In honour of World Doula Week, we thought we should take the time to really dig into what a doula is. While the word ‘doula’ has become another buzzword among pregnant moms and is entering the common woman’s lexicon, the work of a doula is as old as time. There are doulas in India, but read this blog first so you know exactly what you are looking for!

7 Things to Know about Doulas 

doulas in IndiaA professional doula’s role is to “mother the mother.” Actually, the doula’s job – to serve a birthing woman – is ancient. But as birth moved out of the home and into the hospital, some very basic but fundamental practices got left behind. Earlier, when we birthed at home, our female family members took great care and comforted us. At that time, we didn’t need an external person coming in as a doula – our sister, aunty, mother, or grandmother already was there.

Before birth was hospitalised, by the time many women entered their senior years, they had experienced and seen birth, maybe many times. Knowledge of birth and how to care for mothers and babies was reinforced with each newborn. But now, our loved ones may have never seen or experienced a normal or natural birth. The art of serving the birthing Goddess has largely been lost…

But here steps in a modern professional doula. She is here to fill in the gap created by the present maternity care system. She has been trained to provide you with continuous care and support that you actually really deserve and need! A birth doula will be knowledgeable about:

  • Massage and touch
  • Labour positions and movement
  • Relaxation techniques and breathing
  • The normal physiology of labour and birth
  • Common medical interventions
  • How to incorporate and assist your other birth partners (like spouse)

A doula is there to provide you with 100% undivided support and love. While she will be knowledgeable about the preceding points, she can also easily take pictures for you, bring you food, tidy up, or run an errand. Doulas are sensitive to your needs. Sometimes you and your partner may want privacy and time alone. A doula cannot replace the intimacy of your partner our close support people. In the absence of support, a doula can give you everything you need, so each birthing experience is actually unique and different.

While the doula concept in the modern paradigm has originated in the West, an Indian birthing women and a Western birthing women have virtually the same needs – to be loved, supported and comforted. Therefore, a doula is just as helpful to you wherever you are in the world.

doulas in India

It’s important for you to be clear about the role and limitations a doula has at your birth. You should know doula’s do NOT:

  • Make decisions for you
  • Speak on your behalf, “stick up for you” or negotiate with your doctors and nurses
  • Replace your husband/partner
  • Track your and your baby’s wellbeing through assessments and monitoring or give you medical advice
  • Have skills to attend to emergencies or
  • Necessarily prevent a c-section, other interventions or less than optimal outcomes

She may also remind you of what you stated in your birth plan, but she will not enforce it.

Some women feel disappointed that their doula did not “stick up” for them more during their birth experience, but that’s not the doula’s role and it is unethical to do so. She can give you information so that you can make informed decisions, but those decisions need to come from you or your partner/family member, directly from your mouth.

Here’s a scenario of what a doula shouldn’t do:

DOC: You have been labouring for XX amount of hours. I would like to start Pitocin to speed things along.

WOMAN: (Looks at doula worried.)

DOULA: [Mother’s name] has said many times and has in her birth plan that she wants a natural birth.

DOC: (Thinks to himself how it was a mistake to let a doula come to the birth and doesn’t want to work with a doula again.)

You can see, this sort of advocacy will usually not go over well with the healthcare team. Not only that, but the doula has become an authority over the mother.

Here’s a similar scenario of what a doula could do:

DOC: You have been labouring for XX amount of hours. I would like to start Pitocin to speed things along.

WOMAN: (Looks at doula worried.)

DOULA: (to woman) The doctor wants to speed up your labor. Do you feel like you have enough information to consent? Is there anything else you want to know or ask?

WOMAN: (to DOC) Am I or the baby at any immediate risk? What are the risks of waiting another hour?

In the second situation, given the time, the doula may also give the mother information she needs to know about the risks and benefits of augmenting labour with Pitocin when not medically indicated. This, however, is not to convince the mother, but to empower the mother to make fully informed decisions.

doulas in India

Receiving continuous labour support, like that provided from a doula, has been shown to:

  • Decrease C-section rates*
  • Increase the likelihood of spontaneous vaginal birth*
  • Decrease the use of Pitocin (drug to speed up labor contractions)*
  • Decrease the need for pain relief or epidurals
  • Increase positive birth experiences*
  • Decrease labour time (by 40 minutes)
  • Decrease the amount of babies going to the Intensive Care Unit

Note that most of these outcomes are dependent on having a DOULA as a support person, rather a partner or loved one as your labor support. The points with an asterisk (*) are all outcomes dependent on doulas as the labour support.

While the above statements are true, let me also give you a grain of salt. The studies that assess the effectiveness of a doula are done in western countries like the US that have different medical systems and different cultures. No studies have been done in India to study the effectiveness of doulas. However, my guess is we would see similar results. The needs of birthing women- continuous support, love, and comfort- are the same, the world over.

doulas in India

A doula is not a substitute for a trained medical professional. She does not have the training and it goes against her code of ethics to diagnose or treat you. Even so, a lot of people confuse midwives with doulas, but there is an important distinction.

A professional midwife is a health care provider that can provide primary care to pregnant, birthing, and newly postpartum women. This means, the midwife is responsible for monitoring and assessing you and your baby’s well being. She performs assessments like taking blood pressure, checking fetal heart tones, performing vaginal exams, etc. and is very knowledgeable and experienced with natural and normal birth. She can do a lot of the work of a doula, but she also has the responsibility of ensuring your and your baby’s safety.

