What a Positive Birth Means & The Role of the Doula

Here at Baby2Body our aim is to deliver the latest developments and up-to-date guidance on all areas surrounding the pre and postnatal period. To do that we are working an incredible panel of key experts to bring you the resources you need most.

We are so excited to introduce you to our newest expert, Kicki Hansard, who is on hand to talk to us about positive birthing and the role of a doula. In these additionally stressful times a focus on a positive birth can be all the more impactful. Kicki has been a doula since 2002 and a doula trainer since 2006 and she is the founder of the Birth Bliss Academy and The Doula Directory.

If you've heard about the positive birth movement and are keen to learn more about it, you won't want to miss our conversation with her. We asked Kicki to discuss positive birthing and the role that a doula can play in this experience, and asked her some of the top questions our users had about doulas as well!

Positive Birth & The Role of The Doula, A Chat with Kicki Hansard

Baby2Body: How can one define a positive birth? And what is the key to a positive birth experience?

Kicki: This is such a good question as there can be a lot of pressure on women to achieve a specific kind of birth for it to qualify as ‘good’ or ‘bad’. A positive birth is a birth where the woman or birthing person felt completely involved in the decision making, and was treated with kindness, respect and dignity. It’s not so much about the specifics of how the baby was born but how the woman or birthing person felt during the whole process.

The key to a positive birth experience is to spend time getting the right birth team together, ensuring everyone is on the same page and that you have good, evidence-based information so that you can make the right choices for you, and then being open to changes if they come along. Try and avoid becoming attached to a certain outcome. Write a birth preference document rather than a birth plan and focus on the things that you would like rather than on all the things you don’t want. I would still argue that a good birth team is more important than a birth plan!

A positive birth is a birth where the woman or birthing person felt completely involved in the decision making, and was treated with kindness, respect, and dignity.

Kicki hansard

How might a doula help with the above?

The doula helps provide unbiased information to her clients and will be able to bring together the statistics and research that is out there in an easy to understand manner. Doulas enable their clients to choose what is right for them by ensuring that they are well educated.

That means some women will choose to have a home birth whilst other women will book an elective caesarean and there’s many variations in between. The important thing is that they will make these choices based on evidence-based information, thinking about what is right for them, rather than doing something they are being told or based on fear rather than fact.

Your doula will be there to ensure you’re part of making all the decisions, and always understanding why procedures are suggested or taking place. Chances are that whatever twists and turns your baby’s birth takes, you will still feel it was a positive experience!

Can you talk us through the difference between a midwife and a doula?

I believe midwives and doulas come into the profession for the same reasons: wanting to support women, birthing folk and families during the childbearing years. However, midwives have medical training and carry the medical responsibility for the health of both the mother and the baby. They will have training in emotional support and will provide information, but they are often tied to the hospital’s guidelines and protocols. Midwives will give medical advice on what they think is the best thing to do in different situations. Midwives also work shifts so are often unable to offer continuity of support, unless you have hired an independent midwife. It’s common to see a different midwife at each antenatal appointment and different midwives for the birth and afterwards.

A doula has been specifically trained in offering emotional, practical and informative support. A doula doesn’t give advice, as in telling anyone what they should do, but instead brings all the different options to the table. A doula is able to offer continuity of support by preparing for the big day, being present throughout the birth itself and then offer support afterwards. A doula is not tied to hospital policies or guidelines but will always try and find information that is rooted in research. A doula does not give any medical advice, carry out any examinations or procedures. Most doulas do follow a Code of Conduct and have guidelines around how they offer their services.

What are the benefits of having a doula by your side during birth?

Doulas have been trained in offering emotional and practical support, and they're able to turn an environment that might feel quite scary into a safer and more welcoming space. Having someone that is purely there to support you and your partner removes much of the anxiety and worry about the unknown.

Doulas are also in themselves a form of pain relief. The calming effects that the doula provides increase the woman’s or birthing person’s natural pain management system (beta-endorphins). The doula’s presence also helps with the release of oxytocin, the hormone that causes the contractions, as well as helping make labour more manageable.

