Information for Midwives and Obstetricians

New Zealand is quite a unique country in its maternity health care system; the independent midwifery system is wonderful for women to choose a person they would like to support them throughout pregnancy and birth giving them the continuous support that has proven to bring great benefit. I think it is for this reason that birth doulas have previously not been thought of as necessary within the New Zealand system of care.

However, more and more New Zealand women are looking for the support of birth doulas for many different reasons. From my past experience, the New Zealand medical profession have been both curious and welcoming as well as hostile and rejecting towards doulas. Below I have listed some commonly raised questions and complaints about having a birth doula present and my clarifying response. If you have more questions about our Joyful Childbirth doula being present at a birth you are attending please do get in contact as we would appreciate the opportunity to discuss these with you.

"I look after my mums very well; they don't need any other support"
Midwives are great at their job and take pride in how they look after their pregnant and birthing mums. Doulas are not here to take that special relationship away. As much as midwives would love to spend the whole duration of a womans' labour with her, it just isn't feasible. For a midwife to be called out in the middle of the night to a labouring mum and then to spend up to 24 hours or more with that one mother would make it incredibly difficult for her to see to her other expectant women, as well as getting any sleep. Because doulas only take on four or less clients a month, it's easier for them to offer that continuous support.

Some of the other benefits of doula support include keeping a birthing mum and her partner calm and relaxed before going to the hospital while the midwife isn't there. They will also ensure that both mum and partner are well hydrated and adequately nourished. This makes the midwifes job much easier as relaxed and confident mums and dads mean easier and happier birthings and healthier babies. Our Joyful Childbirth doula is also a professionally trained masseuse, specialising in labour massage, and so can give a birthing mum a well needed rub for as long as she wants (up to two-three hours before needing to swap for a break).

One of the main reasons why a pregnant woman will call on a birth doula for support is that they want someone there to give them encouragement, massage and offer a calm and relaxed presence, as well support for her partner, without that person being part of the medical system. This is a psychological need for someone neutral who she is comfortable with to be naked around and relax and let go (which she might not be able to do with another family member or friend). Midwives have a dual role of supporting a birthing woman as well as diagnosing complications being the bringer of potentially bad news (e.g. "you're only 3cm dilated, we may need to do something soon"). A doula is unable to give that sort of care and so remains the one person in the room that she needn't "fear" (not that midwives are scary!)

"I don't want someone getting in the way of my job"
A midwife spends many years training on the ins and outs of birthing and then once qualified attends many, many varied births. She holds specialist knowledge about birthing and how to recognise if things are starting to get complicated and more support is needed. A doula will not replace this vital role. What we sometimes find is that hospital procedures and routine care can sometimes forget the individual and it may be routine practise for a hospital to talk about interventions even when mother and baby are happy and safe (eg. failure to progress). We also sometimes find the medical terminology used with birthing couples at a time when emotions are stretched and they are exhausted can often lead to confusion or a quick decision that in hindsight wasn't what they wanted.

A doula may help the birthing couple understand what is happening by asking more relevant questions and help them in any way they can to keep to their original ideal of what they wanted for their birth. However, a doula will not interfere with emergencies nor will they tell midwives or obstetricians how to do their job. Requests may be made for particular things, such as limiting the use of continuous foetal monitoring (except obviously during an induction/ augmentation) due to the high correlation between monitoring and an increase in the caesarean rate, or maybe request that a routine vaginal exam be omitted if there's no medical indication for its need.

"Why should a doula get paid so much when we're medically qualified and take all the risk?"
Midwives have an amazing, rewarding, exhausting and demanding job. The care and health of the pregnant and labouring woman and the health of the baby are the midwives responsibility and if anything happens to either it is the midwives neck on the line. Midwives also spend a long time in training and give a lot of commitment to the mums they support. Doulas on the other hand have no medical responsibility to the mother, but they do have a time commitment to them. Our Joyful Childbirth doulas are on call for two weeks before and two weeks after the mothers due date and guarantee that they will be available (unless they are sick) for that whole time. Obviously if the birth happens early then they will still be there.

Once the mother knows she is in labour, her doula will come to her house to be with her and her partner giving them any support and reassurance they need and will stay with them until baby is snuggled in their arms. This could mean 2 hours to 48 hours or more of continuous support as well as the many hours spent with the couple before the birth giving them encouragement, information and helping them to feel positive and relaxed about the birth. Because our doula will only take on four or less births a month, they are limited in their income and so need a second source to sustain themselves. Our doula works for Bella Mama and Joyful Childbirth, Aucklands' only pregnancy massage specialists. If a birth occurs on a work day they need to find someone to cover appointments and make up for the loss of earnings from being with a birthing couple. These are the factors that largely make up our doula fees.

"If a couple wants to spend money on maternity support, they may be wiser to get the back up of a private obstetrician if the need arises on the day of labour instead of an extra birthing partner [doula]"
Having a private obstetrician on standby is a great option to have if there are complications as it means that you have someone fully qualified and experienced to deal with emergency situations and medical procedures safely. What has been found in research studies, however, is that the continuous presence of a doula significantly reduces the likelihood of complications arising in the first place. Numerous studies from around the world have found great benefits from birthing doulas. A study in 1993 by Kennell, Klaus and Kennell found:

50% reduction in caesareans
25% shorter labours
60% reduction in epidural requests
40% reduction in the use of synthetic oxytocin (to induce labour or to make contractions more effective)
30% reduction in requests for pain relief
40% reduction in forceps deliveries

The doula phenomena, as mentioned above, is a psychological one. Having skilled continuous, reassuring support by someone who is not part of the medical profession is very different from the support given by medical professionals who deliver medical news. A doula is a neutral party who can stay positive and relaxed so that both parents also feel positive and relaxed before they even get to the hospital or birth centre and while they're there. For a midwife or obstetrician to deal with a stressed out mother, father and baby on their arrival to the hospital or birth centre is far more difficult and may have created complications. Generally a birthing couple wanting the support of a doula will also have a natural birth as their ideal and may rather spend their money and energy on supporting that ideal rather than the alternatives. And the last response to this question is that an obstetrician is unlikely to massage a woman at all, certainly not for over two hours like our doula can.