courses/workshops, doulas, networks

Birth Stories

For many doulas, our journey begins with our own birth story. Our first experience of pregnancy, giving birth, breastfeeding, becoming a parent. Our first understanding of being part of our new family. And our first contact with the maternity care services. 

The quality of physical, emotional and social support that we have received during this time can make a huge impact on our experience of childbirth. And whether it has turned out as we hoped or expected, or whether it has confirmed our worst fears, it is nonetheless so often the trigger that starts us thinking about the idea of supporting other mothers through the same experience.

Listening to other women’s birth stories is bread and butter to doulas therefore. It is the way we learn about and connect to the mothers and fathers we support. It forms the baseline upon which our relationship with our clients during this birth experience balances, it provides waymarkers and flashpoints. And allows for the unpacking of a whole heap of the grief, anger, fear, hurt and disappointment that can sometimes accompany the joys of holding our newborn.

We need to be strong, mindful and steady in order to weather the storm of some birth stories, as well as gentle and yeilding enough for the parents to know we are with them from our hearts. This can be tough, it can resonate with our own birth trauma or postnatal illness, and touch us in ways we never knew was possible. Not only can it connect us back to the circumstances surrounding the birth of our own babies, but also to our personal (unconscious) memories of our own birth.

It’s useful for new doulas to be aware of the powerful and valuable impact that birth stories bring to their learning and preparation I feel. Not only does the novice hear about the physiology of natural birth and what happens when this is disturbed, but also it is an opportunity for her to begin to explore what it might mean to provide birth and postnatal support in practical and emotional terms within a safe setting.

To become humble, to begin to know a little of the amazing art of just being.


courses/workshops, doulas, midwives

Against the professionalisation of doulas – where next?

The role of the doula has been formalised in the UK for ten years now and I sense that the doula community and what we stand for may be standing at a threshold. My recent blogposts challenging the case for professionalisation of doulas have been met with some interesting feedback from both sides of the pond. 
There seems to be a general consensus that doulas work in a ‘professional’ way – we do what we say we are going to do when we say we are going to do it and we work with respect and integrity towards our clients as well as health professionals – but that we are not ‘trained professionals’ in the same sense that a midwife or a teacher is. And I do believe that the majority of doulas, including myself, would concur with this theory.
However, I also believe that there is MUCH more we could do in the way of giving a consistent message to the public and to health professionals by avoiding the use of the word ‘professional’ altogether. In essence, Doula UK’s Philosophy has traditionally promoted the doula as a lay person:
“The doula role, we believe, is a way of “being” not “doing”. A “training” implies completion and it is not useful to believe that a woman can attend a two or three day workshop or … course and believe that she is a doula. Doulas are learners, they are explorers, they are guides, friends, sharers, it goes on and on. Without an open approach to self development and human growth it is impossible to be available to enable others. Within a doula’s education there must be a deep concentration and focus on self awareness and … a lot of time reflecting.” “We do not want doulas to add another layer of ‘professionalism’ to an already overloaded maternity system.”
  
yet terms like ‘training’, ‘trainee’, ‘profession’ and ‘continuous professional development’ still feature in the organisation’s vocabulary. There is perhaps room for adjustment here therefore, a replacement of such professionalised terms for others that are more in keeping with the lay role perhaps, such as ‘preparation course’, ‘new doula’, ‘doula work/doulaing’ and ‘ongoing learning’.
      
During the doula preparation course too, much work can be done by course leaders and facilitators to remind new doulas that our role is not a professional one. Terms such as ‘qualified’ and ‘certified’ simply suggest that doulas have some special ‘professional’ status which in fact we do not. Why not ‘attended an information session’ or ‘completed a preparation course’? If all doula course leaders were consistent in perpetuating the use of lay language, our students would carry this with them on out into their work.  
In any occupation, jargon particular to that line of work may be found, jargon that is relayed initially to new workers via their educators or supervisors – so why not doulaing too?   
As we stand on this threshold where an awareness of our role has reached a wider public, where more mothers and fathers are choosing to enlist a doula during childbirth and more maternity health professionals are beginning to take the value of lay support seriously, we can surely step forward from here and make ourselves what we want to be.    
I believe that now is the moment to commit to our principles and fuse the definition of our role into how we want it to represent us into the future, for if we do not, I fear we will miss the moment, and possibly miss the greatest opportunity UK doulas will ever have to unite as one voice.

