Giving birth is hard labour, literally, and expectant mothers need all the help they can get to ensure their delivery is as stress free as possible. But being far from home can mean having a baby without a familiar support system in place, which is why more and more women in the UAE are enlisting the help of a doula - women with no medical experience who provide emotional and physical comfort before, during and after birth and empower mothers to make the right choices.
Filling in for family
While women have been helping each other give birth for centuries, today's doulas have been trained to be in the labour room, and research has proven their presence can not only shorten labour by up to two hours, but also reduce the risk of complications as well as post-natal depression. And for expat couples thousands of kilometres from their home environment, a doula can fill the gap usually taken by a female relative or friend.
"Expat couples feel anxious, not knowing exactly what to expect during labour or how they will care for their newborn after they have been discharged from hospital," says Annette Kirby from www.expatdoula.com, who works as a birth doula and also offers antenatal classes. "There is a lot of scientific evidence that says once a woman feels that she is in good hands during childbirth, she is more likely to have a good outcome. I know of people who have gone to their home country to give birth because of lack of personal support here - one of the main reasons why doulas are gaining popularity in the UAE."
This was exactly the reason 32-year-old American Desiree Cameron decided to have a doula present for the birth of her first son Max, now two.
"I was researching pregnancy and birth when I stumbled onto the word ‘doula' on an internet forum, so I got in touch because I wanted that extra reassurance," says the mother-of-two who moved to the UAE with her British financier husband Stuart, in 2008. "The doula explained the benefits of using her, and my husband and I felt that as first-time parents without any family here, we could do with the help."
The couple met their doula three times before the due date to talk through all their birthing options. Desiree, who wanted to have as natural a birth as possible, believes her doula empowered her to stick to her birth plan and avoid having an epidural or Caesarean section.
"Having her there meant there was another voice in the room, someone who could help us gather our thoughts and make an educated decision," explains Desiree. "When you are in the middle of labour, your mind is not all there and I knew my husband would depend on whatever decision I made, so it was important having someone else there who could explain things to us."
Understanding the options
While first-time mothers, like Desiree, find the presence of a doula an enriching experience, doula Elizabeth Bain of www.dubaidoulas.com, says being on hand during labour is also "an honour and a privilege" for her.
Briton Bain, a former midwife and health visitor, trained as a doula in 2008 after a friend invited her on a training course. And despite being slightly cynical about the profession at first because of her midwifery background, she says it is the best thing she has ever done.
"I met all these women who wanted to change the birthing experience for the better by offering couples options, and ensuring that birth is not a fearful experience. And when I did my first birth as a doula I loved it, and knew this was what I wanted to do."
Bain believes the presence of a doula in a labour room is important in the UAE because the birth process is often very medicalised here and women do not have options, such as a home birth or water birth, that they may in other countries.
"Here you have to give birth in a hospital, but I say to couples, ‘It's your birth, your body and your baby'," says Bain. "For example, research highlights that if the birth is normal and there are no complications, then a woman does not require constant monitoring. Instead intermittent monitoring means that the woman can walk about, get into positions that are beneficial for progressing labour and does not need to be lying on a bed."
Bain, who supports two pregnant women a month and is on call 24/7 for two weeks prior to the birth and two weeks after, says she discusses how the couple would like the birth to go, to ensure it is the best experience possible.
"I don't call it a birth plan because birth can change and I feel that when you've planned something in your head, and it doesn't go that way, it becomes a disappointment and that can have a psychological knock-on effect on women and their husbands," she explains. "So I'll say let's see how we can make it the best for you. Women have to remember that birth is normal so they can wear their own clothes rather than the hospital gown, continue to eat and drink and be in normal control of their body during the birth."
Knowledge and support
Doulas stay with labouring women throughout the process, no matter what the outcome, and some are even allowed to attend Caesarean sections if the couple requests it and the doctor allows it. But their main role is to be on hand to support the mother-to-be in whatever way she wants.
"We may massage her back, support her with encouraging words, make sure she is eating and drinking to keep her strength up, help her to get into positions that are comfortable for her to labour in and support the husband to be the main supporter of his wife," says Bain.
"I have sung, counted, walked, talked, laughed, danced, belly danced, smiled, hugged, cried, prayed; all are part of being a doula. It is a journey with that precious mother and father as they make their way to parenthood."
For Desiree, her labour turned into a 13-hour marathon before she managed to deliver her son naturally and with minimum pain relief. But she is adamant she would never have been able to achieve the result she wanted without her doula, who arrived shortly after she was admitted to Dubai's American hospital.
"I wasn't dilating very well because Max was slightly oblique. It meant I couldn't lie on the bed because everything would stop, so they had to keep me moving all the time.
"I was in a lot of pain, but my doula had a TENS machine and gave advice on how to manage the pain. She gave me massages or put a wet cloth over my head when I needed it and really encouraged me to stay focused and find different positions to manage the pain.
"Without her I would have been scared about the pain and would have had an epidural, which would have stopped me moving around - and therefore Max from coming down - which would have meant a C-section."
