Doulas: Making delivery a stress-free experience

What you need to know:

While no labour is perfect, one of the best ways to make it a positive experience is to have people with you who will meet your physical, emotional, and informational needs.
A doula is a trained professional who helps women through labour. She is a part of your birthing team, along with you, your partner, family members, your physician or midwife, and your nurse.

Darren Kazibwe had always feared going with his wife for delivery, “I was not ready for the trauma that the labour ward brought. Because of this, he stayed away during the birth of their first two children. However, when his wife told him about hiring a doula, Kazibwe seemed sold and ready to walk the journey with her.
A doula is a professional trained in childbirth, who provides continuous physical and emotional support and assistance in gathering information for women and their partners during labour and birth. The doula offers help and advice on comfort measures such as breathing, relaxation, movement and positioning.

Maria Kazibwe, Darren’s wife, says she met a wonderful woman through a mutual friend who walked with her from the time she was 20 weeks pregnant. “Apart from giving me all the information and answering all questions, she renewed my hope of having a vaginalbirth after two C-sections,” Maria Kazibwe shares.

Laura Wando has been a birth doula in Kampala for the last three years. Trained through Doulas of North American International (DONA), Wando says, “A birth doula ‘mothers the mother,’ enabling her to have the most satisfying experience from pregnancy and into motherhood. This type of support allows the whole family to relax and enjoy the birth experience too. Doulas usually receive training and possess an empathetic and calm nature. Most are mothers themselves,” she says.
Doulas are hired by the expectant parents and work independently but are part of the birth team. They do not provide medical or clinical care at all, nor do they make decisions for those they support, but assist them through the decision-making process and provide balanced, evidence-based information so that the couple can make their own choices.

Role of a doula
Unlike relatives who can easily get emotional as situations change, doulas stay calm because they are concerned about facilitating communication and providing a calm environment for their client. For example, if a mother is advised to go for a C-section, while relatives may get scared, the doula helps the mother and her family get the information they need from their doctor about what is happening, so that an informed decision is made.

Working in sync
A doula has to meet with their client before delivery. While every doula has a way they go about their prenatal visits, Wando shares what she does during the two or three visits before the due date and one after birth. “During the first visit, I discuss with the client their birth expectations, desires and preferences, and provide helpful resources for an independent hospital tour. I go over my role, and ask about previous birth experiences, how they feel about the current pregnancy, and answer practical questions about when to call, and logistics,” she says.

During the second visit, we discuss birth planning. I provide my clients with a worksheet so they can think through different choices they may have to make at each stage of labour. “We discuss all the options they have. This can be related to use of pain relief, preferred positions for labour and pushing, and after birth procedures, such as cord clamping or bathing of the baby,” she says. We also talk about what they will do if plans change and a surgical birth becomes necessary.

“During the third visit, we review a comfort measures checklist to identify with the client what relaxes her. We practice different techniques for comfort, such as breathing techniques, guided relaxation or developing positive phrases (birth affirmations) to encourage her during labour. The partner is involved as well and this is usually a very relaxing session,” she adds.

Wando is “on call” for clients 24/7 two weeks before the estimated due date (EDD) until the woman delivers. She provides continuous emotional, physical and informational support during active labour and up to two hours postpartum.
She also visits the family either at their home or in hospital usually no later than four days after the birth to discuss the entire birth experience, the mother and her partner’s emotions around the birth, provide early breastfeeding support and referrals as needed.

Is it all good?
“The woman’s partner is essential in providing support for the woman. A doula cannot make some of the unique contributions that the partner makes, such as long term commitment, the doula is there in addition to, not instead of, the partner,” Wando shares. Ideally, the doula and the partner make the perfect support team for the woman, complementing each other’s strengths.

Betty Lwantale was pregnant with her fourth child when on advice from another mother, she hired the services of a doula. “Quite frankly, I loved her professionalism and that she was quick on her feet. However, I did not like that my husband who had been with me through all the previous births took a back seat.
In my mind, I thought, “Does he think that she has now become my husband?” I was indeed infuriated but let it slide.”

While the doula helped Lwantale in voicing her views, there was nothing more she brought to the table. “I had been on this journey before and I had very few or no grey areas that she helped clear. Anyhow, she helped remind the doctor about my need to delay cord cutting. I got lost in my emotions for a while that I almost missed it if it wasn’t for her,” she says.
While all was going well, the main doula got an emergency call leaving Lwantale with her replacement, “If there was anything that infuriated me, it was that. She was a novice and I was glad that I knew almost all there was to know. If it was a first time mother, I wonder what would have happened. Nonetheless, on a whole, I had a relaxed birth”.

Guidelines
Confidentiality is crucial in this field. “We never make obvious reference to our clients to the public because we believe that one should enjoy our services without wondering if their details will someday be public knowledge,” she says.
No medical advice is given at all.

“While there are some doulas who are also midwives, one cannot present themselves to a client as a midwife and doula at the same time as that would violate the code of conduct. For example, a doula cannot perform a vaginal examination,” she clarifies.
In case of any emergency, which would prevent the doula from attending the birth, there should be a backup doula identified. “Contacts of the backup are given to the client and with their permission, I share their details with the backup doula. Nonetheless, from 38 weeks, I am on call and never leave town without telling my client,” Wando says.

Medical facilities
If the woman and her partner are working with a doula, they ought to talk to the administration of their hospital of choice as well as their obstetrician or midwife to ensure that doula services are accepted. “Besides that, find out about the hospital’s policy on the different birth methods,” Laura Wando, a doula, advises. Nonetheless, she has supported clients to deliver at many hospitals in Kampala, where the majority have agreed to the presence of a doula.

“While women that have given birth before may know a whole lot more, first time mothers are headed for a ‘dark’ world since they have no experience to compare with. Doulas give such mothers all the necessary information, prepare them for the process and ensure that their interests during delivery are met,” Dr Aggrey Lubikire an anaesthesiologist at Jinja Referral Hospital says.

He adds however that doulas have not been widely accepted, more so in government hospitals where the midwives and obstetricians are seen as the sole custodians of delivery knowledge. Besides, some relatives believe that the use of doulas is against tradition where the mother or sister would assist the delivering woman.

Difference with midwife
Every woman, during labour needs continuous support, and having a doula means that she has someone by her side continuously from start to end. Nurses, midwives and doctors will come and go owing to the various responsibilities at hand and their obligation to the mother ends with their shift. “However, the doula only has one obligation, to be with you all the way,” Laura Wando, a doula, says.

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