The mother of all rows breaks out over doulas

Doctor questions benefit of female supporters at births

Like some ancient wounded creature, the male medical establishment occasionally lashes out in uncomprehending fury at "patient-led" developments in medical care that threaten to undermine its power.

In the latest example, an anaesthetist from Worthing Hospital has penned an invective in the esteemed British Medical Journal (BMJ) against the rise of the "doula", the female supporters who assist women through childbirth and whose popularity is growing rapidly on both sides of the Atlantic.

Around 1,000 doulas – the word comes from the Greek meaning "woman servant" – are thought to be practising in Britain, a three-fold rise in six years. They charge from £400 to £900 for a care package, which includes antenatal visits, labour, postnatal visits and being on call. The idea was imported from the US where there are more than 100,000 doulas who provide support to expectant mothers to challenge the technological tyranny of the medical establishment.

When Dr Abhijoy Chakladar had his medical authority questioned on the maternity ward at Worthing hospital, he admitted the experience was uncomfortable. He had suggested to the labouring mother, his patient, who was accompanied by her husband and a hired doula, that after he had topped up her epidural she change position and lie on her side to assist the spread of the local anaesthetic. The doula objected, saying the mother felt comfortable as she was, and she stayed on her back.

"I found myself disconcerted by the doula's presence as I was unfamiliar with her role. In retrospect, I should have confirmed everyone's roles and established ground rules acceptable to all ... In this clinical situation, the presence of a doula swayed the decision-making incorrectly," he wrote in a "Personal View" published by the BMJ.

He added: "The presence of doulas during labour may alter the doctor-patient dynamic and can compromise communication and therefore patient care ... The need for doulas implies a failing of medical and midwifery services. As the trend grows, a cynic might ask whether the doula business is actually necessary or whether it is exploiting – for profit – unspoken fears about NHS perinatal care and the seemingly limitless market for birth-related products and services."

Obstetrics has long been a battleground between the male obstetricians who dominate the specialty under whom birth has become technology-driven, and their female patients who have sought to wrest control back from the doctors and ensure labour and childbirth follow a natural trajectory.

It has been a losing battle so far as the women are concerned – half of all deliveries involve some form of medical intervention, such as induction, anaesthesia, forceps,or a Caesarean. The coveted "natural" birth has proved a difficult goal to achieve. But it has not curbed the demand and women have learnt that hiring a female supporter may be the most effective way of obtaining it.

Marcia Blackstock, managing director of Doula Consultancy Services, said Dr Chakladar was right to criticise the doula who interfered with the care of his patient, but wrong to dismiss the movement of which she was a part. "I would be appalled if one of my doulas behaved like that. We are very clear that doulas are there to give psychosocial support to the woman, and do not give a medical or midwifery opinion."

She added: "We need doulas because women want them. We do not replace midwives, we step back and provide support and let the medical team get on with providing the medical care. Research shows that they are effective."

A review of 15 trials involving 13,000 women published in 2003 showed that a female supporter was the best guarantee of a natural birth. Mothers who had continuous support throughout labour from a woman trained to give that support needed less pain relief, had fewer "operative" births – Caesareans or forceps deliveries – and had a more positive experience than those who received the normal attention of an often overworked midwife.

According to the researchers, from the University of Toronto, the key was the relationship the carer had to the woman. The evidence showed that if continuous support was provided by a nurse or midwife, it was less effective. Louise Silverton, deputy general secretary of the Royal College of Midwives, said: "There is no doubt that some doulas are performing a role that should be done by midwives. However, maternity services are seeing rapidly rising birth rates, increasingly complex births and midwife shortages. The pressure of work that midwives are facing means that too often they simply do not have the time to provide the kind of emotional support that doulas are offering."

Earlier this year, the Government announced £270,000 over three years for development of volunteer doula services in England.

Case study: 'I liked the idea of somebody being there for me'

Michelle Campbell's husband was working out of London when she was expecting her first baby, Luella, born last June, and she wanted the reassurance of knowing there was someone else who would accompany her to St Mary's hospital in Paddington, west London, when the moment came. So she hired doula Tracey-Anne Neil

"We got to know each other when I was three months' pregnant, and from two weeks before the baby was born she was on 24-hour call. I had never been in hospital for anything and I liked the idea of someone being there for me, who would relay my messages to the hospital staff."

Michelle said she had read about doulas on the internet and liked the sound of them. "I had my baby on the NHS, but it was almost like going private, because I felt there was someone in my corner for me. There were loads of midwives coming and going on shifts. I liked knowing that if I was left in the room because they thought I was doing OK and then things started happening, my doula could go into the corridor and shout for help."

Michelle went into labour at 6.30am, but with Tracey's experience was able to delay going to the hospital until she was ready to be admitted at about 2pm. "Tracey knew the procedure and timed my contractions. The mother next to me in hospital had been in and sent home twice because she was too early and she was hysterical. She ended up having a Caesarean. I was able to get up and walk around as I wanted, with Tracey's help, and I just had gas and air and Luella was born at 7.50pm."

