We dance on a stage that is painted many shades of grey. We offer a service that is as old as the hills, yet remains by its very nature a mystery. How can it be anything but? Most women having a straightforward pregnancy have a guess-date and birth might take half an hour or many days – as doulas we never really know in advance what kind of birth or personalised needs a woman will have. Our job description is stretchy, and there can be various facets to our role. We know with certainty that we are not midwives and that our support is not clinical, and do not have the certainty or timetable of hours we will work since our employer is not the NHS. We don’t generally walk away after twelve hours. But if burnout for midwives who work 12hr shifts is very much a reality…. what about doulas?
Burnout for doulas is a very real phenomenon. Before we even attend a woman’s birth we may have been on call for a whole month already. A month of checking our mobile phones obsessively, often waking in a panic in the middle of the night, sleeping with one ear always pricked up “just in case”. Many of us, like myself, have to make childcare plans and navigating potentially complex logistics with our own families every single day, being mindful not to go too far from home, or be in areas with no or poor phone signal.
Being supportive through long latent stages or helping nervous new mothers who are convinced they are in labour for a week before active labour begins takes time and energy. Listening and coaching women through the intensity of pregnancy and labour is emotional work, and being on prolonged standby with false starts can be exhausting. When we arrive at a birth, we may have already been doing a lot of intense supporting in the weeks, days and hours before.
So how do we each define the scope of our work and create healthy boundaries or contracts since birth is not a neat and tidy or predictable event? How many hours can or should we give our physical, or emotional support without a break? Different doulas have different home circumstances and some may have grown up children and be able to take 48 hours to recover after a marathon birth. It’s wonderful if someone is in a position to be able to do that. But what about the rest of us, with other commitments?
In an ideal world, each of us who does this work would drop everything and be with a woman for the whole labour and birth. We know how lack of continuity can be disheartening for women and the reason they have hired us is often because they feel dizzy from meeting so many different midwives and just want a sense of someone who knows them personally to cling to for the duration – a friendly face who will be there just for them. When they are investing hundreds of pounds to have you there – a sum which some partners need a lot of convincing to spend in the first place – then it feels like a contract of honour that we stay until the end.
But what if, a woman’s journey meant she was in labour for three… four… or even five days? Who really wants to leave a woman when we have invested so much in her story and she in us? Especially if she has had earlier traumatic experiences and is pinning her hopes on ‘succeeding’ at this birth, righting all the wrongs of earlier experiences and finding healing and closure for herself?
Firstly, I believe we need to do some antenatal healing so this idea of ‘failure’ or ‘success’ is identified and explored in advance. If a woman is pinning her hopes for healing some deep-seated identity issues on ‘succeeding’ at giving birth naturally for example, or avoiding a caesarean at literally all costs, is this healthy? Should we be encouraging every mother antenatally to take a more healthy view of her own identity so her feelings of self-worth aren’t entirely tied up with achieving a particular kind of birth? I say this as someone who abhors the over-medicalisation of birth and the sometimes impersonal and protocol-led conveyor belt of NHS care, and do not suggest we undermine her efforts in any way.
But even if a mother wants to avoid interventions at all costs, is it reasonable for her to expect that her doula should stick around and give physical, emotional and practical support if her birth takes days and days? How long can we function usefully, ethically and from a place of physical and emotional strength before we walk away and lovingly and peacefully accept that perhaps we need to let this woman go through her own labyrinth? Let her find her *own* strength?
I recently decided that at this point in my life, with young children to care for, that I needed to lay down some boundaries so I could work from a place of true strength and integrity.
For my own sanity, protection, and sustainability as a doula (Thanks to Maddie McMahon and her Doulavation course), I have made a new contract capping my support at 24hrs, with breaks, leaving it to my discretion if I choose to help for longer. I’ve drawn some new lines and patterns on that grey stage, and have admitted to myself that I personally can’t dance indefinitely. I’ve owned the fact that it’s not my responsibility how the birth plays out. To offer solid gold, loving support for the weeks and days before birth, for twenty four hours of labour and in the days after is more than most good people on planet Earth are offering. We are not superheroes. Women don’t need us to rescue them. They must rescue themselves. We simply ‘hold space’ for it all – whether we are dancing on stage or watching from the sidelines!
Paula Cleary is a mother, birth doula, activist, author and antenatal teacher. She is the Founder of the Go With The Flow Birth School and Birthplace Matters and runs the Home Birth Norfolk Group with doula Siobhan Ridley. She lives at the crossroads of Cambridgeshire, Norfolk and Lincolnshire with her husband, five children and a fluffy dog called Martha. You’ll often find her in her yurt with a cup of tea in hand, talking with anyone who cares passionately about this subject and loves to natter about all things birth-related.