Doula: Give Birth Comfortably with a Friend

Pregnancy | March 2, 2012 | By

Sister touching pregnant belly

It was one in the morning. Something happened while she was dreaming. She was all wet. But it was still two weeks before her baby’s due date. Was this the start of labour? Little did she know that it would be the start of 14 painful hours of labour.

Another time: It was 10 pm and the same thing had happened. Her four-year-old child was asleep, her husband not yet home from work. When they finally arrived at the hospital at midnight, they were lucky that their obstetrician happened to be in the labour ward delivering another baby. He popped by an hour later. As labour progressed, she couldn’t bear the intensifying contraction pain and asked for an epidural. After it was administered, the baby slid down the birth canal unexpectedly fast. The obgyn barely made it back in time to deliver the baby.

Her two labour experiences were lonely. Her husband nearly missed the second birth as he was busy with their older child. How do I know all this? Because this is my story.

Don’t get me wrong. I love my obstetrician. He is professional and thorough. My experience of giving birth is not something I remember negatively.

But today, I felt the mist lift from my eyes as I walked in to a doula’s living room and met other mums at a mother-and-baby bunch. I had given birth twice and still didn’t know that my babies and I could have enjoyed this kind of support pre- and post-birth, thanks to a doula.

WHAT IS A DOULA?
The concept of a doula has become popular in Singapore in recent years. One group says that it is four times busier now than four years ago. Another is now up to 10 times busier than it was eight years ago. Why the amazing popularity?

The name doula is derived from a Greek word for “slave” or “servant”. It was later used to describe “a helper of new mothers”. These days, a doula is an independent caregiver – usually a female – who provides non-clinical support to expecting parents throughout the pregnancy, labour, and early babymoon days. She acts as a knowledgeable buddy for the mommy-to-be.

Trained as a professional birth companion, a doula’s skills, presence, and continuous guidance can be the best form of pain relief in during labour. An expecting mother may also be motivated to rope in a doula because her family or support system is not in Singapore. Even if they are, some mums may prefer to have continual professional support from a doula in addition to her mother or her mother-in-law’s company.

WHY USE A DOULA?
Why would we need a doula when you have selected a good obstetrician? And won’t there be obstetric nurses around? Yes, but they will not be assigned to you exclusively. Nurses have other patients to attend to in the maternity ward. And if your experience turns out to be like mine, the doctor may only be able to check on you in the morning before his clinic opens, and just before before your final push.

In this case, you would probably be glad to have the dedicated physical and emotional comfort from a doula during those hours of waiting, even if your hushand is with you. Anna Chou, a first-time mother, confirms that, “My doula did a lot of advocacy for me. She also provided good support to my husband to ready him for delivery”.

Abbey Banks, another first-time mother, adds, “Although my doula was helpful on the days leading up to the delivery day, I found it was after delivery that having her around was most beneficial. My mom was with me but she couldn’t help me cope with the newborn baby the way the doula could”.

If you are set on having a drug-free, intervention-free birth, a doula can also help you to achieve this goal. Some mothers prefer this kind of delivery as it has been found that pain-relieving medications used in labour and delivery can cause side-effects like dizziness, nausea, numbness. The drugs can also cross over to the placenta and cause drowsiness in the baby.

HOW DOES A DOULA HELP?
Obstetricians in Singapore (and elsewhere) generally adopt the following styles of care for their maternity patients.

One is called Expectant Management. This adopts a “watch and wait” approach and views birth as a natural physiological process. The other, termed Active Management, sees birth as a medical event. In this case there are regular ultrasound and vaginal check-ups scheduled, even for healthy and low-risk pregnancies.

Most first-time parents will not have enough experience to be able to decide which style they prefer. A doula can help them parents make informed decisions. Manuela Trisoglio, who has been a doula for seven years, explains, “It is important for us to make sure the couples we work with are well-educated in terms of what to expect during labour and birth, what each hospital has to offer, and how different obgyns work”.

