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Doulas – An integral part of a woman’s birth team

Studies have shown that births supported by ‘doulas’ present a 50 per cent reduction in caesarean rates and a 25 per cent decrease in lengths of labour.

The word ‘doula’ — pronounced ‘doo-la’ — is a Greek word meaning ‘woman servant or caregiver’. Today, it refers to someone who offers emotional, informational and physical support to a woman and her partner before, during and after childbirth. A doula believes in ‘mothering the mother’ and enables a woman and her partner to have a satisfying and positive birth experience, from pregnancy and into parenthood. This type of support allows the whole family to relax and enjoy the experience too.

The role of a doula is somewhat new to the Middle East, however, it in fact dates back centuries with women supporting other women at its core. A doula, also known as a birth companion, birth coach or post-birth supporter, is a non-medical professional who is trained and certified in childbirth education and support.

A doula may provide some or all of the following services, dependent on her training and skills:

• Birth education and preparation

• Birth planning (including creating a written birth plan/birth preferences document)

• De-briefing previous births (if any)

• Massage and other comfort measures i.e Acupressure

• Suggest positions and changes to help ease pain and facilitate a smoother, more effective labour

• Provide reassurance and encouragement

• Talking through emotional blockages, which may come up during pregnancy and in labour

• Keeping a mother hydrated with beverages and snacks

• Keeping a mother’s ‘environment’ comfortable – aromatherapy, music, flameless candles etc.

• Assisting with negotiation of a mother’s labour and birth preferences

• Standard photography and/or video of the birth itself, as well as those precious first moments as a family

Does the UAE need doulas in maternity care?

The UAE is a great nation to promote new concepts as the vast majority of its population, regardless of the personal culture, is curious and open to discovering new information.

Doulas are a recognised profession in the majority of Western countries such as the U.S., UK, Brazil and Europe in general, and it was soon realised that many people and medical professionals were unaware of this unique role and the benefits it brings to a birthing couple and new families.

Being in Dubai, the majority of birthing couples are expats, who are away from their close family and friends, and so the option of having their mothers beside them during labour, may not be an option for many. Doulas tend to fill that void, as they present with a maternal approach that makes a woman feel safe and relaxed.

As women, we believe we play a huge role in the birth room, because we know that when women come together in difficult times or in times of need, amazing things can happen! It is that wonderful ‘woman’ energy that fills the room that helps a birthing woman feel calmer and more focused.

During the initial phase of setting up our company, Belly Baby Mom L.L.C, we introduced the Doula concept to several hospitals and medical professionals, and the feedback was very positive, which led us to approach the UAE licensing authorities to legalise the profession. After several months of discussion, in March 2018, Belly Baby Mom, became the first licensed Doula & Childbirth Support & Education agency in the UAE and the region, with a growing team of birth and postnatal doulas, childbirth educators, lactation consultants, baby massage instructors and more, supporting new and expectant couples throughout their parenting journey through classes, 1-1 labour support and target focused events.

Our main goal is to create awareness about the doula profession in the UAE and the importance for a birthing woman to feel and be respected, listened to and supported during her child-bearing experience.

The relationship between doulas and hospitals in UAE

We are well aware that some medical staff and hospitals are doubtful about the job role of a doula and its benefits for the mom and partner, however, we believe that the personal educational background has a big impact in how we are perceived. We find it very fulfilling when, after supporting a mom with her birth, and the medical team experiences first-hand what we do, they tend to become more relaxed in having us supporting their patients, as they see and understand what we do and how we really help the women have a more comfortable birthing experience.

It is a process that will take time, yet we are confident that our profession will be welcomed in different hospitals, as we have already secured partnerships with some of Dubai’s well-established hospitals.

Evidence-based benefits of doula support

Several studies (Cochrane, WHO, NCBI) have been conducted in the past years studying the impact of a doula’s presence during the prenatal and more importantly, the birthing experience. All these studies have reached the common result that, ‘to have a continuous professional birth partner (doula) staying at the side of a mother during labour and birth had several positive outcomes for both mother and baby.

