Doula UK were glad to see doulas get some national media recognition recently, with an article published in The Independent on Monday 20 April, but we were disappointed at some of the suggestions made in the article.
The article ‘Pregnant women employ ‘doulas’ for support during labour as NHS cuts hit’ commented on the increasing popularity of doulas for support during pregnancy, birth and the early weeks with a new baby. It linked the increasing popularity of doulas with NHS shortages affecting maternity care. However, whilst the lack of continuity of care during pregnancy, birth and beyond is sometimes a factor in why some families choose a doula, Doula UK feel that this article rather misses the point.
The article states that doulas support women to have easy births. The term ‘easy’ is rather subjective and could mean different things to different people. Doulas support women and couple to have positive births – births that result in a mother feeling proud of her achievements and with happy memories of the event. The medical evidence is that, with a doula, certain risks are reduced and what the medical profession term ‘normal’ birth is more likely with a doula in the mix.
However, doulas support women through all manner of birth experiences; some simple, some more complicated. Doulas support women with complex pregnancies and those planning elective caesarean births, as well as those who are “low risk” and planning vaginal births. Doulas support their clients no matter how a birth goes, and the testimonials from past clients show that it is often those parents, whose birth didn’t perhaps go as hoped, who most appreciated the support of their doula.
Doula UK disagrees strongly with the suggestion that doulas are exploiting fears about NHS perinatal care – based on a suggestion in 2009 British Medical Journal (BMJ) article by Dr Abhijoy Chaklader, who publicly complained at the time about the way the press had quoted him out of context and who later, after correspondence with Doula UK stated, “Doulas obviously make a great difference to some women, lifting the childbirth experience, and it is in no one’s interest to demean that role.”
Rather than having concerns about doulas, as the article suggests, the Royal College of Midwives (RCM) actually works closely with Doula UK and supports doulas working alongside midwives, recognizing that doulas are not trying to take on the role of midwives or crossing any professional boundaries. The RCM Director of Midwifery, Louise Silverton, appears to have been quoted out of context, discussing concerns about non-midwives providing midwifery care to women – which is not what doulas do.
Doulas are not exploiting rising demand or NHS shortages. On the contrary, most doulas charge less than £1000 for a birth package, with most recognized doulas charging between £600-1000 for a full birth package, typically supporting 5-10 women a year. Simple maths will show that this is no money-making scheme. Only a few, very experienced, doulas, in London, charge in the £2,000 ballpark. Mentored doulas are likely to only charge £150-450 for a birth package. With the hours worked and the costs involved, a typical doula’s birth package fee is often lower than minimum wage.
Doulas are not there to take the place of midwives and are not trying to be midwives. Doulas would usually work alongside healthcare professionals caring for a client and facilitating a good relationship between the client(s) and their healthcare professionals is seen as part of the doula’s role. The role of a doula is a very old role and, historically, most women would have had experienced women to support them through pregnancy, labour & birth and then postnatally. With smaller families, fractured and larger communities, many adults moving away from their immediate families before having their own children and the medicalisation of birth and reduction in breastfeeding rates over the last century, the non-medical support from experienced women has been lost to many new mothers. This is the role doulas take on, enabling women to independently arrange the non-judgmental emotional and practical support they, and their family, want and need during the childbearing year.
The growth of the doula community worldwide, particularly in the USA and the UK, is not just about what health-care women receive. It is more about women reclaiming the child-bearing years and seeking out the kind of non-medical, psycho-social support that their great-grandmothers might have had. Doulas work with women and families in all situations, from the wealthy to the financially disadvantaged or vulnerable. Support from a skilled doula can, and does benefit all kinds of families, irrespective of the healthcare they are receiving.
In conclusion, the implication that doulas are cashing in on a crumbling NHS is insulting, not just to doulas, but to the hardworking midwives working to provide compassionate, respectful, joined up care to mothers and their babies.