We spoke to Doula, Natalya Morris about her work and the impact she has on mothers.
According to busy, London-based Doula, Natalya Morris, experts say that ideal childbirth exists, but every mother puts their own meaning to the concept. Whatever that becomes, she argues a Doula will help you get there.
A Doula is a professional birthing partner that is common elsewhere in the world, but relatively new to the UK. Natalya explains that a Doula allows you to get closer to the ideal birth you want. They are the ones who can cut through stereotypes and assumptions based on experience. Childbirth needn’t be a trauma that you might want to quickly forget. A Doula can help women answer the question; how will I become a mother?”
What Are The Main Functions of a Doula?
“To understand who a Doula is and what her functions are”, Natalya continues, “we must, first of all, disassemble the arrival of newborn souls as the initiation of women into motherhood. It is a deeply transformative process and one of the most significant events affecting women's self-esteem and mental well-being. No one can predict how childbirth will develop, but they can often unhelpfully become like an injury or illness and a huge drain on a mother’s resources. The Doula, no matter how the birth goes, will fight this and help mothers get through as comfortably as possible.”
“The Doula, first of all, is a continuous emotional and physical support. Doulas care primarily for women's safety and, of course, can tailor their approach to a mother’s individual needs to a degree impossible by any other medical professional. Considerable value comes from navigating mothers-to-be through the huge amount of information provided as birth comes closer. Some of this is contradictory, and most working moms won’t have time to understand everything. A Doula will guide you through what is important, provide useful recommendations and share contacts of specialists, focusing on the mother's requests.”
“Doulas,” Natalya stresses, “will never try to convince women of a course of action or impose their opinions. A good Doula will know how to accept a mother’s position and respect her choices - making sure childbirth is carried out following her wishes. Doulas prepare the schedule towards birth taking into account the characteristics of the expectant mother too. Doulas’ knowledge of birth processes and medical protocols in numerous situations means nobody is better qualified to help women consider their options, discuss alternatives and explain to mothers and their partners what is likely to happen to them and their child - thus reducing stress levels.”
“Doulas will also reduce stress by teaching women to trust their bodies, understand their instinctive needs and choose the perfect place for them to give birth. For some, it will be a modern medical institution with doctors, multifunctional beds, cardiotocography (CTG) monitors and other support. Others will feel safer in a home space with minimal intervention. Unfortunately, the medical service in England is built so that a pregnant woman is usually observed by several midwives who are limited in time. Often the pregnant mother leaves an appointment with the same questions she arrived with. It can be hard to feel safe and secure in any decision-making. As the Doula works, she melts the fears of a pregnant woman away. Since a pregnant woman is sometimes vulnerable, it is important her voice is heard and sensitive, effective support is vital.”
Natalya explains that as a Doula, she talks through different situations with women and their partners. She talks about the physiology of childbirth, the existing general pain relief methods, when to go to the hospital and what to take.
She continues, “I help the mother and partner draw up a plan for childbirth. I also
advise women on how to prepare for life after childbirth, including recovery methods, what neonatal things need buying and how to organise life. I also help to establish healthy breastfeeding.”
“Some,” Natalya ponders, “compare a Doula to a lawyer acting in a pregnant mother’s interests, others as an intermediary or even a conductor leading an orchestra. Others simply use the term friend.”
Natalya, however, thinks a Doula is a combination of three things. A Doula can translate from the medical to the public sphere. They can explain why health workers might suggest certain procedures and help mothers understand their rights - especially to say no sometimes. For example, if there are no medical indications otherwise and a woman wants to wait for the spontaneous start of contractions, she can say no to artificial stimulation. Successful childbirth also depends on setting realistic expectations. A Doula can help here by explaining what is possible given a range of scenarios. Finally, a Doula can help with decision-making during childbirth. Having a baby is a unique process. It cannot, for example, be stopped or restarted. A Doula can steer mothers through what moments lend themselves to our control, and which ones we should just accept and follow.
How Not to Make a Mistake in Choosing a Doula?
All women are unique, with different characteristics and needs, so the choice of ‘one's own’ Doula is important. It is desirable (especially if we are talking about the first birth with a doula) to meet with several candidates to find and choose one with which you are fully comfortable. If, in their presence, you can relax, this is a good sign, explains Natalia. She adds that undoubtedly “a Doula should have experience, know the British system of obstetrics, terminology, physiology of childbirth and understand what mothers need. It is imperative that your Doula recognises and believes in your strengths and capabilities too.
A mother’s partner may feel emotionally connected to the unborn child and feel a degree of responsibility, yet not have specific knowledge or responsibilities. This can lead to a feeling of helplessness. Because of this, a Doula teaches a woman's partner as carefully as possible too to effectively accompany her in childbirth.
If English isn’t your first language, it's worth noting that childbirth is not something you can tackle with online translations. A Doula who can speak your language will help you with the necessary medical vocabulary and terminology. Natalya continues “I know about 10 Russian-speaking doulas; we are all different, with our own approach. And that's good - there are more chances for Russian speakers to find a specialist.”
Is Childbirth with a Doula Suitable for Everyone?
“Speaking of this,” Natalya says, “you need to remember that the Doula’s role is to provide comprehensive assistance throughout pregnancy and the postpartum period and not exclusively during childbirth. But just before childbirth, a Doula will have the most work to do.
There are women (although in the minority) who say: “I don’t need anyone during childbirth” however in reality support is required. Moreover, if the birth is long, it is important to have someone she trusts next to her to communicate with doctors. With a birth lasting 2-3 days, for example, hospital staff will change shifts. A partner might need to leave to work or even simply eat. In these circumstances, a Doula can not only prepare a partner but replace them at times during the process.
