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To Doula Or Not To Doula

Author: Guest Post

Jess has joined us before on RMS and so we’re thrilled that today she takes up one of our Monday afternoon additional family related posts.
At 35 weeks pregnant it is probably a bit late to be deciding whether or not I want to hire a Doula but it didn’t really occur to me until I looked into both my situation regarding birth and how a Doula can assist. A bit of background story: I gave birth to my daughter almost two and a half years ago. I didn’t go into labour naturally and therefore was induced which ended in basically every intervention you can name, culminating in an emergency c-section when she got stuck.

Fast forward to 20 weeks pregnant this time around and I met the consultant who basically told me that he thinks I’m a great candidate for VBAC (vaginal birth after caesarian) and that the only thing that makes me “high risk” is the potential of scar rupture (this occurs in 1 for every 200 births) but that he believes it should be fine. A few more weeks go by, I’m happy – it’s agreed I’m having a vaginal birth and I won’t be induced again: wonderful. But then I start looking through my maternity notes and looking up some of the acronyms and comments that the consultant has written down. CEFM he has written means that I will have “continual fetal electrical monitoring”.

I remember from my first birth that this means two rather large bands around my waist that connect to a machine telling me the baby’s heart rate throughout labour, I also realise this doesn’t make me very mobile and will probably mean I’m more restricted to the bed (the same as last time). He has also written “cannula on admission” and I’m told this is a precautionary measure in case I end up needing a c-section. I’m also advised (as last time) that I shouldn’t eat or drink during labour in the event that I have to have general anesthetic and another emergency c-section. I started to feel worried about how good my chances of actually having a vaginal birth would be. For someone who had told me that I have a very good chance of VBAC, everyone seemed awfully well prepared for my failure.

And so that is how I found myself head deep in research learning some very interesting things (such as the fact that continual electrical fetal monitoring is more likely to end in a caesarian and has a 60% false positive reading of saying something is wrong when it isn’t.) I also found out that some of what was being advised was more about policy than safety. I began to realise my second birth experience might end up not much better than my first if I didn’t arm myself with the knowledge and support to ensure a better experience.

Where I live in Cornwall there is a well known and highly regarded Doula called Gilly Nevin who runs amazing workshops preparing couples for birth. I got in touch with Gilly and met her for tea and to find out more about hiring her as a Doula. I am fairly new to the idea of a Doula but here is how it works. A Doula is not a medical professional such as a Midwife, she is a strong, supportive woman, helping the mother throughout the labour process. So like a friend, right? Yes but a friend with immense knowledge. After meeting Gilly for only an hour I understood what kind of knowledge I had been lacking. She told me that I could have managed without an epidural. She reminded me that I had made it to 6cm completely alone with no husband present, no midwife and in a strange environment. She told me that the attitude and language used by my midwife could have negatively affected my birth – my midwife had asked what pain relief I had wanted and when I had asked for none she had told me “they all say that, you’ll crack.” I did indeed crack, fearing what she knew that I didn’t and I took the epidural. I didn’t know that being on my back would reduce my pelvis size by 30% not to mention the fact that I would be working against gravity and reducing oxygen to the baby, I didn’t know the potential issues that could be caused by artificial rupture of membranes, I never questioned why I couldn’t eat or found out how Syntocinon would affect my labour and my baby. It’s safe to say I was clueless.

After one hour with Gilly I felt much more informed and also very sad at how things could have been different if I had been equipped with this knowledge the first time around. Gilly couldn’t support us as our Doula because she has a busy schedule and is completing an MA at the time we are expecting. But she did agree to do a private one-to-one workshop with Jake and I and to hold something called a “Birth Art” session.

When I pulled up in her drive ready for my birth art I couldn’t help but think that it was crazy that I was spending £50 on drawing some pictures, I haven’t drawn in years and I was never particularly good at it. Gilly took me to her barn and I sat down on cushions and beanbags. She left me to make some tea and during that time I just sat and listened to the birdsong with the sun on my face. Already I felt more relaxed and less stressed than I had felt throughout my entire pregnancy. Gilly returned with freshly brewed tea and a tin of small chocolate biscuits and then she left me to draw. I was expected to firstly draw a map of my birth followed by individual pictures of my experience using pastels. I sat there, mind blank not knowing what to do. So I ate a biscuit. Then another, then another. And then I picked up the chalk and out it came.

