Enough is SURELY enough?

Please explain to me why a birthing person can’t choose to have their partner AND their Doula present at birth….

I am a Doula and before I talk to you about my frustrations, I will briefly explain what a Doula does! A Doula is a professional who works with birthing people (and their partners) to provide practical and emotional support during pregnancy, birth and postnatally. I provide evidence-based information about the full range of choices available to my clients as they  navigate the bureaucracy of maternity services. I spend time understanding their hopes and helping to allay anxieties around their journey to parenthood. A big part of what I provide is continuity of support for spouses/partners. A lot of partners find it extremely stressful, the thought of being sole support for their partner during birth. Working as a doula is a job that I adore and one that provides tangible results and improves outcomes for birthing people and their babies.

During the pre-Covid19 life, I attended hospital births as a second birth partner. I was always well received by the midwifes and it was regularly acknowledged that the doula support that I had provided enhanced the maternity experience for all involved.

Then Covid19 hit and the UK went into lockdown. Birthing partners were reduced to one person only and even then, were restricted as to when they could physically be with their partner. During the time of lockdown, I tried to do what I could to support the birthing people in my network, to help get their voices heard. I spent time advocating for birthing person-centred care, highlighting the importance of meeting the individual needs, rather than blindly following blanket guidelines. I had some successes, but I had even more failures, which saw NHS service users being ‘sheep-dipped’ through maternity service Covid19 guidelines, with very little thought being given to the emotional support that they needed.

Then a glimmer of hope shone through; ‘the curve started to flatten’, conversations began around ways in which the lockdown could begin to be lifted. Households were allowed to start to mix. We heard talk of hotels, cafes and restaurants reopening. Then pubs were to reopen, along with other non-essential retail. I could now be in an indoor space with 10’s of different people each day if I chose to eat out or head to my local pub for a long-awaited cocktail. I didn’t even need to wear a facemask in most of these places. The world was taking more than a tentative step towards the old normality.

I waited for details of how this would impact maternity services. Would we see a move back to ‘normal’ services, that allowed birthing people choices around, the location of their birth, to be accompanied to antenatal appointments and the choice of who supported them during birth? Surely we would? Surely??…. I refer you back to pubs, nightclubs and restaurants being reopened and large numbers of strangers being allowed to mix socially.

SURELY, we can lift maternity restrictions, when all staff have full PPE, birth partners can take sensible precautions, like only attending if symptom free and wearing face coverings. Plus, maternity wards provide the optimum environment for maintaining good hand hygiene; with sinks, soap and hand sanitiser readily available.

But no, this is not the case…. There are still heavy restrictions in place around birth partners being able to fully support birthing people. And as for Doula access, unless we go directly to the local Director of Midwifery to justify the specific needs of a birthing person, we are currently excluded from the majority of maternity wards across the UK.

I really need someone to explain to me how we have reached this point. As a doula I am non-medical expert in birth. For the vast majority of women, birth does not need to be a medical experience; a doula is a fabulous option to support a birth, even when birth is taking place within a medical setting. Where someone genuinely requires a medicalised birth, a doula still plays a key role; supporting the client to establish benefits and risks of proposed actions, as well as helping to reduce the anxiety that usually comes hand-in-hand with medical intervention.

There is evidence-based research to prove that Doulas reduce medical intervention. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003766.pub6/full

https://www.cochrane.org/CD003766/PREG_continuous-support-women-during-childbirth

When there is a professional available to support improved outcomes, in what world do we stop them from doing their job?? I am beyond frustrated and I have so many questions… Why does the NHS fail to hear and respond to the reasonable needs of the public who fund it? Where is the evidence that restricting birth support provides a safer/better outcome? Are the restrictions going unnoticed because they mainly affect women and the oppression of women is engrained in society? Does the removal of a Doula from the birthplace suit clinicians because it disguises the increase in obstetric violence that has occurred during the pandemic?

I cannot find any evidence-based reason why Doulas should not be welcome professionals at a birth. Are we the victims of gaslighting?…. maybe ‘healthcare gaslighting’ is the topic of my next blog!

There are a couple of great resources that I would recommend that birthing people and partners check out if you feel that you need extra support –

Birthrights – particularly their Covid19 advice and information

AIMS – particularly the template letters that can be sent to your Trust if you are not getting the support you need.