By: Janel Martir, Professional Labor Doula
It was my first day working on the labor and maternity ward in Uganda’s premier hospital, and I had already walked in unexpectedly on three women laboring in the restroom stalls. “Oh, excuse me!” I exclaimed as I locked eyes with one woman who was folded over the sink moaning. She gave me a furtive glance before she raised her hands over her face to mumble prayers into her palms. I stepped out for a second, the door swinging behind me, as I took a second to compose myself before entering the room and offering what help I could in my broken Lugandan.
This marked my first birth at the Mulago National Hospital in Kampala, and as I would soon grow accustomed to, this was a typical day at Mulago for me.
For the next 6 weeks, I was one of the US-trained senior medical students on the medical team who alongside the midwives and surgeons delivered up to 70 babies a day. That number included both day and night deliveries, because birth operates on its own timetable. I have seen my share of women in labor and attended to the wide spectrum of possible births: natural births to surgical births to forceps-assisted births to twin births (of which there were many in Uganda) to breech births and to stillbirths. I knew that I was privileged to witness and work in a world of birth that many only dare to glimpse.
Birth is an intense and universal experience, and I knew that my future was here, in the birthing community, working alongside and supporting mothers in their labor.
As part of the medical team in a resource-limited, high-patient volume setting, I assumed the role of both medical professional and birth coach. There were no doulas in a formal sense in the maternity suite, but there was an unspoken expectation that birth was a female-protected and female-supported experience. Fathers either waited outside or more often the case, were hundreds of miles away in rural villages as their partners traveled on the backs of motor bikes to give birth in the hospital.
Childbirth in this setting was left to the birthing mothers, the midwives and the other women who were in close proximity to support them. In such situations, caregivers like myself, must assume a multitude of roles to provide the most effective and humane care possible in the most extreme of circumstances. Aside from the untiring work of the medical staff, I was moved by the emotional support women provided to each other as they labored. I witnessed a woman who had just given birth in the postpartum ward offer breathing mantras to a woman laboring.
It was here where I realized that most women birth better – that is, have a better experience of their birth – when they are held by the compassionate therapeutic presence of a supportive person.
I found myself assuming a similar role in Uganda to the mothers whose babies I delivered, and this was a role I would invoke again today and exclusively as a professional birth attendant or doula working in Brooklyn Heights.
When I first started work as a professional labor doula, I found myself grappling with the role of a doula in the medical health care system I had trained in. In truth, I did not know what a doula was until my third year of medical school during my obstetrics clerkship in Connecticut where I met a kind woman aptly named Angel who had red pre-Raphaelite curls and a welcoming smile. She introduced herself to me as a doula only very briefly as she continued to knead the shaking thighs of a mother in labor. Now, as a professional doula myself, I am uniquely placed as a liaison between both the medical and wellness worlds.
In my role as a doula, I bring with me a decade of medical training, years of research in academic medicine and extensive experience working in women’s health care in the US and abroad.
I am an advocate for women in their right to have an empowered birth experience.
I am attentive to the needs of the birthing mother and internalize the concerns of the mother and her partner, and I help the mother strategize ways to optimize her best birth.
In the past decade, the US medical system has seen a rise in wellness professionals taking on the more holistic aspects of health care. Doulas are part of this cultural shift to prioritize wellness. The rising national demand for birth workers can be attributed to mothers reclaiming their agency in their own birth experience. The modern hospital birth experience has stereotypically treated the body as a machine and the birth process as mechanical. More and more women, fueled by the growing movement for natural labor and a desire to reclaim birth as a spiritual experience, are opting for doulas whose presence in birth has been associated with an overall decrease in the c-section rate by half, the length of labor by a quarter, and requests for an epidural by 60 percent according to the American Pregnancy Association.
Studies that examine the relationship between birthing mothers and their doulas report consistently positive experiences. In 2006, The Journal of Perinatal Education published the results of a qualitative pilot study entitled “Women’s Perceptions of their Doula Support”. The researchers conducted in-depth interviews on the women who were assisted by a certified doula during their birth and postpartum period. The analysis of the results showed the emergence of positive themes in women whose births were attended by doulas.
Women reported doulas provided specific and tailored approach to allow each woman to have her own birth experience (one mother claimed and praised her doula for “protecting her peace” during her labor). Women also reported that the doulas provided the welcome encouragement and reassurance to cope with the emotional and physical experience of labor. One woman reported that “Without a doula to help reassure that ‘yes, this will hurt,’ it could easily be overwhelming.”
Another surprising theme that emerged was the support doulas could also provide to the birthing mother’s partner: doulas are not just for pregnant woman and can also provide emotional reassurance to husbands or partners.
Women also mentioned that the doula had knowledge that their husbands, who had no prior experience with the birth process, did not have. A quarter of the women in the study specifically mentioned that doulas offered relief to their husbands, allowing them to eat, rest, take a break, and sleep. You want to have a woman who has been through it before, who’s there when you get to a point where you just can’t deal with it anymore, that you have somebody else [doula] that’s there going, “Yes, I’m here, I did it, it’s okay, you can handle it.”
- As a doula, I am part of the non-medical birth support team. I am a birth professional who nurtures and empowers women in pregnancy, childbirth and early into the postpartum period. A doula’s role stands strongly on four conceptual pillars: providing information, providing emotional support, minimizing unnecessary stress and facilitating communication all in the service of ensuring that the birthing mother has a childbirth experience based on the mother’s individual values and expectations.
- Doulas are experts in childbirth. They are trained in the process of and have extensive non-medical experience in labor and delivery. Some doulas, like myself, are or have been medically-trained professionals (physicians, nurses, midwives) and choose to limit their scope of medical practice in order to nurture the important emotional and psychosocial dimensions of the birth experience.
- Doulas are emotionally attuned to the needs of the birthing mother. Doulas exist to facilitate a birth experience in which the mother is treated with kindness, respect and dignity. The framework of care that a doula provides is non-medical and focuses solely on supporting the birthing mother. This support is multifaceted and includes informational support, emotional support, physical support in the form of non-medical comfort measures and advocacy. Collectively, this unique type of nurturing during the birthing experience can help women feel more empowered, which means that a mother feels she can exercise her agency to have the kind of birth experience she wants.
- Doulas encourage the mother to practice her rights as a birthing woman. A doula can empower women by bringing awareness to the birthing mother’s rights during the birthing process, ensuring that women have access to evidence-based resources and information, helping women make informed decisions about their care and their labor experience.