What’s the point of having a doula if she cannot be present physically during the birth? Aren’t doulas just mostly hired for their supporting presence during that special time?
Honestly when lockdown started in 2020 and hospitals in the UK introduced restrictions to one birth partner only, I asked myself the same question. I asked myself this question because despite having worked as a doula for over 8 years I had almost no experience of supporting labour remotely. I was utterly dismayed when I found out that I was no longer welcome in the hospital along the families I was already committed to supporting. Yet over the last 10 months, whilst I didn’t attend many births in person, I acquired a wealth of knowledge and experience in providing incredibly different forms of support in the forever changing rules in and out of lockdown. One thing that never changed for me locally is that my local hospital never relaxed the one partner only rule (I know that other hospitals in the country did things differently).
Interestingly, many couples still choose to hire me for support despite knowing that I may not be able to be present at their birth. I am already booked for several different families in 2021, and including some repeat clients. I’m totally honest with people and explain from the onset that it is unlikely that I’ll be able to be physically present during their birth, unless they birth at home. But in these challenging and unpredictable times, having the support of a doula can still make a world of positive difference to your experience of pregnancy, birth and the postpartum. I’ll make a separate blog post for postnatal doulaing after this one.
So what difference can a doula make even if she cannot be there with you at the birth?
- 1) Antenatal education and birth choices
In the extra challenging situation that lockdown and changing hospital policies bring, having someone to help you navigate your options is more important than ever. As your doula, I have an in depth knowledge of my local hospital policies, often being aware of policy change before members of the public. A doula can help you prepare for the unexpected and help you create birth plan that cover every possible eventuality that may present itself. It’s something doulas have always done, and I wrote a blog post called Why you may want to have a plan C (for cesarean) in your birth preferences.
- 2) Emotional support
Having someone you have gotten to know and trust, and who is always available at the end of the phone or email when you feel the need for support is even more important than before. In most trust there is no named midwife or a person you can contact directly within the health system at the best of times, but since March 2020, with the stretched NHS, this has become worse. Several of my clients said they left messages with weren’t returned. Just having someone you know you can call and talk to when you’ve worried about anything during your pregnancy, birth and the postnatal period, can make a world of difference to your wellbeing.
- 3) Knowledge and information
As before the pandemic, access to knowledge and information is a big part of doula support. There is a whole maze of information to navigate! Where will you have your baby, what kind of birth do you want, what if you cannot get your preferred choice, what are your rights, what’s the scientific evidence behind what you are being offered, what is right for you, yours and your family’s unique circumstances? I can help you access a whole network of people, from other health professional to complementary practitioners outside of the NHS, from osteopaths to complementary therapists to breastfeeding professionals.
I supported a family who wanted to have a VBAC (Vaginal birth after cesarean). They wanted to be in the local birth centre but had been told this wasn’t possible. They weren’t based in Cambridge, but through my network of birth workers, I obtained the details of the consultant midwife at their local hospital. They had a meeting with her and got granted access to the birth centre. They had a beautiful empowering waterbirth there.
I also supported a woman who was facing an induction of labour that she didn’t want or felt was justified. We had a chat over the phone and I reminded her of her rights to choose, ahead of a meeting with her consultant. I received a very grateful email afterwards explaining that she had felt much calmer and confident going into the meeting thanks to our chat, and that the meeting had gone very well. She went into labour naturally.
- 4) Practical support
I am skilled in many support techniques that can help make your pregnancy, labour and birth, and postpartum period more comfortable. I can teach them to you, or signpost you to someone who can support you if you aren’t local to me.
In 2020 several of my clients had breech babies, I was able to teach positional and rebozo breech turning techniques via video calls (I became very good at using a tripod to hold my device, and at contorsioning myself to demonstrate positions!) or in person. I was also able to signpost them to osteopaths who helped balance the pelvis so the baby had more chances to turn, or to acupuncturists who taught them how to do moxibustion. I also helped to access the information to help them decide whether having the baby turned manually (known as an external cephalic version) with an obstetrician was the right choice for them, as well as what would happen during the procedure/
- 5) Labour preparation
I can help you be prepared for what do expect during labour and birth, and decide what kind of comfort measures you’d like to use, and explore their pros and cons. I can teach you such comfort measures so you are feeling prepared and confident, even when I’m not physically present.
In 2020 I started writing custom relaxation scripts to help with things from promoting relaxation and confidence, to help turn a breech baby, to help labour start when due date had passed and an induction date was looming. I recorded myself as I lead expectant parents through those scripts and sent them the recording to listen to. One couple reported that they went into labour after listening to the “overdue” relaxation script I had sent them over and over again, and that the mother went into labour despite the pressures of the looming induction and had a very straightforward birth.
As well as teaching you some of the many comfort and relaxation measures for labour I know, I can teach the ones that suit you to your partner. This means that your partner will feel more confident in supporting you, that the two of you can work better together, and that you are both likely to have.
- 6) In person Labour support
As a doula, I’m still able to provide in person support in early labour at the couple’s home. This means that I can come and support you when labour starts, and help you feel comfortable, confident and safe. This means that you do not have to worry about when it is the right time to go to the hospital (or call the midwife if you’re having a homebirth). This means that there is a reassuring presence in the background. It can help both you and your partner feel much calmer and safe. It means that you are more likely to have a straightforward experience, especially if this is your first baby and you do not know what to expect or what is normal.
All hospitals still allow one partner, and I have supported families who chose to have me being present at the birth in the hospital, for example if the partner had to stay at home to care for older children.
- 7) Remote labour support
Because we will have gotten to know each other well, you’ll have come to trust me and feel safe with me. By the time you are in labour, knowing that there is something you can call at any hour of the day or night, and that I will be there
As I mentioned at the beginning of this blog, I was myself unsure of what difference I could make remotely. I was pleasantly surprised to find that I could still make a world of difference during labour.