Still, other women say “I am having a planned caesarean birth, I don't need a Doula." A caesarean operation only changes the method of delivery. Otherwise, it is the same childbirth journey in which difficulties may arise. In these cases, a Doula can still help mothers with what to expect, how to proceed and what to ask the surgeon, for example. They will also be able to tell about the features of the postpartum period because the mother's health and recovery are obviously vitally important.
Whatever the birthing choices a mother makes, there will be times she might struggle emotionally. This is especially true if things are not proceeding quite as she wanted. She might question herself. At these times, A Doula will be able to talk to a mother about her feelings, explaining what was happening and why and help her avoid feelings of guilt and transform negative experiences into positive ones.”
Tricks Doulas Have for Pain Relief
The feelings of a woman in the birth process vary a lot depending on the mood and atmosphere. To keep her comfortable during labour you need to understand their unique nature. Pain is an integral part of the process of childbirth and it doesn’t need to be disposed of entirely. It needs to be used to navigate what is happening and tell us if everything is going as it should.
In many courses for expectant mothers, the nature of pain is not explained very well. Grantley Dick-Read, in his book Childbirth Without Fear, describes “fear-tension-E-pain and suggests it is a calm atmosphere that helps reduce pain and maximises comfort during childbirth. World-famous obstetrician and gynaecologist Michel Auden, in his work, focused on the physiological needs of the woman in labour and defined three ideal goals; quietness, darkness and warmth. Natalya adds a fourth; a sense of security.
A Doula, with her calmness and presence, helps to create a special childbirth atmosphere. This contributes to the reduction in levels of stress hormones and an increase in the presence of oxytocin and endorphins.
We, as Doulas, continually look at what works best in childbirth. If a woman wants to use an epidural or other anaesthesia, I never dissuade her. If it's the first birth, a mother may not always know what her pain threshold is and how she will deal with it.
All Doulas have their own ways of making mothers comfortable during contractions, especially if labour is long. They could be hypnosis, visualization techniques, breathing, massage, fitball, acupressure, aromatherapy, massage, homoeopathy, hydrotherapy, vocalisation and more. Doulas typically inform women about what methods of non-medical pain relief exist. Natalya always uses the principle of "from the smallest to more.” That is, we start with non-drug methods of anaesthesia that can be used at home. See how they work, combine and connect with medical intervention.
Feedback on Doulas
Comments about Doulas include the following:
“Throughout the pregnancy, Natalya informed and gently guided me and my husband in all matters. But, most importantly, she was able to set us up with positivity. She inspired us past doubt and panic and instilled confidence in us that everything was going to be fine and that my body could cope with such a natural process. I felt that I was in good hands.”
“My Doula knows and understands me. Although at the beginning of the pregnancy, my husband was sceptical about the role, not to mention childbirth at home! However, he was soon able to recognise his importance to the process and become, for me, an amazing support in childbirth. This helped us achieve the best result. There was a moment when, under pressure from the medical profession, I almost agreed to a caesarean. But Natalya watched my progress, kept everything under control and was able to convince doctors I should have a natural childbirth, which passed perfectly and quickly. After that my physical and mental health was excellent. I stayed in euphoria for a long happy time. “
"When a woman gives birth, she often does not know who will look after her. This worries her. But when a woman gives birth with a Doula, this anxiety leaves, she feels calm and secure, because she has a reliable assistant who understands what is happening and can explain everything.”
How Are Relationships Built Between Doctors, Midwives & Doulas?
Health workers are responsible for technical questions that keep the patient and baby alive and well. A Doula takes care of the emotional component. Unfortunately, a pregnant woman is typically led by different specialists and time for appointments is always limited. Therefore, it is extremely important that, when dealing with medical professionals, a mother-to-be feels there is always someone to help on her side. A doula is not associated with any specific protocol or course of action. Rather, she acts as an intermediary between the patient and medical staff. A Doula can explain why doctors offer this or that. She can translate from medical language into common everyday language too and, in turn, check that a woman’s requests have been heard and understood. A Doula can help prevent a mother from feeling stressed and pressured into any course of action that differs from what she initially wanted. We can also be on hand to support women in formulating the right questions during dialogue with health workers.
As an example, a doctor might suggest contractions should be stimulated, but the patient wants to wait until spontaneous, natural childbirth happens. Doula can help with negotiations. Both medical professionals and Doulas rely on similar facts, figures and sources of information so often midwives are pleased to see us. A very special calm and relaxed atmosphere reigns in such births from all sides. Midwives, of course, have to leave from time to time and if, while they’re aware, the Doula notices any changes in the process they will draw it to the professional's attention.
Often, when everything is done, medical personnel thank us for our support and help. They, like us, know that Doula, midwife and obstetrician are one team that serves the mother and newborn baby.
Statistics That Support Doula's Use
According to recent data, 200,000 women a year suffer from post-traumatic childbirth syndrome. Childbirth with a Doula reduces this risk. There are currently about 26 studies from 17 different countries that followed 15,000 women.
The positive effects of continuous support for women from a Doula include increasing the chance of spontaneous natural childbirth and reducing labour by approximately 2 hours. Decreased use of medication including painkillers and hormonal stimulation is reported too. The risks of emergency caesarean surgery and postpartum depression are also reduced.
“The most important result of a Doula’s work,” concludes Natalya” is the satisfaction of women through the process of childbirth. This is our main task. No matter how the birth scenario goes, the main thing is that, for a woman, it is not a traumatic experience. A Doula’s task is to inspire confidence, fill the process with calmness and joy and leave only pleasant memories.
This interview is based on an interview published in Rutáge Magazine 2020.
Doula: Natalya Morris
How to contact Natalya:
Doula UK: https://doula.org.uk/doula/natashamorris/
Tel: 07747 672699