I don’t really remember much after that but at the end of it I looked down at my drawings and realised how much my negative birth experience had affected me. How all of my memories involved machines and strip lighting and a faceless cold midwifery team (I did have one very good midwife but not until I had been there 24 hours). Talking over the pictures with Gilly and opening up to my experience I allowed myself to feel all of the feelings: disappointment, upset, guilt, anger… and a grief for the birth experience I never had. Following this we had the workshops with Gilly which taught us about how the body works during birth, the importance of Oxytocin and different techniques for labour.

However, one thing was clear. That having a consistent voice who believes in you, someone who champions you during labour is key and that this can make all of the difference to a birth experience. I knew I would have Jake (and he is much more clued up this time) but would it help me to have some added support in the form of a Doula? Doulas range in price but the two I know of in Cornwall both charge around the £1,000 mark which is quite an investment. But people invest double that and more without even blinking for just the photographer alone at their wedding, someone to capture the memories. Surely it’s worth £1,000 for someone who could help to shape your memories and make it a more positive experience for you. After all, you never forget the birth of a child. And yet, not only had I not yet convinced my husband on the expense, I also hadn’t found the “right” Doula who was either a fit for us (and confident with VBAC) or someone that was available, as was the case with Gilly.

So my question is… to Doula or not to Doula? Would I benefit from having one? Did you have one? Did it help you? Time is running low for me with only 5 weeks or so until D day. Is a Doula an unnecessary expense or an important investment for a second time (in all honesty terrified) mother?

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Guest Post by Jess Collins
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19 thoughts on “To Doula Or Not To Doula

  1. Hi Jess, I think its really hard to face birth after you’ve had a traumatic experience the first time round and I have heard amazing things about doulas.

    Have you looked into Hypnobirthing at all?

    When we fell pregnant I downloaded a hypnobirthing book and downloaded the tracks. My husband and I would practice regularly especially as the birth got nearer. I found it really relaxing and positive so we booked onto a local course which really helped to get us focussed on how and what would happen and about getting our mindset as positive as possible.

    In the end, I laboured at home, when we finally got to hospital I was 9cm and it was quickly realised I had a breach baby, I panicked… a lot! But I had been so calm and focussed before this point, and I did manage to draw on some of what I learned and get myself back into some sort of a state and delivered our baby with minimal intervention. I would highly recommend hypnobirthing for giving you the tools to be able to cope with what ever is thrown at you whether you end up with pain killers or intervention a birth can still be a positive experience.

    Wishing you all the best! x

    1. Hi Jessica,

      Thanks so much for commenting, I am actually doing an amazing hypnobirthing course online through a company called The Positive Birth Company who only charged £35 for a set of videos, downloads and a guide. I also have some downloads that a friend sent me – I am a bit late to the hypnobirthing party but I do feel it has made a difference, thank you! I can’t believe you laboured at home until 9cm, that’s phenomenal, well done.

  2. Jess I would 100% recommend having a doula by you and your husband’s side to advocate for your wants for your birth and to support you throughout the entire process and to safeguard your emotions. I had my doula for my birth and she was £1000, as you’ve mentioned, and she was worth every penny. I had a lot of complications in the end, because I had a midwife who I feel wasn’t supportive of what I wanted, which was quite traumatic because I had hoped for such a natural birth at home (I am terrified of hospitals). If my husband and I hadn’t of had our doula I think it would have been a really awful and scary situation. She did sessions with me before my birth and a birth debrief afterwards which really helped me cope with my sadness and, as you’ve said, grief for the birth I didn’t have. She provided the strength and support I needed to get through my birth, a familiar face who knew what was going on with the birth and could interpret the medical terminology for me and my husband. I hope that’s of help to you!!

    1. Hi Rebecca,

      Thank you for your advice, it’s much appreciated. It’s so good to hear someone say that it is worth the money – it is such an investment but even more than that, I worry if I’ve left it too late to build a relationship with a doula. Many of my friends hired a doula at a much earlier stage and have spoken with and built relationships with them. I’m sorry to hear you had complications (I also had an unsupportive midwife in labour and it certainly affects things, in fact Gilly, the doula in my article said that this alone can make or break a labour and spoke about the importance of the language that midwives use in the delivery suite). I never thought of the benefit of a birth debrief either – I only found out 2 years (and 20 weeks pregnant with the second!) later what had gone wrong in my first birth and had spent a large part of those two years beating myself up for it going wrong. I will add this to my “pro” list for hiring a doula! Thank you 🙂

