Health & Well-Being: Mother care - Doulas

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Doulas provide emotional and practical support during pregnancy, birth and the postnatal period. According to Doula UK, ‘While doulas are not there to change outcomes, there is growing evidence that having a birth or postnatal doula brings a number of tangible benefits, from reducing intervention rates to shortening labour and improving the condition of babies at birth.’ Other benefits include an increased likelihood of successful breastfeeding and lower rates of postnatal depression.

Emily Bray, a doula in Bristol and Cornwall, says doula support, or ‘mothering the mother’, can be vital in today’s society. ‘Women have supported women having babies since the beginning of time,’ she says. ‘The community surrounding a woman, their “village”, would come together to give hands-on help and emotional support. Today, we are living differently; often working longer hours, having children later and with more opportunity to live in different places. A result may be a loss of that “village”. The doula community helps women find it again.’

There is, however, a lack of understanding of the doula role (see box) and a shortage of doula support available to disadvantaged families. ‘There should definitely be more community-based doulas or doula programmes, but there are financial and social barriers,’ explains Ms Bray. ‘Doulas are usually self-employed and paid directly by the client. Some people think doulas are only for a particular type of person, but doulas are really for every woman.’

One area that is providing doulas for disadvantaged families is Bradford, which has high levels of deprivation and unemployment.

AT-RISK FAMILIES

Staffed by volunteer doulas and offered free of charge to women in the city, Bradford Doula service provides support six weeks before and after birth to women who request help or are referred by their midwife, doctor, health visitor, early years staff member or other community organisation. The service provides support including:

• home visits once or twice a week
• attending appointments
• help with developing social networks, such as introducing mothers to local family hubs
• help completing a birth plan
• packing a hospital bag
• attending the birth
• assisting with breastfeeding, bonding and attachment, bathing, etc.
• providing a listening ear for a debrief of birth
• bringing mother and baby home
• getting mother and baby out and about.

While the project is theoretically open to all women, with only between ten and 12 volunteer doulas available each quarter, priority is given to ‘high-risk’ families.

‘Research indicates that deprivation factors and stresses within the home can have adverse effects on women’s mental and physical health in pregnancy,’ explains Aliya Fazil, project manager of the Bradford Doula service. ‘Doulas can be a consistent face and “professional friend” in a world of uncertainty for families from more disadvantaged groups.

‘We tend to take women who are isolated, new to the country, or who have had negative previous birth experiences. We have women who have smoked in pregnancy, have mental health issues, a history of sexual exploitation, abuse or trafficking, a history with social services, children previously removed or child bereavements.’

BOUNDARIES

A doula should not be a replacement for a health professional, stresses Ms Fazil. ‘Some health professionals have reservations about doulas as they have experienced problems with doulas overstepping the line into giving clinical advice.’

To prevent this, the Bradford Doula service invites consultants from the Bradford Royal Infirmary to attend its free Level 3 doula training sessions for volunteers. ‘We have very clear boundaries about practical and emotional support, rather than clinical,’ says Ms Fazil. ‘Doulas provide information rather than give advice, and work closely with community midwives, who often carry out joint visits to better understand the role doulas can play in the process.’

BENEFITS

Since it was set up in 2012, initially funded by the Department of Health through the Goodwin Development Trust, the project has trained more than 60 volunteer doulas and helped 270 families. It now has funding guaranteed until 2020 through Bradford City Clinical Commissioning Group and Better Start Bradford, a National Lottery-funded programme.

The service has helped 84 per cent of its mothers to breastfeed, and achieved a breastfeeding rate at six weeks of 58 per cent, both of which are above Bradford averages.

‘Easier labour and a positive birth experience will only benefit the baby and promote an easier transition into its first 1,001 days, where bonding and parent-infant relationships are top of the agenda,’ says Ms Fazil.

Every year all the service’s families and doulas past and present are invited to a reunion. Ms Fazil says, ‘We see mothers returning with completely different body language; more confident and happier than ever before.’

CASE STUDY

‘A mother who was new to Bradford from Iran was referred to us by a health visitor who was supporting the family’s bid to seek asylum in the UK,’ explains Ms Fazil.

‘She didn’t speak English, so initially we brought in an interpreter. We ran through safeguarding procedures to check the father could take over translation going forward, as interpreters are one of the hardest things for us to source and fund. We take on some doulas who speak other languages, but they are not allowed to interpret for health professionals as it can blur the boundaries.

‘The family’s journey to the UK had been very difficult; they had seen a lot of distressing things and were emotionally and mentally in quite a difficult place. Although they had three children, the mother had never given birth in the UK, and she clearly felt very alone and anxious. The doula was able to explain the process to her and calm some of her fears.

‘We also discovered the father had never been present at a birth before. At first, he questioned if it was appropriate, but our doula advised it would be fine to stay, so he witnessed the birth of his child. It was amazing that our doulas were able to make this shared experience happen for them.’

MORE INFORMATION

Doula UK, membership association of around 700 UK-registered doulas, https://doula.org.uk

Bradford Doula service, https://betterstartbradford.org.uk/families-get-involved/our-projects/bradforddoulas

Community Doula Birth Program, https://communitydoulas.org

Project Mama, a Bristol charity supporting vulnerable women, https://projectmama.org

Birth Companions, a charity providing support for women in prisons and the community, www.birthcompanions.org.uK