Desiree says she also felt great comfort from the doula's presence when, moments after the birth, her newborn son was taken away to be checked by the paediatrician. "My husband went with Max, everything hurt and I felt quite overwhelmed, so it was nice to have the doula there holding my hand," she recalls. "And of course, it was great to have someone to talk to about the experience again."
Three's a crowd?
While Desiree's experience was extremely positive, involving a doula in the birthing process does not always work out so favourably. Sometimes an extra presence can cause tension with the medical staff and some maternity hospitals around the world have actually banned doulas, because they believe that they either interfere with the medical process or force their own agenda onto the mother.
While Dubai-based midwife and educator Cecile de Scally says she loves having doulas involved because they enhance the mother's care when she cannot be as supportive as she needs to be, tension can occur.
"Doulas are the woman's advocate in her choices, offering advice and comfort, and they look after dad too," explains De Scally. "But while some midwives have a good relationship with doulas, some do not, much the same as the midwife-doctor relationship.
"Unfortunately, some doulas have been asked to leave the room. It is very much dependent on the situation and doulas who are well trained should have enough background knowledge to actually be helpful… Maybe if we agreed we all wanted the client to have the best outcome, stopped trying to be the one in charge and handed that role back to the woman - which I think the doulas are trying to do - then the competition would stop."
Doula Bain agrees that there should never be any conflict in the labour room because ultimately the doula and the medical staff have the same goal -a healthy birth.
"We are working for the same thing, and I've never encountered anyone who's been against what we do. If there is conflict in a birthing room, then it's time for one of us to leave because it's not the place for it.
"I do not see myself as part of the medical team as doulas do not offer any medical, midwifery or obstetrical support or care at all. We are basically there for the women to fulfil her emotional needs and support her; we are there to protect the birth space not cause conflict."
Desiree's memories of working with her doula were so positive, she then asked her to be present at the birth of her second son, Mason, now eight months, even though her doula felt she could cope alone.
"She told me it would be a piece of cake, but I felt I couldn't remember anything about pregnancy any more, as I was now more focused on how to bring up a baby. I wanted her there not just as my doula, but as my friend," recalls Desiree.
Despite her concerns, she ended up giving birth 15 minutes after arriving in the hospital, subsequent to staying at home for what she believed to be the early stages of labour because she felt she could manage the pain. "My doula wasn't there and my doctor didn't make it either, and they all teased me about it later. But I still maintain that if I hadn't had the doula present for my first birth, I would have turned up at hospital for the second birth after the first contraction and taken every drug they could give me," says Desiree, who adds that she would not have considered using a doula back home in the States, partly because she trusted her own doctor so much and partly because she hadn't heard of them before.
"Being away from home and having no family or best friend on hand makes a difference, and to have the doula's support was great for my husband and me. For a man to see his wife in that much pain is hard and having her there letting him know it is natural was very helpful for him. Now I tell everyone to have a doula present." A
All About Doulas
What is a Birth Doula?
The word ‘doula' comes from ancient Greek meaning ‘a woman who serves', and is now used to refer to a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the post-partum period.
How will a doula enhance my birth?
You can choose a birth doula or a post-partum doula, or someone who covers both areas.
A birth doula's role is to:
- Recognise birth as a key experience the mother will always remember.
- Understand the physiology of birth and the emotional needs of the woman.
- Assist the woman in preparing for and carrying out her plans for birth.
- Stay with the woman throughout the labour.
- Provide emotional support, physical comfort and objective viewpoints.
- Help communication between the woman in labour, her partner and her clinical care providers.
- Allow the woman's partner to participate at his comfort level.
A post-partum doula's role is to:
- Offer education, companionship and non-judgemental support during the last trimester.
- Assist with newborn care, family adjustment and meal preparation.
- Offer practical information on feeding, emotional and physical recovery from birth, baby soothing and coping skills and make appropriate referrals when necessary.
What do the experts say?
According to Mothering the Mother by Dr Marshall H Klaus, having a doula present at a birth:
- Shortens first-time labour by an average of two hours.
- Decreases the chance of a Caesarean section by 50 per cent.
- Decreases the need for pain medication.
- Helps fathers participate with confidence
- Increases success in breastfeeding.
According to Dr John Kennell and Dr Klaus, the founders of Dona International, the world's largest doula certifying organisation, doula-assisted births generally have more positive outcomes. Clinical trials show:
Caesarean deliveries: No doula 18%; doula 8%
Epidural: No doula - 55%; doula 8%
Forceps delivery: No doula 26%; doula 8%
Prolonged breastfeeding: No doula 29%; Doula 51%
How much does it cost?
How much you pay for a doula depends on your personal and financial circumstances and the doula herself. Prices range from nothing for a trainee, to an hourly rate of Dh100 to Dh600, depending on the level of education and experience she has.
Where can I find a doula in the UAE?
Visit www.expatdoula.com and www.dubaidoulas.com
Can I train to be a doula?
Yes. There are training courses held in the UAE, so log onto www.nurturingbirth.co.uk or www.dona.org for more information.
Alice Haine is a contributor for Aquarius magazine