      1. I think that at any point during your pregnancy journey you decide to get a doula, I think it’ll be worthwhile. I completely understand what you’re saying about building a relationship but you still have 5 plus weeks and if I’m honest, it’s one of those things like when you’re dating people – you either take to them or you don’t aha!!! And it’s not like you need to give them a sympathy date because you’re going to pay them to help you with your most important job, bringing a little life into the world. You’re so so right to be weary of language used and I would definitely go as far as to put this in your birth plan in big capitals!!!! what was said to me and about me (which I overheard) really tipped me off course with my birth and I honestly feel that I could – with pinpoint accuracy – highlight the exact moment everything started going awry. If myself and my husband hadn’t had our doula to keep us both calm and to be there for me when my husband had to go to the loo I honestly think we would have ended up in a really scary situation with our birth as I had a panic in the middle – after comments from the midwife – and needed to be reassured and calmed back down with my positive affirmations and my Hypnobirthing. My doula was very responsive to my needs and reactive to the changing situation in order to keep me feeling safe. I would honestly plonk the £1000 on the credit card, I would actually pay way more than that to have a doula again to protect me and my husband during birth. For us it really was make or break having her by our side. There is a national directory of accredited doulas that people can search to find doulas in their area and contact them to ask them questions etc. Just thought I’d point that out to anyone who might be on the search. Huge, huge congratulations to you and massive good luck vibes for your birth. You sound like you’re fully arming yourself with information and preparing for the task in hand. Xxxx

        1. That’s so incredible to hear, thank you! That makes me feel like it’s the right decision to partner with a doula that I can trust, no matter how late in the day it is. To know you not only don’t regret the spend but also would spend more tells me a lot! Thank you so much for your wonderful advice and I hope to be back here in a month or so with a happier tale to tell than the first time around! x

  3. I don’t know about a doula but I just wanted to let you know that as I had high blood pressure during my pregnancy, I had to have foetal monitoring during my son’s birth (in fact a whole consultant led birth was sprung upon me when I was admitted!), and I also had a canula fitted early too (which they messed up on the back of my hand so I had to have between my index finger and thumb) in case I needed medication at any point. But I had a wonderful birth and the midwives were very supportive of my moving around and I wasn’t flat on my back at any point. I didn’t even notice the canula after it had been fitted (until afterwards anyway!). I didn’t even see a consultant as the birth was pretty straightforward. It was a good experience regardless of these things and I didn’t feel like the monitoring held me back. Obviously this was only my experience but it could happen for you too! (If a doula helps you, though, go for it!) Good luck!! xxx

    1. Thank you Katie, it’s so good to hear of a positive consultant led birth experience. Also, really positive to know that you weren’t confined to your back! The monitor system at our local hospital doesn’t allow for much movement but I like to think if I ended up there that I could argue not being on my back as that was when labour started to go wrong for me. I’m very funny about cannulas (think I prefer the entire labour to having a cannula administered! Ha!) so I want to avoid one at all costs but I can understand the benefit of it. Thank you for sharing the other side and showing me that maybe if I end up back on the labour ward, it doesn’t have to be the same as last time.

  4. I had to have an emergency c section with my eldest son, as he was large and stuck. I felt so disappointed, especially as I’d managed to cope for 36 hours of labour and reach 9cm with no epidural, I felt like I could manage it and I was almost there… And then everything went wrong. When I got pregnant with my second baby the midwives kept telling me I could definitely have try for a vbac, but I had to see a consultant a couple of times, and every time they tried to convince me to have an elective cesarean, because I was expecting another big baby. All the way through the pregnancy I insisted I didn’t want one, they even booked a c section for me at 39 weeks but I refused it. But then I went a week overdue, baby measured large and they wouldn’t induce me because of previous c section, so I had to have a planned c section at 41 weeks.
    I felt massively let down this time, because they didn’t even give me the chance to try. I feel like it sort of ruined the pregnancy and early newborn days because I got a bit obsessed with trying to avoid a c section…i don’t really know why, because the last thing I would want is to put my baby at risk, and that is what the medical professionals advised, but I just felt that they were so biased towards c section being the safest option, they didn’t listen at all to me and the birth that I wish I’d been able to experience. I wish that I had booked a doula, long story short!!