Michelle's husband, Hugh Clarke, had arrived earlier, and the couple were able to cuddle the baby while Tracey made arrangements to get them a room of their own in the hospital. Michelle said: "She sorted all that for us. Hugh was with me, but there are times when it is quite nice to have another woman there. And she provided support for him, too, phoning to update him while he was on his way to the hospital and reassuring him when I was in pain. I would absolutely recommend a doula."

Life and Style
ebookNow available in paperback
ebooks
ebookA delicious collection of 50 meaty main courses
Latest stories from i100
Have you tried new the Independent Digital Edition apps?
SPONSORED FEATURES

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    Recruitment Genius: Senior Environmental Adviser - Maternity Cover

    £37040 - £43600 per annum: Recruitment Genius: The UK's export credit agency a...

    Recruitment Genius: CBM & Lubrication Technician

    £25000 - £27500 per annum: Recruitment Genius: This company provides a compreh...

    Recruitment Genius: Care Worker - Residential Emergency Service

    £16800 - £19500 per annum: Recruitment Genius: Would you like to join an organ...

    Recruitment Genius: Senior Landscaper

    £25000 - £28000 per annum: Recruitment Genius: In the last five years this com...

    Day In a Page

    Refugee crisis: David Cameron lowered the flag for the dead king of Saudi Arabia - will he do the same honour for little Aylan Kurdi?

    Cameron lowered the flag for the dead king of Saudi Arabia...

    But will he do the same honour for little Aylan Kurdi, asks Robert Fisk
    Our leaders lack courage in this refugee crisis. We are shamed by our European neighbours

    Our leaders lack courage in this refugee crisis. We are shamed by our European neighbours

    Humanity must be at the heart of politics, says Jeremy Corbyn
    Joe Biden's 'tease tour': Could the US Vice-President be testing the water for a presidential run?

    Joe Biden's 'tease tour'

    Could the US Vice-President be testing the water for a presidential run?
    Britain's 24-hour culture: With the 'leisured society' a distant dream we're working longer and less regular hours than ever

    Britain's 24-hour culture

    With the 'leisured society' a distant dream we're working longer and less regular hours than ever
    Diplomacy board game: Treachery is the way to win - which makes it just like the real thing

    The addictive nature of Diplomacy

    Bullying, betrayal, aggression – it may be just a board game, but the family that plays Diplomacy may never look at each other in the same way again
    Lady Chatterley's Lover: Racy underwear for fans of DH Lawrence's equally racy tome

    Fashion: Ooh, Lady Chatterley!

    Take inspiration from DH Lawrence's racy tome with equally racy underwear
    8 best children's clocks

    Tick-tock: 8 best children's clocks

    Whether you’re teaching them to tell the time or putting the finishing touches to a nursery, there’s a ticker for that
    Charlie Austin: Queens Park Rangers striker says ‘If the move is not right, I’m not going’

    Charlie Austin: ‘If the move is not right, I’m not going’

    After hitting 18 goals in the Premier League last season, the QPR striker was the great non-deal of transfer deadline day. But he says he'd preferred another shot at promotion
    Isis profits from destruction of antiquities by selling relics to dealers - and then blowing up the buildings they come from to conceal the evidence of looting

    How Isis profits from destruction of antiquities

    Robert Fisk on the terrorist group's manipulation of the market to increase the price of artefacts
    Labour leadership: Andy Burnham urges Jeremy Corbyn voters to think again in last-minute plea

    'If we lose touch we’ll end up with two decades of the Tories'

    In an exclusive interview, Andy Burnham urges Jeremy Corbyn voters to think again in last-minute plea
    Tunisia fears its Arab Spring could be reversed as the new regime becomes as intolerant of dissent as its predecessor

    The Arab Spring reversed

    Tunisian protesters fear that a new law will whitewash corrupt businessmen and officials, but they are finding that the new regime is becoming as intolerant of dissent as its predecessor
    King Arthur: Legendary figure was real and lived most of his life in Strathclyde, academic claims

    Academic claims King Arthur was real - and reveals where he lived

    Dr Andrew Breeze says the legendary figure did exist – but was a general, not a king
    Who is Oliver Bonas and how has he captured middle-class hearts?

    Who is Oliver Bonas?

    It's the first high-street store to pay its staff the living wage, and it saw out the recession in style
    Earth has 'lost more than half its trees' since humans first started cutting them down

    Axe-wielding Man fells half the world’s trees – leaving us just 422 each

    However, the number of trees may be eight times higher than previously thought
    60 years of Scalextric: Model cars are now stuffed with as much tech as real ones

    60 years of Scalextric

    Model cars are now stuffed with as much tech as real ones