AIDING NATURAL PAIN RELIEF
One of the main ways in which a doula helps a mum-to-be is by teaching her how to stay calm during labour and delivery. Women have given birth throughout history. Our bodies are designed to labour naturally. And once women are educated about childbirth and the coping techiques for pain, they are usually able to birth their babies without drugs or other intervention.

Your body produces Oxytocin (the love hormone) to get labour started. As labour progresses, adrenaline (the fear hormone) takes over and suppresses the release of Oxytocin. As contractions progress, your body produces Endorphins (a natural painkiller) to combat the intensity. When you remain calm and confident, your body produces more Oxytocin. These two hormones work together to make labour more manageable, quicker, and easier.

First-time mum Anna Chou continued shopping, baking and talking on the phone while in labour. She left for the hospital only after she was nine centimetres dilated, and gave birth four hours later, drug-free.

BIRTH PLAN GUIDE
A doula can also help you to formulate a birth plan, which is a way to communicate your preferences to those who care for you during your labour. You can find many examples of birth plans online. Do clarify with your obstetrician your intention to submit a birth plan from the very beginning, as some Singapore doctors charge for the service of reviewing a birth plan.

DURING A C-SECTION
A doula can also be useful during a Caesarean delivery. Even if you end up having to go under the knife, the presence of your doula can help allay your operation fears. Your doula can also stay by your side during the stitching up, act as a go-between when your husband is in the nursery, and coach you on breathing techniques to ease your pain after the painkillers wear off.

DOULAS IN SINGAPORE
In Singapore, births are assisted by obstetricians. This means that every expecting mother is cared for by highly qualified and trained surgeons. There are some who welcome doulas for their patients. You can go online to find them, or ask friends for recommendations.

Some midwife-led service is available in selected hospitals. The KK Women’s and Hospital Children’s Hospital offers this service for subsidised patients. This is also available at the National University Hospital through its Enhanced Midwifery Maternity Care Programme (EMMa Care). EMMa pairs a mother with a midwife who supports her throughout her entire pregnancy regardless of what her birthing choice is. This programme was established in February last year and has been used by 67 mothers at time of publication.

During the pregnancy, both doulas and midwives work in tandem with doctors to make sure that the baby is developing well and that the pregnancy are free from complications. The doctor will advise on the most appropriate method of intervention should complications arise.

During labour the doula will follow protocols and decisions made by the doctors. At a water birth, the obstetrician leads the team. Dr Tony Tan of Raffles Women’s Centre explains, “The obstetrician undertakes the conduct of the labour and is ultimately in charge of following the protocol on the water birth. The midwife monitors the mother and the baby during the labour. The doula provides continuous one-to-one assistance to the patient, assisting with the non-medical non-nursing aspects.”

CHOOSING A DOULA
Sandra Versele of Tranquil Beginnings doula agency advises meeting your doula-to-be to have a chat before hiring her. Ask her about her:

• Experience
• Education
• Certification
• How many births she has attended in Singapore, at which hospitals, and with which doctors
• How she can support your partner
• Back up and fees

You should also ask for references. Most doulas will be willing to provide contacts of former clients for referral purposes. Observe if she listens to you, or whether you feel that she is taking over the conversation. This is important because she would probably do the same on your delivery day. You should also ask what she would do under different circumstances, for instance: “What if I want a natural birth but I ask for an epidural right away?”

WATCH
What Doula! The Ultimate Birth Companion, a 65-minute documentary that follows three doulas as they support parents before, during, and after having their babies. The film features actual footage of three doula-supported births including two home water births. For more information about the film, visit its official web site.
When 22 March 2012, 7-10 pm
Where Balanced Living Asia, 779 Bukit Timah Road
Cost $12 per person or $20 per couple. RSVP required.
Contact Di Bustamante, Director, Parentlink. Tel 6536 4626 or 9451 7702. Email diann@parentlink.org

FIND A DOULA IN SINGAPORE
Manuela Trisoglio, Baby Bliss or manu@trisoglio.com
Sandra Versele, Tranquil Beginnings
Ginny Phang, Four Trimesters
Di Bustamante, ParentLink

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