    1. Hi Jane,

      Thank you so much for sharing your story. I may not end up in too dis-similar a boat to you as if I go over too far I will also go to elective caesarian. I’m so interested that your hospital wouldn’t induce you due to previous section (because of course it doubles or more your risk of rupture). For me, my consultant wanted me to have an induction but I have refused as I know it puts more pressure on the area increasing rupture risk (not to mention the fact I have a sneaky suspicion it’s advised as a cheaper option, not necessarily a better one for mother or baby). In saying that, I really don’t want a caesarian – I am trying to hold onto stories from friends who tell me that a planned caesarian is very different to an unplanned one and it will be calmer and more relaxed. Hopefully I manage to avoid it and get my much longed for VBAC but time will tell.

      It makes me so sad to read that you felt let down, I can only imagine this (and this could be me in a few weeks) but hearing another woman say it makes me feel so sad because I feel it doesn’t make us any less of a mother because it ended that way for us and I wonder why we are so hard on ourselves when we grew our children and did our best for them. When I look at my daughter she is so incredible and I have to remind myself, my C section didn’t affect our bonding or anything, I just felt extremely traumatised by it and all of the talk of “failure to progress”. It is only now that I am realising perhaps it wasn’t my failure to progress, but my hospitals failure to support. Congratulations on your second baby and thank you so much for taking the time to comment.

  5. Jess I could have pretty much written this post word for word as you have done. Gavin and I are debating on whether or not to hire a Doula to avoid the same complication and intervention filled birth we had with Ethan. I am aiming for a VBAC and will be refusing continual fetal monitoring in favour of intermittent fetal monitoring. I’m currently meditating on this and trying to establish a feeling of ease that if I get the natural birth I want great, but also, if a csection is the way I have to go, then I need to be ok with that too.

    I think a Doula would make us feel more supported and help Gavin too, but I too am feeling the pinch at the thought of handing over £1000. I have no answers for you, but I would LOVE to hear how your birth goes and if you end up taking the plunge. Best of luck either way dear. You can absolutely do this.

    1. Ah thank you Naomi, when are you due? I’m obviously very soon so time is running out for me! I’m hoping to have the chance to write a follow up post on how it ends up for us and all I can hope is that no matter what the outcome, I know so much more this time, I’m informed, I have better support, I’ve been doing hypnobirthing and I know my rights so it can’t be any worse than last time, right? (nervous laugh!) Thank you for support 🙂

      Ps it took me a long time to have the courage to decide on intermittent monitoring, I read a lot of books (highly recommend the AIMS VBAC book), spoke to friends, sought forum advice, spoke to doulas and midwives and came to the conclusion that with the right care (e.g. a dedicated and present community midwife) checking every 15 minutes and monitoring both my pulse and baby’s heart rate, I think I can do this and I’ll be supported by a vigilant team and not just a machine that doesn’t even have that reliable a success rate!

  6. Hi Jess,

    Another option for you might be a private midwife? I’m not sure who practices down our way but there was this week a shift to the insurance and legal support system for private midwives allowing them to practice more freely so perhaps worth looking into?

    As a SW person, can I ask if you’re looking at Treliske, R D and E or Derriford? Each hospital will had different consultants and attitudes to policies and if you live somewhere with a big journey anyway it might be worth looking around. There’s a growing HBAC movement too.

    I’m sure Gilly will have emphasised this but you don’t have to do anything- it’s your birth and nobody can dictate to you. I would really advise making what I call a “birth road map” so you can figure out what you do and don’t want. A bit like the one you did but for your plans not the past. I had an awful first birth and suffered nightmares and flashbacks in my second pregnancy- making the map really helped me. I divided my page into a yes and no and thought about what I did and did not want to happen, and I also succinctly pit why- e.g. NO pessary induction, previous bad reaction, hypercontractions. It stated clearly that these things were not to even be mentioned to me- no clock watching, no negativity.

    As mentioned above hypnobirthing really helped for me. I read Maggie Howells book and burnt my fears that I’d written down which felt so good! After two nights the nightmares went.

