Dads are great – but Pat Thomas reveals the identity of another partner who can support you through labour

Some mums to be are lucky enough to have a midwife, who also acts as a friend and advocate during delivery. But this isn’t always the case and this is where the doula comes in. The name doula (pronounced doola) comes from a Greek root and refers to a ‘knowledgeable support person’. While any woman can act as a doula, she’s usually someone who has been professionally trained to provide support in labour, and this can be really useful if your partner doesn’t want to witness the scene in the labour room, or you’re a single parent giving birth. Having said that, lots of couples have also valued having a doula to help them through.

A female companion (midwife, doula or friend) has long been accepted as the best kind of ‘medicine’ a labouring woman needs, and studies show that the outcome of birth is better if a doula (a ‘trained’ female birth partner) is present. One study published in the New England Journal of Medicine an amazing 20 years ago, showed that having a doula present, cut the average length of labour, from admission to delivery, by half (from 19.3 hours to 8.8 hours).

According to the International Childbirth Education Association, a doula’s job is to accompany a woman in labour and assist her in having a safe and satisfying birth. The doula draws on her knowledge, experience and intuition to provide emotional support and physical comfort. Antenatally, she can help to provide the information you need to make decisions about labour and delivery. NHS doctors or midwives will still attend your birth but your doula will act as an advocate for you when you are in labour. She’ll make your needs and plans for birth a priority for everyone in the delivery room, when you and your partner might have other things on your mind. A doula can also make suggestions about how to help the progress of labour, and about relaxation, massage, positioning and other techniques for comfort.

Doulas don’t take over

A doula doesn’t perform clinical tasks such as blood pressure, foetal heart checks or vaginal examinations. Nor is she there to make decisions on your behalf. Some doulas may have expertise in areas such as aromatherapy, acupressure, or herbal medicine, but you should make sure your doula has a recognised qualification in these areas before allowing her to treat you.

Research has shown that a female birth companion can offer other benefits.

A study in the American Journal of Obstetrics and Gynaecology showed that, women who had a female companion during labour experienced less anxiety and were less prone to depression after birth. The authors concluded that female companionship in labour ‘had a striking effect on the woman’s feelings of self confidence.’ Another American study (published in the journal Birth in 1999), compared women who had a female relative present at birth with those who had no support.

It found that women who had this support were more likely to give birth vaginally (91% versus 71%). The women also needed fewer drugs to augment labour (13% versus 30%), less pain relieving drugs (53% versus 73%). Fewer had their waters broken (30% versus 54%), fewer had vacuum extractions (4% versus 16%), and the caesarean rate in the supported group was less than half that of the other women (6% versus 13%).

What you need to check before you hire a doula:

• A doula is usually a paid companion (some charge by the hour, others have a flat fee, usually around £150).
• You need to find out what your doula’s own experience of birth has been, what emotional baggage, if any, she is bringing with her, and how it might affect your labour.
• A number of doulas believe passionately in natural birth, which is fine, but if you intend to give birth in hospital, you will probably fare better with someone who understands the need for, and has experience of, acting as a strong advocate for the mother’s wishes in a hospital setting.
• Doula training can vary. To be confident you should look for a companion whose training lasted more than a weekend or two.

Be choosy and don’t be shy about shopping around

Phone several doulas with a list of questions to help you decide if they are right for you. Then meet one or two and interview them, raising these points:

• What training have you had?
• What is your philosophy about childbirth and about supporting women and their partners through labour?
• How many births have you attended in hospital/at home?
• Tell me (us) about your experiences with birth, personally and as a doula.
• May we call you with questions or concerns before and after the birth?
• When do you join me in labour?
• Do you work with one or more backup doulas (for times when you are not available)?
• May we meet them?
• What is your fee?

• Is she kind, warm, and enthusiastic?
• Does she communicate well?
• Is she a good listener?
• Is she comfortable with your choices?
• Do you feel comfortable with her?

The British Doula Association (helpline 020 7565 2640, Mon-Fri 9.00-5.00) can provide a list of trained doulas in your area and advise you about standards, practice and training.