These days, few women can count on a close support network at short notice; families live further apart and many women work. Perhaps that's why doulas are becoming increasingly popular in Britain. A doula - the name comes, not entirely aptly, from a Greek word meaning slave woman - acts as a companion who will offer whatever support a new mother needs, either during the birth itself, afterwards in the mother's home, or both. "A doula is not a nursery nurse, nanny, midwife, cleaner, cook or housekeeper, but she will do a bit of all that," explains Sylvia Mcginnis, who is a birth doula as well as a breastfeeding counsellor and a childbirth educator and runs training courses for doulas.
"The midwife is there for the baby, but the doula is there for the mother," says Lynne McTaggart, editor of Natural Parent magazine. In a way, she says, the doula is acting as the mother's mother once would have done. "She is not a servant but a companion and protector. During labour she can help create a more calm, comfortable and conducive environment - giving birth is exquisitely sensitive and if the mother is upset, her hormones shut down." After the birth, too, she says, the doula is a reassuring presence. "Health visitors and the other professionals can be great but they have a long list of people to attend to. The doula cares only for the individual mother's needs."
The doula system is already fairly widespread in the US and researchers have been monitoring it for some years. The Journal of the American Medical Association published studies in 1991 suggesting that having a doula meant a shorter, less painful labour that was less likely to end with procedures like forceps deliveries and Caesarean sections. Dutch women also have a similar system of help available. But in this country doulas are much less well-known.
Now, however, doulas here are beginning to organise themselves into trained groups. The newly formed British Doula Association, which has just published its first newsletter, has begun a series of training courses which have been devised and run by Dr Michel Odent, the French natural childbirth pioneer who helped to popularise water births.
According to Dr Odent, "What a doula can do is create an atmosphere in which a woman can feel safe to go inside herself, to go to another planet, to do whatever she needs to do. When that happens, birth can be much easier." Dr Odent has found that a doula can be at least as effective a birth companion as a husband or partner - or even more so. "The father of the baby often makes the pain worse because he gets so upset for his partner," he says.
"Many women feel constrained by the presence of their partners," agrees Natural Parent's Lynne McTaggart. "They may feel hurried or stressed. It is wonderful for dads to be participatory but we don't have to be cut and dried about the father being there." In fact, she says, the baby's father can be confused or upset at the intensity of the experience, and the doula can reassure him too. "An experienced doula can comfort the dad as well. She can tell him that these strange noises and extreme behaviour are normal."
Jean Birtles, founder of the British Doula Association and director of Top Notch Nannies in north London, says that a doula's duties do not end in the delivery room if the mother needs more support. "A doula isn't medically trained and if there are any medical problems you would go straight on to a doctor. But she's quite able to say 'That's just a bit of colic, don't worry'. And she will help around the house to let the mother spend time with her baby - she isn't like a maternity nurse who just looks after the baby, she takes care of the mother too. She'll put a casserole in the oven, fold the washing, look after the toddler for a few hours." Doulas, she says, are particularly useful for young, inexperienced mothers - "if the baby is crying and won't stop, for example."
A doula from Top Notch Nannies works for a minimum of four hours, at a rate of pounds 10 per hour. "It is money well spent," says Jean Birtles firmly. "It can transform a life - turn a mother from someone who is very unhappy and overburdened to someone who can cope." Doula trainer Sylvia Mcginnis believes that more and more women will start turning to doulas. She plans to set up a nationwide doula register. "Interest is growing," she says. "In a way, anyone who has had a baby themselves is a doula, but by training, doulas broaden their experience and learn that there are other ways to give birth and other experiences to their own. I have done four training weekends now, I very much enjoy it and the doulas are going on to get work."
Sylvia herself is a birth doula. "I have accompanied women in childbirth for a long time, though we didn't call ourselves doulas," she says. "The key is to be receptive to the mother's wishes. We don't want to tread on the toes of the midwives, but they don't have the time to be with the woman throughout labour and she might also want someone who knows her better to be with her. Being a birth doula can mean practical help like massaging the mother, helping her into the shower, holding her hand, but the most important thing is giving her the confidence that she can do it."
Women helping women through childbirth is by no means new, says childbirth expert Sheila Kitzinger, who is currently working on a new book on birth in different cultures and through the ages. She started a successful doula system for women in Holloway Prison a year ago, inspired by a friend of hers who trains American doulas and run by unpaid volunteers. "In medieval times," she says, "what we now call doulas were known as sisters in God, or god sibs. They would bring food, drink, charms and herbs to the birth and men were turned out. The word later became gossips." Doula, she says, is not a term she is particularly keen on. "It's a Greek word that actually means 'female slave' - it originally meant the woman you'd have by you when you had your baby if you were well-to-do. I prefer the term 'birth sister'. People often say that a doula is like a mother for the mother, but I think of her as being more like a sister - closer in age and certainly not someone who comes in dishing out advice or taking over the home."
Sara Berbank found her doula invaluable when she gave birth to her youngest daughter, Nancy. She was something of a doula pioneer, as Nancy is now five. "My family weren't close by, and the father was too stressed out and busy with other things to help, so Michele did incredible things. She was with me at my antenatal classes, helped me write my birth plan and helped me follow that through. She was there reminding me what I'd written, helping me with my breathing, giving me huge pats on the back and telling me I was doing well." The medical staff at a birth, she says, simply don't have time to do what a doula does. "She has got your best interests at heart and is there for you when the birth becomes very technical and practical and the medical staff don't have time."
When Sara took Nancy home, with Michele's help, she was able to spend time with her new baby. "I didn't have to worry about things like making sure I had enough food in. When I had my first baby I was married, and my husband went back to work after two days. I was on my own with a new baby and lots of questions and nobody to ask. Women are much more intuitive about another woman's needs and I felt I had a lot more support when Nancy was born." Sara would recommend a doula to any pregnant woman. "You can rely on them, you know they're going to be there. They won't be too busy or too stressed for you. Their priority is your pregnancy, your birth, your child."
Margaret Abbott is a post-birth doula who trained with Dr Michel Odent on one of the courses run by the British Doula Association. "I'm an ex- nurse with four children of my own and when I heard about doulas I thought 'I've got some knowledge that could be useful to someone else'," she says. She has acted as a doula to five women and is still working with four of them. "They all have different needs," she says. "Some of them only need 10 hours when they first come out of hospital, others want three mornings here or afternoons there. I am very flexible. I can take the baby out, do light housework, whatever is needed, but just having someone there to talk to is the most important thing - there's a real art to breastfeeding, for example, and I might say 'Perhaps try it this way or that way'. I just do what comes naturally to me," she adds with a jolly laugh.
Margaret works all over London, and loves the job. "It's exhilarating - I get such great feedbacks from the mums. And I really feel that I'm filling a need. Knowledge and experience is something you can't buy and it's a fantastic opportunity for women who have that knowledge to pass it on to another mother."
She believes that everyone benefits from a doula in the home. "If you've got a happy mum, you've got a happy baby. And if you've got a happy baby you've got a happy household."
Sylvia Mcginnis 0171 485 0437. British Doula Association/Top Notch Nannies 0171 938 2006