midwives or family members, and that may involve anything from making tea to quietly explaining the massage I give or the homeopathy that the mother has requested. Sometimes fathers need some extra support too, and I do my best to ensure that he feels comfortable and empowered in order to better support his partner.

Q: How do you think the lack of midwives is affecting women in the UK? Do you have practical experience of this?

A: There are many women wanting to study midwifery, but there are comparatively few university places.

Studies have shown that caseload midwifery (where the midwife’s care is centred around the woman rather than being attached to a hospital, and the mother is more likely to know the midwife that attends her during labour) leads to more ‘normal’ births.

Caseload Midwifery, A Review; Andrews S, Brown L, Bowman L, Price L and Taylor R.

I was lucky when I had my children that I saw the same NHS midwife throughout my pregnancy, and she also came to my home for their births. Unfortunately this isn’t the case for most women. It can be difficult to build trust during labour with a midwife if the mother has never met them before.

Many women who have chosen to birth their babies at home have also been told that there aren’t enough midwives to enable that to happen, and are encouraged to go in to hospital.

I have supported women in various hospitals when the labour ward was extremely busy, and I have seen how stretched the midwifery team were. It affects the mothers as they tend to not get the support from the midwives that they would have liked due to time constraints, and that’s of detriment to both the families and the midwifery team.

Q: Childbirth seems to be such a political thing at the moment ('natural' vs 'unnatural' birth, formula vs breast feeding etc) - how do you stay neutral when working with women?

A: The role of a doula is to support women, whatever their choices are. I don’t make judgments on the choices that other people make, as pregnancy, birth and mothering is such an individual path. My role is to support and pass on information to women so that they can make informed choices about their care. As a doula, its vital to debrief regularly with a mentor to help talk through any personal difficulties that may arise from supporting women with different viewpoints, or after a challenging birth. This enables us to let go of our own experiences and opinions to be able to fully support women and their choices.

Q: Are doulas used in other countries? For example, countries with higher home birth rates, is this because they use doulas to supplement midwives or just that they have more midwives generally?

A: Yes. Doulas are found in most places around the world, although they might not be called ‘doulas’. For example, in Mexico the rural areas are still quite traditional, and therefore doulas are used to support mothers, but its not a profession that is recognised as such; it’s just what women do, support other women in their community.

In my research into the origins of belly dance, I found out that in the Middle East and North Africa women traditionally gathered around a birthing woman from their community, and danced certain movements to encourage the mother to do the same to help ease the sensations of the contractions and to help facilitate the birth. How wonderful to have the choice of a whole community of dancing doulas!

The Netherlands has a good model of support with it’s medical service for new mothers. A maternity nurse or health professional comes to the mother’s home to help support her with the early days of looking after the baby, and to make sure that the mother recovers properly after the birth.

Q: My impression of doulas is that they are for women who are a bit hippyish, although this is not based on any experience! Can all women use a doula during birth?

A: All women can use doulas, we’re not just for hippies. ;)
Doulas come in all shapes and sizes, there is a doula for every woman! Every woman deserves to be empowered and nurtured.

Q: What do you think of One Born Every Minute? It seems to have made birth more acceptable to talk about but to be honest it terrifies me and I'm done having children years ago!

A: I find that One Born Every Minute tends to portray birth as fearful and a medical procedure, and this can make women fearful. Birth is a normal physiological event (although it does need assistance sometimes), and this sort of show perpetuates the idea portrayed by the media that birth is something to be afraid of. It is known that when women are fearful, their birthing hormones can’t flow properly, and this can interfere with labour. A labouring woman’s hormones flow much more effectively when she feels safe, so women need to be in the place where they feel safest to give birth - for some women that will be hospital, for other women that will be at home.
Of course, some women will need extra assistance at times, and so I’m thankful for the full range of obstetrical medicine that is available here in the UK, but we need to get the word out to all women that birth is a normal event. When women understand the normal physiological process of birth, and just how amazing their bodies are and what they are capable of, they usually feel more confident in their ability to birth, and are better able to make informed choices about their care. It’s so important that women know their rights around birth so that they can make truly informed choices.

Q: And a question we ask everyone - what's your favourite cake!

A: Raw chocolate cheesecake!

Fiona Willis
Shiatsu practitioner, doula, childbirth educator and belly dance teacher.

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