Are Doulas worth it?

‘My doula Terri calmly kept repeating, “This is completely normal,” while I shook uncontrollably and shouted for a c-section,’ remembers new mum Abi Croutear-Foy, 27. ‘I was in the transition stage of labour, when you dilate from eight to 10cm, which I found the hardest bit of giving birth to Harrison, now five months. But I knew I could trust Terri – she’d had six children and knew what I wanted. With her help I stuck to my planned home birth and my labour lasted just seven hours.’

For Abi, hiring someone experienced in birth was the best support she could have hoped for. But is having a doula a luxury we can afford today? Can you have a positive experience without one?

Guaranteed support

Birth doulas attend around 2000 births a year in the UK, offering non-medical support to the new mum. If you hire a doula she’ll meet you during your pregnancy, offering information and answering questions, and give you emotional and practical support during labour.

There’s no UK government regulation on doula training. However Doula UK – the only not-for-profit doula organisation in the UK – has 450 members who must complete an approved course covering birth physiology, a doula’s boundaries and breastfeeding. A doula’s training doesn’t involve attending a birth, but newly trained doulas have a mentor with whom they can discuss the first few births they help with.
‘Doulas’ fees vary from £150 to £900, with £450 the average per pregnancy,’ says Valerie Goedkoop from Doula UK. ‘This normally includes a couple of ante- and postnatal visits, as well as labour support.’

While doulas are still quite unusual they are gaining popularity in the UK, with the average number of births attended by Doula UK doulas almost doubling since 2004*. But are they worth your money? ‘If a doula’s role is supporting a woman in labour and alleviating anxieties, then she’s doing what a midwife is trained to do,’ says Denise Linay from the Royal College of Midwives.

‘However, increasingly midwives are looking after several women at one time so can’t give the quality of care they’d like to,’ admits Denise. Additionally, if you give birth in hospital it’s unlikely a midwife you know will deliver your baby.

Other options

While this makes paying for a doula’s support appealing, Denise notes that your own partner may be able to offer the physical and emotional support you need. Most women are encouraged to have two birth partners, which means you could turn to a friend or relative for the female support you’d find especially beneficial. ‘A woman, especially one who’s had children, can sometimes offer support to the woman in pain without getting as anxious as her partner,’ says Denise. ‘She understands what the woman is going through.’

Denise and Valerie agree that a doula’s role is one female relatives would have taken in the past. But with new mums today often living miles away from their families, a doula can step in.

When Nagris Bi, 22, from Birmingham, was without a partner for her third birth, she found doula Tina invaluable. ‘We have two children so my partner had to babysit when I went into labour. I was scared, as I was anaemic and my baby was expected early,’ says Nagris. ‘Tina kept me at ease.’

In cases like Nagris’s, doulas may be especially beneficial. ‘A woman who is alone, is very scared or has had a bad birth experience before might need more reassurance,’ says Valerie. The same applies to a woman expecting multiples or a couple expecting an ill or disabled baby.

‘Another benefit is that because doulas understand the maternity services, we can clarify your options and give you useful contacts. We’re also on call any time of the day or night,’ says Valerie.

Evidence backs up Valerie’s claims that having a birth doula can be beneficial. While according to NHS statistics nearly a quarter of births in the UK are c-sections, a 2008 Doula UK survey of doula births found only around 14% were caesareans. And while NHS figures show a third of women have an epidural and over 20% need intervention, the figures are more than 10% lower on both counts for doula-assisted births.

What’s not to like?

So are there any drawbacks? ‘We do hear rare stories of doulas stopping the midwife entering the room, which can place the woman at risk,’ says Denise. However, this is unlikely to happen to you.

Valerie explains, ‘There’s a complaint system with Doula UK, so if a midwife complained about one of our doulas, the doula would face a panel and, if found to be at fault, may be asked to leave the organisation.’

A mum-to-be might have other reasons for not opting to have a doula, including having had easy labours before or being very private.

‘For a home birth, you’ll have a community midwife and are all but guaranteed that she’ll attend the birth,’ says Denise. In this case you’ll have less need of a doula, although a doula would give support in early labour before a midwife arrives. If you choose to hire an independent midwife she would provide all of your antenatal care and be guaranteed at your birth – her services would set you back at least £2500, though . Her fee is so much higher than a doula’s because a midwife is medically trained and can do all your antenatal appointments and screening tests at home, as well as delivering your baby.

A middle ground

While a doula doesn’t cost thousands, £450 is still a significant sum to find if you’re cash-strapped. ‘However, a newly trained doula will often charge less,’ says Valerie. ‘For her first four births, a Doula UK member can only charge £150.’

Doula UK also has a hardship fund. ‘Women on benefits can apply and we’ll try to find a doula who’ll accept a payment of £150 from the organisation,’ says Valerie. She also suggests asking for vouchers from Doula UK as baby-shower gifts or using your £190 health in pregnancy payment (visit direct.gov.uk for how to apply).

So is a doula a credit-crunch luxury or  a birth necessity? ‘You don’t need to have a paid, labelled doula if you have a birth partner or a community midwife,’ says Valerie. ‘But for women who need more support, a doula is clearly an advantage.’ Ultimately, the decision of whether a doula is a necessity for your birth rests with you.

Can’t afford a doula?

Here’s how you can still have a positive birth without one

- Choose your birth partner(s) carefully – don’t just assume it should be your husband.
- Get them to attend antenatal classes and help write your birth plan so they know what you want – and what you don’t.

- Have a couple of birth partners – labour can last for many hours.

- A female friend or relative who’s given birth may be a good support.

- Check what services are available when you book in with your midwife. Can you be guaranteed that a familiar midwife will attend your birth?

- If not, address specific anxieties during the antenatal period when you’re seeing one of the midwives you know.

Doula facts

Doula is a Greek word meaning ‘woman servant’.

Thirty five per cent of births with a doula in attendance last under six hours.**
A post-partum doula helps out with caring for your baby and household chores after the birth, charging between £10 and £25 an hour.

The official UK doula movement started in 2001.

Having a birth doula

- Find a trained doula through Doula UK (visit doula.org.uk or call 08714 333103).
Or, For a free to use Doula Directory visit www.douladirectory.org.uk

- Contact several doulas and arrange interviews with a few you like.

- Click on the ‘find a doula’ link on the Doula UK website for a list of questions you should ask her before hiring.

- Your first doula appointment will be around 32-36 weeks, but hire someone any time from 12 weeks.