I rolled over to grab my phone in the darkness. Its in the wee hours of the morning and my first thought was ”Who is it going to be this Saturday?” My client called to inform me that her membranes has released, I asked the usual questions to check that all is normal and asked her to keep me updated. This will be the third consecutive Saturday that I will be attending a birth and perhaps missing a class once again.
The first thing I usually do when I know that a client is in early labor is to go to bed, just to make sure that I get adequate rest before being called over. But I could not sleep and kept tossing and turning. I had not prepared for the class that afternoon and felt that I should get things ready if I need my back up to teach the class, which I needed to do for the past two Saturdays. So I got up and prepared my stuff.
Within half an hour, my client called again and asked me to meet them at the hospital. I arrived shortly after they had arrived. After settling down with the administrative work, I suggested to her to focus on relaxing and her husband to get some sleep whilst he still can. He turned on her HypnoBirthing Rainbow Relaxation CD and went to get some sleep on the armchair, whilst she was focusing on relaxing and sleeping in-between surges. As for me, after I have taken down the birth notes, I whipped out a book and started reading.
In the US and some other parts of the world, you will hear of the “singing” doulas, where they sing whilst a mother is laboring. In Holland, where homebirths are the norm, there usually would be two midwives attending a birth together. At the start of labor, one midwife would sit in the corner of the room and start knitting a baby’s cap for the baby. I can’t remember where I read it before but it has been said that to have a woman sitting in a corner doing something repetitive during labor, such as knitting, is very comforting to a laboring woman. Many times during my work as a Doula, some of the mothers during or after labor would suggest to me to take up knitting so I could knit whilst attending a birth. I always laughed because knitting wasn’t my cup of tea.
One of the things we learn as a Doula is the art of doing nothing. When a laboring mother is coping well and does not need us to do anything, we sit on our hands and do nothing. I liken it to watching your child fall, its hard to sit back and watch them fall, even though we know that they need to fall and learn how to pick themselves up again. When I first started out as a Doula, I would always remember to “sit and do nothing” when there was nothing to do, so I would end up just looking at the laboring mother and smiled at her when she looked my way. Instead of being helpful, many a times the mother would ask me why I am looking at her, or why I am smiling. It made me realize that it made them feel very conscious of themselves. Since then, I have always made a point to bring a book with me when called to attend a birth, because I am, as I call myself, the Reading Doula.
When the mother is laboring and there is nothing for me to do, I get the father to settle down or support the mother by holding her hand and through supporting her physically with her choice of laboring positions and I whip out my book to read. At the corner of my eye, I would always observe the laboring mother when she is experiencing a surge just to check on how she is doing and if I am not needed, I go back to reading my book, which sets the pace for the husband to settle in and do nothing as well. It helps make the mother feel more at ease and less self-conscious too, and she knows that I am within reach should she need me. I only provide support when there is a need too and if not, I hold the space by reading my book.
Tracy, my partner who is now based in Ireland, helped organized and attended Dr. Michel Odent’s doula training when it was held in Ireland a couple of months ago and she said his Doula training was very simple, just understand and meet the basic physiological needs of a mother in labor. As Michel Odent has written in his book, The Cesarean, I quote:
“The terms ‘support’, ‘emotional support’ and ‘supportive companion’ are ubiquitous. They proliferate in the titles of articles published in the mainstream medical literature. The word “support” suggests that a woman cannot give birth by herself: she needs some energy brought by another person. This word suggests an active role for the birth attendant. It belongs to the depowering vocabulary commonly used in the field of childbirth.
In order to realize how misleading and therefore noxious is the fashionable vocabulary, we must once more refer to the needs of laboring women. A woman in labor needs to feel secure without being observed or judged. This is the pre-requisite for a reduction of the activity of her neocortex, the thinking brain. An analogy between falling asleep and “falling in labor” may be useful. In both cases the neocortex must be at rest and the basic needs are the same. Let us think of a little girl who needs to feel the presence of her mummy at bedtime. She needs to feel secure without feeling observed or judged. A mother would never say ‘My young daughter needs a support person to fall asleep. ‘ Another opportunity to recall that an authentic midwife is first and foremost a mother figure.
Not only is the term ‘support’ misleading, furthermore it is harmful. It has overshadowed the basic mammalian need for privacy. An anecdote may be useful to make clear why it can be dangerous. A homebirth midwife was telling her colleagues about a birth that had been unexpected long and difficult. She could not understand why because this woman had ‘a lot of support’ – she had a supportive husband, old friend, doula etc.. I guess this woman could have given birth easily if there had been no one in the house except an experienced and silent midwife.
The term “support” became overused after the publication by the team of John Kennell and Marshall Klaus of an important study conducted in the 1970s in Guatemala. In two busy hospitals where 50-60 babies are born every day and where doctors and nurses trained the American way had established routines, they evaluated the effects on statistics of the presence of a lay woman (a ‘doula’) belonging to the community. They found that the presence of a doula reduces dramatically the incidence of all sorts of intervention and the use of drugs, and tends to improve the outcomes. The term ‘supportive companion’ was introduced in the title of the report. The researchers reproduced their studies in Houston, Texas, in a neighbourhood where the population is predominantly Hispanic and incomes are low. The birthing caregivers there were directed by English-speaking residents in a twelve-bed ward. The doulas were mothers who could speak Spanish. As in Guatemala, the presence of a doula had positive effects. The authors once more used the word ‘support’ in order to interpret the results. My own interpretation is that, in such an unfamiliar and strange environment, the doula is felt to be a protector. She is as protective as a mother would be. She is a screen between the laboring woman and the white coat staff.”
Parents-to-be like to ask me how a Doula helps at a birth, and I always ask them to ask the parents I have worked with instead, simply because everyone’s motivation to have a Doula at birth is different. Our vision at Four Trimesters is to improve maternity care in Singapore. Our aim for parents is help them achieve a positive and empowering birth experience, and most of the work we do with the parents we work with are done prenatally. At the birth itself, we work towards holding the space for you in an unfamiliar environment, offer you informational, emotional and physical support when needed, give reassurance and help laboring mothers feel secure without being observed.
The hormones we use for making love are the same hormones we use for giving birth. Birth is instinctive when we can help mothers by meeting the basic physiological needs of a laboring woman, from there, she will know what to do.
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