Outsourcing support: doulas
The season of pregnancy, childbirth and breastfeeding can be empowering as women embrace their biological ability to grow and nourish a whole new person. However, this can also be a season when women find themselves at odds with a system they have previously had little to do with.
A healthy adult may only have seen a doctor for the occasional bad virus or sports injury. Many people have never been in hospital as a patient. If conception and pregnancy are free of complications, routine check ups are mostly touching base and dealing with minor symptoms.
Antenatal education focuses almost entirely on childbirth and even that is all about having the best experience of birth possible.
It can come as a huge shock, therefore, to find yourself facing unanticipated challenges and feeling powerless to overcome them.
In labour and delivery, women are increasingly employing a doula to provide professional support.
A doula is a companion to the birthing couple. Her role is not a medical one but one of support. In the past, an experienced mother - often the woman's own mother - would work alongside the midwives, bringing reassurance and comfort as well as wisdom from the many births attended in large extended families living in proximity. As birth became medicalised and moved from homes to hospitals in the 20th century, these circles of women became excluded. Mid-century childbirth under light sedation (known as “twilight sleep”) meant women had no need of companions during labour or birth.
In the 60s and 70s, as women reclaimed their rights to be unmedicated during childbirth, a new birth companion entered the space: fathers increasingly wanted to be present for the birth of their child and support their partners through what was described as “active birth”. Couples attended classes together in pregnancy, to learn Lamaze and other natural, drug-free childbirth pain management.
However, when births are complicated by long labours and interventions are required, fathers can often be in need of their own support. Short-staffed birthing units mean rushed midwives don't always have the luxury of time to explain in detail or answer questions. Doulas can be the bridge between the medical and the personal. Familiar with parent's birth plans and expectations, they can advocate for the mother, allowing the father to focus on his own supportive role.
By providing a continuum of care, a doula is available throughout the labour at home and attends the birth in the hospital. In the postnatal period, she can support the breastfeeding mother and will continue to provide practical support in the home post-discharge. Some doulas specialise in the childbirth period, others in the postnatal but ideally, they provide support before, during and after childbirth.
Doulas work in private practice, employed by the parents at some cost. This is an investment not available to all expectant parents.
However, while employing a doula for childbirth is becoming more common, engaging one for the postnatal period is still relatively uncommon. Yet it could be argued this is an even more crucial time for parents to have additional support. After the experience of having midwives on-call within the hospital setting, many mothers feel anxious going home with just their partner on hand. Both parents are likely to be sleep-deprived and not all fathers access paternity leave even if it is available to them. For the self-employed running a small businesses, taking any leave may not be possible.
Expectant parents often invest thousands of dollars in decor and equipment setting up a nursery for their first child. Yet reality for most families is this room is under-utilised in the first 6-12 months and much of the equipment has a limited use. Yet the suggestion of investing in postnatal doula support is seen as an indulgent waste of money!
The rise in caesarean births and other medical interventions means many new mothers are not only adjusting to their new life and establishing breastfeeding but are also recovering from surgery, tears or other childbirth injuries.
Extended family support is no longer to be relied on as it was in the past. Your mothers are likely to both live overseas or interstate and even if they live locally, might be either still in paid work, busy living a retiree grey-nomad lifestyle or - in the case of a growing number of parents starting families in their 40s, needing care or support themselves.
If you are unable to depend on your partner or family for intensive support in the early weeks at home then engaging some kind of paid support is important. Whether you employ a postnatal doula, a regular cleaning service or meal preparation provider, doing so is an investment in your breastfeeding experience, postnatal mental health and recovery from pregnancy and childbirth.