courses/workshops, doulas, midwives

The Doula-Midwife Relationship 1 – training & boundaries

I am in the unusual position of being a trained midwife (no longer practising) as well as a currently working doula and doula trainer (or ‘course leader’ as I prefer to say) at Mindful Doulas. This has given me much cause for reflection lately regarding the issue of boundaries between the two roles and how this is being presented to student doulas during their ‘training’ course.
 
Although I have always supported the idea that doula courses are most appropriately led by working doulas, for we are lay people and do not require to be ‘trained’ in the same way as a midwife, I guess this is because I do have the experience of having been a practising midwife. I do therefore fully understand the working boundaries between the two roles. 

How can a doula, generally speaking, be in a position to comment from a truly informed position on the midwife’s role? How can she fully understand the way the midwife is bound by policies and the pressure to conform to a system of care, or how if she steps out of the box, she can be ostracised from her own professional community? Or how the boundaries of this ‘box’ can vary so drastically between trusts/units, with much depending on the support the midwife receives from her senior colleagues?

This is not a failing of the doula, simply a fact that doulaing and midwifery are different roles. And therefore, I believe that, rather than focusing on any ‘bad midwife’ or ‘unsupportive NHS’ stories, it is more relevant and useful for the doula course leader to keep clarifying with her students the working boundaries of the doula, to reiterate that while she is there to protect the mother’s birthing environment, a part of this includes striving to ensure a harmonious relationship with the attending midwife


So perhaps there is a place for inviting a midwife speaker in to the doula course, as some already do, to share exactly what her working boundaries are? Working together does require respect and integrity between us, but I believe this is helped hugely if we are well informed about and have had a good experience of each other’s role.
 

Regardless of whether she had completed a course or not, a doula may be very experienced in supporting birthing families as a lay companion. And yes, her role is to protect and promote normal physiology, but often the reason why the doula is enlisted in the first place is because the mother feels her voice was not heard during a traumatic birth experience the last time round. The doula develops a close trusting relationship with the mother and her partner through pregnancy and works on sharing resources with the parents to enable them to make their own informed choices about the maternity care that feels right for them.

If things start to deviate from the norm during labour, the birth doula can only be led by the parents on how best to support them and the midwife’s advice will also enter this equation. However, the doula also knows (or should know) that sometimes, disturbance of the birth space (through noise, lack of privacy, stressed or fearful supporters, strangers entering the room) can be the very reason why the birth process starts to deviate from the norm in the first place. If the parents also understand this and have prepared well to minimise the risk of this, then it is likely that in view of her own role in supporting the couple’s wishes, the attending midwife will be mindful of limiting disturbance in the birthing room too. 


Indeed, many doulas and midwives are working amicably and effectively together in this way to support normal physiology right now – for example, supporting a mother to birth her twins in water!

In the same way that the midwife may feel caught between her employer’s rules and regulations and the choices of mother or couple she is attending, the doula may feel caught between her client’s wishes and medical advice. Of course it is not her role to defy professional opinion, but it is the doula’s role to support the mother if the mother chooses not to accept medical intervention. 


Since the biggest impact on the doula/midwife relationship is likely to be established in the clinical area, and since the doula may be perceived as the ‘newcomer’ on the scene, I feel we have a responsibility to take the initiative towards establishing a harmonious working relationship. However, this does not mean that I would encourage a doula to coerce with the midwife if the mother’s wishes were not being heard. And let’s face it, despite the best will in the world, there is evidence to show that this does happen, as indeed there are doulas who equally inappropriately cross their working boundaries.

We are all only human, but one thing we do all have in common is a passion for supporting women, men and families to enjoy the best birth and early parenting experience possible. I believe that if we both, as doulas and midwives, truly have the mother or couple and their baby’s best interests at heart, most times we will do our utmost get it right between us, and doula course leaders can do much to mindfully promote this good intention.