A doula is also not a nurse because a doula will also not be be performing any assessments or assisting the doctor. Also, in many places, nurses don’t have the time to provide women with even an ounce of comfort that doulas do because they are tied up with other women and tasks. A doula on the other hand is there JUST FOR YOU and providing you with all the continuous support that you not only deserve, but need.

Consider the work of a doula it’s own unique profession with its own role and set of responsibilities. She is there to serve you, and you only. It may sound like a luxury, but it’s actually the forgotten imperative need of birthing women to have continuous support during labour.

doulas in India

While your husband/partner or someone else near and dear to you is very important to have with you during your birth, it’s still beneficial to have a doula. We already touched on this in Q&A #4, but there are reasons why this is true.

For one, even if you have one loved one with you, that person also has needs. They will need to pee, eat, and maybe sleep. A doula is a great person to “relieve” your birth partners so they can also remain fresh during the experience. In addition, most modern people lack experience or much knowledge about birth or what goes on in hospitals. Therefore, they may find it challenging to support you fully when they are also having to cope with the process themselves!

As I refer to many times in this blog, the work of a doula is actually an essential job. It shouldn’t be reserved to the upper class as it presently is. A birthing women really needs undivided love and support. We all deserve it. Let us hope that sooner than later, our maternity care systems have changed to meet the basic, yet consequential, needs of women. A newsletter in Delhi last year published that all women will be able to have a female birth companion, even in government hospitals. We are yet to see this initiated.

doulas in India

Unfortunately, it’s hard to secure a doula presently in India. The need and work of a doula is not new, but the profession is. However, there are some professional doulas in India. There are also foreign doulas working in India “under the table” and may not have a website or listing.

You can also ask your hospital if they ever work with doulas and get referrals if so. This is almost a win-win situation because – a) you may have found a doula and b) you know that careprovider is comfortable working with a doula. Additionally, you can ask anyone who provides services to pregnant women, like prenatal yoga teachers, lactation consultants, or childbirth educators, if they know doulas or do doula work.

Also note, some doulas are tied up with certain hospitals which may present a conflict of interest. A doula should be responsible to the client (the birthing woman) and not to the hospital. In hospitals like this, it’s not uncommon for them to deny the use of an “outside” doula.

If you do manage to find a doula, or several, you still want to make sure she is a good fit. You may want to ask her:

  • Approximately how many births have you attended?
  • Are you certified? How were you trained?
  • (If a hospital birth) Have you attended hospital births?
  • (If a home or birth center birth) Have you attended home/birth center births?
  • What items do you bring to births?
  • Will you be around during my due month?

In addition, you should pay attention to if you feel like you “click” with her or not. In fact, this may be the most important aspect of the interview.

Now, let’s say a doula isn’t going to happen for whatever the reason. Then the next best thing is to enroll yourself in an independent childbirth education class. In these classes, there can be tips for partners attending birth so they can better meet your needs. There are also great books you can get to help get you partner up to par, like The Birth Partner, by Penny Simkin.

doulas in India

The most well known doula certifying organizations would be Doulas of North America (DONA International), Childbirth International (CBI) Childbirth and Postpartum Professional Association (CAPPA), and International Childbirth Education Association (ICEA). However, there is also Birth from Within, Hypnobirthing, BirthWorks, Birth Arts International and probably more if you search. They may run anywhere from $400 to $1000 US dollars (approximately 26,000 to 65,000 rupees) or more.

These organisations will all probably require you to do coursework and tests which you can usually either do online or submit by mail, attend a doula training workshop, attend a certain amount of births, and then take a certification test. The good thing is, with the exception of a workshop, the coursework and births can generally be done wherever you are. In India, doula training workshops are few and far between. But the good news is, there will be a training in Hyderabad this April with a DONA International teacher! Check it out!

And it should be noted that you can still “doula” for a birthing mom without certification or extensive training or experience, so long as you truthfully relate your status to the mother.

Doulas in India at work:

doulas in India

Celestina, a doula in India, preps her client

doulas in India

Dr. Jayashree, who does doula work in India, supports this couple.

Birth with Doulas in India

And now, a word for pregnant women in India. You very well may be convinced at this point that you want a doula at your birth. However, there are very few professional doulas in India as of now. And even so, not all hospitals allow doulas to accompany women during labour and delivery birth. So if you are really keen to use a doula, you need to make sure that the place where you want to give birth supports it! There are many hospitals in India that do not allow doulas to attend births! Therefore, it’s important that you know ahead of time if your healthcare provider will support you bringing a doula.

If your healthcare provider is skeptical, ask if he or she would be willing to meet the doula first. In this meeting, the doula may want to clearly lay out what she will and will not do during the birth. She probably needs to assure that doctor that she won’t be a liability or nuisance.

Birth is usually hard work! So please, be kind to yourself and practical. There are many things you can do to aim for an informed, safe and satisfying birth. Hiring a doula is one of them.

Happy World Doula Week!!!

REFERENCES:

https://evidencebasedbirth.com/the-evidence-for-doulas/

https://www.birthconnection.com.au/what-is-a-doula/

https://www.dona.org/

http://www.childbirthconnection.org

Zoe Quinn is an American living in India since the begining of 2013. After a fantastic homebirth in 2014, she has been studying to be a midwife. She lives in a cob house with her husband and wild child outside of Pune.

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