I could join couples at home in early labour, I could be there on the phone or video calls in early or later labour. Because I had prepared the partner with extra techniques, when they called me describing a stall in labour, I was able to guide them through specific rebozo techniques designed to help resolve such issues with great success. I was still able to provide advocacy and help people navigate their options.
During a birth in 2020, a partner called me as labour had stalled and there were talks of moving to theatre. As I had taught him some of the most useful labour dystocia resolving techniques I know. After asking him a few specific questions I suggested a couple of positional and rebozo techniques. The baby was born vaginally 40 min later. Another partner called me telling me that his wife had been pushing for 2h, and that due to arbitrary limits on pushing duration from the hospital, transfer to the delivery unit was being strongly suggested. He asked if they could refuse. After asking if both mother and baby were well, I reminded him that it was their decision to make. The baby was born in the birth centre pool 20 min later.
A challenging time last year was when I had to watch a woman that I had previously supported as a doula 3 times before, walk into the hospital alone for her planned cesarean birth (my local trust currently only allows partners in the ward as they go into theatre, so the mother is alone in the antenatal ward until she gets called to go to theatre). I went to meet her in front of the hospital. I thought I hadn’t made a difference but later one she said “It definitely helped to still have you as my doula in lockdown as it was really lovely and comforting to know you were just at the end of the phone for a chat or advice. It was also lovely to see you outside the hospital before I went in, and to talk to you in the evening about the birth”.
“It feels like she’s wrenched the phone out of her husband’s hand, as her eyes lock on to mine “Zelle!” she breathes as a surge crashes like wave over her “Zelle-I-really-need-an-epidural” she scrunches her face up “I can’t CAN’T do thissss”. I am calm. An even tone. The bit I wish I was there for, because I would stroke her hair out of her face and be gentle with her poor tired body and be slow and gentle and grounding. I have to do it all with my voice instead. “A,” I say. “You are so strong. You are magnificent. This is transition, that hard bit we talked about. This feeling will leave.” I’m conscious of the fact the adrenaline will kick in momentarily. ” You know what to do. Your body knows this. You’ve been in labour a *long* time. It’s a lot of hard work. There’s no shame in an epidural if you want one. But you’re wrong on one point, A, you CAN do this. I completely believe with every fibre of my being that you can do this. I believe in you.” She shoves the phone back in to her husband’s hand. “I CAN do this!” she breathes. I am so proud I wipe tears away.”
- 8) Navigating the unexpected
If anything happens during pregnancy, birth or the postpartum you can rest assured that I will be there to help you navigate the situation. From labour starting early or labour, or a sudden diagnostic of a medical situation which changes your birth choices, I have supported these kinds of scenarios for the last 8 years and I know how much of a difference it makes to have someone by your side to help you find out how to make the best of it.
- 9) Postnatal preparation
Postnatal preparation and support is one of my favourite topics. I feel it is so important that I wrote a book about it, called Why postnatal recovery matters. As your doula, I can help you prepare for the postpartum, be it the immediate few hours post birth in the hospital or at home (including how to prepare for the fact that most partners may not allowed to visit postnatally in the hospital), or the later parts from coming home with your baby, from feeding choices to parenting choices. As part of my contract you get 6 weeks of unlimited phone and email support after the birth of your baby.
- 10) Postnatal support
After your baby is born, especially if you are alone in a postnatal ward without your partner, or if you have your partner but medical staff is too busy to help support you, I can do call or video calls as soon as you need me to help answer any needs you may have. I have become skilled at provided feeding help over video calls, either myself or putting you in touch with breastfeeding counselors, who have also become very skilled at providing feeding support over video calls. More in my next blog on postnatal support during lockdown.
Finally, here is a story from a mother I supported in 2020:
“It would be easy to feel like pandemic restrictions preventing extra birth partners would make hiring a doula pointless. After all, if they can’t be at the birth, why bother, right? I might have felt the same, if it weren’t for our experience of growing and birthing our daughter in 2020 with Sophie’s help.
When the pandemic hit, and suddenly even my husband wasn’t allowed in to scans or appointments. Secondary birth partners were banned from births completely. These restrictions still hadn’t been eased by July, when I unexpectedly entered prodromal labour at 36 weeks gestation. After a week of contractions at home that weren’t getting any more frequent, I entered the hospital to have my labour artificially progressed. I laboured, for large parts alone, for five further days, before finally delivering my daughter by c-section (or belly birth, as I like calling it!). Again, even getting my husband into hospital to support me was a fight. The presence of a doula was a complete non-starter.
So do I regret hiring Sophie? ABSOLUTELY NOT.
If anything, I am MORE grateful we did because of COVID. More than ever, being asked to navigate the labyrinth of the maternity care system is a nearly impossible challenge women are being asked to undertake. Especially in a pandemic, alone. I have no idea how I would have begun to survive it without the preparation Sophie did with us, and the support she still managed to provide both during and after our birth.
I had the space I needed to process rather than internalise my grief. I had the planning and preparation I needed to take care of myself both during and after the birth. I had the support I needed to bring my baby home to an overjoyed family that was ready to receive her. I had the confidence to know I can be and am exactly the mother she needs. I was left so in awe of the work of doulas that I’m becoming one. ” Elle.
If you’d like to read more about this topic, I wrote a blog called The Value of a doula, one called What do you get when you hire a doula, or why she’s totally worth the money, one about how a doula can support you if you are having a planned cesarean birth, and one called The incredible things doulas do to support their clients. Whilst these were written before 2020, much of what I explain in them still applies.