    As I’ve written about on RMF, my 8lb 13 son was born at home in half an hour almost painlessly. It was magical. I really really hope it works out for you too. Best of luck xxx

    1. Wow thank you Lucy, that’s really helpful! I can’t seem to find a practicing private midwife in Cornwall, I only managed to locate one and she isn’t currently taking on clients (I can only assume due to the insurance situation). I’m looking at Treliske, if I was closer to Derriford then that is where I would be as they allow VBACs in the MLU and Treliske don’t. Treliske also only have a 50-55% VBAC success rate versus the national rate of 70-73% but it’s over an hour to Derriford and it’s just not viable. I am currently looking at HBAC as an option because I feel so unconfident both in the hospital and the information I am being given this time around and the attitudes from the senior team at large. Just to put you in the picture, Treliske have been rated as 229 out of 230 hospitals in a government league table on openness and transparency (and that’s just the tip of the iceberg!)

      Gilly did highlight that and I’ve learned a lot from looking around, speaking to other people, reading up and researching. Disappointingly in my first birth things weren’t phrased as options – I was told categorically that I couldn’t eat, that they were about to pop my waters, that the cannula was about to be fitted etc – I also got told I wasn’t in labour repeatedly when I was and so my husband wasn’t even allowed in and they refused to check me. This time around I know things will be different but it certainly has affected me and I’m feeling more nervous as the date approaches.

      I love your idea of the birth map and will definitely do that, I think something visual would be good for me also to help me focus on how I see it and help me feel some sort of level of control again. I don’t know your birth story but would love to read it. Perhaps you can share it with me – you could send me the link privately if you prefer to haveaword@jesscollins.co.uk

      Thank you Lucy and lovely to speak with someone from the South West, it means you know what I’m up against! Ha! X

  7. hi jess
    Just to add I had a doula with my first and again, think she was worth every penny. Not only was she amazing in the run up to the birth but she was invaluable once my waters broke and things didn’t strictly go to plan…. they’ve literally seen every scenario, know the hospital and its procedures (which varies so much!) so can really advocate for you. My doula was also so supportive afterwards and really helped me with breastfeeding. I wouldn’t hesitate to book her again if we have another. I hope you find someone just as good to look after you xxx

    1. Hi Emma,

      Thank you so much for taking the time to reply to the post and say how worth it you think your doula was, this is so great to hear! I think there’s a resounding YES for hiring a doula as a response to this post, not one person has said they regretted the cost which is really good to know. Thank you again! x

  8. hi Jess, I just got round to reading this and wanted to comment – hope you see! We didn’t have a doula and to be totally honest never considered it nor would we in future (for no reason other than just not for us). So I can’t help on that front but I wanted to say I had first baby 4 weeks ago (eek!) and ended up with an emergency cesarean after 51 hrs of labour, the final verdict was a failure to progress. Very frustrating and I feel my body let me down a bit. BUT I was consultant led, in delivery suite, had cannula on admission in case of complications, had fetal monitoring every 15 mins until the last 6 hrs where I had the continuous monitoring but even then I could be on my feet and move a bit (just not too far from bed), then ended in a cesearean but as baby wasn’t in distress it was the calmest of emergencies where everything was fully explained and we felt much more in control – what I imagine a planned section could feel like. Basically I wanted to say I feel Positively about our experience even though it wasn’t Plan A and I hope that can be slightly reassuring xxx

  9. Hi Jess,

    I have no advice, I just wanted to say thanks for writing this because my first birth story is IDENTICAL to yours. My last vivid memory of it was being wheeled up to post natal ward and being reassured “If you have another one you won’t have to go through it again as you’ll only be allowed to deliver via c section now.” Thank you so much for all this information! Now I’ll be able to research and make informed choices if we do ever decide to have another. Thanks most of all for sharing about the emotions and grief, it’s always nice to know you’re not alone in your experiences, and that those things are a very normal response to a traumatic birth. Wishing you all the best with birth and baby number two, I really hope the whole thing is a healing experience for you.

    XO

  10. I’ve only just read this and could be reading about myself. Very similar first birth experience and my consultant was very blasé about my vbac, didn’t read my notes etc… I saw the consultant midwife which made a massive difference immediately. She totally got my concerns, went through my notes in detail, discussed all my fears and gave me her mobile number! I also did hypnobirthing which really got my head ready as that was the real issue. I wanted a doula but my husband was dead against it. He felt he had failed me in our first birth and wanted to be the one to be my voice in our second, that that was his job. And he was, he was brilliant, always asking me if I was happy with what the midwives were saying. I had a vbac and is was such a different experience, went from a 52 hour labour to a 4 hour one! I was 7-8cm by the time I was in hospital. There were still things I would have wanted to change but overall it was a very positive birth. Truly wishing you all the luck in the world.xx

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