Having a doula in the delivery room is increasingly common – and for good reason
At the time of publication, doula Ann Fenton could be activated at any moment. At any minute she could get the call from the pregnant woman she’s been working with in Ho Chi Minh City, a client who she’s met with before to discuss the intricacies of her pregnancy but who may still be feeling a height of emotion with onset of contractions that precede the arrival of a child.
It’s a special moment that, in her professional judgement, is routinely mishandled. The lights: often too bright. The moment: too rushed, too brusque, in her view. In the rush to just get it over with, Fenton said doctors can even forget the basics, like asking. “It’s saying, ‘Hey, I would like to do this thing. Is that okay with you?’” Fenton explained. “That’s what’s called ‘informed consent.’”
Fenton explains her craft (www.facebook.com/birthingabroad) with the ease of articulation of a former barrister. She previously worked as a corporate attorney before volunteering as a doula in the Washington, D.C, area before becoming certified with Childbirth International Training & Certification. The cool hand under pressure is partly what doulas offer their clients in the heat of the moment. Preceding conversations have been had about what kind of pregnancy the woman wishes to have, if she wants to have a bath or shower available to her—everything down to the lights has been discussed and planned ahead of time. “Some things that clients like to do is to create a space, like a physical space, where they feel comfortable and safe and cared for. Those things that we surround ourselves with physically can impact our mental state,” said Fenton.
So, a calm and tranquil mother is better able to undertake the birthing process than a uncalm one, a conclusion which seems to make sense intuitively too. What’s perhaps less understood is that the sense of readiness and urgency mothers have in a space like this is hugely determinative of the smoothness of the process, Fenton said. “Labor is 99 percent a mental state. Some clients like to bring in music. Other clients like to bring in scarves. I had a client—my first client here in Ho Chi Minh City—brought in lamps and fairy lights. It was just lovely. We turned out all the lights and put on some music and kind of made a little nest for her.”
Hospital staff, she recalls, were alarmed to discover the alterations. “The nursing staff was freaking out. They were like, oh my god. What’s going on? The lights are out. Mom’s in a corner with a scarf,” she said. Finally, the staff relented. “They let her create her space.”
“That was what she wanted, so that was how I supported her,” Fenton said. Other elements of the doula’s care center around patient advocacy, explaining doctor decisions and giving the patient the opportunity to make an informed decision. As an example, Fenton cited the use of Potocin, a powerful oxytocin-like compound that’s meant to induce labor. It’s used to increase contraction frequency and bring the birthing process closer to a close, but with it are a wealth of health risk including a ruptured uterus and even fetal death. “These consequences are not something that’s explained or even discussed very well,” Fenton said.
The medical literature studying the health impacts of doulas like Fenton seem to show they’re a health positive asset. A 2013 study involving about 200 pregnant mothers in The Journal of Prenatal Education showed that doula involvement on average reduced low birth weights and other infant complications as well as increased initiation of breastfeeding. Doula involvement can also be literally lifesaving. In Sweden, a country with a generous migration policy that has welcomed an influx of foreign-born residents, doulas are being used to abate maternal mortality. Mothers born in developing countries are up to seven times as likely to die during childbirth. Currently, this population is giving birth at an increased rate, according to demographics research body Statistics Sweden. The country is providing doulas to ensure the births happen without incident and deliver healthy children.
A big share of the doula’s value is in connecting and synching all parties involved, Fenton said. “I’m a facilitator. I’m really there to bridge the gap between doctors and midwives, and the woman that’s in labor. It can be difficult when you’re in labor. You might make decisions differently were you in a calm [place]… not a physically compromised, emotional state.”
For new mothers, Fenton said the experience of visiting the hospital to deliver the child can range from uncomfortable to traumatic. The doula tries to create a natural, comfortable environment for the mother: a bath or shower for those who’d prefer one to be there, regular walking breaks for those who’d like them, music, and so on. Where possible, Fenton said she advises women to delay their hospital visit and just labor briefly at home, and just hang out. Drink some water. Take a nap. Snack a bit. Maybe watch Netflix, and chill.
Image by Vy Lam