More women are hiring a ‘doula’ to help them through pregnancy, childbirth and the first stages of their postnatal experience. The service has been available in cities for a while and now Shaftesbury has a doula. Alfred’s Keri Jones met Carla Walsh.
A doula was a profession that I had not heard of until I met Carla Walsh in her Shaftesbury home. “It comes from ancient Greece and it means ‘girl servant’. It has moved on from there,” said Carla. “It started in America and is very big there. It came over here in the 1980s and it’s been developing ever since.”
As we chatted inside Carla’s living room in a cottage on Bell Street, I realised that her profession is more established than I had thought. She was drinking out of a mug featuring the inscription, ‘This is what an awesome doula looks like’.
Carla has been a doula since the start of this year. “I went to Birth Bliss Academy in London and had training. I am now mentored, which means that I have a highly experienced doula behind me whom I can contact on the phone at any time if I have any problems. Until you’ve done a certain amount of births, you don’t become a recognised doula.”
So, what does a doula do? “A doula supports, informs and empowers women who are giving birth both before, during and after,” she said, adding that she doesn’t give medical advice. Whilst most doulas have had children themselves, Carla says it’s not necessary, in the same way that there are male midwives.
It is helpful to have been through the birthing process. “A lot of doulas got interested during their own experience. There are a couple of gentlemen, although it is predominantly a woman.”
Carla decided to become a doula after she attended the birth of her grandchild. “From my own experience, I knew nothing when I gave birth. From being present when my daughter gave birth, I realised that women need to be much more aware of what is happening,” she said. Carla was there for her daughter.
When I first read about the need for a doula to accompany women on their childbirth journey, it seemed sad. I assumed that women would pay for the service because they did not have close friends or family to call on. But Carla reassured me. “Your partner probably would provide an awful lot of support, but it might not be the kind that’s needed at the time and maybe they would be overwhelmed themselves,” said Carla. “It’s not replacing a partner. It’s to add to a partner because they would also need support. Both of them would, at different times, need help in coping with whatever is happening. Reassurance is one of the important things that a doula can give to a partner.”
“Some women would rather not have their mother with them,” she added. “We are trained in what to expect during birth. We aim to have a positive birth. We know how you can do that.”
Carla says people approach a doula at differing stages in the pregnancy. “Some women come to us very late. They suddenly have a little bit of a panic and think they need to have a doula. Some people book a doula the minute they find out that they are pregnant. In an ideal world, our work will start at around 28 weeks, and we will do antenatal visits and help the woman to be as informed as possible about what will happen, what could happen and what the choices are. Then we go on call for two weeks before and two weeks after the estimated due date. We are on call 24 hours a day, seven days a week, for four weeks so the woman can ring us at any time of day. We can go to the hospital or wherever she wants us to go. Then we will do a postnatal visit.”
Carla says that the role of the midwife has changed and that has encouraged people to book a doula. “Years ago, the midwife would cover emotional and physical support. Now a midwife is more medical, so there is a big gap. I think that is the role that a doula fulfils. It helps a woman go into birth prepared for what might happen,” she explained.
“A lot of women have absolutely no idea and that can be a frightening experience. They will have learned the skills which bring about a better birth and will be helped to understand the reality of birth, so they have been empowered to make whatever decision they have to make.”
A doula will provide information about a range of childbirth matters so an expectant mother can make her own choices. “It would be about pain medication, what would happen in a caesarean, what would happen if they chose to be induced or had to be induced,” said Carla. She says she researches the questions she is given every time she is asked, so her advice is current. “We know where to go and we have access to a lot of reports.”
Carla says one of the best reasons for using a doula is that they will give you a positive experience of birth. “The advantages can be that there is a massive reduction in caesarean rates and a greater likelihood that you will have a physiological birth and it can reduce postnatal depression and increase the chances of successful breastfeeding. There are so many positives for the woman and the baby.”
Carla says the likelihood of reducing a c-section is partly because a woman will be informed of the choices. “They will have learned skills that will help them cope better when the surgeons come, so they are less likely to need medication. They would feel more relaxed because they know what is happening. They are prepared. A caesarean has to happen in a medical emergency, but you can avoid a lot of problems just by using the right methods. We advise that people follow the medical advice, but they need to know how big a risk it is if they are told they are at risk. Then they can make their own decision instead of being frightened of what the options are,” said Carla.
I was curious to know how people felt about sharing one of the most special moments of their life with a stranger rather than a friend or relative. Carla said some women think it’s good to be supported by somebody with whom they have no connection. “They don’t meet their midwives very often. It’s often much easier when they don’t have to worry about how the doula is feeling but if it’s the relative, you’d be concerned whether they’re hungry, whether they are tired or fed up. You don’t have to worry about any of that with a doula. With a doula, all the concentrations is on the person who is birthing and that’s all they have to worry about – their own experience.”
And Carla says she is used to being shouted and sworn at. “It’s usually a really good sign. It means that they are in the zone and doing well.”
Few doulas are operating in North Dorset. Carla covers an area that is within 45 minutes’ drive of Shaftesbury. That includes Frome, where there has been a great deal of interest in the service and several doulas operate.
“Frome has its birth centre, which is probably why it is quite heavily resourced. I think we are isolated from a lot of services in rural areas here in North Dorset. The antenatal service here is not great. I have a colleague who is trying to start-up something here,” said Carla.
A doula must be on call ready to attend the birth and Carla says she has to manage her diary carefully. “I am currently doing shared care with another doula who has got the same situation. She has two women that are due within ten days of each other, so she has teamed up with me. If she is away with the first client and the second client goes into labour, then I would take over. You balance it. We are a very strong network. Doulas work well together and support each other. You also have postnatal clients, people who have given birth that you are helping, and they understand that if the birth comes, you go.”
I asked Carla whether doulas are expensive since they are retained and on-call for a long period. “Every doula does a package. You get paid very little considering you are on call. Prices depend on your area and which doula you use, but they vary between £600 and £1,200,” she said.
Carla says she has had no difficulty in accessing hospital wards even as she is not a relative. “I’ve been working closely with the midwives in Salisbury and I’ve been doing some work with people voluntarily who they felt needed some extra help and that’s worked well. They feel it makes their job easier because they can concentrate on the medical side. They know the mother’s welfare will be looked after.”
Although it’s not an expected part of the doula’s role, Carla keeps in touch with former clients. “Yes, I go and see them. It’s a wonderful experience. Obviously, you don’t want to pester them, but my experience, you are always welcome to pop in if you are passing and I always like to take them something to eat when they first get home,” she said.
You can contact Carla at www.doulacarla.co.uk.