Here are some actual statistics of the impact of having a doula:

• 39% decrease in the risk of Caesarean
• 15% increase in the likelihood of a spontaneous vaginal birth
• 10% decrease in the use of any medications for pain relief
• 38% decrease in the baby’s risk of a low five minute Apgar score
• 31% decrease in the risk of being dissatisfied with the birth experience
• Shorter labours by 41 minutes on average

The benefits of having a doula have a long-term impact on bonding and attachment for the whole family.

Kicki hansard

Do you think every woman could benefit from having a doula?

Yes, without a doubt! A doula is not a new thing! Women have always supported women when they have babies and afterwards and they still do in many cultures. Having someone there, no matter what your plans are for your baby’s birth, who can reassure, normalise and protect the memory of your baby’s birth is priceless.

OK, now for a few questions from our users... Is a doula just for birth or can a doula assist before and after?

There are many different types of doulas that offer support in different settings. A birth doula usually supports antenatally, leading up to and during birth. Often a follow-up meeting is included in the package to talk about the birth and answer any questions the new parents might have.

A postnatal (or postpartum) doula is someone that comes in after the baby has been born and works perhaps 3-5 hours per day for the first 4-6 weeks. The postnatal doula helps support the new parents in finding the way they want to do things. The doula will help with practical things, like laundry and cooking perhaps so that the new mother and father can focus on getting to know their baby and also getting some rest. A postnatal doula is often trained in offering breastfeeding support as well as being able to signpost new parents to extra resources and information.

The difference between a postnatal doula, maternity nannie and mother’s help is that a doula has specific training and is not there to take over from the mum when it comes to taking care of the baby. A postnatal doula’s focus is to support the mother and the whole family, so that they can all adjust to the new normal.

Do different doulas have different styles? How can you find the right one for you?

There are as many different types of doulas as there are people! The stereotypical type of a doula is often someone more alternative or hippie but not all doulas are like that. I believe there is a doula for every woman out there and it’s important to find the right one. You can only do that by speaking to and meeting up with a few doulas before you make your decision.

The focus should not just be on the experience or training a doula has had. It’s much more important to think about whether you can spend time with this person, how they make you feel, and what your gut instinct is telling you.

What should someone expect from their doula?

A doula should not give advice and what I mean here is tell you what to do. That includes saying things like “In my view…” or “If I was you, I would…”

A doula should bring unbiased and evidence based information and support you in the choices you make for yourself and your baby. A doula should have clear boundaries and work with contracts so that you know what services are on offer. A doula should always look for the good in any situation and be flexible and able to offer the right support at the right time.

What should someone not expect a doula to do (as in, what are unfair expectations to have of them)?

You should not expect your doula to tell you what to do. Making decisions for yourself and your baby are important aspects of becoming a mother and parent.

If you hire a birth doula, don’t believe that this gives you any guarantees of a certain outcome. A postnatal doula usually doesn’t offer cleaning as part of her services but will do light housework, like emptying the dishwasher.

In the light of the recent pandemic, how have you seen the doula role change? Is it something that can be done effectively through virtual support?

There has been a slight decline in birth doula enquiries, and this is mainly due to the hospital changing their policies on birth partners, only allowing one instead of two. Many doulas are still offering support remotely and other doulas are self-isolating so that they can still be there in person for their clients who are planning home births.

Having a doula at the end of the phone is still going to make a difference so remote support, both for birth and postnatally, should still be considered by parents-to-be. It also seems to be working well as the feedback from clients has been positive. Many doulas are using Zoom to conduct antenatal sessions and demonstrate breastfeeding positions and even show how to bath your baby!

Before we go, is there anything else you want women to know about doulas?

Doulas have no agendas! They simply want you to do what is right for you, which you will only know when you have all the information and knowledge. A doula’s main role is to nurture their client’s confidence and emotional well-being. A doula does this by normalising and helping her client gain a healthy perspective of the whole process.

Childbirth is generally extremely safe and women have been giving birth for millions of years, but I think this quote says it all:

“Asking your husband to be your sole guide through labour is like asking him to lead the way on a climb of Mt. Everest. He may be smart and trustworthy, and you may love him, but in the Himalayas you’d both be a lot better off with a Sherpa! ”

Pam England

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Big thanks to Kicki for answering all of our (and your!) questions. If you're interested in working with a doula we recommend going to The Doula Directory so you can find the right doula for you. If you're interested in becoming a doula yourself, you should absolutely check out The Birth Bliss Academy.