Studies have shown that births have:

• 25 per cent decrease in length of labour

• 60 per cent decrease in Epidural Analgesia requests

• 50 per cent decrease in caesarean rate

• 40 per cent din Synthetic Oxytocin (induction) use

• 40 per cent decrease in forceps delivery

• 30 per cent decrease in Epidural Analgesia use

• 38 per cent decrease in a low five-minute Apgar score

• 31 per cent decrease in being dissatisfied with the birth experience

Source: Evidence Based Birth

“Of all the ways birth outcomes could be improved, continuous labour support by a doula seems like one of the most important and basic needs for birthing people. Providing labour support to birthing people is both risk-free and highly effective,” said a report by Evidence Based Birth.

How do mothers and doulas work together?

Belly Baby Mom offers a wide range of services for supporting women through the different stages of motherhood from early pregnancy and towards the first year of a baby’s life.

‘Doula support services’ include a personalised educational and emotional support service during pregnancy, birth and the postpartum period, and are split between ‘Birth Doula’ & ‘Postnatal Doula’ packages that a mother can choose between according to her personal needs and circumstances.

Typically, an expectant mother would contact us to be educated about what we do and how we can support them. A lot of the times, they seek recommendations for doctors and hospitals that are well experienced and that would be supportive of their birth choices. As doulas, we can only share our experiences and unbiased reviews with these mothers, while making sure they understand that every person is different and may gravitate towards one doctor over another. We always suggest that they visit a few doctors before making a decision on the selection of their care provider.

Birth doulas

The ‘birth doula’ offers two private prenatal sessions in the comfort of the mother’s home during which she becomes acquainted with the expectant couple and discusses the couple’s birth wishes regarding the birthing experience. These sessions are tailor made on the couple’s needs, as some prefer them to be more educational whilst for others, they could cover pain relief techniques (medical and natural coping techniques), what to expect at the hospital, signs of labour etc.

It is important to note that the doula from this point onwards, becomes the couple’s “Maternity coach” and is available to provide non-medical advice and emotional support through phone, messages and emails.

From the 38th week of pregnancy, the doula is on call 24 hours a day and 7 days per week, ready to be called to join the mother at the hospital at the start of active labour and when she is requested to be present. The doula remains with the mother in hospital providing ‘continuous labour support’ until one hour after the birth.

The doula returns back to the mother’s home within a week from birth, for a private postnatal session to support her with understanding her new role as a mother, as well as to debrief the birthing experience.

“Birth is not only about making babies. Birth is about making mothers strong, competent, and capable mothers who trust themselves and know their inner strength,” a U.S.-based professor, Barbara Katz Rothman, was quoted saying.

Postnatal doulas

Postnatal doulas offer a personalised service to the new mother through a vast array of services stemming from different traditional practices. The aim of a Postpartum Doula is to comfort and hold the new mother’s space for her to have more clarity about her new role as a mother, fostering a healthy relationship with her baby and supporting her with her own mothering decisions, without imposing any personal believe or ideology. The postnatal doula can also provide informational and practical support on healthy breastfeeding practices, diaper changing, baby sleep, emotional well-being and more.

For many mothers in the UAE, especially the ones who are willing to take care of their baby by themselves, it is very important to have a supporter in the first days of motherhood in order for them to find their own path whilst being supported professionally and through the latest evidence based information available. The support of a ‘Postnatal Doula’ is typically presented in 10-hour packages that a mother can avail.

Are doulas medical professionals?

Doulas are trained and experienced in childbirth support and the physiology of birth and are usually mothers themselves. While they have good knowledge and awareness of the birth process, a doula does not support the mother-to-be in a medical role, as that is the job of the midwife or doctor. A doula helps the mother-to-be to achieve the birth she hopes for, no matter if it’s a birth with or without medication, or even a c-section. This makes a doula a valuable addition to the birth team, who are all there to support her and her choices.

The most important value for us as doulas, and why we believe it is beneficial for birthing mothers, is that we tend to hear of many negative birth stories, and for which we feel many could have been avoided only if a mother knew a little better.

As doulas, a lot of the times we cannot change a birth outcome, especially if a medical procedure is suggested and is necessary, but we make sure that parents know that they have a right to ask questions, evaluate the benefits and risks, and more importantly have the right to accept or decline. This is crucial, because many women in the UAE suffer post-natal depression because they feel they have failed their babies and themselves or feel guilty for making the wrong decisions. In the end, we are also there to comfort a mother and talk to her about her own birth experience and how she feels about it, which is an important step in healing, should she have had a negative birth experience.

References available on request.

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